A naïve comparison to assess the success of ultra-short implants

Introduction

Conventional implants are associated with ridge augmentation/sinus lift procedures in vertically insufficient ridges, which increase morbidity and healing time. Short implants provided some hope in this context. The present study considered the use of ultra-short implants in vertically insufficient posterior mandibular ridges and evaluated their success. Hence, study was done to evaluate the success of ultra-short implants in partially edentulous posterior mandible clinically and radiographically.

Materials and Methods

The study is a "Naïve direct comparison" of ultra-short implants to conventional implants for assessing their success in vertically insufficient posterior mandibular ridges. A total of 10 ultra-short implants were placed in a partially edentulous posterior mandibular ridge with at least 8-mm horizontal (at crest) and vertical dimensions. A delayed loading was done at three-month follow-up. Data acquisition was done at baseline (immediately after loading), 6-, 9-, 12-month intervals. Parameters assessed were marginal bone loss (MBL), probing pocket depth reduction (PPDR), modified plaque index (mPI), modified gingival index (mGI).

Results

All the placed 10 implants survived, and no failure was observed. "Independent sample t-test" and "paired sample t-test" was done for intergroup and intragroup analysis, respectively. Intergroup comparison between the ultra-short and conventional implants presented a statistically insignificant difference between all the parameters at all the follow-up visits (baseline, 6-, 9-, 12 months).

Conclusions

Within the limitations, it was thus concluded that ultra-short implants may be considered as a viable treatment option for vertically insufficient mandibular ridge. Further, long-term randomized controlled trials are required to establish the evidence.

Detection of asymptomatic Leishmania donovani in healthy voluntary blood donors

OBJECTIVE

To check incidence of Asymptomatic Leishmania donovani reporting to Armed Forces Institute of Transfusion Rawalpindi.

MATERIAL AND METHODS

Two thousand (n = 2000) consecutive healthy voluntary blood donors were tested for 18 s rRNA by Real time Polymerase chain reaction. One thousand (n = 1000) subject's permanent resident of Azad Kashmir along with a thousand (n = 1000) healthy voluntary blood donors from rest of Pakistan were included. The study was carried out over a period of three months Jun - Aug 2020.

RESULTS

Total of 2000 blood donors were enrolled in the study, all were males with age ranging from 16 to 60 years. Stratification based on residence, 1000 (50 %) resided in the Azad kashmir, 349 (17.45 %) were from Islamabad and Rawalpindi, 541 (27.05 %) from Punjab mainly residing in Lahore and Multan, 110 (5.5 %) were from other cities of Pakistan. Grouping on the basis of age, 55.25 % (n = 1105) of the donors were 16-25 years old, 19.45 % (n = 389) were in age range of 26-40 years old, 15.55 % (n = 311) were 41-50 years old and 9.75 % (n = 195) 51-60 years old. No donor was diagnosed as an asymptomatic carrier.

CONCLUSION

Screening of blood donors for Leishmania donovani is not recommended.

Comparison of delta-tocotrienol and alpha-tocopherol effects on hepatic steatosis and inflammatory biomarkers in patients with non-alcoholic fatty liver disease: A randomized double-blind active-controlled trial

OBJECTIVE

We aimed to compare the efficacy of δ-tocotrienol with α-tocopherol in the treatment of patients with non-alcoholic fatty liver disease (NAFLD).

DESIGN AND INTERVENTIONS

This study was a double-blinded, active-controlled trial. The patients with NAFLD were randomly assigned to receive either δ-tocotrienol 300 mg or α-tocopherol 268 mg twice daily for 48 weeks.

ENDPOINTS

The primary endpoints were change from baseline in fatty liver index (FLI), liver-to-spleen attenuation ratio (L/S ratio), and homeostatic model assessment for insulin resistance (HOMA-IR) at 48 weeks. Key secondary endpoints were change in markers of inflammation, oxidative stress, and hepatocyte apoptosis. Clinical assessment, biochemical analysis, and computed tomography scan of the liver were conducted at baseline, 24 and 48 weeks.

RESULTS

A total of 100 patients (δ-tocotrienol = 50, α-tocopherol = 50) were randomized and included in the intention to treat analysis. Compared with baseline, there was a significant improvement (p < .001) in FLI, L/S ratio, HOMA-IR, and serum malondialdehyde in both groups at 48 weeks that was not significant between the two groups. However, there was a significantly greater decrease in body weight, serum interleukin-6, tumor necrosis factor-alpha, leptin, cytokeratin-18, and increase in adiponectin in the δ-tocotrienol group compared to the α-tocopherol group at 48 weeks (p < .05). No adverse events were reported.

CONCLUSION

δ-tocotrienol and α-tocopherol exerted equally beneficial effects in terms of improvement in hepatic steatosis, oxidative stress, and insulin resistance in patients with NAFLD. However, δ-tocotrienol was more potent than α-tocopherol in reducing body weight, inflammation, and apoptosis associated with NAFLD. TRIAL REGISTRATION: Sri Lankan Clinical Trials Registry (https://slctr.lk/SLCTR/2019/038).

Publication dynamics: what can be done to eliminate barriers to publishing full manuscripts by the postgraduate trainees of a low-middle income country?

OBJECTIVES

This study aimed to determine the publication rate of free paper abstracts presented by the postgraduate (PG) trainees and determine the reasons for non-publication. A mixed methods study was conducted. PG trainees presenting free papers at the at the Pakistan Society of Chemical Pathologist conferences from 2012 to 2018 were included. Three databases were searched to identify if the abstracts were published or not. The PG trainee authors of abstracts not published as full manuscript, were surveyed to determine the barriers and challenges in publishing a manuscript.

RESULTS

The average rate of full manuscript publication was 51.8% (n = 93/177) for the abstracts presented by the PG trainees. Publication rate was higher for oral (n = 73/119, 61.3%) compared to poster presentation (n = 20/58, 34.5%). Most of the manuscripts were published after two years of abstract presentation. The survey showed that the main challenges to publishing an abstract were lack of time, limited scientific writing or submission skills, lack of funding for publication fee, and negative or statistically non-significant results. This reflects a need to arrange workshops/symposia for the PG trainees of low-middle income country (LMIC) to enhance their writing and time management skills and improve the full manuscript publication rate from LMICs.

Effects of delta-tocotrienol supplementation on glycaemic control in individuals with prediabetes: A randomized controlled study

OBJECTIVE

To study the effects of delta-tocotrienol on glycaemic control parameters in individuals with pre-diabetes.

METHODS

The randomised control trial was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from July 15 to November 15, 2019, and comprised individuals aged 18-60 years having fasting plasma glucose of 5.6 to 6.9 mmol/L or glycosylated haemoglobin of 5.7 to 6.4%. They were randomised into group A receiving 300mg delta-tocotrienol and group B receiving a placebo once daily for 12 weeks. Weight, height, waist circumference, fasting plasma glucose, insulin and glycosylated haemoglobin were measured at the beginning and end of the trial to assess any change. Body mass index and homeostatic model assessment-insulin resistance were also calculated. Data was analysed using SPSS 21.

RESULTS

Of the 77participants, 40(52%) were in group A and 37(48%) in group B. Group A showed significantly greater reduction in terms of fasting plasma glucose, glycosylated haemoglobin, insulin and homeostatic model assessment-insulin resistance index (p≤0.001) post-intervention.

CONCLUSIONS

Delta-tocotrienol supplementation was found to have a significant effect in improving glycaemic control parameters in persons with pre-diabetes. Futures larger scale clinical trials are needed to confirm these findings.

CLINICAL TRIAL NUMBER

SLCTR/2019/024.

Comparison of Turbidimetric Inhibition Immunoassay, High-Performance Liquid Chromatography, and Capillary Electrophoresis Methods for Glycated Hemoglobin Determination

OBJECTIVE

The purpose of this study was to compare the performances of and evaluate the agreement among glycated hemoglobin values analyzed by using National Glycohemoglobin Standardization Program-certified and International Federation of Clinical Chemistry-standardized analyzers.

THIS CROSS-SECTIONAL STUDY WAS CONDUCTED AT THE

Armed Forces Institute of Pathology, Department of Chemical Pathology from March 2019 to May 2019.

METHODS

Glycated hemoglobin (HbA1c) was measured in the blood specimens from 100 patients on an ADVIA 1800 by a turbidimetric inhibitory immunoassay (TINIA), Sebia instrument by electrophoresis, and Bio-Rad Variant II Turbo system by high-performance liquid chromatography (HPLC). Quantitative variables were calculated as the mean ± standard deviation (SD). Precision and method comparisons were carried out according to Clinical and Laboratory Standards Institute recommendations. The results obtained from each analyzer were compared by correlation analysis. Method comparison was done by linear regression and Bland-Altman plots using the SPSS software version 24.

RESULTS

The mean ± SD HbA1c values from TINIA, electrophoresis, and HPLC were 7.188% ± 1.89%, 7.164% ± 1.866%, and 7.160% ± 1.85%, respectively. The between-run coefficients of variation for TINIA, electrophoresis, and HPLC were 0.64%, 0.61%, and 0.60%, respectively. All 3 showed good correlation (TINIA, R2 = .994, P = .00; electrophoresis, R2 = .992, P = 0.00; and HPLC, R2 = .994, P = 0.00).

CONCLUSION

The good clinical agreements of HbA1c and strong correlations between analyzers indicate that these analyzers can be used interchangeably.

Acute post traumatic portal venous thrombosis associated with shattered spleen: A case report

Post-traumatic portal venous thrombosis is a rare event, and is usually seen in association with penetrating injuries. Portal venous thrombosis following blunt abdominal trauma is extremely rare with only few reports in the literature, some associated with underlying coagulation disorders. We report multidetector computed tomography findings in a case of blunt abdominal trauma with otherwise normal coagulation profile, which showed shattered spleen and MDCT evidence of acute thrombosis in the right branch of the portal vein. To the best of our knowledge, this is the first documented report of acute portal venous thrombosis in association with shattered spleen.

A clinical evaluation of efficacy and safety of cefepime monotherapy versus piperacillin-tazobactam in patients of paediatric age group with febrile neutropenia in a tertiary care centre of north India

Objective

To evaluate clinically the efficacy and safety in northern India of cefepime monotherapy versus piperacillin-tazobactam in patients of paediatric age group with febrile neutropenia.

Material and Methods

Children aged ≤18 years admitted febrile with chemotherapy-induced neutropenia were randomised into two groups comprising 20 cases in each group viz. CEF (receiving cefepime only) and PIP-TAZO (receiving piperacillin-tazobactam). Based on clinical and laboratory tests, patients were classified into: microbiologically documented infections (MDI); clinically documented infections (CDI); and unexplained fever (UF). They were assessed for clinical signs and symptoms as well as laboratory parameters at the time of enrolment and subsequently on days 3 and 7.

Results

Incidence of MDI, CDI and UF were 22.5%, 47.5% and 30%, respectively. The mean duration of neutropenia (in days) was 5.45 ± 2.1 in the PIP-TAZO group and 5.5 ± 1.5 in the CEF group ( P = 0.305). The success rate defined as clearing infection effectively and improvement of neutropenia was comparable ( P = 0.705). There was a mortality rate of 20% in the PIP-TAZO group as compared to 10% in the CEF group.

Conclusion

We conclude that cefepime monotherapy and piperacillin-tazobactam are equally efficacious and safe in treating patients with febrile neutropenia. Empirical monotherapy with cefepime would prevent an unnecessary extra economic burden as well as avoiding the serious adverse or toxic effects of multi-drug regimes, especially in low- and middle-income countries.

Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study

Background:

Information regarding early predictive factors for mortality and morbidity in sepsis is limited from developing countries.

Methods:

A prospective observational study was conducted to determine the clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock. Children aged 1 month to 14 years admitted to a tertiary care pediatric intensive care unit (PICU) with a diagnosis of sepsis, severe sepsis, or septic shock were enrolled in the study. Hemodynamic and laboratory parameters which discriminate survivors from nonsurvivors were evaluated.

Results:

A total of 50 patients (30 [60%] males) were enrolled in the study, of whom 21 (42%) were discharged (survivors) and rest 29 (58%) expired (nonsurvivor). Median (interquartile range) age of enrolled patients were 18 (6, 60) months. Mortality was not significantly predicted individually by any factor including age (odds ratio [OR] [95% confidence interval [CI]]: 0.96 [0.91-1.01], P = 0.17), duration of PICU stay (OR [95% CI]: 1.18 [0.99-1.25], P = 0.054), time lag to PICU transfer (OR [95% CI]: 1.02 [0.93-1.12], P = 0.63), Pediatric Risk of Mortality (PRISM) score at admission (OR [95% CI]: 0.71 [0.47-1.04], P = 0.07) and number of organ dysfunction (OR [95% CI]: 0.03 [0.01-1.53], P = 0.08).

Conclusion:

Mortality among children with sepsis, severe sepsis, and septic shock were not predicted by any individual factors including the time lag to PICU transfer, duration of PICU stay, presence of multiorgan dysfunction, and PRISM score at admission.

The relationship of D-dimer levels with risk for developing deep-vein thrombosis and/or pulmonary thromboembolism after orthopaedic trauma surgery

BACKGROUND

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are common complications in trauma patients. Fibrin-related markers (FRMs), such as fibrin and fibrinogen degradation products (FDPs), D-dimer, and soluble fibrin (SF), are considered to be useful for the diagnosis of thrombosis (DVT).

OBJECTIVE

We report on 3-month follow-up of fibrinolytic activity after Orthopaedic Trauma Surgery (OTS).

METHODS

Patients who entered the study were divided into (group 1) patients who did not develop DVT/PE after OTS while patients who developed DVT/PE were included in (group 2). Blood samples were obtained on day of surgery and postoperative days 1, 7 and 30, and assayed for blood counts, C-reactive protein (CRP), and D-dimers. Demographic and clinical data were also collected.

RESULTS

Postoperative levels of D-dimers of both groups increased on day 1, and remained elevated on day 30. Postoperative levels of D-dimers on day 1, 7 and 30 were higher in group 2 (p < 0.05). There were no differences in perioperative levels of CRP between groups, and they correlated with D-dimers both preoperatively and on day 30. Taken together, these data suggest that orthopaedic trauma surgery induced an activation of coagulation and fibrinolysis. This situation lasts at least as late as 30 days after surgery.

CONCLUSION

The D-dimer levels were significantly higher in patients developing DVT/PE post OTS.