ObjectivesTo compare health-related quality of life and prevalence of chronic diseases in housed and homeless populations.DesignCross-sectional survey with an age-matched and sex-matched housed comparison group.SettingHostels, day centres and soup runs in London and Birmingham, England.ParticipantsHomeless participants were either sleeping rough or living in hostels and had a history of sleeping rough. The comparison group was drawn from the Health Survey for England. The study included 1336 homeless and 13 360 housed participants.Outcome measuresChronic diseases were self-reported asthma, chronic obstructive pulmonary disease (COPD), epilepsy, heart problems, stroke and diabetes. Health-related quality of life was measured using EQ-5D-3L.ResultsHoused participants in more deprived neighbourhoods were more likely to report disease. Homeless participants were substantially more likely than housed participants in the most deprived quintile to report all diseases except diabetes (which had similar prevalence in homeless participants and the most deprived housed group). For example, the prevalence of chronic obstructive pulmonary disease was 1.1% (95% CI 0.7% to 1.6%) in the least deprived housed quintile; 2.0% (95% CI 1.5% to 2.6%) in the most deprived housed quintile; and 14.0% (95% CI 12.2% to 16.0%) in the homeless group. Social gradients were also seen for problems in each EQ-5D-3L domain in the housed population, but homeless participants had similar likelihood of reporting problems as the most deprived housed group. The exception was problems related to anxiety, which were substantially more common in homeless people than any of the housed groups.ConclusionsWhile differences in health between housed socioeconomic groups can be described as a ‘slope’, differences in health between housed and homeless people are better understood as a ‘cliff’.

Dysregulation of Hedgehog (Hh) signaling pathway has been documented in mammary gland development and breast cancer (BC) progression. Despite the remarkable progress in therapeutic interventions, BC related mortality in Bangladesh increased in the last decade. Triple negative breast cancer (TNBC) still presents a critical therapeutic challenge. Thus effective targeted therapy is urgently needed. In this study, we report the clinicopathological characteristics and prognosis of BC patients from Bangladesh. Routine immunohistochemical analysis and high throughput RNA-Seq data from the TCGA library were used to analyze the expression pattern and association of high and low level of Shh expression in a collection of BC patients with a long-term follow-up. High levels of Shh were observed in a subset of BC tumors with poor prognostic pathological features. Higher level of Shh expression correlated with a significantly poorer overall survival of patients compared with patients whose tumors expressed a low level of Shh. These data support the contention that Shh could be a novel biomarker for breast cancer that is involved in mediating the aggressive phenotype of BC. We propose that BC patients exhibiting a higher level of Shh expression, representing a subset of BC patients, would be amenable to Shh targeted therapy.

The aim of this study was to estimate the prevalence of teeth with apical periodontitis (AP) and root‐filled (RF) teeth in an adult Sudanese population. Panoramic and periapical radiographs were obtained for 200 patients over 18 years of age seeking routine dental care and attending the dental clinics (University of Khartoum) and the dental hospital (University of Science and Technology) for the first time. The periapical status of all teeth (except third molars) was categorized on the basis of the presence or absence of radiographic signs of AP. In addition, the frequency of RF teeth was recorded. Data were analyzed using the chi‐square test and odds ratio (OR).The periapical status of 4,967 teeth was assessed. AP in one or several teeth was identified in 95 (47%) patients and in 3.3% of the teeth. The prevalence of AP was higher in molar teeth (7.3%) than in premolar (3.5%) and anterior teeth (0.9%, p ≤ .001). There were 80 (1.6%) RF teeth in 42 (21%) patients. The probability of root‐filling in molar and premolar teeth was almost twice that of anterior teeth (OR with 95% confidence intervals: 1.06 < 1.91 < 3.44, p ≤ .05).The prevalence of RF teeth increased with age (OR of 48 ± year = 3.06, p ≤ .001). Statistical analysis showed that the probability of radiological detection of AP in RF teeth was 17‐fold higher than in nonfilled ones (OR with 95% confidence intervals: 9.87 < 16.83 < 28.25, p ≤ .001).Therefore, the probability of AP, RF teeth with or without AP, and missing teeth was high in molar teeth than in anterior or premolar teeth. The frequency of RF teeth was low compared to that demonstrated in most other epidemiological studies. This highlights the need to focus on improving the quality of restorations and the procedure by which root canal is shaped and disinfected.

Background: Bonded retainers are widely used as they are esthetically pleasing, easily acceptable, provide greater stability, compliance free and causes no soft tissue irritation and speech problems. Though, fracture and bond failure are their shortcomings. Therefore, the objectives of this study were to evaluate the number of bond failures and type of failure pattern between two types of mandibular canine-canine bonded retainers. Methods: Total 60 subjects were recruited initially and were assessed for eligibility, out of which 6 were excluded and 2 were lost to follow up. They were randomly divided into two groups. Fiber reinforced composite (FRC) retainers were inserted in group 1 subjects while group 2 subjects received multistranded stainless steel (MSW) retainers. The subjects were recalled after every 3 months over a period of 1 year. Bond failure rate and failure pattern based on adhesive remnant index were evaluated at each visit. The bond failure rate and failure pattern were compared between the two retainers by using Chi-square test. Results: The bond failure rates were 42.94% for FRC retainer and 31.41% for MSW retainer. Hence, total number of bond failures in both retainers were 37.17%. The difference of bond failure between two groups was statistically significant (p = 0.012). Type "0" failure pattern was detected commonly with both types of retainers (p < 0.001). Conclusion: Our findings indicate that multistranded stainless steel wire retainer is a superior option to be used for fixed lingual retention in mandibular arch as it exhibited lower bond failure as compared to fiber reinforced composite retainer. Adhesive failure is the most common type of bond failure observed with both types of fixed retainers. Trial registration: ID NCT03881813 (https://clinicaltrials.gov/); March 19, 2019, retrospective registration.

Background: Cataract is the leading cause of avoidable blindness in most parts of developing world, including India. The objectives were to assess cataract surgical coverage (CSC) and investigate the determinants for CSC among people aged 50 years or older in India.Methods: A population-based, cross-sectional survey was conducted to include 2023 residents aged ≥50 years old from 72 clusters of 20 districts in six states from various parts of India. Presenting visual acuity (VA), history of cataract surgery and operable cataract were assessed by trained professionals. Prevalence of CSC and factors influencing cataract surgery (CS) were studied in the multivariable logistic regression model. A two-sided p-value of <0.05 was considered to be statistically significant.Results: Cataract surgery was done in 478 (23.6%) people in both eyes. Using VA<6/18 cut-off, the CSC was estimated as 67.2% in persons. In LR model, increased age was significantly associated with increased CS (P<0.0001). The odds of prevalence of CS was significantly lower in Uttar Pradesh; adjusted Odds Ratio (OR), 0.59; (95% CI: 0.36-0.95; p=0.032) and in persons with diabetes; OR: 0.61; (95% CI: 0.38-0.94; p=0.028).Conclusions: Cataract surgical need is currently not being met in India and the increasing prevalence of diabetes is an additional major challenge in addressing the gap in CS.