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BACKGROUND: Mandibular angle fracture are frequently associated with presence of third molar. This study aimed at assessing the role of third molar with angle fracture in relation to its positioning and the remaining bone between the apex of third molar and inferior border of mandible. METHODS: A retrospective study of all patients who reported for treatment of mandibular fracture between January 2019 to January 2021 were undertaken. Patient's data and orthopantamogram radiographs were obtained from there medical records. The collected data included presence/absence of mandibular angle fracture, presence/absence of mandibular third molar, angulation and positioning of third molar along with residual bone height. Statistical analysis was done in SPSS version 20 with p-value set at p<0.05 Results: Total of 86 mandibular fracture reported in the study period, of which 34 (39.53%) had angle fracture. Third molar was present in 31 (45.6%) cases and was associated with angle fracture with statistical significance of p<0.026. Mesioangular impaction (86.4%) with class II (57%) ramus relation and position B (72.7%) in occlusal relation were associated with angle fracture in comparison to non-angle fracture group where angulation and occlusal position were statistically significant p<0.001 and p=0.002, respectively. Residual bone height was also found to be less in angle fracture group in comparison to other mandibular fracture group showing statistical significance (p<0.023). CONCLUSIONS: Patient with partially erupted mandibular third molar are more frequently associated with angle fracture and the residual bone height could also be a good predictor for risk of angle fracture.
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Fracturas Mandibulares , Humanos , Mandíbula/diagnóstico por imagen , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/epidemiología , Fracturas Mandibulares/etiología , Tercer Molar/diagnóstico por imagen , Nepal/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND: In the collaborative business environment, blockchain coupled with smart contract removes the reliance on a central system and offers data integrity which is crucial when the transacting parties rely on the shared data. The acceptance of such blockchain-based systems is necessary for the continued use of the services. Despite many extensive studies evaluating the performance of blockchain-based systems, few have focused on users' acceptance of real-life applications. OBJECTIVE: The main objective of this research is to evaluate the user acceptance of a real-life blockchain-based system (BBS) by observing various latent variables affecting the development of users' attitudes and intention to use the system. It also aims to uncover the dimensions and role of trust, security and privacy alongside the primary Technology Acceptance Model (TAM)-based predictors and their causal relationship with the users' behavior to adopt such BBS. METHODS: We tested the augmented TAM with Trust Model on a BBS that comprises two subsystems: a Shopping Cart System (SCS), a system oriented towards end-users and a Data Sharing System (DSS), a system oriented towards system administrators. We set research questions and hypotheses, and conducted online surveys by requesting each participant to respond to the questionnaire after using the respective system. The main study comprises two separate sub-studies: the first study was performed on SCS and the second on DSS. Furthermore, each study data comprises initial pre-test and post-test data scores. We analyzed the research model with partial least square structural equation modelling. RESULTS: The empirical study validates our research model and supports most of the research hypotheses. Based on our findings, we deduce that TAM-based predictors and trust constructs cannot be applied uniformly to BBS. Depending on the specifics of the BBS, the relationships between perceived trust antecedents and attitudes towards the system might change. For SCS, trust is the strongest determinant of attitudes towards system, while DSS has perceived privacy as the strongest determinant of attitudes towards system. Quality of system shows the strongest total effect on intention to use SCS, while perceived usefulness has the strongest total effect on intention to use DSS. Trust has a positive significant effect on users' attitudes towards both BSS, while security does not have any significant effect on users' attitudes toward BBS. In SCS, privacy positively affects trust, but security has no significant effect on trust, whereas, in DSS, both privacy and security have significant effects on trust. In both BBS, trust has a moderating effect on privacy that correlates with attitudes towards BBS, whereas security does not have any mediating role between privacy and attitudes towards BBS. Hence, we recommend that while developing BBS, particular attention should be paid to increasing user trust and perceived privacy.
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Fibrodysplasia ossificans progressiva is a genetic disorder of the connective tissue differentiation characterized by congenital malformation of the big toes and progressive heterotopic ossification in the extra skeletal tissues like tendons, ligaments, fascia and skeletal muscles leading to permanent disability. The prevalence is one in two million people. During childhood, it may be asymptomatic but in later life, progressive stiffness of major joints renders movement of the individual impossible. Currently, there is no effective treatment for this debilitating disease. Here, we present a case of 27 year old male with clinical and radiological features of fibrodysplasia ossificans progressiva.
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Miositis Osificante/fisiopatología , Adulto , Humanos , Masculino , Miositis Osificante/complicaciones , Miositis Osificante/diagnóstico por imagen , Nepal , Dolor/etiologíaRESUMEN
BACKGROUND: Evidences on dental anxiety scale are essential in dental practice for better service delivery. The main objective of this study was to determine the anxiety level of patients undergoing oral surgical procedures and explore its associated factors. METHODS: This was a cross sectional study enrolling 142 patients. Semi structured questionnaire based on Corah's dental anxiety scale was prepared and administered to gather information. Descriptive statistics, chi- square test and independent t- test were used to analyze the data. RESULTS: Sixty nine percent were feeling relaxed in waiting area. Nine patients (6.3%) were afraid of persons in white attire. About 17% reported that they were afraid of sound of dental apparatus. Many participant (81%) expected better outcomes of their dental procedures. When waiting for their procedure at the waiting area, about 50% stated to sense restlessness. Nearly 56% felt unease while waiting at dental chair. Nearly 70 % of cases had less than 7 dental anxiety scale score indicating low anxiety to dental procedures, 23.2% showed moderate anxiety with score of 7 to 9 and 7% showed high anxiety by scoring 10 or more out of score of 15.Average dental anxiety scale scores did not vary as per age differences. The anxiety scores for both sexes were alike. CONCLUSIONS: Even though anxiety level was low among the cases undergoing oral surgical procedure, being in waiting area and dental chair raises their apprehension.
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Ansiedad al Tratamiento Odontológico/epidemiología , Procedimientos Quirúrgicos Orales , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Glucokinase activators (GKAs) are among the emerging drug candidates for the treatment of type 2 diabetes (T2D). Despite effective blood glucose lowering in clinical trials, many pan-GKAs "acting both in pancreas and liver" have been discontinued from clinical development mainly because of their potential to cause hypoglycemia. Pan-GKAs over sensitize pancreatic GK, resulting in insulin secretion even at sub-normoglycemic level which might be a possible explanation for hypoglycemia. An alternative approach to minimize the risk of hypoglycemia is to use liver-directed GKAs, which are reported to be advancing well in clinical development. Here, we report the discovery and structure-activity relationship (SAR) studies on a novel 2-phenoxy-acetamide series with the aim of identifying a liver-directed GKA. Incorporation of a carboxylic acid moiety as an active hepatocyte uptake recognizing element at appropriate position of 2-phenoxy-acetamide core led to the identification of 26, a potent GKA with predominant liver-directed pharmacokinetics in mice. Compound 26 on oral administration significantly reduced blood glucose levels during an oral glucose tolerance test (oGTT) performed in diet-induced obese (DIO) mice, while showing no sign of hypoglycemia in normal C57 mice over a 10-fold dose range, even when dosed at fasted condition. Together, these data demonstrate a liver-directed GKA has beneficial effect on glucose homeostasis with reduced risk of hypoglycemia.
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Activadores de Enzimas/química , Activadores de Enzimas/farmacología , Glucoquinasa/metabolismo , Hiperglucemia/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemiantes/química , Hipoglucemiantes/farmacología , Animales , Glucemia/metabolismo , Células Cultivadas , Activadores de Enzimas/efectos adversos , Activadores de Enzimas/farmacocinética , Humanos , Hiperglucemia/sangre , Hiperglucemia/metabolismo , Hipoglucemia/sangre , Hipoglucemia/metabolismo , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/farmacocinética , Hígado/efectos de los fármacos , Hígado/metabolismo , Ratones Obesos , Simulación del Acoplamiento Molecular , RatasRESUMEN
Charitable foundations play a significant role in advancing public health, funding billions of dollars in health grants each year. Evaluation is an important accountability tool for foundations and helps ensure that philanthropic investments contribute to the broader public health evidence base. While commitment to evaluation has increased among foundations over the past few decades, effective use of evaluation findings remains challenging. To facilitate use of evaluation findings among philanthropic organizations, evaluators can incorporate the foundation's theory of change-an illustration of the presumed causal pathways between a program's activities and its intended outcomes-into user-friendly products that summarize evaluation findings and recommendations. Using examples from the evaluation of the Kansas Health Foundation's Healthy Living Focus Area, we present a mapping technique that can be applied to assess and graphically depict alignment between program theory and program reality, refine the theory of change, and inform grantmaking.
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Organización de la Financiación/métodos , Organización de la Financiación/estadística & datos numéricos , Organizaciones de Beneficencia/economía , Organizaciones de Beneficencia/métodos , Organizaciones de Beneficencia/estadística & datos numéricos , Organización de la Financiación/economía , Humanos , Kansas , Modelos Económicos , Innovación OrganizacionalRESUMEN
BACKGROUND: Non-traumatic perforation of the small bowel is an uncommon serious complication associated with high morbidity and mortality. Diseases that cause small bowel perforation vary in different areas of the world. OBJECTIVE: To highlight difficulties in the diagnosis and management of non-traumatic perforation of small bowel. MATERIAL AND METHODS: The medical records of four patients who have presented with non-traumatic perforation of the small bowel and were treated at Al-Ain Hospital during the last 5 years were studied retrospectively. RESULTS: The presenting symptoms of all patients were similar. Erect chest X-ray has shown free air under diaphragm in 3 patients. Leukocytosis was present in only one patient. HIV was confirmed in one patient. Patients were diagnosed to have typhoid, HIV, hook worms and tuberculosis. Only the HIV patient died while the others were discharged home in a good condition. CONCLUSION: Clinical findings of small bowel perforation are usually non specific and diagnosis is usually reached after surgery. The Histopathological examination of the small bowel ulcer were non conclusive in three patients. We have made our management plan according to the clinical findings. Non traumatic perforation in developing countries can be due to typhoid, HIV, tuberculosis and possibly hook worms.
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Infecciones por Citomegalovirus/complicaciones , Infecciones por Uncinaria/complicaciones , Enfermedades del Íleon/etiología , Perforación Intestinal/etiología , Fiebre Tifoidea/complicaciones , Adulto , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antinematodos/administración & dosificación , Antinematodos/uso terapéutico , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Diagnóstico Diferencial , Resultado Fatal , Infecciones por Uncinaria/tratamiento farmacológico , Humanos , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/cirugía , Perforación Intestinal/diagnóstico , Perforación Intestinal/cirugía , Laparotomía , Masculino , Mebendazol/administración & dosificación , Mebendazol/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis/complicaciones , Tuberculosis/diagnóstico , Tuberculosis Gastrointestinal/complicaciones , Tuberculosis Gastrointestinal/diagnóstico , Fiebre Tifoidea/tratamiento farmacológicoRESUMEN
Advances in diagnosis and management of multiple trauma patients have lead to adopting a conservative approach for most patients with blunt abdominal trauma. Intestinal obstruction is a rare complication for this approach. Herein, we report a 37-year-old male, who did not have an abdominal operation, and who developed adhesive intestinal obstruction 7 weeks following blunt abdominal trauma. We detected no signs of peritonitis or intra-abdominal bleeding clinically or radiologically on admission. We initially treated the intestinal obstruction conservatively, but the obstruction did not resolve. Finally, we performed laparotomy, which showed that the small bowel was matted together by thick fibrous layers of adhesions. We performed adhesiolysis, and the patient was discharged home 3 weeks later. Histopathological findings of the fibrous layer were consistent with repair due to previous trauma and hemorrhage. We review the literature of this rare condition.
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Traumatismos Abdominales/complicaciones , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Heridas no Penetrantes/complicaciones , Traumatismos Abdominales/diagnóstico , Adulto , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Obstrucción Intestinal/diagnóstico , Intestino Delgado/cirugía , Laparotomía , Masculino , Medición de Riesgo , Adherencias Tisulares/etiología , Adherencias Tisulares/cirugía , Resultado del Tratamiento , Heridas no Penetrantes/diagnósticoRESUMEN
Actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphy's sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required.
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Actinomicosis/diagnóstico , Actinomicosis/tratamiento farmacológico , Colecistitis Aguda/diagnóstico , Antibacterianos/uso terapéutico , Colecistectomía Laparoscópica/métodos , Colecistitis Aguda/tratamiento farmacológico , Colecistitis Aguda/cirugía , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Laparotomía , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Enfermedades Raras , Medición de Riesgo , Resultado del TratamientoRESUMEN
Recurrent gastrointestinal bleeding from hepatocellular carcinoma HCC invading the duodenum is very rare. We present a case of 50-year-old male who was admitted with a history of recurrent upper gastrointestinal tract UGIT bleeding, weight loss and anemia. The patient was known to have a chronic hepatitis C. Endoscopic examination showed grade-2 non-bleeding esophageal varices, and a large ulcerated duodenal mass partially obstructing the duodenal bulb outlet and causing recurrent UGIT bleeding. Pathological evaluation of the mass revealed HCC.
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Carcinoma Hepatocelular/patología , Neoplasias Duodenales/secundario , Neoplasias Hepáticas/patología , Humanos , Masculino , Persona de Mediana Edad , Invasividad NeoplásicaRESUMEN
We report a case of a 36-year-old lady who presented with a huge fungating tumour that involved the entire right breast. The tumour was diagnosed histologically as undifferentiated primary stromal tumour of the breast with axillary lymph node metastasis. We review the literature of this rare malignant tumour. Stromal sarcomas of the breast lack epithelial participation, and diagnosis of these tumours can be difficult. Genome-wide expression profiling is currently used to determine the cell of origin of most sarcomas. Surgery offers the best therapeutic option. Adjuvant radiotherapy is not very beneficial, while chemotherapy has, to date, no established role in the management of this disease. The prognosis is dismal for patients with lymph node involvement. The size of the tumour has a lesser bearing on outcome.
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Neoplasias de la Mama , Sarcoma Estromático Endometrial , Adulto , Mama/patología , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Sarcoma Estromático Endometrial/patología , Sarcoma Estromático Endometrial/cirugíaRESUMEN
BACKGROUND: Torsion of the fallopian tube is an infrequent but significant cause of acute lower abdominal pain in adolescent females that is difficult to recognize preoperatively, although prompt diagnosis and timely surgical treatment are vital to salvage the oviduct. CASE REPORT: A 17-yr-old virgin presented with sudden and severe right-sided lower abdominal pain with guarding and tenderness, fever, nausea, and vomiting at mid-cycle. Ultrasound scan showed a right ovarian cyst measuring 3 cm in diameter and a normal appendix. There was no leucocytosis. Presumptive diagnosis was a cystic ovarian follicle with ovulatory pain. Her condition improved but did not resolve with supportive treatment. At laparotomy, the right fallopian tube was twisted completely, distended with blood, and necrotic, with a small fimbrial cyst. The left tube, ovaries, appendix, and uterus were normal. Right salpingectomy was performed. Histologic examination revealed diffuse hemorrhagic infarction of the tube and a cyst of the hydatid of Morgagni. She remains well at follow-up. CONCLUSION: Unless a high index of suspicion is maintained for torsion of the fallopian tube in adolescent females, this disorder may not be detected until after tubal destruction.