Using Continuous Glucose Monitoring Values for Bolus Size Calculation in Smart Multiple Daily Injection Systems: No Negative Impact on Post-bolus Glycemic Outcomes Found in Real-World Data

BACKGROUND

Recent evidence shows that it may be safe to estimate bolus sizes based on continuous glucose monitoring (CGM) rather than blood glucose (BG) values using glycemic trend-adjusted bolus calculators. Users may already be doing this in the real world, though it is unclear whether this is safe or effective for calculators not employing trend adjustment.

METHODS

We assessed real-world data from a smart multiple daily injections (MDIs) device users with a CGM system, hypothesizing that four-hour post-bolus outcomes using CGM values are not inferior to those using BG values. Our data set included 184 users and spanned 18 months with 79 000 bolus observations. We tested differences using logistic regression predicting CGM or BG value usage based on outcomes and confirmed initial results using a mixed model regression accounting for within-subject correlations.

RESULTS

Comparing four-hour outcomes for bolus events using CGM and BG values revealed no differences using our initial approach (P > .183). This finding was confirmed by our mixed model regression approach in all cases (P > .199), except for times below range outcomes. Higher times below range were predictive of lower odds of CGM-based bolus calculations (OR = 0.987, P < .0001 and OR = 0.987, P = .0276, for time below 70 and 54 mg/dL, respectively).

CONCLUSIONS

We found no differences in four-hour post-bolus glycemic outcomes when using CGM or BG except for time below range, which showed evidence of being lower for CGM. Though preliminary, our results confirm prior findings showing non-inferiority of using CGM values for bolus calculation compared with BG usage in the real world.

Determining health-related quality of life and health state utility values of recurrent urinary tract infections in women

INTRODUCTION AND HYPOTHESIS

Health state utility values estimate an individual's valuation of their health-related quality of life. Despite prevalence of recurrent urinary tract infections (rUTIs), the health state utility value of rUTIs is unknown. The primary aim was to determine the utility value of rUTIs using the standard gamble (SG). The secondary aim was to compare the SG utility value with that derived from the EuroQol 5 dimensions (EQ-5D) and visual analog scale (VAS). We hypothesized that a utility value would be successfully derived from the SG and would differ from that derived using the EQ-5D and VAS.

METHODS

Nonpregnant, adult English-speaking female patients with a diagnosis of rUTI were recruited and completed the EQ-5D, VAS, and SG (n = 25). Utility values were evaluated using Wilcoxon signed-rank tests and Spearman's rho correlation.

RESULTS

Health state utility values varied depending on the assessment tool used: EQ-5D 0.76 (IQR 0.52), VAS 0.70 (IQR 0.30), and SG 0.85 (IQR 0.25). There were differences between VAS and the other two assessment methods (p<0.001), as well as between EQ-5D and SG (p=0.013). Spearman correlation demonstrated a moderately positive correlation between EQ-5D and VAS values (r(25) = 0.59, p=0.0019).

CONCLUSIONS

Our data suggest that 0.85 reflects the true health state utility value of rUTIs among nonpregnant adult English-speaking women. The utility value for recurrent UTIs is worse (lower) than that previously published for nonrecurrent UTIs, reflecting the ability of the SG to convey the compounding impact of recurrent disease. In this study, neither the EQ-5D nor the VAS produced results consistent with those found using the SG, which suggests limited validity in this population.

Comparative evaluation of antibacterial efficacy of nonsteroidal anti-inflammatory medications and proton-pump inhibitor against Enterococcus faecalis: An in vitro study

Aim

The present in vitro experimental study was undertaken to evaluate and compare the antimicrobial activity of triple antibiotic paste (TAP), diclofenac, and proton-pump inhibitor (PPI) against the microorganism Enterococcus faecalis.

Materials and Methods

Three medicaments were selected for the study, TAP, diclofenac, and PPI. The experimental groups for the test were as follows: Part 1 - Group 1: TAP, Group 2: diclofenac, and Group 3: PPI; Part 2 - Group 1: TAP + PPI and Group 2: diclofenac + PPI. An agar well diffusion test was used to determine the efficacy of the experimental medicaments against E. faecalis (ATCC 29212). The diameter of inhibition zones was measured in millimeters using an inhibition zone measuring scale and the results were recorded.

Statistical Analysis

The statistical analysis was done using an analysis of variance and an unpaired t-test. P value was set at < 0.05.

Results

There was a significant difference in the diameter of growth inhibition zones, with the greatest diameter noted for TAP + PPI followed by diclofenac sodium (DS) + PPI, TAP, DS, and PPI.

Conclusions

The antimicrobial effectiveness of TAP + PPI was found to be superior to all other medicaments (DS + PPI, TAP, DS, and PPI).

Comparison of trends and outcomes of infective endocarditis in patients with versus without leukemia, 2002 to 2017, from a nationwide inpatient sample

Patients with leukemia are at an increased risk for infective endocarditis secondary to their immunocompromised state, chemotherapy, and specific risk factors such as the presence of indwelling central venous catheters. There is a paucity of data regarding temporal trends and clinical outcomes of infective endocarditis in leukemia patients. Previous studies have shown a high rate of complications related to surgical valve procedures for treatment of infective endocarditis in patients with hematological malignancies. In this study, we aimed to analyze the contemporary trends and clinical outcomes of treatment in infective endocarditis patients with and without leukemia based on data available from the Nationwide Inpatient Sample, which is a publicly accessible, large sample-sized national dataset of hospitalized patients across the US. We present key findings on baseline characteristics, microbiological profile, outcomes, rates of valve surgical procedures, and mortality in infective endocarditis patients with and without leukemia between 2002 and 2017 in the US.

Community Level Physiological Profiling of Microbial Communities Influencing Mine Spoil Genesis in Chronosequence Coal Mine Overburden Spoil

Ecological restoration through mine spoil genesis should be dogmatic and the strategies involved a holistic approach, which emphasizes the role of microbial community composition that varies in accordance with the physiological and nutritional status of mine spoil profiles. This is because the patterns observed aboveground is being driven by the belowground diversity and processes. Thus, the relationship between microbial community structure and mine spoil genesis in chronosequence coal mine spoil has attracted considerable research attention. The occurrence of higher microbial diversity and difficulties in culturing microbes necessitate the use of a culture-independent approach through community-level physiological profiling based on the patterns of carbon source utilization using BIOLOG Ecoplate and thereby the functional diversity of microbial communities in different age series coal mine spoil was determined. The average well-color development exhibited an increasing trend with a minimum in OB0 (0.0640) and a maximum in OB15 (0.5060) over time. The patterns of substrate utilization (carbohydrates, carboxylic and ketonic acids, amino acids, polymers, amines, and amides) reflect the shift in microbial community composition in different age series coal mine spoil over time. Gradual increase in species richness and Shannon diversity index with the increase in age of mine spoil substantiated relatively higher microbial diversity reflecting the sign of mine spoil genesis. Principal component analysis and redundancy analysis based on the differential patterns of substrate utilization discriminate different age series coal mine spoil into independent clusters, which evaluated the broad-scale patterns of microbial community dynamics influencing the pace and progress of mine spoil genesis.

Catheter Ablation for Hospitalized Atrial Fibrillation Patients with Reduced Systolic Function: Analysis of Inpatient Mortality, Resource Utilization and Complications

Background

Randomized trials have shown improvement in hard clinical end points when catheter ablation (CA) is employed as a management strategy for certain atrial fibrillation (AF) patients with heart failure and reduced ejection fraction (HFrEF). Limited data, however, exist in this realm outside the controlled clinical trial settings. We sought to determine real-world data on mortality and complications after utilization of CA in such patients.

Methods and Results

Data were derived from National Inpatient Sample from January 2008 to August 2015. Patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Baseline characteristics and outcomes were compared among HFrEF and AF patients undergoing CA or not. Propensity matching was done to mitigate selection bias and balance confounding variables. Various CA related complications were assessed. Logistic regression was done to determine predictors of mortality in our study cohort. A total of 2,569,919 patients were analyzed and a total of 7773 patients underwent CA. Mortality was significantly better in CA group in both unmatched (1.2% vs. 4.9%, p < 0.01) and propensity matched cohorts (1.2% vs. 3.6%, p < 0.01). Overall complication rate was 10.2% in CA cohort and primarily driven by cardiac and neurological etiologies. In regression analysis, CA remained a strong predictor of reduced mortality (OR 0.301, 95% CI 0.184-0.494).

Conclusions

CA is associated with improved mortality in admitted AF patients with concomitant HFrEF. Overall complication rate after CA was modest at 10.2%. Consideration can be given to the utilization of this therapeutic modality in hospitalized AF patients with concomitant HFrEF.

Telehealth for COVID-19 Pandemic

The COVID-19 epidemic has caused huge strain on health infrastructure. In this pandemic, burden on healthcare workforce is rising, as there was need to give treatment, observing, and subsequent follow-ups during the epidemic. Consequently, the Covid-19 pandemic has profoundly affected healthcare. Clinical focuses are presently reacting to CORONA VIRUS 19 through fast appropriation of advanced devices and advances, for example, Tele health and effective consideration which allude to the conveyance of medical care directing computerized or a ways off utilizing Information and Communications Technology (ICT) for therapy of One still living. Tele health was required to convey opportune consideration while limiting openness to secure clinical professionals and One still living. In like manner, a quick writing audit was led, and 35 examination contemplates distributed from 2019 to May 2020 were utilized to give hypothetical and functional proof on the hugeness of utilizing Tele health and effective consideration for far off treatment of One still living during the CORONA VIRUS 19epidemic. This article gives down to earth manage dependent on the best way to utilize Tele health and effective consideration during the CORONA VIRUS 19 epidemic. This investigation gives suggestion on the possibilities of combining effective consideration arrangements soon towards adding to incorporate advanced innovations into medical services. Materials and Methods: The material required for the review was taken from the databases of PubMed, Web of science,the from the website of World Health Organization and the patients data of SMHRC and DMMC Wanadongari Nagpur.

Radiological Appraisal of Biodentine and Pulpotec Individually or in Combination with Photo-activated Disinfection as Pulp-capping Cements in Mature Teeth

AIM AND OBJECTIVE

The aim of the study was to evaluate and compare radiographically, Pulpotec cement and Biodentine as direct pulp-capping agents in mature teeth, individually and in combination with photo-activated disinfection (PAD).

MATERIAL AND METHODS

In the present study, 80 mature teeth with deep occlusal caries were selected for direct pulp-capping procedure and randomly assigned to one of the four groups [Pulpotec (I), Biodentine (II), Pulpotec + PAD (III), and Biodentine + PAD (IV)] allocating 20 teeth to each group. Direct pulp capping and cavity disinfection were performed based on the group allotted followed by permanent restoration with composite. The teeth were evaluated radiographically (densitometric analysis) at intervals of 3, 6, and 12 months. The radiographic gray values obtained at follow-up periods for each group were subjected to two-way analysis of variance (ANOVA) with repeated measures.

RESULTS

There was a significant improvement (p <0.0001) in the scores of all the groups at follow-ups as compared to the baseline. There was a significant difference between group I/group II with groups III and IV (p = 0.000) with group IV scoring highest at all follow-ups. However, the difference between groups I/II and groups III/IV was nonsignificant.

CONCLUSION

Both, Biodentine and Pulpotec can be used for direct pulp capping of mature teeth. Furthermore, PAD prior to material application significantly improved the radiographical success of Biodentine and Pulpotec, with Biodentine showing better results than Pulpotec.

CLINICAL SIGNIFICANCE

Biodentine and Pulpotec demonstrated comparable success as a pulp-capping agent and PAD application exhibited a synergistic effect when used in conjunction with these materials.

Baseline characteristics and outcomes of end-stage renal disease patients after in-hospital sudden cardiac arrest: a national perspective

PURPOSE

End-stage renal disease (ESRD) is a well-recognized risk factor for the development of sudden cardiac arrest (SCA). There is limited data on baseline characteristics and outcomes after an in-hospital SCA event in ESRD patients.

METHODS

For the purpose of this study, data were obtained from the National Inpatient Sample from January 2007 to December 2017. In-hospital SCA was identified using the International Classification of Disease, 9th Revision, Clinical Modification and International Classification of Disease, 10th Revision, Clinical Modification codes of 99.60, 99.63, and 5A12012. ESRD patients were subsequently identified using codes of 585.6 and N18.6. Baseline characteristics and outcomes were compared among ESRD and non-ESRD patients in crude and propensity score (PS)-matched cohorts. Predictors of mortality in ESRD patients after an in-hospital SCA event were analyzed using a multivariate logistic regression model.

RESULTS

A total of 1,412,985 patients sustained in-hospital SCA during our study period. ESRD patients with in-hospital SCA were younger and had a higher burden of key co-morbidities. Mortality was similar in ESRD and non-ESRD patients in PS-matched cohort (70.4% vs. 70.7%, p = 0.45) with an overall downward trend over our study years. Advanced age, Black race, and key co-morbidities independently predicted increased mortality while prior implantable defibrillator was associated with decreased mortality in ESRD patients after an in-hospital SCA event.

CONCLUSIONS

In the context of in-hospital SCA, mortality is similar in ESRD and non-ESRD patients in adjusted analysis. Adequate risk factor modification could further mitigate the risk of in-hospital SCA among ESRD patients.

The Effectiveness of Virtual Training on the MiniMed™ 670G System in People with Type 1 Diabetes During the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability to do face-to-face training on advanced diabetes management technologies. In the United States, Medtronic Diabetes shifted from occasional to 100% virtual training on all diabetes devices in mid-March 2020. We studied the outcomes of virtual training on the MiniMed™ 670 G hybrid closed-loop system in type 1 diabetes. Methods: From March 20, 2020, to April 22, 2020 (intra-COVID-19), virtual training on the MiniMed 670 G system was completed using Zoom with satisfaction captured through online post-training surveys. Training efficiency was measuring by the days between the date of product shipment and the date of the first and final trainings. Patient satisfaction with training on the MiniMed 670 G was determined by Net Promotor Score^® (NPS^®). Uploads from CareLink™ Personal and CareLink Professional and calls to the Medtronic 24-h technical support team requesting educational/software assistance and/or help with health care provider telehealth visits were recorded. Continuous glucose monitoring (CGM) results were measured using the CareLink Personal database. All results except for the Zoom satisfaction survey were compared with data from January 20, 2020, to February 22, 2020, (Pre-COVID-19) when training was performed in-person. Results: The CGM metrics were comparable between pre- and intra-COVID-19 training. The Zoom video conferencing application had 98% satisfaction. The NPS rose from 78 to 84. The time between the pump shipment and the first and last (automode) training was significantly reduced from 14 ± 7 days to 11 ± 5 days (P < 0.001) and from 19 ± 7 days to 15 ± 15 days (P < 0.01), respectively. There was a decrease in the calls for educational assistance to the technical support team but an increase in requests for login and software installation support. Conclusions: Virtual training of individuals with diabetes on the MiniMed 670 G system resulted in high satisfaction and short-term glycemic results comparable with in-person training.

Improved Real-World Glycemic Control With Continuous Glucose Monitoring System Predictive Alerts

BACKGROUND

Most standalone real-time continuous glucose monitoring (RT-CGM) systems provide predictive low and high sensor glucose (SG) threshold alerts. The durations and risk of low and high SG excursions following Guardian™ Connect CGM system predictive threshold alerts were evaluated.

METHODS

Continuous glucose monitoring system data uploaded between January 2, 2017 and May 22, 2018 by 3133 individuals using multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) therapy were deidentified and retrospectively analyzed. Glucose excursions were defined as SG values that went beyond a preset low or high SG threshold for ≥15 minutes. For a control group, thresholds were based on the median of the low SG threshold limit (70 mg/dL) and the high SG threshold limit (210 mg/dL) preset by all system users. During periods when alerts were not enabled, timestamps were identified when a predictive alert would have been triggered. The time before low horizon was 17.5 minutes and the time before high horizon was 15 minutes, of all users who enabled alerts. Excursions occurring after a low SG or high SG predictive alert were segmented into prevented, ≤20, 20-60, and >60 minutes.

RESULTS

Excursions were prevented after 59% and 39% of low and high SG predictive alerts, respectively. The risk of a low or high excursion occurring was 1.9 (P < 0.001, 95% CI, 1.88-1.93) and 3.3 (P < 0.001, 95% CI, 3.20-3.30) times greater, respectively, when alerts were not enabled.

CONCLUSIONS

The predictive alerts of the RT-CGM system under study can help individuals living with diabetes prevent some real-world low and high SG excursions. This can be especially important for those unable to reach or maintain glycemic control with basic RT-CGM or CSII therapy.

Catheter ablation for atrial fibrillation in patients with reduced systolic function: a national perspective

Background

Randomized trials have shown improvement in hard clinical end points when catheter ablation (CA) was employed as a management strategy for certain atrial fibrillation (AF) patients with heart failure and reduced ejection fraction (HFrEF). We sought to determine real world data on mortality and complications after utilization of CA in such patients.

Methods and results

Data were derived from National Inpatient Sample from January 2008 to August 2015. Patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Baseline characteristics and outcomes were compared among AF and HFrEF patients undergoing CA or not. Propensity matching was done to mitigate selection bias and balance confounding variables. Various CA related complications were assessed. Logistic regression was done to determine predictors of mortality in our study cohort. A total of 2,569,919 patients were enrolled and out of these approximately 7773 patients underwent CA. Mortality was significantly better in CA group in both unmatched (1.2% vs. 4.9%, p&lt;0.01) and propensity matched cohorts (1.2% vs. 3.6%, p&lt;0.01). Overall complication rate was 10.2% in CA cohort and were primarily cardiac and neurological in origin. In regression analysis, CA remains a strong predictor of reduced mortality (OR 0.301, 95% CI 0.184–0.494).

Conclusion

CA is associated with improved mortality in admitted AF patients with concomitant HFrEF. Overall complication rate after CA was modest at 10.2%.

Funding Acknowledgement

Type of funding source: None

Evaluation of Changes in Microbiology and Periodontal Parameters During and After Fixed Orthodontic Appliances

The objective of the study was to evaluate the changes in microbiology through quantitative analysis of aerobic and anaerobic colonies and periodontal measurements during and after 1 month of removal of fixed orthodontic appliances. This prospective study comprised 30 patients, aged 12-30 years seeking orthodontic treatment in the department of Orthodontics and Dentofacial Orthopaedics of People's College of Dental Sciences and Research Centre, Bhopal from May 2016 to November 2017. Microbiological samples (supra- and subgingival plaque) and periodontal measurements like bleeding on probing (BOP), periodontal pocket depth (PPD) with oral hygiene assessment indices {plaque index (PI), gingival index (GI)} were used at 2 time interval: when patient undergoing orthodontic treatment >12 month (baseline, T₁) and 1 month after the removal of appliance (T₂). Bacterial culture method used to detect aerobic and anaerobic colony forming units (CFU) and their ratio (aerobic/anaerobic). Data analyzed using paired t-test and chi-square test. There was a significant decrease in an aerobic and anaerobic CFU (both supra- and subgingivally) and increase in CFU ratio (relatively less anaerobes) (p≤0.05) at T₂. Supragingival plaque sampling showed greater diminution in the CFU count as compared to the subgingival CFU, as these sites are more accessible for maintaining hygiene. Also, periodontal measurements showed significant decrement (PI, GI, PPD and BOP) at T₂ (p≤0.05). Fixed orthodontic treatment has transient effect on periodontium as supra- and subgingival CFU count decreases and periodontal health was ameliorated after removal of appliances which was accompanied with periodontopathic bacteria and clinical periodontal signs of inflammation during treatment.

Comparative Heat Transfer Analysis of MoS2/C2H6O2 and SiO2-MoS2/C2H6O2 Nanofluids with Natural Convection and Inclined Magnetic Field

This article explores the comparative analysis of MoS2/C2H6O2 nanofluid and SiO2-MoS2/C2H6O2 hybrid nanofluid natural convective boundary layer flow through a stretching area. Uniform inclined magnetic field is applied together with viscous dissipation. The governing model of the flow is solved by Runga-Kutta fourth orde method using appropriate similarity transformations. Temperature and velocity field are presented for various flow pertinent parameters. It is conclude that if we give an increment in the convection parameter the velocity profile increases and opposite effect is noticed for the temperature profile for both fluids. Also with increased volume fraction parameter Φ2, we get increased velocity and temperature profiles for both nanofluids.

Targeted temperature management in cardiac arrest patients with a non-shockable rhythm: A national perspective

INTRODUCTION

Retrospective studies have shown conflicting benefit of utilizing targeted temperature management (TTM) in cardiac arrest (CA) patients with a non-shockable rhythm and presently there is only one randomized trial in this realm. We sought to determine trends and outcomes of TTM utilization in these patients from a large nationally representative United States population database.

METHODS AND RESULTS

Data were derived from National Inpatient Sample (NIS) from January 2006 to December 2013. All patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Patients with evidence of shockable rhythm (ventricular tachycardia, ventricular flutter and ventricular fibrillation) were excluded. Trends in TTM utilization and mortality were assessed over our study period. Various outcomes were measured in patients receiving TTM and no TTM in unmatched and propensity matched cohorts. Logistic regression analysis was done to determine predictors of mortality. A total of 1,185,479 CA patients were identified in whom cause of arrest was a non-shockable rhythm. Overall, there was a steady increase in TTM utilization over our study period. In propensity-matched groups, mortality was higher in patients in whom TTM was utilized compared to non-TTM group (72.9% vs 68.7%, P < .01). In adjusted analysis, TTM remains an independent predictor of increased mortality in our group. Mortality remained high with TTM utilization regardless of location of CA.

CONCLUSIONS

TTM utilization was associated with increased mortality in CA patients with a non-shockable rhythm. These findings merit further confirmation in a large randomized trial before application into clinical practice.

OR30-01 Real-World Minimed™ 670G System Use and Glycemic Outcomes of Pediatric and Adult Individuals Living with Type 1 Diabetes (T1D) in the United States

Introduction: The MiniMed™ 670G system was FDA-approved in 2016 for adults and adolescents ≥14yrs, and in 2018 for children ages 7-13yrs with T1D. Since then, use of the system has grown to over 180,000 people in the U.S. The glycemic control benefits of real-world MiniMed™ 670G system Auto Mode use in the U.S. were assessed. Methods: System data (aggregated five-minute instances of sensor glucose [SG]) uploaded from March 2017 to July 2019 by individuals (N=118,737) with T1D and ≥7yrs of age who enabled Auto Mode were analyzed to determine the mean % of overall time spent &lt;54mg/dL/&lt;70mg/dL (TBR); between 70-180mg/dL (TIR); and &gt;180mg/dL/&gt;250mg/dL (TAR). The impact of Auto Mode was further assessed in a sub-group of individuals (N=51,254) with, at least, 7 days of SG data for both Auto Mode turned ON and turned OFF. The % of TIR, TBR and TAR, and the associated glucose management indicator (GMI) were evaluated for the overall OFF (2,524,570 days) and ON (6,308,806 days) periods, and across different age groups. Results: System data TIR was 71.3%; TBR was 0.4% and 1.9%, respectively; and TAR was 26.8% and 6.2%, respectively. User-wise data of Auto Mode OFF versus ON showed a mean of 70.3% of the time spent in Auto Mode, that TIR increased from 60.9% to 69.9%; and that both TBR and TAR decreased. For those 7-13yrs (N=1,417), TIR increased from 48.7% to 61.5%; TBR increased from 0.5% to 0.6% and from 2.0% to 2.2%, respectively; and TAR decreased from 49.3% to 36.3% and from 20.5% to 13.0%, respectively. For those 14-21yrs (N=4,194), TIR increased from 51.0% to 61.5%; TBR decreased from 0.7% to 0.6% and from 2.3% to 2.0%, respectively; and TAR decreased from 46.7% to 36.5% and from 18.5% to 12.5%, respectively. For those ≥22yrs (N=45,643), TIR increased from 62.2% to 70.9%; TBR decreased from 0.7% to 0.5% and from 2.6% to 1.9%, respectively; and TAR decreased from 35.2% to 27.3% and from 9.9% to 6.3%, respectively. The mean GMI decreased by 0.23% (overall), 0.48% (7-13yrs), 0.35% (14-21yrs), and 0.22% (≥22yrs), respectively, with Auto Mode ON versus OFF. Discussion: In over 6 million days of real-world MiniMed™ 670G system Auto Mode use in the U.S., TIR of a large pediatric and adult population with T1D improved by 9% compared to when Auto Mode was OFF, which was comparable to or exceeded the TIR observed in the smaller pivotal trials. These results further support outcomes of the pivotal trials and increased glycemic control with system use.

Predicting Nocturnal Hypoglycemia from Continuous Glucose Monitoring Data with Extended Prediction Horizon

Nocturnal hypoglycemia is a serious complication of insulin-treated diabetes, which commonly goes undetected. Continuous glucose monitoring (CGM) devices have enabled prediction of impending nocturnal hypoglycemia, however, prior efforts have been limited to a short prediction horizon (~ 30 minutes). To this end, a nocturnal hypoglycemia prediction model with a 6-hour horizon (midnight-6 am) was developed using a random forest machine- learning model based on data from 10,000 users with more than 1 million nights of CGM data. The model demonstrated an overall nighttime hypoglycemia prediction performance of ROC AUC = 0.84, with AUC = 0.90 for early night (midnight-3 am) and AUC = 0.75 for late night (prediction at midnight, looking at 3-6 am window). While instabilities and the absence of late-night blood glucose patterns introduce predictability challenges, this 6-hour horizon model demonstrates good performance in predicting nocturnal hypoglycemia. Additional study and specific patient-specific features will provide refinements that further ensure safe overnight management of glycemia.

A Scanning Electron Microscope Analysis of Sealing Potential and Marginal Adaptation of Different Root Canal Sealers to Dentin: An In Vitro study

AIM

The present study aimed to evaluate the sealing potential and marginal adaptation of different root canal sealers to dentin.

MATERIALS AND METHODS

A total of sixty human lower premolars of the permanent dentition that were extracted were used for this study. The visible debris and calculus were removed from the extracted teeth ultrasonically and were kept for 2 hours in 2.5% sodium hypochlorite and stored in normal saline till next use. A low-speed diamond disc was used to section all the teeth samples at the cementoenamel junction. Later, cleaning and shaping of the canals was done. Based on the sealer used, the samples (each group consisting of 20 samples) were divided randomly into three groups: group I-bioceramic sealer, group II-resin-based sealer, group III-MTA-based sealer. All split samples were visualized under scanning electron microscope (SEM) at apical and coronal thirds of root canal, the marginal gap at root dentin and sealer interface were assessed.

RESULTS

The highest marginal adaptation (5.60 ± 0.12) was demonstrated by EndoSequence BC sealer, followed immediately by ProRoot MTA sealer (4.48 ± 0.12) and EndoREZ sealer (2.10 ± 0.54). A statistically significant difference (p = 0.001) was seen between the EndoSequence BC and ProRoot MTA sealer for apical and coronal marginal adaptation. Also, a statistically significant difference (p < 0.05) was found between EndoSequence BC sealer vs EndoREZ sealer at coronal and EndoSequence BC sealer vs EndoREZ sealer and EndoREZ sealer vs ProRoot MTA sealer at apical third.

CONCLUSION

The present study concluded that significant and better sealing ability and marginal adaptation was demonstrated by EndoSequence BC (bioceramic sealer) when compared to ProRoot MTA sealer (MTA-based sealer) and EndoREZ sealer (resin-based sealer).

CLINICAL SIGNIFICANCE

Numerous endodontic sealers enter the market with various factors to attain acceptable seal. According to current study bioceramic sealer, is the appropriate sealer that hermetically seals all the margins.

Evaluation of Efficacy of Different Instrumentation for Removal of Gutta-percha and Sealers in Endodontic Retreatment: An In Vitro Study

AIM

The aim of the present study was to evaluate the efficacy of different instrumentation for removal of gutta-percha and sealers in endodontic retreatment.

MATERIALS AND METHODS

A total of single-rooted mandibular premolars were collected. Access opening was performed in all specimens. The working length was determined by reducing 1 mm from the length of instruments that were seen reaching the apex. All the canals were dried with paper points. Lateral condensation technique was used to obturate the canals with gutta-percha and zinc oxide eugenol was used as a sealer. The specimens were randomly segregated into three experimental groups. Group I: ultrasonic retreatment tip, group II: R-Endo retreatment files, group III: Mtwo retreatment files. Roots were grooved into two halves with a diamond disc in a longitudinal, buccolingual direction. A stereomicroscope with ×40 magnification was used to image the quantity of gutta-percha and sealer on canal walls.

RESULTS

With ultrasonic retreatment tip, least amount (1.96 ± 0.32) of gutta-percha and sealer remained, followed by Mtwo retreatment files (2.84 ± 0.24) and R-Endo retreatment files (3.18 ± 0.63). A statistically significant inter-group difference among different instrumentation groups was demonstrated by ANCOVA analysis.

CONCLUSION

In the present study, ultrasonic retreatment tip file systems was found to be more effective in the removal of root canal filling material, followed subsequently by Mtwo retreatment file system and R-Endo retreatment file system.

CLINICAL SIGNIFICANCE

Thorough removal of filling material from the root canals is essential during root canal retreatment for probable cleaning and shaping of canal morphology. Thus, clinicians should be aware of the suitable and better instrumentation system that provides a clean and sterile root canal system without any debris. How to cite this article: Agrawal P, Ramanna PK, Arora S, et al. Evaluation of Efficacy of Different Instrumentation for Removal of Gutta-percha and Sealers in Endodontic Retreatment: An In Vitro Study. J Contemp Dent Pract 2019;20(11):1269-1273.

Loss of Subpodocytic Space Predicts Poor Response to Tacrolimus in Steroid-Resistant Calcineurin Inhibitor-Naïve Adult-Onset Primary Focal Segmental Glomerulosclerosis

Focal segmental glomerulosclerosis (FSGS) is the most common cause of adult-onset nephrotic syndrome, but its pathophysiology is poorly understood. The question as to why only a subset of patients responds to treatment in unanswered. In the past few years, change of podocytic phenotype from stationary type in health to migratory type in disease has been described, of which loss of subpodocytic space is a surrogate marker. Diagnostic biopsies of adult-onset steroid-resistant calcineurin inhibitor-naïve primary FSGS cases, which were subsequently treated with tacrolimus were included in this retrospective study conducted from 2011 to 2013. The ultrastructure of all cases was studied in detail, especially in context to the presence or absence of subpodocytic space. In the present study, we have compared presence or absence of subpodocytic space in tacrolimus-responsive versus tacrolimus-resistant cases to identify potential electron microscopic features predictive of response to treatment, of which loss of subpodocytic space indicating migratory phenotype is the most important and consistent feature. The present series included 7 tacrolimus responsive cases (includes two cases with partial response) and seven tacrolimus-resistant cases. The tacrolimus-resistant patients were of older age, had a longer duration of illness, and a lower eGFR as compared to tacrolimus responsive cases. The subpodocytic space was preserved in patients on tacrolimus with complete remission and lost in patients with partial response and tacrolimus-resistant cases.

Evaluation of Intracanal Calcium Hydroxide Removal with Different Techniques: A Scanning Electron Microscope Study

AIM

This study aimed to evaluate the efficacy of Intracanal calcium hydroxide removal with different techniques.

MATERIALS AND METHODS

Seventy-five freshly extracted, non-carious, single canalled lower first premolars, having anatomic characteristics similar to each other, extracted for the orthodontic purpose were collected. After the root canal preparation, Calcium hydroxide was placed into the working length using lentulo spiral instrument till the medicament was visible at the apex. The specimens were segregated into three groups; Group 1: Rotary Files, Group 2: EndoVac system and Group 3: Ultrasonics. The evaluation was done with SEM in the coronal and apical third of the roots with a magnification of 1000x. The statistical analysis was done using statistical packages for social sciences (SPSS) software, version 20.0 for Windows (SPSS Inc., Chicago, IL). A p-value of less than 0.05 was considered significant statistically.

RESULTS

Maximum removal of Ca(OH)₂ was analyzed in the EndoVac system (2.90 ± 0.12) followed by the rotary files (1.76 ± 0.26) and least was seen with Ultrasonics (1.32 ± 0.14). The p-value of 0.001 was seen between the coronal and apical third with the EndoVac system which is statistically significant. The significant difference statistically was observed between Rotary Files vs. Ultrasonics at apical third and with the EndoVac system vs. Ultrasonics at coronal third as well as at the apical third with p-value 0.001.

CONCLUSION

It can be concluded that the EndoVac technique was effective in removing Ca(OH)₂ medicament from the coronal and apical third of the root canal significantly.

CLINICAL SIGNIFICANCE

Calcium hydroxide removal before the obturation was of priority as the Ca(OH)₂ remnants have a negative impact of the ability for sealing the obturation material. Therefore, having a complete knowledge regarding the effective technique is much important.

Retrospective Analysis of 3-Month Real-World Glucose Data After the MiniMed 670G System Commercial Launch

Real-world data from the first 3141 patients who completed 3 months of SmartGuard™ Auto Mode-enabled MiniMed™ 670G system use during the MiniMed 670G System Commercial Launch are reported. CareLink™ system data uploaded by real-world patients in the Commercial Launch from March 17, 2017 to December 31, 2017 were deidentified and analyzed. Comparisons of overall and night (10:00 PM-07:00 AM) time spent below, within, and above target glucose range (TIR) (70-180 mg/dL) between the baseline Manual Mode and closed-loop Auto Mode periods were made. These were evaluated alongside data from the 124 patients (aged 14-75 years) who completed the 3-month MiniMed 670G system pivotal trial (NCT 2463097), from June 2, 2015 to March 7, 2016. Real-world patients used Auto Mode a median 80.8% of the time (19 h and 24 min of the day). The overall mean of time spent in TIR was 66.0% during baseline Manual Mode versus 73.3% during Auto Mode (P < 0.001); the mean percentage of sensor glucose values <70 mg/dL was 2.7% versus 2.1% (P < 0.001); and that >180 mg/dL was 31.4% versus 24.6% (P < 0.001). The nighttime and early morning (03:00 AM-06:00 AM) TIR during Auto Mode was greater than that during baseline Manual Mode (nighttime: 77.2% vs. 67.4% [P < 0.001], early morning: 70.9% vs. 84.6% [P < 0.001]). Similar differences between Manual Mode and Auto Mode TIR were observed across different age groups. A slight increase in total insulin delivered was also observed. Consistent with improved glycemic control demonstrated in the pivotal trial, analysis of CareLink system data from >3000 real-world patients who completed 3 months of Auto Mode-enabled MiniMed 670G system use demonstrated increased TIR and decreased time below and above TIR compared with baseline. These improved clinical outcomes were observed across a broad age range of patients with type 1 diabetes.

Monoclonal Gammopathy of Renal Significance Triggered by Viral E Hepatitis

Monoclonal gammopathy of undetermined significance does not have end organ damage, but a proportion of cases manifest with renal injury when it is called monoclonal gammopathy of renal significance (MGRS). Herein, we describe a case of acute hepatitis E infection, which precipitated the development of MGRS. The patient underwent kidney biopsy for elevated creatinine with clinical suspicion of drug-induced interstitial nephritis. On light microscopy, there were periodic acid–Schiff negative-fractured casts in tubules with giant cell reaction around them. The tubular epithelial cells showed intracytoplasmic bile pigment. On direct immunofluorescence, casts showed kappa restriction. A diagnosis of bilirubin proximal tubulopathy and light chain cast nephropathy was made, and possibility of myeloma was suggested. On further evaluation, κ:λ ratio was 27, β2 microglobulin was 8036 ng/ml, and bone marrow examination showed 5% plasma cells. There were no bony lesions, and serum calcium was 8.6 mg/dl. The present case is unique in two aspects. First, the patient developed MGRS triggered by acute hepatitis E in less than a month. Second, the MGRS lesion was manifested in the form of light chain cast nephropathy.

Novel Bio-Markers for Prediction of Preeclampsia

Pre-eclampsia (PE) is a pregnancy related disorder. It is an important cause of maternal and perinatal morbidity and mortality worldwide. Two to eight percent of pregnancies were affected by PE. It is characterized by de novo hypertension and proteinuria after 20 weeks of gestation. The etiology and pathogenesis of the disease is unknown, but recent studies have revealed that placenta is the place of origin of this disorder and widespread maternal endothelial dysfunction is the characteristic feature of the disease. Some biochemical molecules are identified recently which are involved in the pathogenesis of the disease, which may help in early identification of patients at risk and help in providing proper prenatal care. Several promising biomarkers have been proposed, alone or in combination. Maternal serum concentrations of these biomarkers either increase or decrease in PE during gestation. This review focuses on the various biomarkers available and their utility in prediction and diagnosis of pre-eclampsia.

Effectiveness of Automated Insulin Management Features of the MiniMed® 640G Sensor-Augmented Insulin Pump

BACKGROUND

Automated insulin management features of the MiniMed® 640G sensor-augmented pump system include suspension in response to predicted low sensor glucose (SG) values ("suspend before low"), suspension in response to existing low SG values ("suspend on low"), and automatic restarting of basal insulin delivery upon SG recovery. The effectiveness of these features was evaluated using CareLink® software data.

METHODS

Anonymized data from MiniMed 640G system users (n = 4818), MiniMed 530G system users (n = 39,219), and MiniMed Paradigm® Veo™ system users (n = 43,193) who voluntarily uploaded pump and sensor data were retrospectively analyzed. Comparisons were made between days in which system features were enabled at any time and those in which they were not. Comparisons were also made between pump suspension events for which insulin delivery was automatically or manually resumed and between glycemic parameters of users who switched from the MiniMed Paradigm Veo system to the MiniMed 640G system.

RESULTS

Days in which the MiniMed 640G "suspend before low" feature was enabled had lower percentages of SG readings ≤70 mg/dL (3.9 mmol/L) or ≥240 mg/dL (13.3 mmol/L) than days when it was not enabled (P < 0.001 for each). Users who switched from the MiniMed Paradigm Veo system to the MiniMed 640G system had fewer excursions below ≤70 mg/dL (P < 0.001) and ≥240 mg/dL (P < 0.001). SG values following automatically resumed pump suspension events recovered more rapidly and had a more stabilized endpoint than following manually resumed events.

CONCLUSIONS

Automated insulin management features of the MiniMed 640G system can reduce the frequency of both high and low SG values and help stabilize SG after resumption of insulin delivery.

Anti bacterial Effectiveness of Electro- Chemically Activated (ECA) Water as a Root Canal Irrigant- An In-vitro Comparative Study

INTRODUCTION

Sodium hypochlorite, is the irrigant of choice for many clinicians, but its strong toxic and damaging effects on vital periapical tissues is always a matter of concern. So, the search for a root canal irrigant with a broad antimicrobial spectrum yet with a limited toxicity on vital tissues is always desirable.

AIM

The study evaluated antimicrobial efficacy of Electro-Chemically Activated (ECA) water as a root canal irrigant against E. faecalis.

MATERIALS AND METHODS

Forty eight single rooted human teeth were decoronated to a length of 15mm. All teeth were divided into four test groups (group A - ECA anolyte, group B - 1% sodium hypochlorite, group C - 3% sodium hypochlorite, group D - distilled water) of 12 each. Only 1ml of Ringer's solution and calibrated suspensio of E. faecalis was injected into each canal, aspirated and placed on agar plates and incubated aerobically at 37°C for two days. The suspension was aspirated and spread onto the blood agar plate and incubated. All samples were irrigated with four test solutions and Brain Heart Infusion (BHI) solution was injected into each canal then aspirated and spread onto blood agar and incubated. After inoculations Colony Forming Unit (CFU) and optical density was measured under a microscope and spectrophotometer. The data obtained were statistically analysed by one way ANOVA and Dunkan's multiple range test.

RESULTS

CFU reduction was not statistically significant between the test groups. The optical density showed statistically significant difference between the test groups (p≤0.001).

CONCLUSION

The antimicrobial efficacy of ECA was found to be comparable to sodium hypochlorite solutions.

Spectrophotometric Evaluation of the Pulpal Peroxide Levels in Intact and Restored Teeth - An Invitro Study

INTRODUCTION

Hydrogen peroxide (30%) is a commonly used "in office" bleaching agent. Deleterious effects of hydrogen peroxide on the pulp have been observed.

AIM

The present study was conducted with the aim to evaluate the penetration of 30% hydrogen peroxide into the pulp chamber through intact teeth and through the surface of teeth, restored with either hybrid composite or Resin Modified Glass Ionomer Cement (RMGIC).

MATERIALS AND METHODS

Sixty extracted human maxillary central incisors were selected and divided into six groups. Two groups were restored with hybrid composite resin and two with RMGIC, while two groups were left intact. The teeth with acetate buffer solution in their pulp cavity were then immersed in either 30% hydrogen peroxide or distilled water depending upon the group, for 60 minutes at 37°C. Then horseradish peroxidase and leucocrystal violet were added to the acetate buffer solution present in the pulp chamber after it was transferred to a test tube and the optical density of the resultant blue solution obtained was measured spectrophotometrically.

STATISTICAL ANALYSIS

The data obtained were analyzed using one way ANOVA and Student's t-test.

RESULTS

The data obtained established that hydrogen peroxide penetrated into the pulp from the bleaching agent used. Hydrogen peroxide (30%) showed the highest pulpal peroxide level in teeth restored with RMGIC followed by teeth restored with hybrid composite resin and the least amount of penetration was observed in intact teeth.

CONCLUSION

The amount of peroxide penetration into the tooth is more through restored tooth than intact tooth and is also dependant on the type of restorative materials used.

Expression of VP1 protein of serotype A and O of foot-and-mouth disease virus in transgenic sunnhemp plants and its immunogenicity for guinea pigs

Recently, transgenic plants expressing immunogenic proteins of foot-and-mouth disease virus (FMDV) have been used as oral or parenteral vaccines against foot-and-mouth disease (FMD). They exhibit advantages like cost effectiveness, absence of processing, thermostability, and easy oral application. FMDV VP1 protein of single serotype has been mostly used as immunogen. Here we report the development of a bivalent vaccine with tandem-linked VP1 proteins of two serotypes, A and O, present in transgenic forage crop Crotalaria juncea. The expression of the bivalent protein in the transgenic plants was confirmed by Western blot analysis. Guinea pig reacted to orally or parenterally applied vaccine by humoral as well as cell-mediated immune responses including serum antibodies and stimulated lymphocytes, respectively. The vaccine protected the animals against a challenge with the virus of serotype A as well as O. This is the first report on the development of a bivalent FMD vaccine using a forage crop.

KEYWORDS

foot-and-mouth disease; sunnhemp; Agrobacterium tumefaciens; FMDV-VP1 gene; serotype O and A; in planta transformation; transgenic plants; bivalent vaccine.