To the Editor,
We read with great interest the article titled “Local Flap Reconstructions in Oral Cavity Defects: An Insight from 104 Cases” and commend the authors for their valuable contribution to the field of reconstructive surgery. We believe that individuals diagnosed with oral cancer undergoing flap reconstruction should have physical therapy incorporated into their prehabilitation and postoperative rehabilitation.
To the Editor. We thank authors Babar as well as Abu Fraiha and Leibowitz for their interest in and correspondence about our paper regarding the regalia and symbols worn by medical students and the protests and disruptions at commencement ceremonies.
Extremism, displacement, and ongoing conflict have affected Palestinians and Israelis personally and collectively, endangering their health and lives. A theory circulating in public health publications posits that settler colonial determinants of health (SCDH) are the root cause of health inequities in the region. We argue that this assertion is misleading, ignores key facts, and exacerbates polarization, thus harming health. Public health is an evidence-based, scientific discipline based on hypotheses, research, and analysis. Throughout the scientific process, careful assessments of bias are essential. Knowledge is subsequently translated into policy and action. The SCDH theory rejects this approach as tainted by “colonialism.” We also argue that the SCDH concept, as applied to health disparities in Israel-Palestine, is an ideologically driven theory in search of evidence. Rather than developing testable hypotheses, the promoters of SCDH use selective evidence to support its relevance to health in the region. The theory collapses when examined against relevant facts related to regional history and the health status of Israelis and Palestinians. It invokes one-sided racism as a driver of health inequities in a context-inappropriate manner, and ignores many upstream determinants including actions of the Palestinian leadership, and their role as drivers of health. It denigrates peace-building and collaboration which are key to future health and wellbeing in the region, and which have a proven record in improving health outcomes. We call on public health professionals to distance themselves from unfounded rhetoric that polarizes the communities, and undermines the discipline’s scientific integrity, while contributing nothing to promote health in the region.
Background: Parental caregivers of children with special needs manage their child’s daily tasks, taking on responsibilities such as making health and financial decisions, assisting with routine activities, and ensuring their safety from self-harm. The level of a child’s disability determines the amount of time and effort a caregiver must invest, with higher disability levels meaning greater dependency and thus requiring greater support. While rewarding, caregiving may also be highly demanding. The parental caregiver’s physical and mental health can decline due to stress, potentially leading to anxiety and depression, and may worsen pre-existing conditions. This research aimed to provide insights into the psychological well-being of parental caregivers, shedding light on their challenges and needs for better support and intervention.
Methods: This study examined the psychological health of parental caregivers of special needs children at a special education school in Puducherry, India. Following an orientation program, 66 parental caregivers volunteered and provided informed consent to participate. The mean age of the parents was 38.4 years (±6.6). Demographic details were collected, and psychological parameters were assessed using standardized scales: Zarit Burden Interview–Caregiver Burden Scale (ZBI-CBS), Depression, Anxiety, Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of Life—brief form (WHOQOL-BREF).
Results: The study findings revealed that most parents experienced caregiver burden and poor sleep quality, consistent with previous studies. Specifically, 93.9% of parents had poor sleep, while 84.8% reported caregiver burden. Additionally, 89.4% of the parents experienced depression, 89.4% have anxiety, and 86.4% have stress. Quality of life was low across all domains.
Conclusion: The stress of managing their child’s needs can negatively impact parental caregivers’ physical and psychological health. Providing counseling and promoting healthy lifestyle choices can significantly enhance caregivers’ overall well-being.
Purpose: This study was aimed at identifying biomarkers that could help exclude pulmonary embolism (PE) in patients aged 65 years and older, considering age-related challenges such as atypical clinical presentations and the presence of comorbidities.
Methods: This single-center cohort study retrospectively collected data on 28 potential markers from patients aged 65 years and older who underwent computed tomography scans for PE diagnosis in emergency or internal wards over a 2.5-year period.
Results: The study included 157 patients after exclusions, with 35 diagnosed with PE. Patients with PE exhibited higher D-dimer levels, lower platelet counts, and higher Padua scores. Six markers were selected based on likelihood ratio, each with an area under the curve above 0.7 and P-value below 0.05. Multiplying D-dimer levels with the Padua score (PaDd) improved specificity from 9% to 32% while maintaining 100% sensitivity in identifying PE. Further refinement by incorporating activated partial thromboplastin time (aPTT) into the Padua score multiplied by D-dimer (PaDd/aPTT) resulted in improved sensitivity and specificity.
Conclusion: The Padua score multiplied by D-dimer is a simple yet effective tool that enhances specificity while maintaining high sensitivity, potentially reducing computed tomography utilization in elderly patients. Prospective, multicenter studies are needed to validate these findings and integrate them into routine clinical practice.
Background: An odontogenic keratocyst is presently considered a cyst by the 2017 World Health Organization (WHO) classification, even though, at times, it shows highly aggressive behavior and a high recurrence rate. Ki-67 is a protein associated with the proliferative activity of the intrinsic cell populations. In tumors, Ki-67 is associated with tumor aggressiveness. This study aimed to compare the Ki-67 expression rates of odontogenic keratocysts to those of other odontogenic cysts and normal mucosa.
Materials and Methods: A retrospective cross-sectional study was conducted using pathology samples retrieved from the archives of a tertiary care center to evaluate Ki-67 expression. Histopathologically confirmed cases of odontogenic keratocysts, radicular cysts, dentigerous cysts, and ameloblastomas were selected. The standardized immunohistochemistry streptavidin–biotin detection system HRP-DAB method was employed for analysis.
Results: All the odontogenic keratocysts pathology samples demonstrated some degree of Ki-67 expres¬sion: mild, moderate, and severe Ki-67 expressions were identified in 26.7%, 53.3%, and 20.0% of the samples, respectively. Compared to the odontogenic keratocyst samples, the samples from dentigerous cysts, periapical cysts, ameloblastomas, and normal mucosa demonstrated no Ki-67 expression in 33.3%–66.7% of the samples, mild expression in 13.3%–40.0%, moderate expression in 0%–33.3%, and severe expression in none of the samples (P<0.001).
Conclusions: Ki-67 was either moderately or severely overexpressed in the majority of odontogenic keratocyst samples. The 2017 WHO classification, which reclassifies keratocystic odontogenic tumors as cysts, conflicts with our findings.
To the Editor:
We found the letter from Dr Munusamy and co-workers, titled “Optimizing Recovery in Oral Flap Surgeries: The Undervalued Role of Physiotherapy,” of great value and interest. The letter comprehensively addresses the true outcomes of a surgically treated oral cancer patient, mostly adjunct with postoperative radiotherapy.
Objective: This study examines the interplay between childhood trauma, war exposure, and maladaptive coping mechanisms, with a focus on post-traumatic stress disorder (PTSD) as a mediator and war exposure as a potential moderator in the relationship between childhood trauma and emotional eating.
Methods: Participants completed validated measures of childhood trauma, PTSD, and emotional eating. Statistical analyses included Pearson correlations, stepwise linear regression, and moderated mediation models, adjusting for age and gender.
Results: The study included 426 Hebrew-speaking Israeli adults (52.8% female, 47.2% male, mean age 40). Childhood trauma, particularly emotional abuse, was significantly associated with PTSD and emotional eating. The relationship between childhood trauma and emotional eating was fully mediated by PTSD, with a stronger effect observed for emotional abuse. War exposure significantly predicted PTSD but did not moderate the link between PTSD and emotional eating. Sex differences emerged, with female participants exhibiting higher PTSD levels than males.
Conclusions: The findings emphasize the enduring impact of childhood trauma, particularly emotional abuse, on maladaptive coping mechanisms like emotional eating, mediated by PTSD. While war exposure intensified PTSD symptoms, it did not significantly influence emotional eating. These results highlight the differential effects of early- and later-life traumas, offering insights for targeted interventions in trauma recovery.
Background: Xerostomia, or dry mouth, often intensifies oral health problems like dental caries and periodontitis. Smoking is a key factor influencing salivary flow, potentially leading to these issues. This study assesses the prevalence of xerostomia and reduced salivary flow (hyposalivation) among smokers.
Materials and Methods: As case and control groups, the study groups include 150 smokers and 150 healthy non-smokers. A detailed questionnaire was used to collect data on smoking behaviors and symptoms associated with xerostomia. A modified Schirmer test was conducted at 1, 2, and 3-minute intervals to measure unstimulated salivary flow. Descriptive statistics were calculated for age, sex, type, frequency, and duration of smoking. The Mann–Whitney test was done to compare the salivary flow between smokers and non-smokers and to compare smoking parameters with salivary flow. Correlation was also determined for salivary flow with age and smoking parameters.
Results: All the smokers were males, and most were cigarette smokers (86%). Xerostomia symptoms were reported by 19% of smokers and none by non-smokers, which was statistically significant (P<0.000). Salivary flow rates at 1, 2, and 3 minutes were significantly lower in smokers than in non-smokers. A comparison between the frequency and duration of smoking and salivary flow yielded statistically significant P values of 0.005 and 0.043, respectively. There was a weak negative correlation between age, frequency of smoking, duration of smoking, and salivary flow.
Conclusion: This study found a clear association between long-term smoking and xerostomia, with a notable decrease in unstimulated salivary flow. This highlights the adverse effect of smoking on oral health, which could be used in effective counseling for tobacco cessation.
Introduction: Pulp stones (PS) are incidental, mostly asymptomatic, radiographic findings that may hinder endodontic therapy. They are observed as radiopaque aggregates within coronal or radicular pulp tissue on intraoral periapical, bite-wing, panoramic radiographs, and cone beam computed tomography images. This study aimed to evaluate PS prevalence in patients with cardiovascular disease (CVD), diabetes mellitus (DM), and chronic periodontitis (CP) as compared with controls, as a function of age and sex.
Material and Methods: This cross-sectional study included 200 subjects: 50 healthy controls, and 50 patients each with CVD, DM, and CP. All participants underwent digital panoramic radiograph (orthopantomogram) (OPG) evaluation for the presence/absence, number, and location of PS.
Results: Significant differences in PS prevalence were observed among the groups (P<0.01), with CVD patients showing the highest prevalence. Older individuals (>50 years) and first molars were most frequently affected. The maxillary arch showed a significantly higher prevalence than the mandible (odds ratio [OR]=1.45; 95% CI 1.22–1.72). The strongest risk factor was CVD (OR=7.38; 95% CI 5.20–10.47), followed by DM (OR=4.18; 95% CI 2.91–5.99) and CP (OR=4.16; 95% CI 2.88–6.00). Age was significantly associated with PS, while sex showed no association.
Conclusion: The presence of PS, even among healthy controls, may serve as an adjunctive radiographic marker and could also alert dental practitioners to the possibility of underlying systemic disease.
