Tooth decay, if left untreated even in the earliest stages of life, can have serious implications for a child’s long-term health and well-being. Early preventive care is a sound health and economic investment. Dental assessments and evaluations for children during their first year of life have been recommended by the American Academy of Pediatric Dentistry (AAPD) and the American Association of Pediatrics (ADA). Establishment of dental home and use of anticipatory guidance is one of the concepts in comprehensive oral health care. AAPD and ADA support the concept of a “dental home,” which is the ongoing relationship between the dentist and the patient. Establishing a dental home means that a child’s oral health care is managed in a comprehensive, continuously accessible, coordinated, and family-centered way by a licensed dentist. The dental professional’s ability to provide optimal oral health care, beginning from when the child is 1-year-old, dental visit leading to preventive care and treatment as part of an overall oral health care foundation for life, is enhanced by dental home. The establishment of the dental home also assures appropriate referral to dental specialists when availability of direct care is not possible within the dental home.
Introduction: The effects of bariatric surgery on improvement of the metabolic syndrome is well-described, but its effect on intrinsic bone fragility and fracture propagation is unclear. Therefore, the aims of this systematic review of the literature were to examine (1) the incidence of fracture following bariatric surgery, (2) the association of fracture with the specific bariatric surgical procedure, and (3) site-specific types of fractures associated with bariatric surgery. Methods: A comprehensive literature search was conducted through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library, and HTA database. The search terms used were gastric bypass, sleeve gastrectomy and fracture. Results: Eight studies were included (n = 42,567 patients). This included no randomized controlled trials. The average patient age was 43.3 years and 24.9% of patients were male. The average follow-up time was 3.7 years. 1960 patients had at least one fracture, and the total number of fractures encountered was 2326. Overall, 4.6% of patients who underwent bariatric surgery suffered from a fracture post-operatively. The operation associated with the greatest risk of fractures post-operatively was following a biliopancreatic diversion (10.66%), followed by restrictive procedures such as adjustable gastric band and sleeve gastrectomy (5.71%), with the Roux-en-Y gastric bypass having the lowest risk (2.66%). Of the fractures encountered, 1458 (63.08%) were of the lower extremity and pelvis and 763 (33.01%) were of the upper extremity. Only 90 (3.89%) axial skeleton fractures were reported. Conclusions: The overall risk of sustaining a fracture of any type after undergoing bariatric surgery is approximately 5 percent after an average follow up of 3.7 years. The greatest risk of fractures is associated with the biliopancreatic diversion surgery, with the Roux-en-Y gastric bypass being the most favorable. Fractures following bariatric surgeries tend to occur mostly in the lower extremity and pelvis. Highlights:
Perinatal ischemic stroke results in focal brain injury and life-long disability. Hemiplegic cerebral palsy and additional sequelae are common. With no prevention strategies, improving outcomes depends on understanding brain development. Reactive astrogliosis is a hallmark of brain injury that has been associated with outcomes but is unstudied in perinatal stroke. We hypothesized that gliosis was quantifiable and its extent would inversely correlate with clinical motor function. This is a population-based, retrospective, and cross-sectional study. Children with perinatal arterial ischemic stroke (AIS) or periventricular venous infarction (PVI) with magnetic resonance (MR) imaging were included. An image thresholding technique based on image intensity was utilized to quantify the degree of chronic gliosis on T2-weighted sequences. Gliosis scores were corrected for infarct volume and compared with the Assisting Hand and Melbourne Assessments (AHA and MA), neuropsychological profiles, and robotic measures. In total, 42 children were included: 25 with AIS and 17 with PVI (median = 14.0 years, range: 6.3–19 years, 63% males). Gliosis was quantifiable in all scans and scores were highly reliable. Gliosis scores as percentage of brain volume ranged from 0.3 to 3.2% and were comparable between stroke types. Higher gliosis scores were associated with better motor function for all three outcomes in the AIS group, but no association was observed for PVI. Gliosis can be objectively quantified in children with perinatal stroke. Associations with motor outcome in arterial but not venous strokes suggest differing glial responses may play a role in tissue remodeling and developmental plasticity following early focal brain injury.
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