Palatally Displaced Canine and Anterior Crossbite Management with a Combination of Palatal Flap Window and MEAW Technique: A Case Report Canine impaction is a frequent problem, ranking third in occurrence behind the impaction of the mandibular and maxillary third molars. Palatally displaced canines (PDCs) require more omprehensive treatment and are more challenging to manage. This case report describes the management of a rotated palatally impacted permanent maxillary right canine using the open palatal flap window method and the multiloop edgewise arch wire (MEAW) technique. A 19-year-old female patient presented with dental misalignment, which included a skeletal Class I relationship with Angle Class I malocclusion, a protruding lower jaw, anterior crossbite, and the upper left canine being palatally impacted. The panoramic radiograph indicated the existence of a Type II impaction of the canine teeth (Yamamoto classification). The treatment employed the MEAW technique to expand the maxilla and handle an anterior crossbite. The palatal window flap technique was utilized to achieve access to the maxillary right canine by using a button chain and ligation to the upper archwire. The posttreatment outcomes demonstrated satisfactory eruption and alignment of the maxillary right canine, correction of the anterior crossbite at the maxillary right lateral incisor, and realignment of the midline. One year after retention, a satisfactory occlusion was maintained without recurrence of the anterior crossbite. The use of the open palatal window flap technique and button chain application is effective in correcting PDCs and achieving adequate tooth alignment within the dental arch.

Purpose: Real-world evidence comparing surgical techniques for symptomatic hemorrhoidal disease (HD) remains limited, despite the availability of multiple approaches. This study aimed to evaluate short-term, interim outcomes from a prospective, nationwide cohort study that compared the effectiveness of different operative techniques based on patient-reported outcome measures (PROMs) in patients with symptomatic HD. Methods: A prospective, nationwide cohort study was conducted at 20 tertiary care centers across Turkiye between July 2022 and July 2024. Adult patients aged 18 years or older with symptomatic HD (grades I–IV) who underwent surgery during this period were included. The choice of procedure was determined by the operating surgeon, and patients were categorized into excisional, fixative, and ablative groups according to the surgical approach used. The primary outcomes were changes in the Hemorrhoidal Disease Symptom Score, Short Health ScaleHD, visual analog scale for pain, and patient satisfaction, assessed from the preoperative period to postoperative day 7 and postoperative week 6. Results: The study included a total of 315 patients after excluding those who did not fulfil the inclusion criteria. Among them, 239 (78.9%) were male, with a mean age of 43.7±11.7 years. The distribution of patients across surgical groups was 207 (65.7%) in the excisional group, 30 (9.5%) in the fixative group, and 78 (24.8%) in the ablative group. All groups demonstrated significant improvements in PROM scores from preoperative to postoperative assessments. However, no statistically significant differences were observed between groups at any time point for PROM scores or for changes in PROM scores across consecutive evaluations (P≥0.05 for all comparisons). Urinary retention occurred more frequently, and hospital stays were longer in the fixative group (P=0.006 and P<0.001, respectively). The excisional group had a greater need for narcotic use and longer duration of use (P=0.003 and P<0.001, respectively). Conclusion This real-world cohort study shows that all 3 surgical approaches are effective for HD, providing comparable short-term symptomatic relief and patient satisfaction. These techniques appear equally valid treatment options, and the choice of procedure may best be individualized based on patient-specific characteristics and surgeon preference.Trial registration: ClinicalTrials.gov identifier: NCT05429060

Objective: The study investigates experimental brain trauma in rabbits, assessing levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and interleukin 6 (IL-6) in serum and cerebrospinal fluid (CSF) and compares these biomarkers among trauma groups. Methods: Thirty rabbits were randomized to a control group (n=6) or to mild-, moderate-, and severe-trauma groups (n=8 each) created by dropping 200, 350, or 500 g weights, respectively, onto their skulls using a modified Marmarou impact acceleration model. CSF and venous blood samples were collected at 0, 12, and 24 hours after injury; UCH-1 L, GFAP, and IL-6 concentrations in CSF and serum were quantified by enzyme-linked immunosorbent assays, and group differences were analyzed with a Friedman test followed by Dunn-Bonferroni correction. Results: Neither CSF nor serum concentration of GFAP, IL-6, or UCH-L1 differed from those of controls after mild trauma. Severe head trauma produced markedly higher GFAP and IL-6 concentrations in CSF compared with the control group (P<0.05), with both biomarkers peaking at 12 hours after injury. Serum UCH-L1 increased significantly in both moderate-trauma (peak at 12 hours) and severe-trauma groups (peak at 24 hours) compared with the control group (P<0.05), whereas no intergroup difference in CSF UCH-L1 levels was evident. Conclusion Serum UCH-L1 differentiated moderate and severe trauma from controls in a rabbit model, whereas CSF GFAP and IL-6 levels reflected severe injury. Validation in larger preclinical and clinical studies is warranted.

Background: The management of cleft lip and palate aims at improving the patient’s aesthetic and functional outcomes. Delaying primary repair can disrupt the patient’s functional status. Long-term follow-up is essential to evaluate the need for secondary repair or revision surgery. This article presents the epidemiology of cleft lip and palate, including comprehensive patient characteristics, the extent of delay, and secondary repair at our institutional center, the Bandung Cleft Lip and Palate Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. Methods: This retrospective study aimed to determine the epidemiology and recurrence rates of cleft lip and palate at the Bandung Cleft Lip and Palate Center, Indonesia, from January 2007 to December 2021. The inclusion criteria were patients diagnosed with cleft lip and/or palate. Procedures such as labioplasty, palatoplasty, secondary lip and nasal repair, and alveolar bone grafting were performed, and data on recurrence were available. Results: In total, there were 3,618 patients with cleft lip and palate, with an age range of 12 months to 67 years. The mean age was 4.33 years, and the median age was 1.35 years. Males predominated over females in all cleft types (60.4%), and the cleft lip was on the left side in 1,677 patients (46.4%). Most cases were unilateral (2,531; 70.0%) and complete (2,349; 64.9%), and involved a diagnosis of cleft lip and palate (1,981; 54.8%). Conclusion Delayed primary labioplasty can affect daily functioning. Primary repair for patients with cleft lip and palate may be postponed due to limited awareness, socioeconomic factors, inadequate facilities, and varying adherence to treatment guidelines. Despite variations in the timing of primary cleft lip repair (not adhering to the recommended protocol), only 10% of these patients undergo reoperation. Healthcare providers should prioritize the importance of the ideal timing for primary repair in order to optimize physiological function without compromising the aesthetic results.

Myeloid sarcoma (MS) is an uncommon extramedullary tumor comprising immature myeloid cells, primarily associated with acute myeloid leukemia (AML). Spinal involvement is observed in fewer than 1% of cases. We present an unusual case of extramedullary MS in a patient with AML. A 23-year-old woman with a history of AML presented with neurological symptoms, including limb pain, weakness, and numbness. Imaging revealed an intramedullary enhancing mass at the cervical level. Partial laminectomy and microsurgical resection were performed, followed by laminoplasty. Immunohistochemistry supported the diagnosis, confirming MS. The patient was subsequently transferred to the hematologic department and received tailored treatment. The diverse clinical manifestations of spinal MS pose diagnostic challenges. In this case, an atypical intramedullary location led to incorrect initial diagnostic impressions. Comprehensive evaluations, including repeated biopsies and immunohistochemistry, were crucial for an accurate diagnosis. Treatment strategies vary based on systemic involvement, and prompt diagnosis is important for favorable outcomes. MS, especially in the spine, presents diagnostic and therapeutic complexities. Timely recognition, an accurate diagnosis through comprehensive evaluations, and tailored treatment strategies are crucial for positive outcomes in this rare hematologic entity.

Background: In Indonesia, the prevalence of cleft lip and palate increased from 0.08% to 0.12% between 2013 and 2018. Children with cleft deformities typically undergo staged surgery. However, the coronavirus disease 2019 (COVID-19) pandemic has had negative impacts on the healthcare sector, including the suspension of elective procedures; this has raised concerns about the safety of performing surgery and the functional consequences of delaying treatment, the latter of which is associated with poor prognosis. The purpose of this study was to report the characteristics of clefts treated by the Bandung Cleft Lip and Palate Center team during the pandemic period. Methods: This brief comparative study based on a chart review was conducted at the Bandung Cleft Lip and Palate Center. We statistically evaluated data from all patients treated between September 2018 and August 2021. Frequency analysis was performed to analyze the average number of each procedure by age before and during the COVID-19 pandemic. Results: Data from 18-month periods before (n = 460) and during (n = 423) the pandemic were compared. Cheiloplasty procedures were examined (pre-pandemic, n = 230; pandemic, n = 248); before the pandemic, 86.1% were performed according to the treatment protocol (patient < 1 year old), and this proportion non-significantly dropped to 80.6% during the pandemic (p = 0.904). Palatoplasty procedures were also compared (pre-pandemic, n = 160; pandemic, n = 139); the treatment protocol (patient 0.5–2 years old) was followed for 65.5% of procedures before the pandemic and 75.5% during the pandemic (p = 0.509). Additionally, 70 (mean age, 7.94 years) revision and other procedures were performed before the pandemic and 36 (mean age, 8.52 years) during the pandemic. Conclusion The cleft procedures performed at the Bandung Cleft Lip and Palate Center did not significantly change during the COVID-19 pandemic.

Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).
Male ; Humans ; Infant ; Hypospadias/surgery* ; Retrospective Studies ; Urologic Surgical Procedures, Male/methods* ; Urethra/surgery* ; Fistula/surgery* ; Treatment Outcome

Anaplasma marginale is the most prevalent tick-borne haemoparasite of cattle and causes huge economic losses to the dairy industry worldwide. This study aimed to determine the occurrence of A. marginale infection in blood and tick samples collected from livestock animals in the districts located in Khyber Pakhtunkhwa (KPK), Pakistan. A total of 184 blood and 370 tick samples were included in this study. It has never been reported that sheep, goats, and cattle in Tank, Ghulam Khan, Birmil and Miran Shah areas were infected with A. marginale. All samples of blood and ticks were collected through random sampling from March 2021 to January 2022 from cattle, sheep and goats and screened through PCR for anaplasmosis by using primer pairs of Anaplasma spp. Three hundred and seventy ticks were collected from infested hosts (120/184, 64.21%). Among the four morphologically identified tick species, the highest occurrence was recorded for Rhipicephalus sanguineus (n=138, 37.29%), followed by Rhipicephalus microplus (n=131, 35.4%), Rhipicephalus annulatus (n=40, 10.81%), Hyalomma anatolicum (n=31, 8.37%), and Hyalomma marginatum (n=30, 8.1%). The occurrence of female tick was highest (n=160, 43.24%), followed by nymphs (n=140, 37.38%) and males ticks (n=70, 18.9%). Among these ticks, A. marginale was detected in female ticks of R. microplus, and R. sanguineus. Molecular identification of A. marginale was confirmed in 120 out of 184 blood samples and 6 out of 74 tick samples. Overall, occurrence of A. marginale in blood and tick samples was found to be 65.21% and 8.1% respectively. Species-wise occurrence in blood samples of goats were 71.11% followed by sheep 68.31% and cattle 50%. Specie-wise occurrence of A. marginale in tick samples of cattle were 12.5% followed by goats 6.89%. The obtained sequence showed similarity with A. marginale reported from Kenya and USA. We report the first PCR based detection of A. marginale infection in blood samples and in R. sanguineus ticks of goats simultaneously.

Characterization as well as prediction of the secondary and tertiary structure of hypothetical proteins from their amino acid sequences uploaded in databases by in silico approach are the critical issues in computational biology. Severe acute respiratory syndrome–associated coronavirus (SARS-CoV), which is responsible for pneumonia alike diseases, possesses a wide range of proteins of which many are still uncharacterized. The current study was conducted to reveal the physicochemical characteristics and structures of an uncharacterized protein Q6S8D9_SARS of SARS-CoV. Following the common flowchart of characterizing a hypothetical protein, several sophisticated computerized tools e.g., ExPASy Protparam, CD Search, SOPMA, PSIPRED, HHpred, etc. were employed to discover the functions and structures of Q6S8D9_SARS. After delineating the secondary and tertiary structures of the protein, some quality evaluating tools e.g., PROCHECK, ProSA-web etc. were performed to assess the structures and later the active site was identified also by CASTp v.3.0. The protein contains more negatively charged residues than positively charged residues and a high aliphatic index value which make the protein more stable. The 2D and 3D structures modeled by several bioinformatics tools ensured that the proteins had domain in it which indicated it was functional protein having the ability to trouble host antiviral inflammatory cytokine and interferon production pathways. Moreover, active site was found in the protein where ligand could bind. The study was aimed to unveil the features and structures of an uncharacterized protein of SARS-CoV which can be a therapeutic target for development of vaccines against the virus. Further research are needed to accomplish the task.

Solitary fibrous tumor (SFT) is a rare type of mesenchymal neoplasm that first was discovered in the pleura but can also affect the peritoneum, lungs, mediastinum, and skin. Cutaneous malignant SFT is an extremely rare tumor that resembles dermatofibrosacoma protuberance (DFSP) histologically and immunohistochemically. Herein, we describe a case of malignant SFT that presented as a recurrent mass on the scalp. The first lesion was totally excised one year before recurrence and was diagnosed as a DFSP based on the histopathology and cluster of differentiation 34 immunostaining positivity. Re-examination of the previously examined specimen was considered. Activator of transcription 6 positivity was also detected in the tissue, confirming the diagnosis of a recurrent malignant SFT rather than DFSP. There was no evidence of recurrence, locoregional, or distant metastases at six months after lesion removal with a safety margin.