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The Effectiveness of Maxillary Expansion in Wearers of Cleft Lip and Palate
Get PDFIntroduction: Cleft Lip and Palate (CLAP) is one of the most frequent craniofacial anomalies. The management of patients with CLAP requires several repair procedures for the soft palate, the primary and secondary bony palate, the alveolar ridge, the lips and the nose. These patients often present with a maxillary transverse deficit responsible for maxillary endognathy which must be corrected for a harmonious development of the maxillomandibular complex. The objective of our work was to evaluate the efficacy of slow, rapid and surgical maxillary expansion in patients with sequelae of CLAP following a systematic review protocol. Materials and methods: Four databases were searched: PubMed / MEDLINE, ScienceDirect, Cochrane Library and EBSCOhost, using the keywords present in the MeSH according to the equation [Maxillary expansion] AND [Cleft lip and palate]. The selection of articles included all studies published since January 2010 and for which the full text is available, such as meta-analyzes, randomized and non-randomized controlled clinical trials, case-control studies and prospective and retrospective studies. Results: Among 1107 references only 8 studies met our inclusion criteria. Following analysis of these, we concluded that there is no significant difference between rapid maxillary expansion and slow maxillary expansion in patients with unilateral CLAP, the expansion observed on the side of the cleft is larger than that seen on the healthy side. Surgically assisted expansion is much more reserved for subjects at the end of growth, having unilateral or bilateral CLAP and presenting anterior or posterior lateral crossbones. The results of our systematic review also showed that maxillary expansion in patients with CLAP results in substantial dentoalveolar compensation. Conclusion: The efficacy of maxillary expansion in patients with sequelae of CLAP is real and alone in some cases allows the restoration of a normal transverse dimension; sometimes in combination with maxillary protraction to correct the anteroposterior deficit
Possibilities and Considerations on the Use of ECMO as a Therapeutic Option for Patients with Acute Respiratory Distress Syndrome due to Viral Infections
Get PDFManagement of acute respiratory distress syndrome due to viral outbreak includes lower tidal volumes, lower inspiratory pressure, prone ventilation and conservative fluid management. Extracorporeal membrane oxygenation (ECMO) has been proposed as rescue therapy in critically ill patients.However, in the absence of larger studies, the role of ECMO in reducing patient mortality rates remains unclear, since studies that reported such effect, both during the current as well as during previous outbreaks, were based on small sample sizes and their results are inconsistent. Furthermore, the use of ECMO might even be contraindicated in the presence of some conditions. Recurring to it has therefore to be discussed by qualified multi-disciplinary teams and based on a case by case strategy
Gestational Diabetes Mellitus: Assessing the Reliability of Risk Factor-Based Screening in a Rural Nigerian Hospital
Get PDFImplementation of the 2013WHO diagnostic criteria for Gestational Diabetes Mellitus (GDM), with lower threshold values required for the diagnosis of GDM, may be associated with further rise in the number of missed cases, especially among “low risk women”. This prospective study determined the proportions of women with GDM who were low risk. A hundred and seventeen pregnant women of gestational age 24-32weeks were screened with 50-g glucose challenge Test (GCT) and their GDM risk factor status noted. GCT positive women had 75-gOGTT, using 2013WHO GDM diagnostic criteria. The prevalence of GDM was 7.7% and about 55% of women with GDM had “low risk” status. There was no significant difference in the plasma glucose values of low risk and high risk women. With more than 50% of women with GDM being low risk, risk factor-based screening approach may be very unreliable in screening for GDM
Stockpiling on Off-label Medicines in Preparation for COVID-19 in Belize: A Qualitative Study
No full textIntroduction: Needless stockpiling of approved medications for the treatment of other diseases cause undue shortages of approved drugs. This study was conducted to assess stockpiling on off-label pharmaceutical products in anticipation of COVID-19 in the country of Belize. The results of the study provide evidence on needless and wasteful stockpiling of medications, with the aim to discourage artificial shortages while reducing the risks of inappropriate medication use.Methods: The study utilized a qualitative phenomenological approach. Interviews using semi-structured questions were conducted with 15 community pharmacists in the country of Belize. The emerged themes and sub-themes were extracted and exported to Excel 2010® for integration, narration, and presented as summary findings.Results: Data analysis yielded three salient and inter-related themes: stockpiled products, motives for stockpiling, and pharmacist response.Conclusion: Panic stockpiling on pharmaceutical products in anticipation of COVID-19 was reported in this study. The World Health Organization advised against the needless stockpiling of approved medications for the treatment of other diseases, thereby causing undue shortages of approved drugs. Observing personal hygiene and social distancing is encouraged as a measure to curb the spread of COVID-19
Risk Factors for Sever Forms of COVID-19 - A Second Level Moroccan Hospital Experience
No full textThe new coronavirus (2019-nCoV) has caused the death of more than 1.68 million patients worldwide, including 6,909 deaths registered in Morocco until 12/20/2020. The main objective of this study is to investigate epidemiological, clinical, and paraclinical factors predicting progression to the severity in order to identify patients at risk and adopt strategies for individualized management.We conduct this observational, descriptive, and analytical study from 01/09/2020 to 25/12/2020, at AL FARABI regional hospital in Oujda. 567 patients were eligible for our study out of 2000 patients who were admitted since our first case on April 2020. Our sample was divided into two groups based on pulse oxygen saturation on admission. We identified 294 as a Severe/Critical case and 273 as a Mild/Moderate form on admission. The mean age was significantly higher in the severe group (63.28 ± 12.4 vs 55.13 ± 17.2). The sex ratio M/F was 0.87. Compared with non-severe cases, severe cases exhibited more comorbidities, including diabetes (60.4% vs 39.6%; P 0.003), and hypertension (63.6% vs 26.4%; P 0.002). Several biological parameters were associated with disease severity in univariate analysis, the most important being lymphopenia, elevated C-reactive protein, and ferritin levels. lymphopenia (OR 3.76; 95% CI, 4.25-9.23), elevated C-reactive protein (OR, 5.7; 95% CI, 3.84-8.48) ferritin levels (OR, 3.6; 95% CI, 1.64-7.89) were significantly associated with severe cases of COVID-19. Mortality is 2.9% for all of our patients; it increases to 4.5% if we consider severe cases only. Identification and evaluation of epidemiological, clinical, and paraclinical parameters are important to identify patients at high risk of SARS-COV2 severity to guide treatment
Description of Nasoalveolar Molding Process in Neonatal Period of Unilateral Cleft Lip and Palate: A Step by Step
Get PDFStatement of problem. Cleft Lip and Palate (CLP) are common congenital defects of the present day. They result from a failure of facial bud sticking during embryological phenomena. Their therapeutics based on multi-disciplinary care to restore as much as possible the aesthetic and functional prejudices generated by these anomalies. Purpose. Through this work, we will illustrate, through a clinical case supported at the Consultation and Dental Treatment Center of Rabat, clinical and laboratory stages of realization of Nasoalveolar Molding (NAM). Material and methods. We describe original techniques used in our service for manufacturing of NAM fireworks and we define recommendations after insertion and follow-up procedures.Result. Place of NAM in management of these anomalies has increasingly recommended, given limitations of surgery alone to ensure satisfactory aesthetic results. Several fixed or removable appliances has used, in order to reposition gaps in cleft and / or to reshape affected bordering tissues. Conclusion. Despite the controversies surrounding this therapy, it remains highly recommended and scientifically based
An Erosive Lesion of the Buccal Mucosa Revealing an Early Squamous Cell Carcinoma
No full textOral squamous cell carcinoma is the most common epithelial malignant neoplasm affecting the oral cavity. It accounts for 90% of all oral cancers. It usually arises from a pre-existing potentially malignant lesion, and occasionally de novo. The use of tobacco, betel quid, and alcohol are well-known risk factors for oral squamous cell carcinoma.Early detection is an important criterion for achieving a high cure rate. Occasionally, OSCC may be misdiagnosed because of its variable and innocuous clinical appearance.We report the case of an early presentation of Oral squamous cell carcinoma in a patient aged 70 without preexisting risk factors, with a painful and soft erosion in the buccal mucosa for 2 months. The lesion resembled other benign lesions, but the biopsy was mandatory and revealed an early squamous cell carcinoma
Dietary Approach for Post-COVID Treatment of Olfactory Loss
Get PDFThe spread of severe acute respiratory syndrome coronavirus [SARS-CoV-2] has consequently led to the global COVID-19 pandemic. Many patients, whether hospitalized or not, have reported a variety of complications that persist after recovery. The admission for COVID-19 has been associated with anosmia and hyposmia, the inability or decreased ability to smell. Deficiencies in the ability to smell tend to recover within weeks. However, a significant number of cases have been reported in which smell distortions last for several months. Experimental research has identified inflammation as a factor disrupting olfactory neurons. Precisely, local inflammation through cytokine release in sustentacular and horizontal basal cells interferes with the function of olfactory neurons. Further studies have reported that these local inflammatory events are not responsive to common corticoid treatments. Therefore, in order to mediate the recovery of olfaction in COVID-19 patients after viral recovery, this study evaluates vitamin C, vitamin D, vitamin E, and omega-3 polyunsaturated fatty acids to develop a prospective dietary approach with anti-inflammatory properties to reduce the local inflammation of sustentacular and horizontal basal cells
A Beumer Classification of Labial-alveolar-palatal Clefts: Suggestion for Complement
No full textOrofacial clefts are a common birth defect characterized by the involvement of the nasal and oral structures. Several classifications of orofacial clefts have been proposed with the aim of generalizing rational criteria allowing communication and exchange between the different practitioners. Among these classifications, the classification of Beumer has got surgical and prosthodontic interest (making an orthopedic plate).The authors propose to update this classification by modifying it and proposing a class that did not exist in the original classification. This modification seems important to us as a complement to this classification
Essential Oils in Periodontics. What is the Interest?
Get PDFPeriodontal diseases are inflammatory diseases of infectious origin. Their initial treatment is based on a mechanical debridement associated with a chemical approach; through antiseptics and/or antibiotics. Currently, natural products based on essential oils are increasingly used as a new alternative chemical therapy in the treatment of periodontal diseases, due to their innumerable medicinal properties