Temporal and institutional trends in robotic surgery

Robotic surgery has become increasingly prevalent in general surgery practice. While previous studies have shown the safety and efficacy of robotic assistance in laparoscopic general surgery procedures, few studies have evaluated the temporal and regional trends in implementation. In our retrospective population-based study, we aim to evaluate the national trends in robotic surgery. National Inpatient Database (NIS 2009-2014) was used to identify adults who underwent robotic assisted surgery (ICD 9 codes 17.41 to 17.49). Robotic procedures related to seven abdominal organ systems were compared against the trends of Urology, Gynaecologic, and Orthopedic robotic procedures. Discharge weights were applied to calculate National temporal trends separated by hospital size, teaching status and US geographic region. 894,163 patients received a robotic assisted procedure between 2009 and 2014 with 64% increase in utilization. The largest percent change was witnessed in biliary robotic procedures with 2984% change in utilization, followed by hernia (1376%). Lowest percent change was witnessed in esophageal procedures with 114% increase. Medium sized hospitals had the largest change in robotic utilization (41%), with large institutions seeing 18% decrease. Gastric procedures were the most common robotic procedure performed at small institutions (7917 total cases; 316%). Large institutions saw an overall decrease in gastric (- 47%), esophageal (- 17%), small and large intestinal (-16%), and hepatic (- 7%) robotic procedures. Rural non-teaching hospitals saw the largest increase in robotic surgery (274%). Urban non-teaching hospitals saw a decrease of 29%. While urban teaching institutions saw a 20% and 6% increase in gynecological and urological procedures, an overall decrease was seen in esophageal (- 10%), gastric (- 12%), intestinal (- 11%), hepatic (- 17%), biliary (- 10%), pancreatic (- 11%) and hernia procedures (- 14%). Biliary procedures saw the largest increase in rural institutions (740 cases; 392%), followed by hernia (144% increase). South region of the nation had the largest increase in robotic procedures (23%). No change was seen in the use of robotic surgery in the northeast region with the midwest and west seeing an overall decrease (- 4% and - 22%, respectively). Our study highlights the increase in use of robotics for both general and specialty surgery, with an increase in utilization over time. Increased incidence of robotic surgery in smaller, rural institutions with overall decrease in larger, urban teaching hospitals suggests increasing comfort in robotic surgery in the community setting. Further studies are necessary to evaluate the factors associated with increased utilization in smaller institutions.

Clinical effects of Lactobacillus reuteri probiotic in chronic periodontitis - a systematic review

OBJECTIVE

This systematic review examines the effectiveness of Lactobacillus reuteri as an adjunct to scaling and root planing in the treatment of chronic periodontitis.

MATERIALS AND METHODS

Scopus, PubMed, and Web of Science databases were searched according to specific inclusion and exclusion criteria in October 2022. Randomized control trials that evaluated the effects of Lactobacillus reuteri in patients with periodontitis were included. The primary outcome was pocket depth and clinical attachment levels, while the secondary outcome considered was bleeding on probing, microbial levels, and gingival index score. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and the ROB2 tool.

RESULTS

A total of eleven studies that examined 369 subjects were included in the review. Adults in the age group of 18-70 years of age suffering from chronic periodontitis were evaluated. Eight out of the eleven studies reported statistically significant improvement in the intergroup pocket depths, whereas seven studies showed a statistically significant reduction in the clinical attachment levels in the probiotic group. Three studies showed no significant improvement in the pocket depth levels in the probiotic group as compared to the controls. Four studies showed no significant reduction in clinical attachment levels between the two groups. The overall risk of bias was high in four studies, while seven studies reported some concerns about the risk of bias.

CONCLUSIONS

Based on the limited evidence available, the adjunctive use of Lactobacillus reuteri to scaling and root planing may provide some additional benefit in improving periodontal parameters.

Does robotic-assisted unicompartmental knee arthroplasty restore native joint line more accurately than with conventional instruments?

The study's primary aim is the restoration of native joint line in patients having robotic-assisted unicondylar knee arthroplasty and conventional unicondylar knee arthroplasty. Literature in the past has demonstrated that reducing the joint line can result in greater failure rates. This is a prospective cohort investigation of patients who had medial UKA between March 2017 and March 2022.All patient's pre-operative and post-operative radiological joint line assessments were examined by two observers by Weber's methods. Robotic-assisted UKA performed with hand-held image-free robots was compared to conventional UKA groups. The distal position of the femoral component was higher in Group B utilizing conventional tools than in Group A employing robotic-assisted UKA. This positional difference was statistically significant. The mean difference among the pre-operative and post-operative joint lines in Group A was 1.6 ± 0.49 (range 0.8 mm-2.4 mm), while it was 2.47 ± 0.51 (range 1.6 mm-3.9 mm) (p 0.005) in Group B. In Group A, a greater percentage of the subjects (64%) attained a femoral component position within two millimeters from the joint line, whereas just 18% in Group B did. When compared with the conventional UKA technique, the meticulous attention to detail and planning for ligament rebalancing when using the robotic-assisted UKA technique not solely enhance surgical precision for implant placing but additionally provides excellent native joint line restoration and balancing. For validation of its longevity and survivability, the cohort must be tracked for a longer period of time.

A Comparative Evaluation of Three Methods of Disinfection of Gypsum Casts and the Changes in Surface Roughness and Dimensional Accuracy after Disinfection-An Ex Vivo Study

BACKGROUND

One of the major problems of everyday dental practice is cross-contamination. It can place office personnel, dentists, and patients at risk of acquiring serious illness. Disinfection helps in controlling this cross-contamination to an extent. The evaluation was done to find the efficient disinfection method on gypsum casts.

AIMS

The aim of this study is to evaluate and compare the efficacy of three methods of disinfection of gypsum casts, namely, chemical disinfection by immersion, spray method, and microwave method, and also to evaluate and compare changes in surface roughness and dimensional accuracy between the three methods after disinfection.

MATERIALS AND METHODS

Ex vivo and experimental study. Thirty participants were selected, and impressions of the maxillary arch were made using polyvinyl siloxane impression material. Ninety type IV die stone gypsum casts were poured. It was divided into three groups and was subjected to chemical disinfection by immersion and spray methods, and microwave method. The disinfected casts were evaluated for microbial growth, surface roughness, and dimensional accuracy. It was performed by using the one-way analysis of variance test and paired t-test followed by the Kruskal - Wallis test and Wilcoxon signed rank test (α = 0.05).

RESULTS

Microwave disinfection was more effective than both immersion and spray chemical disinfection methods (P < 0.010 and <0.001). The surface roughness of the microwave-irradiated casts had significantly increased after disinfection. However, there were no significant dimensional changes by any of the methods of disinfection.

CONCLUSION

Within the limitations of the study, the microwave method of disinfection is more effective in eradicating microorganisms when compared to chemical methods of disinfection by immersion and spray methods.

Validation of Diagnostic Utility of Salivary Urea in Patients with Chronic Kidney Disease in Chennai: A Cross-Sectional Study

BACKGROUND

Serum urea levels are essential for the diagnosis of chronic kidney disease (CKD), as they are a measure of renal function. Salivary urea has been used as an alternative to serum urea in patients with CKD.

AIM

To estimate serum urea levels and their correlation with salivary urea levels in order to validate the use of saliva as an alternative diagnostic tool for renal dysfunction.

PATIENTS AND METHODS

Thirty healthy individuals and 150 patients with CKD (30 from each CKD stage) were recruited for the study. Serum and salivary samples were collected to estimate the urea levels, and statistical analyses were performed.

RESULTS

Statistically significant (P < 0.05) differences in the mean serum and salivary urea levels were observed between the healthy and each stage of the CKD group; significance at P < 0.05 was observed within the stages of CKD as well. Correlation analysis also showed significant differences between the serum and salivary urea levels at each stage of the disease. Receiver operating characteristic analysis revealed a higher area under the curve of 0.917 at a 95% confidence interval with a salivary urea cut-off of 28.25 mg/dl (sensitivity and specificity: 88% and 84%, respectively).

CONCLUSION

The variability in salivary urea levels in the early and late stages suggests the use of salivary urea in the late stages of CKD. It is suggested that salivary urea levels may be used as an alternative to serum to assess and monitor the progression of renal impairment along with other standard renal function markers.

Comparative Evaluation of Various Lens and Ring Flash Combination for Intraoral Photography

BACKGROUND

Extraoral and intraoral dental photographs serve as preoperative records and document the entire treatment. Correctly composed orthodontic photographs are crucial for remote diagnosis and may serve as a bulwark against medicolegal challenges.

MATERIALS AND METHODS

In this prospective study, intraoral frontal photographs of patients with ideal occlusion were taken using two types of lenses (EF-S 18-55 mm f/3.5-5.6 IS STM lens (Canon, Tokyo, JP), SP 90 mm F/2.8 MACRO VC lens (Model F017 Tamron, NY, USA)) and two different ring flash systems (Meike FC-100 Macro Ring LED Light (Meike, China), Macro Ring flash Lite YN-14EX (Yongnuo digital, China)). The combination of lens and flash used was grouped into four groups. Twenty-eight intraoral photographs of patients were taken. An image quality assessment survey was distributed among two groups - 50 orthodontists and 50 other dental specialists.

RESULTS

The participants were asked to assess all the intraoral images and subjectively score them on a scale of one to ten, with one being very poor and ten being excellent, considering the sharpness, color, brightness, contrast, and overall quality of the image. The general dentists rated the images taken with a 90-mm macro lens and ring flash as the best quality photographs. Images obtained using an 18-55 mm lens and ring LED received significantly lesser scores and were graded good by dentists.

CONCLUSION

This combination of lens and flash may prove a valuable investment in the long-term aiding in excellent dental images for diagnosis and treatment monitoring.

Diode laser targeting red-complex bacteria in periodontitis: a systematic review

OBJECTIVE

This systematic review examines the effectiveness of diode laser irradiation in reducing the levels of red complex bacteria as well as periodontal parameters of pocket depth and clinical attachment level.

MATERIALS AND METHODS

We conducted electronic searches across databases such as Scopus, Embase, Medline, and Web of Science databases in July 2022. Randomized controlled trials that evaluated the reduction of red-complex bacteria in patients with periodontitis using diode lasers were included. The primary focus was the reduction in the microbial count of red complex bacteria, whereas probing depth and attachment level were considered secondary outcomes. Articles in languages other than English were excluded. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and the ROB2 tool.

RESULTS

After searching the databases, eight independent studies were included, with a sample size of 210 subjects. The average age group of the study population was 30-60 years, and there was a lack of consensus on the antimicrobial effect of diode lasers. Out of the eight studies, four studies reported no significant difference in the levels of red complex bacteria before and after laser application. Three studies reported significantly lower levels of red complex bacteria in the intergroup comparison. One study reported that laser had no significant effect on intergroup bacterial levels. The combination of diode laser irradiation with scaling reduced the count of red complex bacteria and improved the clinical parameters, although not significantly.

CONCLUSIONS

Based on the limited evidence available, the adjunctive use of diode laser for scaling and root planning may provide some additional benefit in terms of reduction of red complex bacterial count and clinical parameters. Further well-designed trials and the use of objective measures are necessary before outlining universal guidelines for best practice. The adjunctive use of diode laser in non-surgical periodontal therapy may provide a reduction in the red complex microbial count and improvement in clinical parameters, decreasing the need for periodontal surgery.

Hardware deployment of deep learning model for classification of breast carcinoma from digital mammogram images

Cancer is an illness that instils fear in many individuals throughout the world due to its lethal nature. However, in most situations, cancer may be cured if detected early and treated properly. Computer-aided diagnosis is gaining traction because it may be used as an initial screening test for many illnesses, including cancer. Deep learning (DL) is a CAD-based artificial intelligence (AI) powered approach which attempts to mimic the cognitive process of the human brain. Various DL algorithms have been applied for breast cancer diagnosis and have obtained adequate accuracy due to the DL technology's high feature learning capabilities. However, when it comes to real-time application, deep neural networks (NN) have a high computational complexity in terms of power, speed, and resource usage. With this in mind, this work proposes a miniaturised NN to reduce the number of parameters and computational complexity for hardware deployment. The quantised NN is then accelerated using field-programmable gate arrays (FPGAs) to increase detection speed and minimise power consumption while guaranteeing high accuracy, thus providing a new avenue in assisting radiologists in breast cancer diagnosis using digital mammograms. When evaluated on benchmark datasets such as DDSM, MIAS, and INbreast, the suggested method achieves high classification rates. The proposed model achieved an accuracy of 99.38% on the combined dataset.

Public Awareness on Perio-systemic Interplay: A Cross-Sectional Survey in South India

BACKGROUND

The oral cavity has been referred to as "the gateway to overall health." It is also said to be the meeting point of medicine and dentistry.

AIMS

Our study sought to determine the extent to which the public was aware of the connection between oral/periodontal conditions and general health.

SETTINGS AND DESIGN

The observational cross-sectional study's questionnaire was sectioned into oral health awareness, systemic influence on oral health, and personal oral health assessment.

MATERIALS AND METHODS

A total of 994 responses were recorded and a Chi-square test was performed to uncover the relationships using SPSS version 22.0. According to responses, 70% of the population on average comprehended the responses to the majority of the oral health awareness-related questions.

RESULTS

It has been noticed that only 30% of the general public was aware of the prevalent health issues like diabetes, hypertension, and malnutrition's impact on dental health. However, more than 60% had confidence in their oral health and gave a rating of at least 5.

CONCLUSION

The study indicates that a good number of the population was prioritizing their oral health. However, there exists a definitive need to improve oral health awareness thereby ameliorating the overall health of an individual.

Evaluation of scanning accuracy for two commercially available intraoral scanners in reproducing orthodontic bracket dimensions

OBJECTIVE

The aim of this study was to compare the scanning accuracy of two different intra-oral scanners- MEDIT i500 and TRIOS 3 shape in reproducing orthodontic bracket dimensions.

MATERIALS AND METHODS

This in vivo cross-sectional study comprised seven subjects with a full complement of permanent dentition without third molars. Complete arch scanning was carried out with two intraoral scanners, such as MEDIT i500, TRIOS 3 shape, after bonding with brackets. The control group consisted of bracket dimensions measured directly by using Vernier calipers before bonding. Bracket dimensions of three-dimensional (3D) images were measured by using OrthoAnalyzer software. The accuracy of intraoral scanning was investigated by comparing bracket dimensions among the three groups using One-way ANOVA and Post-Hoc Tukey HSD test, and by evaluating outcomes for each quadrant and an individual tooth in complete-arch scans.

RESULTS

When comparing bracket dimensions of 3D images with manual measurements using a traditional Vernier caliper, MEDIT i500 showed no significant difference when compared to the control group (p>0.05) in full arch scanning as well as the quadrant and single tooth scans in complete arch scanning. TRIOS 3 shape showed a significant difference when compared to the control and MEDIT i500 group (p<0.05) for all parameters.

CONCLUSIONS

MEDIT i500 showed higher accuracy and better reproduction of orthodontic bracket dimensions than TRIOS 3 shape.

Comparison of bacterial colonization on absorbable non-coated suture with Triclosan- or Chlorhexidine-coated sutures: a randomized controlled study

OBJECTIVE

The oral cavity is a colossal reservoir for the bacteria. The healing of tissues is compromised after flap surgery, particularly in the presence of sutures, as they can act as repositories for bacteria, ultimately leading to surgical site infections. Hence, antibacterial-coated sutures have been considered as an alternative to reduce the risk of these infections and further improve the wound healing of the tissues after flap surgery. Since minimal information is available on the effect of antibacterial-coated sutures on periodontal tissues, this study aims to clinically and microbiologically assess the antibacterial efficacy of Triclosan (TCS) and Chlorhexidine-coated sutures (CCS) on periodontal tissues compared to non-coated sutures (NCS).

PATIENTS AND METHODS

A total of 75 subjects with moderate to severe periodontitis were included in the study and randomly allocated to one of the three groups, (TCS, CCS, and NCS groups) equally. Suture removal was performed on postoperative day 8, and parameters such as wound healing and post-operative pain were evaluated. The retrieved suture samples were subjected to microbiological analysis and the bacteria were identified quantitatively and qualitatively.

RESULTS

Intragroup analysis of the wound healing index and post-operative pain for all the groups showed a significant improvement (p<0.01), from day 8 to day 30. Intergroup analysis of the wound healing index revealed significant wound healing (p<0.05) on day 15 and day 30. For post-operative pain, intergroup analyses showed significantly low pain scores (p<0.01) for the TCS group. Microbiologic analysis of aerobic colony counts in both anterior and posterior regions revealed significantly (p<0.01) least colony counts in TCS and highest colony counts in NCS groups, respectively. Although anaerobic colony counts were not statistically significant, relatively fewer colony counts were identified in the TCS group. Whereas, relatively higher anaerobic colony counts were seen in the CCS group in the anterior region and in the NCS group in the posterior region. Qualitative assessment revealed higher amounts of Streptococcus and Staphylococcus species in all the three groups (TCS, CCS, and NCS groups).

CONCLUSIONS

Antibacterial-coated sutures, particularly Triclosan-coated sutures, are effective in reducing bacterial accumulation compared to non-coated sutures. Therefore, these sutures can be effectively utilized in periodontal flap surgery.

Success rate of immediately loaded implants in the posterior zone

Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.

In Vitro Evaluation of marginal adaptation of polyether ether ketone and zirconia copings

Background

Polyether ether ketone (PEEK) has emerged as a new thermoplastic material with potential applications as a restorative material. Aim: This study aimed to evaluate the marginal adaptation of PEEK copings compared to zirconia copings using field emission scanning electron microscopy.

Materials and Methods

A freshly extracted maxillary central incisor was prepared for a full-coverage restoration following standard principles of tooth preparation. The tooth was sent to a laboratory for fabrication of samples using computer-aided design and manufacturing (CAD/CAM). Twenty samples of polyether ether ketone (PEEK) copings (group A) and 20 of zirconia copings were fabricated (group B). The copings were scanned under a field emission scanning electron microscope and measurements were taken at four distinct points. The marginal adaptation over the buccal, lingual, mesial, and distal margins for both groups was evaluated. One-way analysis of variance (ANOVA) and independent t test were applied.

Results

Our findings indicate that PEEK showed better marginal adaptation than zirconia at all measurement points. The mean marginal gap value of the PEEK group was 33.99 ± 8.81 μm and of the zirconia group was 56.21 ± 15.07 μm. On comparing marginal adaptation among the mesial, distal, buccal, and lingual aspects, PEEK showed better adaptation on all four margins, with the best adaptation on the buccal margin that had the lowest mean gap value of 29.27 ± 6.07 μm. The zirconia group adapted best at the distal margin, with a lowest mean gap value of 53.58 ± 15.25 μm (P ≤ 0.05).

Conclusion

PEEK copings had better marginal adaptation and fit compared to zirconia copings. It may have applications as a restorative material in fixed prostheses.

Root surface changes following manual and ultrasonic instrumentation - a scanning electron microscopic study

OBJECTIVE

The aim of this study is to assess the efficacy of hand and ultrasonic scaling and to evaluate the surface roughness on the root surface of periodontally involved teeth using a scanning electron microscope.

PATIENTS AND METHODS

A sample of 90 single-rooted teeth with a hopeless prognosis was selected for the study and divided into three separate groups. Group I consist of no treatment. In Group II, hand scaling was done using Gracey curettes, and in Group III, ultrasonic scaling was done. The teeth were then extracted and fixed in 10% formaldehyde solution for 24-48 hours and subjected to scanning electron microscopic (SEM) evaluation.

RESULTS

The SEM analysis revealed that the remaining calculus index was found to be similar in the ultrasonic group and the hand scaling group, whereas the surface roughness was found to be the least in the ultrasonic group.

CONCLUSIONS

Hand instrumentation has resulted in more surface roughness as compared to ultrasonic instruments.

A split-mouth randomized controlled trial to compare the rate of canine retraction after a soft tissue procedure compared against a corticotomy procedure for accelerated tooth movement

Background and Aim

Various methods to accelerate the orthodontic tooth movement have been used, among which corticotomy is considered to be the most common one. The suggested reasoning for such acceleration was the regional acceleratory phenomenon (RAP). Since the RAP is a property of both the hard and soft tissues, we designed a soft tissue flap procedure to compare the effects with the conventional corticotomy procedure. A split-mouth study was conducted where the two procedures were assessed in a single participant.

Patients and Methods

The total sample size was calculated to be 40 with 20 participants in each group. The rate of tooth movement was the primary outcome measure, and the secondary outcomes were dentoalveolar changes, which were studied in both the conventional corticotomy and the flap-only procedure based on a cone-beam computed tomography (CBCT) wherein the alveolar bone density (BD) around canines, tipping, and rotational changes in canines, premolars, and molars were assessed.

Results

Corticotomy resulted in greater canine angulation, lesser canine rotation and premolar rotation, and greater molar rotation compared with flap elevation, but these differences were statistically insignificant.

Conclusion

Though the corticotomy resulted in higher BD, the differences were statistically insignificant. There was no significant difference in the rate of space closure assessed by the two techniques compared.

Antimicrobial Efficacy of Blended Essential Oil and Chlorhexidine against Periodontal Pathogen (P.gingivalis)-An In Vitro Study

Background

Essential oils (EOs) have a considerable amount of therapeutic and preventive effect in treating dental diseases due to their wider potential as antibacterial and anti-inflammatory agents. EOs like virgin coconut oil, eucalyptus oil, peppermint oil thyme oil, and clove oil, when used in combination, may further have enhanced antimicrobial effects. However, limited information exists on the synergistic effect of these oils when used in combination, especially on the primary periodontal pathogen Porphyromonas gingivalis.

Aim

The current study aims to compare the antimicrobial efficacy of commercially available EO on the periodontal pathogen, P. gingivalis, in comparison to chlorhexidine (CHX).

Materials and Methods

Antimicrobial efficacy of EO and CHX was assessed at various concentrations against the periodontal pathogen P. gingivalis, by evaluating the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC).

Results

P. gingivalis was seen to be sensitive at a MIC of 100 μg/ml and 50 μg/ml concentration of the EO, which is regarded as the MIC of EO against P. gingivalis and CHX effectively inhibited microbial growth at 0.4 μg/ml.

Conclusion

A combination of EOs possesses a potent antibacterial activity against P. gingivalis, and the antibacterial efficacy increases with increasing concentration of EOs.

Paternal stress alters synaptic density and expression of GAP-43, GRIN1, M1 and SYP genes in the hippocampus and cortex of offspring of stress-induced male rats

Adverse experiences during pregnancy have a negative impact on the neuronal structure and behavior of offspring, but the effects of a father's life events on the outcome of progeny are scarce. The present study is intended to investigate whether paternal stress affects the offspring brain structure, especially those regions concerned with learning and formation of memory, namely the hippocampus (HC) and prefrontal cortex (PFC), and also the expression of certain genes linked to learning and memory in the offspring. Induced stress to male rats by five stressors, one per day followed by allowing them to mate with the normal, unstressed female. Synaptophysin immunoreactivity was assessed in the tissue sections of the HC and PFC as well as expression of genes concerned with learning and memory was evaluated by RT-PCR in the progeny of stress-received males. The progeny of stressed rats had reduced antisynaptophysin immunoreactivity in the HC and PFC. The synaptic density in HC was less in the A-S (Offspring of male rats who received stress during adulthood) and PA-S (offspring of male rats who received stress during both adolescence and adulthood) than in P-S (offspring of male rats who received stress during adolescence) and C-C (offspring of control) groups. Similar results were observed even in the PFC. The results of post hoc tests proved that the HC and PFC of the progeny of stress-exposed rats exhibited considerably less synaptic density than control (P<0.05), and the levels of expression of GAP-43, GRIN1, M1, and SYP genes in HC and PFC were down-regulated. This study concludes that paternal adverse experiences can affect the offspring's synaptic plasticity and also the genes, which can regulate learning and formation of memory.

Evaluation of cardiovascular risk scores after implementation of digital therapeutic intervention in patients with uncontrolled primary hypertension

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Terrals Technologies Private Limited

Background

Cardiovascular risk scores serve as a useful tool to reinforce the importance of lifestyle modifications and treatment compliance. Yet, there remains a gap between advice by the physician and its implementation by the patient. Digital therapeutics (DTx) as a technology based approach can help bridge this gap. In this context, knowing the quantum of change in disease outcomes and long term cardiovascular risk after DTx implementation can be helpful in persuading the patients for lifestyle interventions.

Purpose

To evaluate the change in cardiovascular risk scores in hypertensive patients after a digital therapeutic intervention.

Method

We conducted a prospective, single arm, 12-week intervention trial at two primary care sites in India. A total of 125 subjects within the age group of 30-65 years with primary hypertension (≥ 140/90 mmHg) were enrolled. They were provided DTx intervention which consisted of modification in diet, physical activities, self-monitoring and health education superimposed on behavior science theories. Atherosclerotic Cardiovascular Disease (ASCVD) risk scores from Pooled Cohort Equation were calculated for all subjects before & after the DTx intervention and the change in score was assessed.

Results

We received the data of 116 patients having a mean age of 47.66 ± 9.47 years and mean BMI of 27.20 ± 4.77 Kg/m². After DTx intervention, the change in mean systolic blood pressure, among other ASCVD equation parameters, was -26.38 mmHg (154.77 vs 128.39 mmHg, P&lt;0.001). The corresponding post-intervention 10-year mean ASCVD risk score for the sample population decreased by 4.74% (11.86% vs 7.12%, P&lt;0.001). The 10-year mean relative risk of ASCVD decreased by 39.95 %. Similarly ASCVD lifetime risk score decreased by 3.04% (49.54% vs 46.50%, P&lt;0.001), amounting to mean relative risk reduction of 6%. Female subjects (n=60) showed higher 10-year mean ASCVD risk reduction of 5.70% (11.70% vs 6.00%, P&lt;0.001), compared to male subjects (n=56) who showed 10-year mean ASCVD risk reduction of 3.76% (12.06% vs 8.30%, P&lt;0.001). This amounted to a relative risk reduction of 48.69% and 30.71% for female & male subjects, respectively. Patients with stage 1 hypertension (n=82) showed a reduction in 10-year mean ASCVD risk of 2.86% (9.90% vs 7.04%, P&lt;0.001). Patients with stage 2 (n=30) & stage 3 hypertension (n=4) achieved higher 10-year mean ASCVD risk reduction of 8.67% (16.07% vs 7.40%, P&lt;0.001) & 13.6% (20.88% vs 7.20%, P=.006).

Conclusion

Digital therapeutics enabled intervention has caused a significant decrease in 10-year & lifetime ASCVD risks which can eventually lead to a decrease in cardiovascular complications, morbidity and mortality. Therefore, such intervention programs should be further explored and studied.

Prospective evaluation of digital therapeutic intervention on blood pressure control in Indian patients with uncontrolled primary hypertension

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Terrals Technologies Private Limited

Background

Digital therapeutics (DTx) has emerged as a new approach in recent years making use of connected devices, smartphone software and electronic communication tools to help manage chronic cardiovascular diseases such as hypertension. Considering its nascent stage, many questions still remain with respect to its applicability, effectiveness and limitations.

Purpose

Assess the effectiveness of digital therapeutic intervention in controlling blood pressure in Indian patients with primary hypertension

Methods

We conducted a prospective, 12 week, single arm, interventional study, including 125 subjects at multiple sites in India. Subjects with uncontrolled primary hypertension (≥140 mmHg systolic and/or ≥90 mmHg diastolic) in the age group of 30-65 years who were under routine antihypertensive treatment were enrolled. They were provided supplementary DTx intervention comprising of smartphone application based personalized management of diet, exercise, self monitoring and health education by nutritionists and health coaches. Efficacy endpoints such as blood pressure (BP), body mass index (BMI), lipids, etc. were measured before and after the intervention.

Results

A total of 122 subjects who completed the trial had mean age of 47.44 ± 9.43 years, comprising 58 (48%) male and 64 (52%) female patients and mean BMI of 27.21 ±4.7 kg/m². Post-intervention change in mean systolic BP (SBP) was -25.61 mmHg (95% CI 22.55 - 28.66, 154.98 mmHg vs 129.37 mmHg, P&lt;.001). The post-intervention change in mean diastolic BP (DBP) was -18.62 mmHg (95% CI 16.29 - 20.96, 100.04 mmHg vs 81.42 mmHg, P&lt;.001). Patients with stage 1 hypertension (69.6%) achieved mean systolic reduction of 20.87 ± 13.9 mmHg, (148.54 mmHg vs 127.67 mmHg, P&lt;.001). The patients with stage 2 (27.04%) and stage 3 (3.27%) hypertension achieved a higher mean SBP reduction of 34.67 ± 15.19 mmHg (167.24 mmHg vs 132.58 mmHg, P&lt;.001) and 51.5 ± 40.45 mmHg (190.75 mmHg vs 139.25 mmHg, P=.084), respectively. Male and female patients showed almost similar reduction in systolic BP of 25.47 ± 14.72 and 25.73 ± 19.39 mmHg, respectively. Also, the subjects with other chronic comorbidities (23.9%) achieved a mean systolic BP reduction of 29.51 ± 15.25 mmHg.

A total of 79.51% (n=97) patients achieved the SBP &lt;140 mmHg, while 59.84% (n=73) patients achieved SBP &lt;130 mmHg. Combining both the systolic and diastolic targets together, 65.57% (n=80) patients achieved the target of &lt;140/90 mmHg, while ESC/ESH 2018 recommended BP target of &lt;130/80 mmHg was achieved by 31.15% (n=38) patients.

Conclusion

The implementation of Digital therapeutic application integrated with primary healthcare resulted in significant reduction in blood pressure in participants with uncontrolled hypertension. Greater improvement was observed in participants with higher baseline blood pressure.

Anti-microbial efficacy of root canal preparation in deciduous teeth with manual and rotary files: A randomized clinical trial

BACKGROUND

In a pulpectomy, the eradication of microbes from the primary root canal is accomplished through biomechanical preparation, which could be carried out with either manual or rotary instruments.

AIMS

The objective of this clinical trial was to evaluate the efficiency of manual K-files, H-files, and Kedo-S Square rotary files in reducing microbial flora after canal preparation in primary molars.

MATERIALS AND METHODS

This randomized clinical trial consisted of 45 primary molars requiring pulpectomy. The teeth were randomly allocated to one of the three groups: Group I: Manual K-files, Group II: Manual H-files, and Group III: Kedo-S Square rotary files, based on the type of instrumentation. Pre-and Post-instrumentation sampling was performed using clean absorbent paper points and kept in a clean Eppendorf tube having thioglycolate broth as the transport medium. Culturing was performed on agar media from which both aerobic and anaerobic microbial counts were estimated. Collected data were statistically analyzed using one-way analysis of variance (ANOVA) and Wilcoxon signed-rank test. Following root canal preparation, 87-89% reduction of the aerobic and anaerobic microbial load was noted in group I, whereas it was an 89-92% reduction in group II and a 93-95% reduction in group III.

RESULTS

Biomechanical preparation with Kedo-S Square rotary file showed higher efficacy in microbial reduction compared to manual instrumentation.

CONCLUSION

Manual and rotary files were equally effective in removing root canal microbes. Biomechanical preparation with a KedoS Square rotary file resulted in greater microbial efficacy. Hence In children, effective root canal cleaning in a short period of time is a major consideration.

Readmissions among People Living with HIV Admitted for Hypertensive Emergency

OBJECTIVES

People with human immunodeficiency virus (HIV) are at an increased risk of developing cardiovascular diseases. Hypertensive emergency (HTNE), a complication of hypertension with potentially serious health implications, has high healthcare utilization. We attempted to determine the association between HIV status and risk for 30-day readmission after index hospitalization for HTNE.

METHODS

We used the Nationwide Readmissions Database to identify all of the admissions during 2010-2017 with a primary discharge diagnosis of HTNE. Admissions were stratified by HIV status and comparisons were made with the χ² test. We investigated predictors of all-cause 30-day readmission via multivariable logistic regression.

RESULTS

A total of 612,854 hospitalizations with a primary discharge diagnosis of HTNE were identified, and 4115 (0.7%) were HIV positive. There was a total of 43,937 (7.16%) 30-day readmissions, and the rate was higher in regard to positive HIV status (29.8% vs 15.0%; P < 0.001). Renal failure was the most frequent reason for HIV readmissions and the second most frequent reason for non-HIV readmissions (15.6% vs 10.3%; P < 0.001). In contrast, heart failure was the most frequent reason for non-HIV readmissions and the second most frequent reason for HIV readmissions (10.3% vs 11.9%; P = 0.234). There was a higher median cost for HIV readmissions in comparison to non-HIV readmissions ($7660 vs $7490; P < 0.001). Finally, HIV was attributed to 40.6% increased odds of readmission after adjusting for pertinent clinical and demographic factors (P < 0.001).

CONCLUSIONS

HIV-positive status is associated with an increased risk for 30-day readmission after index hospitalization for HTNE.

Socioeconomic status and trends in utilization of catheter ablation in patients hospitalized with atrial fibrillation in united states

Introduction

Atrial fibrillation (AF) is the most common arrhythmia encountered in a hospital setting. However, there is little data on the relationship of socioeconomic status (SES) and the utilization of catheter ablation amongst patients admitted with AF.

Methods

The National Inpatient Sample database was queried from 2003 to 2014 using ICD 9 revised diagnosis codes to identify patients who were hospitalized with a primary diagnosis of AF. SES was determined by median household income (MHI) and divided into quartiles (0–25th, 26–50th, 51–75th, and 76–100th). Trends were analyzed using Cochran Armitage test.

Results

We analyzed 3,618,133 patients with AF that were admitted from 2003 to 2014 (median age: 72 [IQR 61 – 81], female 52.6%). Trends stratified by MHI to compare catheter ablation rates of all 12 years revealed significant differences (Figure 1). A multivariable logistic regression accounting for sociodemographic factors revealed an increasing trend of catheter ablation utilization with higher MHI (Figure 1).

Conclusion

Over a 12-year period, patients admitted to the hospital with AF with higher MHI were found to have increasing rates of catheter ablation utilization due to AF. Conversely, a decline in catheter ablation rates were noted in patients with lower MHI.

Funding Acknowledgement

Type of funding sources: None.

284 Wunderlich Syndrome - Case Report of a Surgical Emergency Due to Spontaneous Non-Traumatic Retroperitoneal Haemorrhage

A 42-year-old female with no other significant co-morbidities presented with complaints of sudden onset abdominal pain, she was in state of shock- her haemoglobin dropped drastically to 6.8g/dl from 11.8g/dl. She was resuscitated and was given blood transfusion.

CT Scan was suggestive of retroperitoneal haemorrhage due to rupture of Renal angiomyolipoma (RAML). Patient underwent selective embolization of renal artery the next day and was discharged after 3 days of post-operative stay.

Wunderlich Syndrome-is a rare condition in which spontaneous nontraumatic renal haemorrhage occurs into the subcapsular and perirenal spaces is most commonly caused due to spontaneous rupture of RAML.It is characterized by Lenk’s triad – Acute flank pain, flank mass, hypovolemic shock. Size of AML (&gt;4 cm), prothrombotic states such as pregnancy are main causes of AML rupture. Patients are managed conservatively or with help of selective arterial embolization. Nephrectomy is last resort in a hemodynamically unstable patient or in cases of embolization failure.

When dealing with acute abdomen with haemodynamic instability in non-traumatic cases it is essential to consider possibility of Wunderlich Syndrome. Early diagnosis, availability of Interventional radiology is key to successful management and potentially avoiding a Nephrectomy.

Prevalence and Pattern of Self-medication with Alternative Medicine: Treatment-switch Analysis in Oral Submucous Fibrosis Patients

Aim

The aim of this study was to investigate prevalence and pattern of self-medication with alternative medicine (ALM) among oral submucous fibrosis (OSF) patients with emphasis on treatment-switch analysis.

Methods

A total of 115 OSF patients were recruited and subjected to scientifically validated questionnaire. Two groups were identified: S-ALM: patients who have previously received modern medicinal treatment but switched to ALM; and DN-ALM: patients who started ALM from De Novo.

Results

A total of 37 (32.18%) patients reported use of the ALM at some point of time. Twenty-five (67.56%) switched to ALM, whereas 12 (32.43%) patients used ALM from De Novo. The pattern of switching to ALM in short period was significantly prevalent in patients with advanced stages (stage III and IV) as compared to early stages (stage I and II) of OSF. Clarified butter, glycerin, and honey were the most commonly used ALM in both the groups. The most common reasons for switching to ALM were the cost of treatment (32.00%), longer duration of medicinal treatment (24.00%) and ineffectiveness of the medications (24.00%).

Conclusions

ALM usage is common in OSMF patients with significant percentage of patient switched from modern medicine to ALM. Therapeutic efficacy of ALM in OSF needs exploration in future.

Does Balancing a Total Hip Arthroplasty Require a New Paradigm? Functional 3-Dimensional Balancing in Total Hip Arthroplasty

BACKGROUND

Traditional principles for successful outcomes in Total Hip Arthroplasty (THA) have relied largely on placing the socket in the native position and trying to restore static anatomical femoral parameters gauged on X-rays or intra-operative measurement. Stability is conventionally achieved by making appropriate changes during the time of trial reduction. Post-operative complications of dislocation and significant Limb Length Discrepancy (LLD) requiring foot wear modification represents opposite ends of the spectrum from a biomechanical perspective and these continue to be relatively high. A move towards giving more importance to functional dynamic parameters rather than static anatomical parameters and less reliance on stability testing at trial reduction is warranted.

METHODS

Intraoperative 3D functional balancing of THA without stability testing at trial reduction was practiced in all subjects undergoing THA in our unit from April 2014. To date 1019 patients have had their hips replaced with the same technique. They were followed up till April 2020 for post-operative complications of dislocation and significant LLD needing footwear modification. A secondary cohort of 114 patients from 1st January to December 31st 2017 within this primary group were analyzed clinically and radiologically to ascertain the implications of functional 3D balancing on X-ray parameters, clinical outcome scores (Harris Hip Score and Oxford Hip Score), ability to squat, and subtle subjective post-operative perception of limb lengthening (POPLL).

RESULTS

In the primary group of 1019 patients, there were only two dislocations and no patient needed footwear modification for LLD. In the detailed analysis of the secondary cohort of 114 patients, the correlation with restoration of static radiological parameters was inconsistent. 40 patients could not squat and 4 patients had subtle subjective post-operative perceived limb lengthening (POPLL). Measured outcomes such as HHS and OHS were improved in all patients with significant statistical significance (P < 0.001).

CONCLUSION

This study underlines the fact that more importance must be given to functional dynamic parameters by 3D balancing of the THA and not on static anatomical X-rays parameters and stability testing during trial reduction. This represents a paradigm shift in the evolution of total hip arthroplasty.

LEVEL OF EVIDENCE

A Level II study. (Data collected from the ongoing prospective study) (http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf).

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-021-00505-3.

Recurrent endometrial carcinoma metastasis to the temporal bone and skull base

A 62-year old woman presented with a 1-month history of left otalgia, facial palsy and hearing loss. She had a background of non-insulin-dependent diabetes mellitus and stage 2 endometrial adenocarcinoma, treated 18 months ago. Computed tomography scan showed erosion of the skull base and temporal bone. She was referred to the otolaryngology team with a diagnosis of necrotising otitis externa. On clinical examination, there was an exophytic, necrotic lesion in the ear canal arising from the posterior canal wall. A subsequent magnetic resonance imaging scan showed a lesion located in the left jugular foramen extending into the middle ear, with characteristics consistent with a glomus jugulo-tympanicum. Interestingly, histology of the lesion showed malignant cells with immunohistochemical staining suggestive of an adenocarcinoma. This is the first reported case of metastatic endometrial carcinoma involving the jugular foramen and temporal bone. Although a diagnosis is rare, it is important to consider it when other differential diagnoses are not fitting. Imaging should always be interpreted with caution, correlating to the clinical findings.

Effect of prosthetic framework material, cantilever length and opposing arch on peri-implant strain in an all-on-four implant prostheses

Aim

To evaluate the effect of prosthetic framework material and cantilever length on peri-implant strain in mandibular all-on-four implant-supported prostheses with different types of arch antagonist forces.

Materials and Methods

Models simulating a completely edentulous mandibular arch fabricated in heat-cured acrylic resin were used. On the acrylic models, four implants were placed at regions 34, 32, 42, and 44 simulating all-on-four implant placements. Implant-supported screw-retained fixed prosthesis frameworks were fabricated using three different materials (cobalt-chromium, zirconia, and polyetheretherketone) and with three different cantilever lengths (zero mm, 15 mm, and 25 mm). Strain gauges were attached on the model at the buccal and lingual positions of each implant. Forces simulating opposing natural dentition, conventional complete denture, and the parafunctional habit were applied to the models. The peri-implant strain in each strain gauge was recorded.

Results

Least peri-implant strains (67 microstrains) were observed when forces simulating conventional complete dentures were applied on the models and the highest peri-implant strains (9091 microstrains) were observed when forces simulating parafunctional habit were applied. One-way ANOVA test followed by Tukey's post hoc analysis was performed to compare the mean deformation scores between different materials at 50 N load. The level of significance [P-value] was set at P < 0.05. Tests showed significant differences between zero mm and the other types in all the different materials, and also between 1.5 x AP and 2.5 x AP for Zirconia and Peek material at P = 0.02 & P = .008, respectively. The results showed that the type of framework material, cantilever length, and occlusal forces from the opposing arch influence the peri-implant strain in the bone in all-on-four implant-supported prostheses.

Conclusion

Rehabilitation of a single, completely edentulous arch with implant-supported prostheses should consider the situation of the opposing arch. The choice of framework material, as well as the cantilever length, should be altered based on the forces from the opposing arch.

Triple-negative breast cancers with expression of glucocorticoid receptor in immune cells show better prognosis

Background

Glucocorticoid receptor (GR) is shown to have variable frequency of expression in invasive tumors of the breast. Investigation of additional nuclear receptors like GR in receptor negative tumors like triple negative breast cancer (TNBC) may have prognostic and therapeutic significance.

Methods

Expression of GR was evaluated by immunohistochemistry in 175 tumors of invasive breast cancer with long term follow up. GR Expression was separately evaluated in invasive tumor cells, stromal cells and tumor infiltrating lymphocytes (TIL's). Staining pattern was categorised as positive when more than 1% of the cells stained in each subpopulation of cells. Disease free survival was analysed between GR positive and negative status by Kaplan Meier analysis.

Results

Of the 175 tumors, 121 (70%) were ER positive, 53 (30%) were ER negative and 29% (51) were triple negative. 74% (130/175) tumors showed expression of GR in invasive tumor cells while (84%) 147/175 had expression in TIL's. No significant difference in distribution of GR was noted between ER positive and ER negative tumors (78% vs 66%, p-0.1). Of the TNBC's 54% (28/51) and 70% (36/51) showed expression of GR in invasive tumor and TIL's respectively. Overall, GR positive tumors had significant better survival than GR negative tumors (mean survival time of 85 vs 59 months respectively, p-0.04) Contrary to the reports that GR expression in TIL's are associated with immunosuppressive activity in model systems, TNBC's with increased expression of GR in immune cells were associated with better survival (Mean survival time 74 vs 41 months, log rank test- p-0.03). TNBC tumors which were GR negative had higher lymph node metastases (p-0.04) and none of the other clinical features like age, menopausal state, tumor size and grade were different between GR positive and negative tumors within TNBC.

Conclusions

Glucocorticoids (GC) are often used to alleviate the adverse symptoms during chemotherapy. Determining the GR status is of importance due to the pro cell survival effect of the glucocorticoids mediated through GR during chemotherapy. Though GC mediated effects on chemotherapy are controversial, our results indicate favourable effects in TNBC.