Background: Cerebellopontine angle (CPA) tumors present surgical challenges due to their proxim-ity to the facial nerve. Despite preservation efforts, facial nerve paresis is a major issue. This study aims to identify key factors affecting facial nerve preservation during microsurgical resection of large CPA tumors in a low- and middle-income countries (LMIC) setting. Methods: This retrospective cross-sectional study, conducted at Aga Khan University, includedpatients who underwent microsurgical resection of large (>3 cm) CPA tumors with House-Brackmann (HB) grades 1–4. Postoperative facial nerve function was assessed using the HB grading system. Data was extracted from medical records and analyzed using SPSS 22. Results: This study analyzed 95 patients (M:F=1:1.16, mean age 44.24±13.71 years) withCPA tumors who underwent microsurgical resection. Common presenting complaints included a complete hearing loss (57.9%), headache (52.6%), and abnormal gait (40%). Preoperative facial nerve function was normal (HB grade I) in 75%, with 19%, 7%, and 2% having HB grades II, III, and IV, respectively. Schwannoma (69.5%), meningioma (16.8%), and epidermoid cyst (10.5%) were the most common diagnoses. Postoperative preservation of facial nerve function was achieved in 73.7% of patients. At six months, HB grades I and II were observed in 64% and 11.5%, respectively, while none had complete facial nerve palsy. On univariate analysis, larger tumor size and higher HB grade correlated with worse facial nerve outcomes (p=0.02). Complications were more frequent in patients with worsened outcomes (72% vs. 38.6%, p=0.004). However, in multivariate analysis, only preoperative HB grade was identified as a predictor. Conclusion Facial nerve preservation during CPA tumor resection is influenced by intrinsic tumorcharacteristics, surgical complexity, and patient-specific factors. Detailed preoperative counseling is crucial to set realistic expectations.

Multiple morphological abnormalities of the flagella (MMAF) represent a severe form of sperm defects leading to asthenozoospermia and male infertility. In this study, we identified a novel homozygous splicing mutation (c.871-4 ACA>A) in the adenylate kinase 7 (AK7) gene by whole-exome sequencing in infertile individuals. Spermatozoa from affected individuals exhibited typical MMAF characteristics, including coiled, bent, short, absent, and irregular flagella. Transmission electron microscopy analysis showed disorganized axonemal structure and abnormal mitochondrial sheets in sperm flagella. Immunofluorescence staining confirmed the absence of AK7 protein from the patients' spermatozoa, validating the pathogenic nature of the mutation. This study provides direct evidence linking the AK7 gene to MMAF-associated asthenozoospermia in humans, expanding the mutational spectrum of AK7 and enhancing our understanding of the genetic basis of male infertility.
Humans ; Male ; Sperm Tail/ultrastructure* ; Homozygote ; Consanguinity ; Asthenozoospermia/pathology* ; Infertility, Male/genetics* ; Mutation ; Pakistan ; Adenylate Kinase/genetics* ; Adult ; Pedigree ; RNA Splicing ; Exome Sequencing ; Spermatozoa

Asthenoteratozoospermia is one of the most severe types of qualitative sperm defects. Most cases are due to mutations in genes encoding the components of sperm flagella, which have an ultrastructure similar to that of motile cilia. Coiled-coil domain containing 103 (CCDC103) is an outer dynein arm assembly factor, and pathogenic variants of CCDC103 cause primary ciliary dyskinesia (PCD). However, whether CCDC103 pathogenic variants cause severe asthenoteratozoospermia has yet to be determined. Whole-exome sequencing (WES) was performed for two individuals with nonsyndromic asthenoteratozoospermia in a consanguineous family. A homozygous CCDC103 variant segregating recessively with an infertility phenotype was identified (ENST00000035776.2, c.461A>C, p.His154Pro). CCDC103 p.His154Pro was previously reported as a high prevalence mutation causing PCD, though the reproductive phenotype of these PCD individuals is unknown. Transmission electron microscopy (TEM) of affected individuals' spermatozoa showed that the mid-piece was severely damaged with disorganized dynein arms, similar to the abnormal ultrastructure of respiratory ciliary of PCD individuals with the same mutation. Thus, our findings expand the phenotype spectrum of CCDC103 p.His154Pro as a novel pathogenic gene for nonsyndromic asthenospermia.
Asthenozoospermia/pathology* ; Dyneins/genetics* ; Homozygote ; Humans ; Male ; Microtubule-Associated Proteins ; Mutation ; Mutation, Missense ; Sperm Tail/metabolism*

As the number of COVID-19-related infections and deaths increased exponentially in the during 2020, few countries were equipped to manage and curb this novel coronavirus. Initially there was no proven cure or vaccine to this novel virus (SARS-Cov-2), leaving the authorities with no choice but to impose quarantines at the short-term expense of their economies. As we gain more knowledge on this novel virus, the tried-and-tested method of selective testing of the symptomatic patients, used successfully in almost all infectious respiratory diseases, has been replaced with traceand-test method, as most of the infected patients remained asymptomatic. In early 2021, the availability of vaccines provided a shed of light out from this pandemic. Nevertheless, we faced an enormous task in juggling between vaccination of the population, managing patients with COVID-19 infection as well as non-COVID-19 patients. Here, we share our experience and response in managing this healthcare crisis across a two-year period during the pandemic and we hope other centres can learn from what we went through and help them derive a protocol to navigate through a future pandemic.

Aims: Coral diseases have emerged over the last several decades, causing a loss of live coral cover in the Caribbean and Indo-Pacific reefs. Hence, microbiological and disease cultural techniques are commonly used to investigate their causative microbial agents. This is the first study to identify the potential of pathogenic Vibrio spp. isolated from apparently white syndrome (WS) coral disease in Tioman Island Marine Park using biochemical and molecular techniques. Methodology and results: The Vibrio colonies were isolated from 108 samples of WS infected corals (Acropora cytherea and Montipora aequituberculata) including seawater, sediment and algae found adjacent to infected coral colonies. A total of one hundred representative Vibrio isolates were characterized and most of them (n=50) were identified as V. vulnificus, V. alginolyticus and Photobacterium damselae following biochemical analysis. The molecular analysis revealed six Vibrio spp. (V. coralliilyticus, V. hepatarius, V. brasiliensis, V. tubiashi, V. campbellii, V. ishigakensis) and one Photobacterium rosenbergii. Vibrio coralliilyticus isolated from all infected coral samples may be highly responsible for the sign of WS disease. Conclusion, significance and impact of study The findings of this study provide baseline data and information on potential coral pathogens identified in the coastal waters of Tioman Island. Etiological disease study is suggested to validate their severity and virulence factors in the future.
Vibrio--pathogenicity ; Anthozoa

BACKGROUND: This study aimed to observe the cartilaginous matrix production in SRY (sex determining region Y)-box 9 (SOX9)- and/or telomerase reverse transcriptase (TERT)-transfected chondrocytes from monolayer to three-dimensional (3D) culture.
Alcian Blue ; Cartilage ; Chondrocytes ; Clothing ; Coloring Agents ; Eosine Yellowish-(YS) ; In Vitro Techniques ; Proteoglycans ; Real-Time Polymerase Chain Reaction ; Regeneration ; Telomerase ; Tissue Engineering ; Transfection

Limited studies on prevalence and risk factors of Premature Coronary Artery Disease (PCAD) were done in Malaysia, primarily on lipid profile. This cross sectional study aims to identify any changing patterns in prevalence and risk factors of Premature CAD between 2000 and 2012. From 2000 to 2012 we included 21862 patients who underwent the first Percutaneous Coronary Intervention (PCI). Analysis of risk factors was done to 1660 and 2098 patients from year 2007 and 2012 respectively. Age of less than 45 years was taken as PCAD. Data was collected from PCI database of National Heart Institute (NHI), NHI TrakCare System, and patients’ medical records. PCAD significantly decreased from 18.8% (2000) to 11.6% (2012). Malay ethnicity showed increasing trend over the years from 55.1% to 66.9%. Multiple logistic regression analysis in 2007 showed that smoking had the higher risk (AOR=2.52), followed by male gender (AOR=2.06), family history of PCAD (AOR=1.96), Indian ethnicity, (AOR=1.65), triglycerides level (AOR=1.20) and BMI (AOR=1.06). In 2012, family history of PCAD had the highest risk (AOR=2.00) followed by smoking (AOR=1.91) and BMI (AOR=1.11). There are changes in risk factors patterns of premature CAD between 2007 and 2012. Most of them are preventable at earlier stage.

PURPOSE: To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture. MATERIALS AND METHODS: Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables. RESULTS: Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance. CONCLUSION: Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.
Bite Force ; Bites and Stings ; Dental Prosthesis, Implant-Supported ; Denture, Complete ; Denture, Overlay ; Dentures ; Electromyography ; Humans ; Masseter Muscle ; Muscles ; Prostheses and Implants ; Tooth ; Transducers ; Vertical Dimension

PURPOSE: Study was conducted to determine and assess the effect of different type of denture adhesives on the incisal bite force of complete denture wearers until the dislodgement of upper denture, using pressure transducer. MATERIALS AND METHODS: 30 patients out of 100 were included in the study. Based on the Kapur's method of scoring denture retention and stability, these patients were divided into 3 groups- Group A - Clinically good dentures; Group B - Clinically fair dentures; and Group C - Clinically poor dentures. A custom made occlusal force meter was constructed based on the load cell type of pressure transducers. Different adhesives (powder, paste and adhesive strips) were used in the study. Complete denture wearers were asked to bite on the load cell and the readings of incisal bite force were recorded. The readings of incisal bite force were subjected to statistical analysis using Repeated measures ANOVA followed by post-hoc bonferroni test. RESULTS: The result suggests that denture adhesives improved the incisal bite force of complete denture wearers significantly The incisal bite force (in kg) in Group A without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 2.48 (+/- 0.16), 3.43 (+/- 0.11), 6.01 (+/- 0.11), 3.22 (+/- 0.09) respectively. The incisal bite force (in kg) in Group B without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 1.87 (+/- 0.18), 3.35 (+/- 0.14), 5.34 (+/- 0.18), 3.21 (+/- 0.12) respectively. The incisal bite force (in kg) in Group C without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 1.00 (+/- 0.17), 3.07 (+/- 0.14), 4.37 (+/- 0.26), 2.99 (+/- 0.14) respectively. CONCLUSION: Within the limitations of the study, it was concluded that the use of denture adhesive was found to be significantly effective in improving the incisal bite force of complete dentures until the dislodgement of upper denture. Fittydent paste adhesive was found to be more effective than the powder and strips adhesives. The improvement in incisal bite force was found to be higher in Group C in comparison to that of Group A and Group B.
Adhesives ; Bite Force ; Bites and Stings ; Denture Retention ; Denture, Complete ; Dentures ; Humans ; Polyvinyls ; Reading ; Transducers, Pressure

PURPOSE: Porcelain fused to metal (PFM) crowns provide the best treatment option for teeth that have a large or defective restoration. More than 20% of teeth with PFM crowns or bridges require non-surgical root canal treatment (NSRCT). This may be due to the effect of restorative procedures and the possible leakage of bacteria and or their by-products, which leads to the demise of the tooth pulp. Thus, this study was planned to compare the ability of the restorative materials to seal perforated PFM specimens. MATERIALS AND METHODS: The study evaluates the ability of amalgam, composite or compomer restorative materials to close perforated PFM specimen's in-vitro. Ninety PFM specimens were constructed using Ni-Cr alloys and feldspathic porcelain, and then they were divided into 3 groups: amalgam (A), composite + Exite adhesive bond (B) and compomer + Syntac adhesive bond (C). All the PFM samples were embedded in an acrylic block to provide complete sealing of the hole from the bottom side. After the aging period, each group was further divided into 3 equal subgroups according to the thermocycling period (one week for 70 cycles, one month for 300 cycles and three months for 900 cycles). Each subgroup was put into containers containing dye (Pelikan INK), one maintained at 5degrees C and the other at 55degrees C, each cycle for 30 sec time. The data obtained was analyzed by SPSS, 2006 using one way ANOVA test and student t-test and significant difference level at (P<.01). RESULTS: The depth of dye penetration was measured at the interfaces of PFM and filling materials using Co-ordinate Vernier Microscope. The lowest levels of the dye penetration for the three groups, as well as subgroups were during the first week. The values of dye leakage had significantly increased by time intervals in subgroups A and C. CONCLUSION: It was seen that amalgam showed higher leakage than composite while compomer showed the lowest level of leakage.
Adhesives ; Aging ; Alloys ; Bacteria ; Crowns ; Dental Porcelain ; Dental Pulp Cavity ; Humans ; Tooth