A systematic review and meta-analysis on efficacy and safety of Ganaxolone in epilepsy

INTRODUCTION

Ganaxolone has exhibited potential in managing seizures for epilepsy. This systematic review and meta-analysis aim to assess both the safety and efficacy of Ganaxolone for refractory epilepsy.

METHODS

A thorough search of electronic databases was conducted to identify relevant randomized controlled trials involving patients with drug-resistant focal epilepsy and CDKL5 deficiency disorder. Efficacy and safety outcomes were extracted from the selected studies. Cochrane Review Manager was utilized for data synthesis and analysis, with risk ratios and mean differences calculated to evaluate the efficacy and safety profile of Ganaxolone.

RESULTS

The meta-analysis included a total of five randomized controlled trials. Ganaxolone exhibited significant efficacy in reducing seizure frequency by at least 50% from baseline [RR 0.90 (95% CI: 0.83, 0.98), p = 0.02]. However, the results did not reach significance for reducing 28-day seizure frequency [Mean Difference -1.45 (95% CI: -3.39, 0.49), p = 0.14]. Ganaxolone exhibited a positive safety profile, with no statistically significant occurrence of adverse events [RR 1.30 (95% CI: 0.93, 1.83), p = 0.12] and adverse events leading to discontinuation of the study drug [RR 1.01 (95% CI: 0.42, 2.39), p = 0.99] compared to placebo.

CONCLUSION

Ganaxolone presents itself as a viable therapeutic option for refractory epilepsy, showing efficacy in reducing seizure frequency and exhibited a favorable safety profile.

PROSPERO REGISTRATION NUMBER

CRD42023434883.

Gestational Age at Delivery and Neonatal Outcomes among Infants with Gastroschisis in the Children's Hospitals Neonatal Consortium (CHNC)

OBJECTIVE

 The effect of gestational age (GA) on gastroschisis outcomes is unclear and delivery timing varies in practice. We aimed to correlate clinical outcomes of infants with gastroschisis and GA at delivery in the Children's Hospitals Neonatal Consortium (CHNC).

STUDY DESIGN

This was a retrospective multicenter cohort study of infants with gastroschisis admitted to CHNC neonatal intensive care units (NICUs) from 2010 to 2016. Patients were categorized by GA: 32 to 346/7, 35 to 366/7, and ≥37 weeks. Respiratory and feeding interventions, mortality, length of stay, and common complications were compared.

RESULTS

In 2021 for patients with gastroschisis, median GA at delivery was 36.3 weeks (interquartile range [IQR] 35.1, 37.3) and mean birth weight 2,425 g (IQR 2,100, 2,766). Overall mortality was low and there was no difference across GA groups. Infants <35 weeks' gestation had the greatest need for respiratory and feeding interventions. Complications such as medical necrotizing enterocolitis (NEC), cholestasis, and central line-associated blood stream infection were less common in infants ≥37 weeks. Feeding initiation and full feeds were earliest in term infants, compared with infants between 35 and 366/7 weeks, and longest in infants <35 weeks. Prematurity had a significant negative association with breast milk exposure. Enteral feeding tube support at discharge increased with prematurity. Compared with term, infants born between 35 and 366/7 weeks' gestation had a higher incidence of medical NEC and lower exposure to mother's milk at discharge but the need for respiratory interventions or tube feeding at discharge was similar.

CONCLUSION

Premature infants with gastroschisis had more neonatal complications including respiratory interventions, longer NICU stay, longer time to full enteral feeds, and higher need for tube feeds at discharge as compared with those delivered at term. Differences were greatest for those <35 weeks GA. While overall mortality remains low, these results provide additional information about GA at birth in gastroschisis, with no evidence of benefit from preterm delivery.

KEY POINTS

· Respiratory support was greatest for those with <35 weeks gestation.. · NEC and cholestasis increase with prematurity.. · Term infants have better feeding outcomes..

Risk stratification for donor twin fetal death by evaluating middle cerebral artery in twin-to-twin transfusion syndrome in absence of twin anemia polycythemia sequence

OBJECTIVE

To determine the association of high middle cerebral artery peak systolic velocity (MCA-PSV) with fetal demise in donor twins among pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in the absence of twin anemia polycythemia sequence (TAPS).

METHODS

This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. The primary objective was to explore the association of high MCA-PSV (>1.5 multiples of the median) with fetal demise of the donor twin among pregnancies complicated by TTTS. Secondary objectives were: 1) to evaluate if donor or recipient MCA-PSV is associated with an increased risk for their corresponding fetal death using receiving operator characteristic curve analysis; and 2) to compare the proportion of fetuses with low MCA pulsatility index among donor twins with high MCA-PSV and in those with normal MCA-PSV to evaluate the contribution of blood flow redistribution to high MCA-PSV. Multivariable and Poisson regression analysis were performed to explore the association of isolated high donor MCA-PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR), and other confounders. p<0.05 was considered significant.

RESULTS

Out of 660 TTTS cases, donor MCA-PSV was unavailable in 48 (7.3%) cases. Of the remaining 612 patients, 9 (1.5%) were lost to follow-up, and 96 TAPS cases were excluded. High donor MCA-PSV was seen in 6.5% (33/507) of the study population. High donor MCA-PSV was an independent risk factor for donor fetal demise (adjusted relative risk (aRR) of 4.52; 95% CI: 2.72-7.50), adjusted for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA-PSV was an independent risk factor for donor fetal demise in Quintero stage II (aRR of 14.21; 95% CI: 1.09-186.2) and Quintero stage III (aRR of 3.41; 95% CI: 1.82-6.41). Donor MCA-PSV was associated with donor fetal demise (AUC: 0.69; p<0.001), but recipient MCA-PSV was not associated with its corresponding fetal demise (AUC: 0.54; p=0.44). A higher proportion of donor twins in the group with high MCA-PSV had a low MCA pulsatility index than in those with normal MCA-PSV (33.3% vs. 15.5%; p=0.016).

CONCLUSIONS

Elevated donor MCA-PSV without TAPS prior to laser surgery is associated with a 4-fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage, and other confounders. Doppler evaluation of donor MCA-PSV prior to laser surgery can further stratify TTTS staging to evaluate the risk for donor fetal demise. This article is protected by copyright. All rights reserved.

Comparison of the safety and efficacy of Mitomycin C 0.02% used intra-operatively by subconjunctival injection versus direct scleral application using sponges in phacotrabeculectomy: A prospective randomized controlled trial

PURPOSE

To compare the safety and efficacy of subconjunctival injection (MMC: 0.02%) to those with subconjunctival application of sponges soaked in Mitomycin C (MMC: 0.02%) intra-operatively in patients who underwent phacotrabeculectomy.

METHODS

A total of 68 patients undergoing phacotrabeculectomy were randomized into two groups; the sponge group received 0.02% MMC-soaked sponges (n = 38), and the injection group received subconjunctival injection of 0.02% MMC (n = 30). The primary outcome was post-operative mean intra-ocular pressure reduction (IOP). The secondary outcomes were bleb morphology using Indiana Bleb Appearance Grading Score (IBAGS) and anterior segment optical coherence tomography (AS-OCT), post-operative use of 5-fluorouracil, and complications rates. These were compared at 1 week and 1, 3, and 6 months post-operatively. Complete success was defined as ≥30% reduction in IOP without anti-glaucoma medications.

RESULTS

In sponge and injection groups, the mean pre-operative IOP was 29.1 ± 8.1 and 29.8 ± 8.8 mmHg, respectively. At 6 months, IOP in sponge and injection groups reduced by 52% (14 ± 3.6 mmHg, P < 0.001) and 50% (15.2 ± 4.1 mmHg, P < 0.001), respectively. Complete success was observed in 90.9% in the sponge group and 95.83% in the injection group. Both groups had diffuse, shallow, relatively avascular blebs at 6 months using IBAGS and AS-OCT. A few complications were seen in the sponge group during this period, which were not vision-threatening.

CONCLUSION

Subconjunctival MMC injection is an effective, safe, convenient, and time-saving alternative to sponge-soaked delivery of MMC in phacotrabeculectomy.

Management of large placental chorioangioma: two-port laser approach for fetal intervention

OBJECTIVES

There is a paucity of literature providing evidence-based guidelines for the management of large placental chorioangioma (≥ 4 cm in diameter). The objectives of this study were to compare outcomes between patients managed expectantly and those undergoing in-utero intervention and to describe the different in-utero techniques used for cessation of blood flow to the tumor and the associated outcome.

METHODS

This was a retrospective cohort study of 34 patients referred for the management of large placental chorioangioma in a single center between January 2011 and December 2022, who were managed expectantly or underwent in-utero intervention. In-utero intervention was performed when the fetus developed any signs of impending compromise, including high combined cardiac output (CCO), worsening polyhydramnios or abnormal fetal Doppler velocimetry findings. Interventions included radiofrequency ablation (RFA), interstitial laser ablation (ILA) and single-port or two-port fetoscopic laser photocoagulation (FLP). Treatment selection was dependent on the proximity of the tumor to the umbilical cord insertion (UCI) and placental location. The two-port technique was performed in patients with a chorioangioma with large feeding vessels (≥ 3 mm) located in the posterior placenta, in which one port was used for occlusion using bipolar forceps and the other port was used for laser photocoagulation of the feeding vessels downstream. The single-port technique was used for chorioangioma with small feeding vessels (< 3 mm) located in the posterior placenta. ILA or RFA was performed in cases with an anterior placenta. Supportive treatments, including amnioreduction and intrauterine transfusion (IUT), were performed for worsening polyhydramnios and suspected fetal anemia based on middle cerebral artery Doppler flow studies, respectively. Comparative statistical analysis between cases undergoing expectant management vs in-utero intervention was performed. Descriptive details were provided for patients who underwent in-utero intervention.

RESULTS

Thirty-four cases of large chorioangioma were evaluated, of which 25 (73.5%) were managed expectantly and nine (26.5%) underwent intervention. The frequency of polyhydramnios was significantly higher in the intervention group compared with the expectant-management group (66.7% vs 8.0%, P < 0.001). The live-birth rate among expectantly managed cases with large chorioangioma was significantly higher compared with that in cases that underwent in-utero intervention (96.0% vs 62.5%, P = 0.01). In the intervention group, preoperative CCO was elevated in all cases with available information and preoperative hydrops was present in 33.3% (3/9) of cases. One patient experienced fetal demise following IUT prior to planned FLP. Among the remaining eight patients, four underwent two-port FLP, two underwent single-port FLP, one underwent ILA and one underwent both ILA and RFA. All three cases in which hydrops was present at the time of intervention resulted in fetal demise.

CONCLUSIONS

In-utero interventions aimed at cessation of blood flow in the feeding vessels are a therapeutic option for the management of cases with large chorioangioma. The two-port percutaneous technique appears to improve the efficiency of FLP when a large chorioangioma with large feeding vessels is located in the posterior placenta. We propose that in-utero interventions for large chorioangioma should be initiated prior to the development of fetal hydrops. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Impact of tofogliflozin on hepatic outcomes: a systematic review

PURPOSE

Studies have demonstrated a high prevalence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) patients. The aim was to review the effect of tofogliflozin on hepatic outcomes in T2DM patients.

METHODS

A literature search in PubMed, Science Direct and Cochrane Central Register of Controlled Trials was conducted for randomised clinical trials of tofogliflozin by applying predetermined inclusion and exclusion criteria.

RESULTS

A total number of four randomised clinical trials, including 226 subjects, were included in the review. There was a significant decrease in aspartate aminotransferase (AST) and alanine transaminase (ALT) levels in the tofogliflozin group as compared to the control or active comparator groups. Additionally, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP) and magnetic resonance imaging proton density fat fraction (MRI-PDFF) levels were also significantly decreased in the tofogliflozin group. However, no significant difference was observed in levels of adiponectin.

CONCLUSION

Overall, an improvement in levels of hepatic parameters was observed in T2DM patients with concurrent liver disorders. However, a large number of clinical trials are needed to prove the efficacy of tofogliflozin on hepatic outcomes in patients with T2DM.

Longitudinal efficacy of Ertugliflozin in type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

INTRODUCTION

Ertugliflozin, a sodium-glucose cotransporter-2 inhibitor, seems to improve glycemic control in type 2 diabetes mellitus (T2DM). We aim to evaluate the efficacy of Ertugliflozin across multiple time intervals (18, 26, and 52 weeks) in T2DM patients.

METHODS

A literature search was conducted on electronic databases. Data was extracted from eligible studies at both 5 mg and 15 mg doses in monotherapy and as add-on therapy. Cochrane RevMan was used to perform the meta-analysis.

RESULTS

Ertugliflozin, at both 5 mg and 15 mg doses, demonstrated a significant improvement in HbA1c levels at 18 weeks 5 mg [P = 0.00001], 15 mg [P = 0.05], and at 26 weeks in monotherapy 5 mg [P = 0.006], monotherapy 15 mg [P = 0.006], 5 mg as add-on therapy [P = 0.00001], 15 mg add-on therapy [P = 0.00001] respectively. At 52 weeks, the reduction in HbA1c was significant in 15 mg add-on therapy [P = 0.0001]. Additionally, ertugliflozin as an add-on therapy also led to a significant reduction in FPG, body weight, and systolic blood pressure.

CONCLUSION

Ertugliflozin showed clinical efficacy in improving glycemic control, fasting plasma glucose, body weight, and systolic blood pressure in T2DM patients over the studied time intervals compared to placebo.

Observation and Assessment of the Parameters of Facial Esthetics in 6-year-old Children with Healthy Dentition

Aim

This study was conducted to observe and assess the dental and facial parameters of esthetics in children with healthy dentition and evaluate whether they are comparable to those of adults.

Materials and methods

An observational study included 70 children with ages ranging from 5 to 6 years who had come to the Department of Pediatric & Preventive Dentistry, Institute of Dental Studies & Technologies, Ghaziabad, Uttar Pradesh, India, with intact primary dentition. Standardized photographs of the children were taken and evaluated. Their facial and dental parameters were recorded and compared to that of those of adults.

Result

The relation of tooth and facial components was established, and it was found that they were not in the same proportion as those of adults.

Conclusion

The proportions of facial and dental parameters of esthetics of children at 6 years of age are different from those of adults.

Clinical significance

Since esthetic rehabilitation of primary teeth is becoming an important requisite of successful dental treatment, it is important to establish a standard guideline of dental and facial parameters for children for prosthetic rehabilitation.

How to cite this article

Potsangbam D, Agarwal N, Jabin Z, et al. Observation and Assessment of the Parameters of Facial Esthetics in 6-year-old Children with Healthy Dentition. Int J Clin Pediatr Dent 2023;16(4):608-611.

Network pharmacology and molecular docking analysis on potential molecular targets and mechanism of action of BRAF inhibitors for application in wound healing

Topical application of BRAF inhibitors has been shown to accelerate wound healing in murine models, which can be extrapolated into clinical applications. The aim of the study was to identify suitable pharmacological targets of BRAF inhibitors and elucidate their mechanisms of action for therapeutic applicability in wound healing, by employing bioinformatics tools including network pharmacology and molecular docking. The potential targets for BRAF inhibitors were obtained from SwissTargetPrediction, DrugBank, CTD, Therapeutic Target Database, and Binding Database. Targets of wound healing were obtained using online databases DisGeNET and OMIM (Online Mendelian Inheritance in Man). Common targets were found by using the online GeneVenn tool. Common targets were then imported to STRING to construct interaction networks. Topological parameters were assessed using Cytoscape and core targets were identified. FunRich was employed to uncover the signaling pathways, cellular components, molecular functions, and biological processes in which the core targets participate. Finally, molecular docking was performed using MOE software. Key targets for the therapeutic application of BRAF inhibitors for wound healing are peroxisome proliferator-activated receptor γ, matrix metalloproteinase 9, AKT serine/threonine kinase 1, mammalian target of rapamycin, and Ki-ras2 Kirsten rat sarcoma viral oncogene homolog. The most potent BRAF inhibitors that can be exploited for their paradoxical activity for wound healing applications are Encorafenib and Dabrafenib. By using network pharmacology and molecular docking, it can be predicted that the paradoxical activity of BRAF inhibitors can be used for their potential application in wound healing.

Association of Metformin with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Studies have demonstrated high prevalence of mortality in coronavirus disease (COVID-19) patients with type 2 diabetes mellitus; however, the effects of antidiabetic pharmacotherapy on COVID-19 complications need further exploration. The aim of the study was to explore the association of metformin use and mortality in COVID-19 patients. A literature search was conducted using the databases Medline (via PubMed) and Cochrane Central Register of Controlled Trials until February 09, 2021. Nine studies were included in the meta-analysis, including 12,684 COVID-19 patients. The meta-analysis suggested 37% lower risk of mortality in patients receiving metformin (risk ratio: 0.63; 95% confidence interval: 0.50–0.78; p < 0.001). However, no significant difference in hospitalization days between the two groups (p = 0.197) was observed. The analysis revealed significantly lower risk of having obesity (p < 0.001), hypertension (p < 0.001), heart failure (p < 0.001), and cerebrovascular disease (p = 0.015) in the group receiving metformin. The analysis also demonstrated significantly lower risk of using anticoagulants (p = 0.015), diuretics (p < 0.001), and antiplatelets (p = 0.010) in patients receiving metformin. Our findings suggest that metformin use decreases mortality in COVID-19 patients. However, randomized studies demonstrating the consequences of metformin use are needed to understand the magnitude of the beneficial effects of metformin.

Prognostic significance of soft tissue deposits in head and neck squamous cell carcinoma: a systematic review and meta-analysis

Soft tissue deposits, also known as tumour deposits (TDs), have not been studied well in head and neck squamous cell carcinoma (HNSCC) and are not included in any of the staging systems or treatment guidelines. The aim of this systematic review was to determine the prevalence and prognostic implications of TDs in patients with HNSCC. This systematic review of the literature was conducted following the PRISMA guidelines. The PubMed, Embase, and Scopus electronic databases were searched for relevant studies, from inception to August 2022. Although 14 studies qualified for inclusion, only eight were finally included in the review due to the considerable overlap of patients in several studies. Data from 7127 patients were analysed. The pooled prevalence of TDs was 21% (95% confidence interval (CI) 9-33%). The presence of TDs was adversely associated with overall survival and disease-free survival, with hazard ratios of 2.08 (95% CI 1.60-2.70) and 2.56 (95% CI 1.97-3.32), respectively. TDs are detected in a significant number of patients with HNSCC and adversely affect survival. Longitudinal prospective studies are needed to evaluate the prognostic implications of TDs in HNSCC for their potential role in cancer staging and adjuvant treatment planning.

Comparative evaluation of antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline as root canal irrigants in primary teeth

Background

Microorganisms are the main cause of pulpal and periapical diseases. Hence, the elimination of such potential microbes is achieved by endodontic treatment. Mechanical preparation is the main mechanism to reduce the bacterial load in canals which is enhanced by intracanal irrigants. Despite these procedures, some bacteria might persist within the canals. It is important to disinfect the pulp space and dentinal tubules thoroughly with an effective endodontic irrigant to prevent reinfection of a treated root canal.

Aim

This study aimed to evaluate and compare the antimicrobial efficacy of nanosilver (NS) Solution, Azadirachta indica, sodium hypochlorite, and normal saline when used as irrigants in infected root canals of primary teeth.

Settings and Design

The study was a prospective randomized control trial which was conducted as per the consort statement.

Materials and Methods

Eighty pulpally involved primary teeth requiring endodontic treatment of children aged 5-12 years were selected for this study. The subjects were randomly allocated to 4 groups (3 irrigant and control groups) consisting of 20 children each where Group I = NS solution, Group II = A. indica, Group III = Sodium hypochlorite (2.5%), and Group IV = Control group. Microbiological samples were collected at the baseline (before irrigation) and postirrigation after biomechanical preparation using the selected irrigant. The samples were subjected to an anaerobic bacterial culture test. Microbial colonies were identified and expressed as colony forming units per milliliter.

Statistical Analysis

Data were analyzed using one-way analysis of variance, Paired t-test, and Post hoc Bonferroni test.

Results

NS solution showed the highest mean of 4.384 × 10³ ± 1.019 followed by Sodium hypochlorite with a mean of 3.500 × 10³ ± 1.193 and A. indica of 2.590 × 10³ ± 0.778.

Conclusion

Based on the results of this study, NS solution can be used as an alternative to other root canal irrigating solutions in primary teeth.

Gastroschisis and low incidence of early-onset infection: a case for antimicrobial stewardship

OBJECTIVE

Early onset infection (EOI) in gastroschisis is rare. Excess antibiotic exposure in neonates increases necrotizing enterocolitis and mortality. We evaluated antibiotic exposure and EOI in gastroschisis.

STUDY DESIGN

Retrospective cohort analysis between 2010-2016 in the Children's Hospital Neonatal Database. Included: Infants ≥32 weeks with gastroschisis admitted <48 h. Excluded: major anomalies or surgical intervention prior to admission.

PRIMARY OUTCOME

EOI diagnosis (<72 h).

RESULTS

In 2021 patients with gastroschisis, median gestational age was 36 weeks (IQR 35, 37). 93.9% patients received empiric antibiotics after delivery, with median 7 days duration (IQR 3, 9). Only 13 patients (0.64%) had early positive blood culture. The rate of late onset blood stream infection (7.08%) was higher, and higher in complex (18%) than simple gastroschisis (4.8%, p < 0.001).

CONCLUSION

Despite low incidence of EOI and risks of excess antibiotic exposure, neonates with gastroschisis are exposed to long courses of empiric antibiotics. These data should stimulate interinstitution work to improve antibiotic prescribing.

Assessing Videoconferencing as a Method of Remote Consultation in Pediatric Dentistry

Background

The oral health condition in rural areas remains compromised due to insufficient healthcare providers. Implementation of teledentistry through videoconferencing in these areas can improve this situation when trained personnel are able to carry out real-time consultations of the patients with a pediatric dentist.

Aim

To observe the feasibility of using teledentistry for an oral examination, consultation, and education, and also to assess the participant's satisfaction regarding the use of teledentistry for a routine dental checkup.

Materials and methods

An observational study was carried out with 150 children aged 6-10 years. About 30 primary health centers (PHC)/Anganwadi (AW) workers were trained to perform the oral examination with the intraoral camera (IOC). Four self-constructed and nonstructured questionnaires were prepared to understand the knowledge, awareness, and attitude of the participants toward pediatric dentistry and their acceptance of teledentistry.

Results

A total of 83.3% of children were not scared and felt that the use of IOC was better. About 84% of the PHC/AW workers found teledentistry very convenient, easy to learn, and adapt. And around 92% thought that teledentistry is time-consuming.

Conclusion

Teledentistry is a possible way to provide pediatric oral health consultation in rural areas. It can save time, stress, and money for people in need of dental treatment.

How to cite this article

Agarwal N, Jabin Z, Waikhom N. Assessing Videoconferencing as a Method of Remote Consultation in Pediatric Dentistry. Int J Clin Pediatr Dent 2022;15(5):564-568.

Cognitive impairment and elevated peripheral cytokines in breast cancer patients receiving chemotherapy

BACKGROUND

Anthracyclines-based regimen (5-fluorouracil, doxorubicin, and cyclophosphamide (FAC); cyclophosphamide, epirubicin, and 5-fluorouracil [CEF]) and non-anthracycline based regimens (cyclophosphamide, methotrexate, and 5-fluorouracil [CMF]) are widely used as neoadjuvant chemotherapy for breast cancer patients.

OBJECTIVE

The present study was conducted to observe the effects of FAC, CEF, and CMF regimen on cognition and circulatory proinflammatory cytokines (interleukin 6 [IL-6] and interleukin 1β [IL-1β]) for the duration of three cycles of chemotherapy in breast cancer patients.

METHODS

Eighty newly diagnosed HER-2 negative breast cancer patients were enrolled and divided into 3 groups as FAC- (n = 27), CEF- (n = 26), and CMF- (n = 27) receiving patients. Serum IL-6 and IL-1β levels were measured by using enzyme-linked immunosorbent assay (ELISA), and cognition was assessed using the Mini-Mental State examination (MMSE) questionnaire.

RESULTS

Anthracycline-based regimen was found to increase the levels of IL-6, IL-1β, and decreased MMSE scores compared with CMF regimen (p < 0.05).

CONCLUSION

Anthracycline-based regimen caused comparatively higher peripheral inflammation, which could be the reason for more decline in cognition in anthracycline-receiving patients than non-anthracycline group.

Cross-sectional observational analysis of the genetic referral practices across pediatric ophthalmology outpatient departments in an urban setting

Purpose

To analyze the genetic referral practices of pediatric ophthalmologists in an urban setting.

Methods

(1) The first limb of the study: cross-sectional, observational study among children visiting the outpatient department of pediatric ophthalmology across five centers in Mumbai. All pediatric patients were screened separately by pediatric ophthalmologists and a clinical geneticist for their ophthalmic and systemic complaints. Children were marked for referral to genetics (RTG) by both the specialists based on identification of distinctive features (red flag) and were requested to meet a local geneticist. (2a) Twenty-three months later, patients who had been marked for RTG were contacted telephonically to follow-up if they had met the geneticist. (2b) Additionally, the last 20 proformas from each center were checked retrospectively to note the RTG marked by the ophthalmologist alone.

Results

(1) In the first aspect of the study, 126 patients (male: female = 1.2:1) were included. Forty-nine (38.3%) patients were referred for genetic evaluation, of which three (6.1%), 31 (63.26%), and 15 (30.6%) cases were referred by the ophthalmologist alone, geneticist alone, and by both the specialists, respectively. Glaucoma (100%), nystagmus (86%), and leukocoria (83%) were the most prominent ocular diagnoses in cases referred for genetic evaluation. Facial dysmorphism (55.1%) and neurodevelopmental delays (51%) were among the most common systemic red flags found in patients referred to genetics. (2a) Twenty-three months later, on contacting the 49 patients marked for RTG, only one family had met the geneticist. (2b) Retrospective evaluation of 100 proformas: only three patients were marked for RTG by ophthalmologist alone.

Conclusion

This study found that the genetic referrals by pediatric ophthalmologist were far lesser than those by geneticist. The study highlights an area of knowledge gap among pediatric ophthalmologists, prompting a need for heightened awareness in this area.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Comparative Evaluation of Salivary Fluoride Concentration after Topical Application of Silver Diamine Fluoride and Sodium Fluoride: A Randomized Controlled Trial

Background

The topical fluoride acts on the tooth in many ways and their most important action is inhibition of demineralization and enhancement of enamel remineralization.

Aim

The purpose of this clinical trial was to assess the fluoride concentration in saliva before and after 38% silver diamine fluoride (SDF) and 5% sodium fluoride (NaF) application on enamel and duration of its availability at different time intervals.

Methodology

A randomized clinical trial was conducted among 40 healthy children aged between 6 and 12 years. The participants were then randomly allocated into two different groups in which the first group (group I) was given 30% SDF and the second group (group II) were topically applied with 5% NaF solution. The fluoride concentration was measured in the salivary samples, which were collected at three time intervals, that is, at baseline (S1), 2 hours (S2), and 24 hours (S3) after application. Analysis of variance (ANOVA) test was used for evaluation and independent paired t-test was conducted for comparison between groups.

Results

When using an ANOVA with repeated measures with a Greenhouse–Geisser correction, the mean scores of fluoride concentration were statistically significantly different at different time intervals for both NaF (F = 20.854, p < 0.0005) and SDF (F = 22.746, p < 0.0005).

Conclusion

The present trial concluded that topical fluoride application increases fluoride bioavailability in saliva thereby increasing tooth remineralization. A steep rise in fluoride concentration was observed shortly post-SDF application at 2 hours and 24 hours time interval emerging a need for further research into the field of fluoridation with SDF.

How to cite this article

Jabin Z, Nasim I, Priya V V, et al. Comparative Evaluation of Salivary Fluoride Concentration after Topical Application of Silver Diamine Fluoride and Sodium Fluoride: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(3):371-375.

Efficacy and safety of nelarabine in patients with relapsed or refractory T-cell acute lymphoblastic leukemia: a systematic review and meta-analysis

Nelarabine is approved for the treatment of relapsed/refractory (R/R) T-cell acute lymphoblastic leukemia (T-ALL) patients who relapse following at least two different chemotherapy regimens. Previous studies have evaluated the efficacy and safety of nelarabine with chemotherapy in the treatment of R/R T-ALL. However, the results are inconsistent. This review aimed to summarize findings on efficacy and safety data in R/R T-ALL patients administered with the drug nelarabine. The present review conducted a comprehensive search of MEDLINE (via PubMed), WHO Clinical Trial Registry, Clinical Trials.gov, and Cochrane Central Register of Controlled Trials until 15 January 2022. Thirteen studies fulfilled the eligibility criteria with a total of 2508 patients. The efficacy of nelarabine was studied in terms of complete remission (CR) and partial remission (PR). Included studies reported overall random-effects pooled prevalence of CR and PR were 37.2 (95% CI: 22.8, 51.5) and 10.2 (95% CI: 4.9, 15.5), respectively. Most common adverse events associated with nelarabine were neutropenia, thrombocytopenia, fatigue, infections, and reversible peripheral neuropathy. Nelarabine is being used as salvage therapy as a bridge to hematopoietic stem cell transplantation and the findings of this meta-analysis indicate that it is an effective and safe treatment to be used in addition to the first-line treatment for R/R T-ALL.

Enhancing the Immune System with Vitamin D: Especial Emphasis on Prevention of COVID-19 and Complications

Abstract:

In addition to the classical functions of the musculoskeletal system and calcium homeostasis, the function of vitamin D as an immune modulator is well established. The vitamin D receptors and enzymes that metabolize vitamin D are ubiquitously expressed in most cells in the body, including T and B lymphocytes, antigen-presenting cells, monocytes, macrophages, and natural killer cells, that trigger immune and antimicrobial responses. Many in vitro and in vivo studies revealed that vitamin D promotes tolerogenic immunological action and immune-modulation. Clinical studies have revealed that mentioned immunogenic cells are regulated by the vitamin D status. Vitamin D insufficiency/deficiency is negatively affected autoimmune diseases, (such as multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis), and several communicable and non-communicable. Whereas, vitamin D adequacy positively influences the expression and release of antimicrobial peptides, such as cathelicidin, defensin, and anti-inflammatory cytokines, and reduces the expression of proinflammatory cytokines. Evidence suggests that these protective immunogenic actions of vitamin D reduce the risk, complications, and death from COVID-19. On the contrary, vitamin D deficiency worsened the clinical outcomes of viral respiratory diseases, and the COVID-19 related cytokine storm, acute respiratory distress syndrome, and death. The study revealed the need for more preclinical studies and focused well-designed clinical trials with adequate sizes to understand the role of vitamin D on the pathophysiology of immune disorders and mechanisms of subduing microbial infections, including COVID-19.

Uveitis, glaucoma, and cataract with mevalonate kinase deficiency

We report 7 years of follow-up data on ocular findings in a 2-month-old boy who presented with early-onset bilateral granulomatous panuveitis with subsequent development of secondary glaucoma and total cataract, along with multisystem involvement. He was diagnosed with mevalonate kinase deficiency (MKD), with a homozygous missense variant in exon-6 of the mevalonate kinase (MVK) gene on chromosome-12 that resulted in the substitution of aspartic acid for asparagine at codon 205 (p.Asn205Asp). Despite being managed with topical/systemic steroids and immunosuppression therapy with methotrexate and a short course of adalimumab, the patient continued to develop recurrent episodes of uveitis along with multisystem manifestations. The occurrence of early-onset uveitis is rare, as is the diagnosis of MKD.

Effectiveness of Oral Probiotics in Reducing S. Mutans Count in Caries-active Children: A Comparison with Chlorhexidine and Herbal Mouthrinse (Hiora®)

Aim

The purpose of this study was to compare the reduction in salivary mutans streptococci counts and to evaluate any change in the salivary pH values after the use of oral probiotics, chlorhexidine, and herbal mouthrinse.

Method

Oral probiotics, chlorhexidine, and herbal mouthrinse [Hiora^®] were evaluated for their efficacy against S. mutans in 75 caries-active children, aged 6-14 years.

Results

The values obtained were subjected to statistical analysis. Oral probiotics showed lesser reduction in the S. mutans count as compared to chlorhexidine but the values were statistically insignificant. Herbal mouthrinse was not as effective as the oral probiotics or chlorhexidine in reducing the S. mutans count.

Conclusion

Oral probiotics show a similar efficacy as the gold standard, chlorhexidine, in reduction of oral S. mutans.

How to cite this article

Kamble A, Jabin Z, Agarwal N, et al. Effectiveness of Oral Probiotics in Reducing S. Mutans Count in Caries-active Children: A Comparison with Chlorhexidine and Herbal Mouth-rinse (Hiora®). Int J Clin Pediatr Dent 2022;15(S-2):S207-S211.

Antimicrobial effectiveness of Nano Silver Fluoride Varnish in reducing Streptococcus mutans in saliva and plaque biofilm when compared with Chlorhexidine and Sodium Fluoride Varnishes

Background

This in vivo study was done to investigate the antimicrobial effectiveness of Nano Silver fluoride, Sodium fluoride and Chlorhexidine when used as a varnish on Streptococcus mutans (S.mutans) in saliva and plaque biofilm.

Material and Methods

120 caries free subjects, aged 8-10 years were randomly assigned to four different groups (n=30) - group I: Control, group II: Chlorhexidine varnish (CHX), group III: Sodium fluoride varnish (NaF), group IV: Nano Silver fluoride varnish (NSF). Varnish application was done once at baseline. Saliva and plaque samples were collected at baseline (T0), at the end of 1 month (T1) and 3 months (T3) to evaluate S.mutans levels by culture method, optical density and PCR. OHI-S Index was also recorded for clinical evaluation.

Results

NSF, CHX and NaF were effective against S.mutans activity. The intragroup comparision of CFU/ml and OD/ml count showed a highly significant reduction from baseline to 3 months for all the 3 varnish groups (p=0.001). PCR result revealed that maximum reduction was seen in NSF and CHX followed by NaF group.

Conclusions

NSF reduces S.mutans level in both saliva and plaque biofilm and it is more advantageous than CHX and NaF as it has dual properties of acting as an antibacterial as well as a remineralizing agent.

Key words:Chlorhexidine, Nano Silver fluoride, Sodium fluoride, S. mutans, varnish.

Quantitative Analysis and Effect of SDF, APF, NaF on Demineralized Human Primary Enamel Using SEM, XRD, and FTIR

Introduction

Topical fluoride therapy has proven benefits in the prevention of demineralization. Tooth enamel has shown a great potential for remineralization with an application of topical fluorides if administered at an appropriate time. In an effort to find an effective remineralizing agent, a novel fluoride agent silver diamine fluoride (SDF) has emerged as a potent caries arresting as well as caries preventing agent.

Aim and objective

The present study was aimed at determining the primary tooth enamel resistance to demineralization after topical application of three fluoride agents SDF, APF, and NaF.

Materials and methods

Enamel specimens were prepared from 40 caries-free primary molars. These specimens were randomly allocated into three groups of 10 specimens each and they were treated by different topical fluorides namely: Group I-SDF, group II-Acidulated phosphate fluoride (APF), group III-Sodium fluoride. Three enamel specimens from each group were placed on custom-made acrylic blocks with 5 × 5 mm of an exposed window for scanning electron microscope (SEM) evaluation and rest of the specimens were ground into a fine powder for X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) analysis. The tooth blocks and treated samples were subjected to the demineralization process for 168 hours. They were then qualitatively assessed to evaluate their resistance to demineralization using SEM, XRD, and FTIR.

Results and conclusion

Morphologically, the enamel of all groups specimens was mostly smooth with some groves and microporosities. Chemically, the Ca/P molar ratios of all groups were similar with slight variations. Structurally, the crystalline phases found in enamel by powder XRD were hydroxyapatite and carbonate apatite; and there was a higher amount of incorporated type B carbonate than type A carbonate as evidenced by FTIR. The study concludes that topical application of a 38% SDF solution can inhibit demineralization of enamel.

How to cite this article

Jabin Z, Nasim I, Vishnu Priya V, et al. Quantitative Analysis and Effect of SDF, APF, NaF on Demineralized Human Primary Enamel Using SEM, XRD, and FTIR. Int J Clin Pediatr Dent 2021;14(4):537-541.

Comparative Evaluation of Cleaning Capacity and Efficiency of Kedo-S Pediatric Rotary Files, Rotary ProTaper, and Hand K Files in Primary Molar Pulpectomy

Aim and objective

To assess and compare the cleaning efficacy and instrumentation time of K files, ProTaper, and Kedo-S rotary files in primary molars.

Materials and methods

India ink was injected into 120 root canals of selected primary molars. The root canals were randomly and equally divided into three groups based on instrumentation technique: group I-K files, group II-ProTaper, and group III-Kedo-S. After instrumentation with respective method, the canals were cleared and observed under a stereomicroscope, the instrumentation time for each root canal was also measured with a stopwatch. Statistical analysis was done with one-way analysis of variance (ANOVA) and post hoc Bonferroni.

Result

Kedo-S rotary files performed significantly better cleaning of the canals in the coronal and middle third than ProTaper and K files (p = 0.0001). In the apical third, the difference between the two rotary systems was not significant. The time taken for instrumentation was lowest with Kedo-S followed by ProTaper and K files.

Conclusion

Kedo-S pediatric rotary system showed significantly better cleaning than ProTaper rotary system and K files in cleaning primary molar root canals.

Clinical relevance

The anatomy and morphology of primary teeth demand a specialized file system that will overcome the shortcomings of conventional biomechanical preparation. Kedo-S files, being exclusive pediatric rotary files, might prove to be a boon in primary canal preparation.

How to cite this article

Kalita S, Agarwal N, Jabin Z, et al. Comparative Evaluation of Cleaning Capacity and Efficiency of Kedo-S Pediatric Rotary Files, Rotary ProTaper, and Hand K Files in Primary Molar Pulpectomy. Int J Clin Pediatr Dent 2021;14(3):383-387.

Modulating effects of the synergistic combination of extracts of herbal drugs on cyclophosphamide-induced immunosuppressed mice

OBJECTIVE

Taking leads from the available research, we aimed to develop a synergy-based herbal combination of Tinospora cordifolia (TC), Phyllanthus emblica (PE), and Piper nigrum (PN). Also, evaluating their synergistic effect on CP-induced immunosuppression in mice model and exploring the possible mechanisms involved in reversing the damage.

METHODOLOGY

The immunomodulatory activity of combination, of TC stem, PE fruits, and PN dried fruits, was determined by in vitro assays (splenocyte proliferation and pinocytic activity of peritoneal macrophages of mice) and in vivo study using CP-induced immunosuppression model in Swiss Albino mice. The ratio was optimized for combining three by in vitro MTT assay. The combination was further evaluated for anti-oxidant activity by DPPH scavenging method and quantified for its bioactive metabolites by HPTLC. Serum collected on day 0, 4, 7 and 14 was employed for estimation of haematogram (haematocrit, TLC, DLC, and haemoglobin, etc) and immune parameters (IL-10, IL-6 and TNF-α) by ELISA.

RESULTS

The study demonstrated, that combination of herbal extracts at an intermediate dose could inhibit the proliferation of spleen cells and peritoneal macrophages (P ≤ 0.0001) and induce suppression of pro-inflammatory mediators, and also certified that combination exerts synergized effects. The results showed that the combination possess potential antioxidant activity by DPPH scavenging method (IC50-113.5 µg/ml). It was identified that combination significantly (P ≤ 0.0001) improved the immune markers, haematogram parameters, and histological parameters, with maximum protection offered by an intermediate dose.

CONCLUSION

The results suggested that present combination could be further explored clinically as potent synergy-based therapeutic approach for immune modulation.