Predicting intensive care unit-acquired weakness: A multilayer perceptron neural network approach

In this editorial, we comment on the article by Wang and Long, published in a recent issue of the World Journal of Clinical Cases. The article addresses the challenge of predicting intensive care unit-acquired weakness (ICUAW), a neuromuscular disorder affecting critically ill patients, by employing a novel processing strategy based on repeated machine learning. The editorial presents a dataset comprising clinical, demographic, and laboratory variables from intensive care unit (ICU) patients and employs a multilayer perceptron neural network model to predict ICUAW. The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW. This editorial contributes to the growing body of literature on predictive modeling in critical care, offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.

Efficacy of Periodontal Endoscopy during Subgingival Debridement to Treat Periodontitis: A Systematic Review of Randomized Clinical Trials

This study aims to evaluate the clinical efficacy of periodontal endoscopy (PEND) during subgingival debridement to treat periodontitis. A systematic review of randomized clinical trials (RCTs) was performed. The search strategy included four databases: PubMed, Web of Sciences, Scopus, and Scielo. The initial online exploration generated 228 reports, and 3 RCTs met the selection criteria. These RCTs described a statistically significant decrease in probing depth (PD) in the PEND group compared to controls after 6 and 12 months of follow-up. The improvement in PD was 2.5 mm for PEND and 1.8 mm for the control groups, respectively (p < 0.05). It was also described that the PEND group presented a significantly inferior proportion of PD 7 to 9 mm at 12 months (0.5%) as compared to the control group (1.84%) (p = 0.03). All RCTs noted improvements in clinical attachment level (CAL). It was described as having significant differences in bleeding on probing (BOP) in favor of PEND, with an average reduction of 43% versus 21% in the control groups. Similarly, it was also presented that they were significant differences in plaque indices in favor of PEND. PEND during subgingival debridement to treat periodontitis demonstrated efficacy in reducing PD. Improvement was also observed in CAL and BOP.

Dental and Maxillofacial Manifestations of Axenfeld–Rieger Syndrome: Presentation of a Case in a 5-Year-Old Girl

In this case study, the dental and maxillofacial manifestations of a 5-year-old girl with Axenfeld–Rieger syndrome (ARS) are described. This syndrome is characterized by craniomaxillofacial, ocular, dental, and umbilical disorders. The patient presented ocular dyscoria and corectopia, iris abnormalities, midface hypoplasia with a thin upper lip, and a protruded lower lip. Hyperplastic maxillary labial frenulum, oligodontia, ghost teeth, bilateral Class III molar and canine relationship, and right posterior crossbite were also found. An everted umbilicus with redundant periumbilical skin was evident. Early diagnosis of ARS is essential to establishing preventive and corrective measures that provide a good quality of life for patients who suffer from this syndrome.

Finishing Analysis of Dental Outcome (FADO) as a New Guide in Orthodontic Treatment

OBJECTIVES

Orthodontic treatment has both functional and esthetic goals. The finishing phase is one of the most important and seeks to solve occlusal, dental, functional, and esthetic problems, offering the possibility of obtaining the best possible outcome. This paper aims to describe the Finishing Analysis of Dental Outcome (FADO) guide as a tool to improve orthodontic treatment results.

METHODS

A literature review of finishing procedures and orthodontic treatment outcomes was made. Moreover, current parameters of the esthetics of the smile were considered. The information was systematized to produce a protocol applicable to practice. This guide includes the assessment of mini-esthetic, micro-esthetic, and occlusal results using the Cast Radiographic Evaluation of the American Board of Orthodontics. Treatment options for each item were also suggested. Clinical cases were used to illustrate the application of the guide.

RESULTS

The FADO Guide is presented and explained to give the clinician a systematic and orderly guide to achieve the best possible results in orthodontic treatment. To fulfill the FADO Guide, cast models, a panoramic radiograph, smile photographs (frontal and lateral), and an intraoral frontal photo are needed. The FADO Guide includes four sections: mini-esthetic evaluation (the evaluation of the smile), micro-esthetic evaluation, occlusal analysis, and radiographic analysis.

CONCLUSION

The FADO guide presents a systematic approach to the application of a finishing protocol in orthodontics. Furthermore, this guideline can improve clinical practice and be used as a checklist to optimize clinical outcomes.

Projectile Embolism From a Firearm Injury: A Case Report

Projectile embolism resulting from firearm injuries is a rare but highly lethal complication when not diagnosed early. This report presents a case of projectile embolism from a firearm injury with an unusual entry site, the cerebral venous circulation, which subsequently migrates to the pulmonary circulation with a fatal outcome. A 24-year-old male patient was admitted to a high-complexity hospital due to a gunshot wound. A plain skull computed tomography (CT) revealed a left laminar subdural hematoma and traumatic subarachnoid hemorrhage with multiple metallic fragments embedded in the skull, some penetrating the galeal sinus, with perilesional bleeding. Contrast-enhanced chest tomography showed non-thrombotic embolism of metallic fragments in the pulmonary artery for the apical segment of the left upper lobe and right intraventricular regions. Transthoracic echocardiography revealed a hyperechoic image of 3 mm in the subvalvular apparatus toward the interventricular septum. Subsequently, the patient experienced neurological deterioration with signs of cerebral edema and parieto-occipital epidural hematomas with metallic fragments and projectiles. Measures to counteract cerebral edema were initiated. Later, the patient developed mydriasis, the absence of brainstem reflexes, and experienced cardiac arrest. This report delineates a case of projectile embolism, highlighting a distinctive aspect characterized by an unusual entry point.

Positive correlations between presence of gram negative enteric rods and Porphyromonas gingivalis in subgingival plaque

The association between Gram negative enteric rods and Porphyromonas gingivalis in periodontal diseases has received little attention in the literature. Thus, the aim of this study was to investigate the associations between Gram negative enteric rods, Porphyromonas gingivalis and clinical parameters of periodontal disease. The prevalence of Gram-negative enteric rods and P. gingivalis were examined in patients with chronic periodontitis. Chi-square and Mann-Whitney tests were used to determine differences in clinical variables versus the presence or absence of both microorganisms. Correlations of both organisms and clinical data were determined using Spearman rank correlation coefficient. Gram-negative enteric rods and P. gingivalis were detected in 20 (26.3%) and 51 (67.1%) subjects, respectively. A total 17 (22.4%) individuals harbored both microorganisms studied. There were significantly positive correlations between enteric rods and presence of P. gingivalis (r=0.531, P<.0001). Both microorganisms were significantly and positively correlated with probing depth, clinical attachment level and bleeding on probing (P<0.0001). The mean probing depth (mm) of the sampled sites was significantly deeper in patients with presence of P. gingivalis and Gram-negative enteric rods. This study suggests that the presence of Gram negative enteric rods and P. gingivalis is related to adverse periodontal conditions. These results could have an impact on periodontal treatment and should be taken into account in the mechanical and antimicrobial treatment of periodontal disease in some populations.

Efficacy of microchips and 3D sensors for orthodontic force measurement: A systematic review of in vitro studies

OBJECTIVE

To evaluate the efficacy of microchips and 3D microsensors in the measurement of orthodontic forces.

METHODS

Through September 2023, comprehensive searches were conducted on PubMed/MEDLINE, SCOPUS and SCIELO without restrictions.

RESULTS

After removing duplicate entries and applying the eligibility criteria, 23 studies were included for analysis. All the studies were conducted in vitro, and slightly more than half of them were centred on evaluating orthodontic forces exerted by aligners. Eight utilized microchips as measurement tools, while the remaining studies made use of 3D microsensors for their assessments. In the context of fixed appliances, key findings included a high level of agreement in 3-dimensional orthodontic force detection between simulation results and actual applied forces. Incorporating critical force-moment combinations during smart bracket calibration reduced measurement errors for most components. Translational tooth movement revealed a moment-to-force ratio, aligning with the bracket's centre of resistance. The primary findings in relation to aligners revealed several significant factors affecting the forces exerted by them. Notably, the foil thickness and staging were found to have a considerable impact on these forces, with optimal force transmission occurring at a layer height of 150 μm. Furthermore, the type of material used in 3D-printing aligners influenced the force levels, with attachments proving effective in generating extrusive forces. Deliberate adjustments in aligner thickness were observed to alter the forces and moments generated.

CONCLUSIONS

Microchips and 3D sensors provide precise and quantitative measurements of orthodontic forces in in vitro studies, enabling accurate monitoring and control of tooth movement.

Image Quality, Radiation Dose, and Patient Comfort Associated with Wireless Sensors in Digital Radiography: A Systematic Review

Radiography facilities face challenges with the positioning of digital radiography detectors. This study evaluates the image quality, radiation dose, and patient comfort associated with wireless sensors in digital radiography. A systematic exploration was performed across PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, and SCIELO. Nine papers met the eligibility criteria, including three observational studies with 111 patients, four in vitro experiments with 258 extracted human teeth, and two ex vivo investigations with 16 cadaver mandibles. All studies consistently reported high-quality images produced by wireless sensors. Two studies demonstrated the superiority of wireless sensors, one found comparable accuracy with conventional radiography, and another indicated similar image quality among the sensors. Both wireless and wired sensors significantly reduced radiation doses compared to conventional X-rays. The Visual Analog Scale (VAS) did not reveal a clear superiority of wireless over wired sensors, though both were generally less comfortable than traditional film. The wireless sensors consistently produce high-quality images, comparable to or superior to other digital devices. Both wireless and wired sensors significantly reduce radiation doses compared to conventional X-rays, emphasizing their safety and efficacy. Patient comfort levels vary, with neither sensor type showing clear superiority over the other, and both being less comfortable than traditional film.

Portal Vein Thrombosis in Liver Transplantation: A Retrospective Cohort Study

Portal vein thrombosis was considered a contraindication for liver transplantation. This study analyzes the perioperative complications and survival of liver transplant patients with portal vein thrombosis (PVT). A retrospective observational cohort study of liver transplant patients was conducted. The outcomes were early mortality (30 days) and patient survival. A total of 201 liver transplant patients were identified and 34 (17%) patients with PVT were found. The most frequent extension of thrombosis was Yerdel 1 (58.8%), and a portosystemic shunt was identified in 23 (68%) patients. Eleven patients (33%) presented any early vascular complication, PVT being the most frequent (12%). The multivariate regression analysis showed a statistically significant association between PVT and early complications (OR = 3.3, 95% confidence interval 1.4-7.7; p = 0.006). Moreover, early mortality was observed in eight patients (24%), of which two (5.9%) presented Yerdel 2. For Yerdel 1, patient survival according to the extent of thrombosis was 75% at 1 year and 3 years, while for Yerdel 2, it was 65% at 1 year, and 50% at 3 years (p = 0.04). Portal vein thrombosis significantly influenced early vascular complications. Furthermore, portal vein thrombosis Yerdel 2 or higher impacts the survival of liver grafts in the short and long term.

PoCUS for the management of Fournier's gangrene in the emergency department: A case report

Serious soft tissue infections in the spectrum of rapidly progressive necrosis of the fascia and subcutaneous tissue represent a clinical challenge in emergency department clinical practice. Fournier's gangrene (FG) is a presentation thereof that compromises the urogenital area. A low threshold of clinical suspicion complementary to laboratory evaluation and imaging is necessary to act rapidly and perform diagnostic and therapeutic surgical intervention for this condition. The present study reported the case of a 63-year-old woman who was admitted with buttock skin changes for 72 h. The diagnostic impression was septic shock due to FG. Point-of-care ultrasound (PoCUS) was performed, indicating free fluid in the muscle planes, discontinuity of the muscle fascia and the presence of gas in the subcutaneous cellular tissue. The patient was taken to surgery 2 h after admission. PoCUS was indicated to have an acceptable diagnostic performance that may optimize the care of this type of patient depending on the conditions of the emergency department and the availability of other resources.

Light gradient boost tree classifier predictions on appendicitis with periodontal disease from biochemical and clinical parameters

Introduction

Untreated periodontitis significantly increases the risk of tooth loss, often delaying treatment due to asymptomatic phases. Recent studies have increasingly associated poor dental health with conditions such as rheumatoid arthritis, diabetes, obesity, pneumonia, cardiovascular disease, and renal illness. Despite these connections, limited research has investigated the relationship between appendicitis and periodontal disease. This study aims to predict appendicitis in patients with periodontal disease using biochemical and clinical parameters through the application of a light gradient boost tree classifier.

Methods

Data from 125 patient records at Saveetha Institute of Dental College and Medical College were pre-processed and analyzed. We utilized data preprocessing techniques, feature selection methods, and model development approaches to estimate the risk of appendicitis in patients with periodontitis. Both Random Forest and Light Gradient Boosting algorithms were evaluated for accuracy using confusion matrices to assess their predictive performance.

Results

The Random Forest model achieved an accuracy of 94%, demonstrating robust predictive capability in this context. In contrast, the Light Gradient Boost algorithms achieved a significantly higher accuracy of 98%, underscoring their superior predictive efficiency. This substantial difference highlights the importance of algorithm selection and optimization in developing reliable predictive models. The higher accuracy of Light Gradient Boost algorithms suggests effective minimization of prediction errors and improved differentiation between appendicitis with periodontitis and healthy states. Our study identifies age, white blood cell count, and symptom duration as pivotal predictors for detecting concurrent periodontitis in acute appendicitis cases.

Conclusions

The newly developed prediction model introduces a novel and promising approach, providing valuable insights into distinguishing between periodontitis and acute appendicitis. These findings highlight the potential to improve diagnostic accuracy and support informed clinical decision-making in patients presenting with both conditions, offering new avenues for optimizing patient care strategies.