bluuebunny/crossref_metadata_2025 huggingface dataset:
Ions release evaluation and corrosion of titanium mini-implant surface in response to orthokin, oral B and chlorhexidine mouthwashes
Authors: Alavi Shiva , Ahmadvand Atefe
Published: October 2023

Background:

The present study was performed to evaluate the effect of three types of mouthwash (orthokin, oral B and chlorhexidine [CHX]) on releasing of aluminum (Al), Titanium (Ti) and Vanadium (V) ions from titanium mini-implants (TMIs).

Materials and Methods:

In this in vitro, experimental study, a total of 40 TMIs were divided equally into four groups (10 TMI in each group) and then were immersed into Orthokin, Oral B, CHX, and artificial saliva, as a control. The experiments were performed for 21 days as following groups 1–7 days, 8–14 days, and 15–21 days. The inductively coupled plasma-optical emission spectrometry method was used to assess releasing metal ions after immersion in the storage media. In addition, before and after each experiment, the corrosion of TMIs was assessed using a scanning electron microscope (SEM). All results were analyzed using Kruskal–Wallis, followed by Bonferroni-adjusted Mann–Whitney U-test at 0.05 level of significance.

Results:

Our data showed that the maximum concentration of released Al was in the 1st week of exposure to Orthokin and Oral B (202.3 ± 68.5 and 72.3 ± 15.2 μg/L, respectively). Oral B exposure of TMI also caused to releasing of Ti to 128.1 ± 42.5, 54 ± 19.4 and 22 ± 6 μg/L for 1–7 days and 8–14 days and 15–21 days, respectively. Orthokin and CHX also induced the release of Ti more than artificial saliva (P < 0.05). In addition, there was no significant statistical difference between any types of mouthwashes and artificial saliva in releasing V. The results of SEM images also confirmed the corrosion effects of mouthwashes.

Conclusion:

The factors of exposure time and mouthwash type influenced the pattern of releasing Al and Ti as well as corrosion level.
Efficacy of silver nanoparticle gel on healing of traumatic oral ulcers compared with triamcinolone oral paste
Authors: Rezazadeh Fahimeh , Nazhvani Ali Dehghani , Abolmaali Samira Sadat , Nazhvani Fatemeh Dehghani , Bonyani Alireza
Published: October 2023

Background:

There are many treatment protocols for relieving pain and accelerating oral ulcer healing. The purpose was to evaluate the anti-inflammatory and antimicrobial effect of silver nanoparticle (AgNP) gel on oral ulcers compared with the traditional treatment in animal model.

Materials and Methods:

In this experimental study, 72 adult male rats were randomly allocated into four groups, after ulcer induction: control (receive no treatment), placebo (placebo gel was applied on ulcers once daily), triamcinolone (ulcers were treated with triamcinolone paste once daily), and AgNPs (ulcers were treated with AgNP gel once daily). The animals were sacrificed at three successive periods of 3, 7, and 14 days after ulcer induction. Histopathological scores of re-epithelialization and degree of inflammation were assessed. The wound size was measured clinically. For parametric data, the analysis of variance, and for ordinal histopathological data, the Kruskal–Wallis test using SPSS was done. A P < 0.05 was considered statically significant.

Results:

Control and placebo groups had no case of complete healing. Improvement of wound size by triamcinolone paste was not significant in different days but showed significant differences in degree of inflammation (P < 0.001) and re-epithelialization (P = 0.012). Reduction of wound size by AgNPs gel had significant difference at 14th day (P < 0.001); further, by this gel, significant differences in degree of inflammation and re-epithelialization were seen in long-term medication.

Conclusion:

AgNP gel could be effective in oral ulcer healing clinically and histopathologically. Although this gel showed delayed effect, it had better healing effect according to the cases with complete healing. Hence, the application of AgNP oral gel can be considered as an alternative approach for oral ulcers.
Efficacy of exenatide, ozone, and methyl prednisolone for the recovery of infraorbital nerve paresthesia after injury in rats
Authors: Abrishami Mehdi , Golestaneh Arash , Maleki Laleh , Momeni Hasan , Manshaei Mazyar
Published: October 2023

Background:

Infraorbital nerve injury often occurs due to zygomatic complex fracture. There is no standard protocol to restore the sensory and motor function of the nerve after injury. Some medications are used to improve nerve function. This histopathological animal study aimed to assess the neurotrophic efficacy of exenatide, ozone, and methyl prednisolone for injured infraorbital nerve.

Materials and Methods:

In this animal study, 60 rats were randomly divided into five groups (n = 12) of control, saline, methyl prednisolone, exenatide, and ozone. Under general anesthesia, a unilateral infraorbital incision was made, and the nerve was compressed with a hemostat for 5 s. Depending on the study group, the rats received the designated medications. All rats were sacrificed after 14 days, and the nerve recovery was evaluated by observing the slides prepared from the area under a light microscope using histological and immunohistochemical parameters. Data were analyzed using Chi-square test and Tukey's least significant difference test (P < 0.05).

Results:

No inflammation in the peripheral tissue had a significantly higher frequency in the methyl prednisolone group (P < 0.05). Degeneration, intracellular inflammatory infiltrate, muscle injury, fibrosis around the nerve, granulation tissue, vascular proliferation, and infiltration of inflammatory cells around the nerve were more commonly absent in the exenatide group (P < 0.05).

Conclusion:

Exenatide showed superior efficacy for the recovery of infraorbital nerve function after injury. Thus, it may be beneficial for postoperative care following infraorbital nerve injury.
An experimental study on the effect of four pediatric drug types on color stability in different tooth-colored restorative materials
Authors: Faghihi Taraneh , Heidarzadeh Zohreh , Jafari Karim , Farhoudi Ilnaz , Hekmatfar Somayeh
Published: October 2023

Background:

One of the drawbacks of tooth-colored dental restorations is their discoloration over time. The present study aimed to determine the effect of four categories of pediatric medications, including analgesics, antibiotics, anticonvulsants, and multivitamins, on two types of tooth-colored dental materials, namely, composite resins and glass ionomer cements.

Materials and Methods:

In this in vitro study, a total of 40 specimens with disc shapes (with a diameter of 5 mm and thickness of 2 mm) were prepared from each material and immersed in eight different drugs for 2 min three times a day for 1 week. The values of the baseline color were calculated based on the CIE (International Commission on Illumination) L*a*b* system. After 7 days, ΔE values were calculated. Two-way analysis of variance was employed for statistical analysis. Statistical significance was defined at 0.05.

Results:

Statistical analysis showed that there were significant differences between ΔE and different restorative materials as well as ΔE and drug types (P < 0.001).

Conclusion:

According to the results of this in vitro study, all the four types of drugs caused the discoloration in all the restorative materials, and the color change values were affected by the type of used drug and restorative material.
Successful management of a tooth with canal obstruction using “cold ceramic”
Authors: Modaresi Jalil , Almodaresi Zahra , Mousavi Rahele , Mirzaeeian Alireza , Hosseini Said Abbas Sadat
Published: October 2023

One of the causes of treatment failure is calcification in the canal pathway, which prevents complete access to proper working length, and one of the most difficult and challenging cases of root canal treatment has been reported. In some cases, the dentist will not be able to open the calcified canal. Therefore, the prognosis of root canal treatment in these cases has been reported poor, and the dentist will offer a plan for possible treatments, including tooth extraction or apical surgery. The presented case is one example of those cases with a periapical lesion, which as a temporary treatment, the pulp chamber was filled with cold ceramic. This material, which is an MTA-like (Mineral Trioxide Aggregate) bioceramic with proper sealing ability, has been introduced as a root-end filling material. After 6 years of which the patient returned, he did not express any pain or discomfort during these 6 years. Furthermore, in radiograph that was taken, periapical lesion relative healing and bone regeneration were amazingly seen.
Retreatment of an orthognathic camouflaged case by total lower arch mesialization using temporary anchorage device
Authors: Hemmatpour Siamak , Nahvi Golnaz , Oonchi Mehdi
Published: October 2023

Mandibular tooth extractions for camouflage treatments in borderline Class III patients may end up with unpleasing esthetic results which may lead the patient seeking further complicated retreatments. In this case report, we presented a patient's retreatment with a combined orthodontic and orthognathic surgery treatment plan. The treatment strategy involved an innovative temporary anchorage device (TAD)-based method for total mandibular arch mesialization instead of space reopening for first lower premolar replacement with implants. In the current case report, orthognathic management of a Class III adult female is discussed. The patient had a history of an esthetically unsuccessful previous camouflaged orthodontic treatment with two lower premolar extractions. She was prepared for orthognathic surgery using an innovative custom-made sliding jig based on miniscrews for total mandibular arch mesialization with the aim of dental arch decompensation. After gaining the optimal dental arch discrepancy, the patient had orthognathic surgery (maxillary advancement and mandibular setback and advancement genioplasty). Total mandibular dental arch mesialization with the aim of dental arch discrepancy preparation was successfully conducted using TADs. By means of the innovative miniscrew-anchored sliding jig, the patient's satisfactory esthetic and occlusal results were obtained in 22 months. With innovative application of the miniscrews, more practical and reasonable alternatives are available to replace conventional and complicated treatment plans such as space reopening for implants in patients with unsuccessful previous orthodontic therapies.
Association of adipocyte fatty acid-binding protein and tumor necrosis factor alpha with periodontal health and disease
Authors: Soubiya  , Madaiah Hemalata , Tarannum Fouzia , Faizuddin Mohamed
Published: October 2023

Background:

Adipocyte fatty acid binding protein (A-FABP) is a novel biomarker of inflammation for various chronic systemic diseases. Since periodontitis is a chronic inflammatory disease, this study explores the association of A-FABP with periodontal disease parameters and tumor necrosis factor-alpha (TNF-α) levels in gingival crevicular fluid in periodontal health and disease.

Materials and Methods:

This original research article describes a cross-sectional study conducted at the Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bangalore, India. This cross-sectional investigation was conducted on sixty subjects which were divided into three groups of twenty subjects each – healthy, gingivitis, and chronic periodontitis. Clinical parameters – plaque index, bleeding index, probing depth, and clinical attachment loss were recorded. Gingival crevicular fluid samples were analyzed for A-FABP and TNF-α levels using ELISA. One-way analysis of variance was used to find the significance of study parameters on a continuous scale between three groups. Pearson's correlation has been used to find the relationship between Gingival crevicular fluid concentration of markers and periodontal parameters. Multiple linear regression analysis was applied to the study. The statistical significance was considered at P < 0.05.

Results:

Mean concentration of A-FABP (6.43 ± 2.51) and TNF-α (3454.82 ± 1566.44) was highest in the periodontitis group, and the difference among the groups was statistically significant (P < 0.05). A positive correlation was observed between clinical attachment loss and the two markers among all groups. The correlation between A-FABP and TNF-α in periodontitis groups was positive and statistically significant (P < 0.05). Multiple linear regression model was statistically significant (P < 0.05) indicating that there is a significant relationship between the set of predictors and the clinical attachment loss.

Conclusion:

A-FABP and TNF-α levels in GCF were significantly elevated in the presence of inflammation. A-FABP has a probable stimulatory effect on TNF-α; however, its role needs to be explored. A-FABP could serve as a novel inflammatory biomarker of periodontitis and the scope of using A-FABP inhibition as a treatment modality could be investigated with interventional studies.
Basaloid squamous cell carcinoma of gingiva
Authors: Doddanna Sunitha Jagaluru , Nayak Meghanand T. , Sanath Aparna K. , Abedeen Mohammad Zanul
Published: October 2023

Basaloid squamous cell carcinoma (BSCC) is an exceptional, aggressive variant of squamous cell carcinoma (SCC) because of its unique histological feature and an ominous clinical behavior. Recently, it has been recognized as a high-grade SCC. The most preferential site of occurrence is the upper aerodigestive tract. Because of its aggressive behavior and tendency to metastasize, BSCCs are considered to have poor prognosis. We present a BSCC case in a 60-year-old male, which was clinically diagnosed as an aggressive inflammatory lesion with a differential diagnosis of granulomatous lesion, involving the mandibular anterior gingiva. Till now, only 17 cases of BSCC with gingival involvement have been reported in the literature. Here, we present one additional case of BSCC involving gingiva.
Evaluation of the effect of green tea extract on postoperative pain management following surgical removal of impacted mandibular third molar
Authors: Sh Milad Etemadi , Haghighat Abbas , Fattahi Bahareh , Tajmiri Golnaz , Alizargar Javad
Published: October 2023

Background:

Pain following surgical removal of impacted molars has remained a principal concern among practitioners. Since green tea has anti-inflammatory and anti-bacterial properties, the current study aimed to evaluate the efficacy of green tea extract local application in controlling postoperative pain following surgical extraction of the impacted mandibular third molar teeth.

Materials and Methods:

In a double-blinded randomized controlled trial study with a split-mouth design, 32 patients underwent bilateral removal of impacted third molars in a 2-month time interval; afterward, the sterile gauzes impregnated with green tea extract and saline were applied randomly to the surgical sites. Postoperative pain was evaluated 6, 12, 24, and 48 h after surgery using a questionnaire based on the Visual Analog Scale (VAS) and the number of analgesics used after surgery. Data were subjected to exact and Chi-square tests with the significance level set at 0.05.

Results:

There was a decrease in the mean scores of the VAS and the mean number of analgesic consumptions in the first 2 days after surgery. Chi-square test results showed a significant reduction in the VAS scores after applying the green tea extract only 6 and 12 h after surgery (P < 0.05). Moreover, the number of analgesic consumptions was significantly lower in the green tea group compared to the control group.

Conclusion:

Green tea extract may be an appropriate and safe choice for postoperative pain control after surgical extraction of the impacted mandibular third molar teeth.
A comparative evaluation of light cure calcium silicate and resin-modified glass ionomer as indirect pulp capping agent in primary molars: A randomized clinical trial
Authors: Bhatt Roshni A. , Patel Megha C. , Bhatt Rohan , Patel Chhaya , Joshi Kaushal R. , Makwani Disha
Published: October 2023

Background:

Minimally invasive techniques should be employed to maintain pulp vitality without affecting physiological tooth resorption for pediatric patients. This study aims to evaluate clinical and radiographic success of light cure calcium silicate and resin-modified glass ionomer (RMGI) as indirect pulp-capping agent in primary molars in children between 5 and 9 years.

Materials and Methods:

In this randomized clinical trial study, 40 primary molars with the International Caries Detection and Assessment System criteria 4–6 score were divided randomly into two groups after computerized randomization method. After caries excavation by minimally invasive dentistry principle, affected dentin was lined by either light cure calcium silicate (Group I) or RMGI (Group II) liner followed by composite restoration. Clinical success was determined with the absence of symptoms and bitewing radiographs were taken at baseline, 3, and 6 months' interval to measure increase in dentin increment using ImageJ software. Statistical analysis for intergroup comparison was done using Paired t-test, and Independent t-test was used for intragroup comparison. The level of statistical significance was set at P < 0.05.

Results:

Change in dentin increment seen from baseline to 6 months in Group I was 0.19 mm and in Group II was 0.20 mm (P = 0.924). Intragroup increment was statistically significant during all follow-up intervals for both the groups (Group I – P ≤ 0.001, Group II – P = 0.009). For baseline remaining dentin thickness >1.5 mm, statistically significant increase was observed in the dentin increment at 3 months' interval between both the groups.

Conclusion:

Both TheraCal LC and Vitrebond show acceptable clinical and radiographic results when used in primary molars as indirect pulp treatment agents. Both the liners are equivalent to each other in terms of feasibility and cost-effectiveness but TheraCal LC can be preferred due to better handling and avoiding the manipulation step thereby reducing treatment time.
Evaluation of pain response in children to the SoftClamp™ as an alternative to the metal rubber dam clamp: A randomized clinical trial
Authors: Pottammal Namitha , Rao Ashwin , Natarajan Srikant , Karuna Y. M. , Nayak Anupama P. , Rao Shweta
Published: October 2023

Background:

The use of a rubber dam is more important than ever in today's COVID-19 era to limit cross infections. In children, the placement of the metal clamp to retain the rubber dam is perceived to be painful and often requiring a local anesthetic injection. This dissuades many clinicians from placing the rubber dam. Hence, this study evaluated the pain response of children to a SoftClamp™ compared to the conventional metal clamp.

Materials and Methods:

This was a randomized controlled, equal allocation ratio, split-mouth clinical trial. Forty-two children aged between 8 and 12 years, having two permanent mandibular molars in need of sealants, were divided into Groups A and B (metal clamp and SoftClamp™, respectively). The pain response was recorded using both an objective and a subjective scale i.e., the Faces Legs Activity Cry Consolability (FLACC) scale and the Wong Baker Faces Pain Rating Scale (WBFPRS). The level of significance was set at 5% (P < 0.05). The pain response recorded from the WBFPRS and the FLACC scale for the metal and the SoftClamp™ were analyzed using the Wilcoxon signed rank test. The difference in pain response between genders and between two age groups (below and above 10 years of age) was analyzed using the Mann–Whitney U-test.

Results:

The children reported mild discomfort to clamp placement in both the scales. The P values for the FLACC and WBFPRS scores comparing the pain response to the metal and SoftClamp™ were 0.311 and 0.149, respectively.

Conclusion:

There was no significant difference in the pain response of children to both the clamps. Good rubber dam application practices in children through the use of behavior guidance and a proper topical anesthesia technique may play a far more important role regardless of the clamp used. But the SoftClamp™, with its more child friendly appearance could be a viable alternative to the metal clamp in children.
Comparison of shear bond strength of rebonded stainless steel brackets with three different enamel surface conditioning methods
Authors: Safarzadeh Saba , Kachuie Marzieh , Birang Reza , Sadeghian Saeid
Published: October 2023

Background:

During the orthodontic bonding process, the need for repositioning or rebonding of orthodontic brackets on the enamel surface occurs frequently. The aim of this study is to compare the shear bond strength (SBS) in rebonding orthodontic stainless steel brackets with three different methods of enamel surface conditioning methods.

Materials and Methods:

In this in vitro study, 80 human premolars that were extracted for orthodontic purposes were randomly divided into four groups and underwent orthodontic bonding procedure (N = 20). Except for the control group, three other groups underwent debonding and rebonding process in which after removing the remaining adhesive with tungsten-carbide bur, enamel surface conditioned by three different methods including re-etching with phosphoric acid, sandblasting + acid etching, and Erbium-doped Yttrium–Aluminum–Garnet laser. Then, the SBS of the bracket to the enamel surface was compared between different groups. Scanning Electron microscopy images were also obtained from a number of samples. Statistical analysis was performed by Kruskal–Wallis and Mann–Whitney tests.

Results:

The highest SBS was observed in the primary bond (control group) with an average of 29,440 MPa. There was a significant difference between the studied groups (P < 0.001) and only the group that was re-etched with phosphoric acid had no significant difference with the control group (P = 0.708) ∝ =0.05.

Conclusion:

Rebonding of brackets using phosphoric acid for reconditioning of the enamel surface creates bond strength comparable to the primary bond. Other groups had significantly lower SBS than the control group.
Chest CT features in COVID-19 patients
Authors: Taghavi Mohammadreza , Shokri Azar , Niloofar Parastoo , Poorbarat Salar , Mollazadeh Samaneh , Milani Hamed
Published: October 2023

Objective:

To derive the pooled estimate of chest computed tomography (CT) findings in coronavirus disease 2019 (COVID-19) patients.

Methods:

A comprehensive systematic search was conducted according to the PRISMA checklist from January 2020 to September 2020 in electronic databases including PubMed, Google Scholar, and Scopus based on search terms in title and texts. Original descriptive studies with epidemiological parameters of interest were included into the systematic review and meta-analysis.

Results:

Totally 54 articles comprised of 4 879 patients with a mean age of 49.05 years were eligible for this study. The pooled prevalence for abnormal CT images was 86.0%. Pooled prevalence for ground-glass opacity was 68.0%, 71.0% for bilateral abnormalities, 47.0% for mixed ground-glass opacity and consolidation and 29.0% for consolidation. In addition, 64.0% of lesions were peripheral, and 12.0% were central while 28.0% were both central and peripheral. Furthermore, 61.0% of lower lungs were involved, and 7.0% and 5.0% of the cases presented with pleural effusion and pericardial effusion, respectively. Besides, 11% of the cases showed lymphadenopathy, and 37% had air broncho gram sign. The pooled prevalence of other chest CT findings ranged from 8.0% to 65.0%.

Conclusions:

Chest CT can be used as predictive tools for the detection of COVID-19 disease along with clinical manifestations and the RT-PCR method.
Drug dependence and its risk factors in emergency department patients
Authors: Yavuz Erdal , Turgut Kasim , Gulacti Umut , Lok Ugur , Altunisik Erman
Published: October 2023

Objective:

To determine the characteristics and risk factors of drug dependence among patients who were administered drugs with addictive potential (DAP) in an emergency department (ED).

Methods:

This retrospective cross-sectional study included patients who were administered DAP 3 or more times in the emergency room between September 1, 2019 and March 1, 2020. The demographic and baseline information were recorded. All the prescibed DAP, the reasons to use these drugs, secondary drug dependence, the department where DAP were first prescribed, types of doctors who preferred to prescribed DAP, and the risk factors for the development of drug dependence were determined.

Results:

A total of 3 000 patients were screened from medical records, and among them, 80 patients developed drug dependence. Drug dependence only developed for tramadol (n=57, 71.3%), diazepam (n=11, 13.8%), and biperiden (n=12, 15.0%). Tramadol was the most frequently prescribed drug (n=57, 71.3%). The most common reason for drug dependence was psychiatric disorders (n=29, 36.3%). Drug dependence developed in renal colic patients due to the administration of tramadol (n=7, 100%). On the contrary, dependence to biperiden were mainly developed in patients with psychiatric complaints (n=12, 41.4%). The rate of secondary drug dependence was 15% (n=12). Of the Biperiden users, 41.7% developed secondary drug dependence on diazepam. Most DAP were first prescribed in the ED (n=52, 65%), and the specialist preferred to prescribe DAP (n=43, 53.8%). For the development of dependence, the presence of renal colic (OR: 3.387, 95% confidence interval (CI): 1.473-7.788, P=0.004) and low back pain (OR: 5.778, 95% CI: 2.779-12.014, P<0.001) were the risk factors.

Conclusions:

Most DAP were first prescribed in the ED compared to other departments, and specialist are preferred to use DAP. Tramadol is the most commonly used drugs caused drug dependence. Psychiatric disorder patients are easier to develope drug dependence. Furthermore, renal colic and low back pain patients needs more attention to avert drug dependence.
Effect of traditional Chinese preparation Xuebijing on inflammatory markers in patients with ventilator-associated pneumonia
Authors: Zhang Hong-wei , Wei Li-you , Wang Ji-xuan , Liu Shu-zheng , Xing Dan , Zhang Rui , Guo Hui , Chen Li-juan , Zhang Jing
Published: October 2023

Objective:

To observe the effect of Xuebijing, a complex traditional Chinese preparation, on inflammation and prognosis of patients with pneumonia.

Methods:

The patients with ventilator-associated pneumonia in the intensive care unit (ICU) were randomly divided into the control group and the treatment group with 35 cases in each group. Both groups were given routine treatment such as anti-inflammatory drugs, rehydration, expectorant, and nutritional support, while the treatment group was additionally given Xuebijing injection. Serum C-reactive protein (CRP), clinical pulmonary infection score (CPIS), acute physiology, and chronic health score II (APACHE II) were recorded before treatment, the 3rd and 7th day after treatment. The duration of antibiotic use, mechanical ventilation, ICU stay, and mortality during 28 days was recorded.

Results:

There was no significant difference in CRP, CPIS, and APACHE II between the two groups before treatment (P>0.05). The improvement of CRP, CPIS, and APACHE II in the treatment group was better than those in the control group on the 3 and 7 days after treatment, and the differences were statistically significant (P<0.05). The duration of antibiotic use, mechanical ventilation, and ICU stay in the treatment group were less than those in the control group (P<0.05). The 28-day mortality of the treatment group was lower than that of the control group, but the difference was not statistically significant (P>0.05).

Conclusions:

Xuebijing injection can improve the inflammatory indexes of patients with ventilator-associated pneumonia, and can partly improve the prognosis.
Predictors of antenatal health service utilization among left-behind wives of male outmigrants: Evidence from Patna District, India
Authors: Afzal Fahad , Das Arindam
Published: October 2023

Objective:

To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care (ANC) services utilization.

Methods:

A cross-sectional survey was conducted in rural regions of the Patna district, India. The sample size (n=328) was estimated using Cochran's formula. Five parameters of the social support system were identified (autonomy, spousal support, family support, social circle support, and government support). The score for each was calculated as a composite score using multiple variables; these served as independent variables. The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria.

Results:

The regression results showed that four out of five social parameters had a significant effect on ANC behavior. Spousal support was the strongest predictor (standardized regression coefficient β=0.57, OR 1.16, 95% CI 1.08-1.79, P=0.007). Government support was found to be the second strongest predictor (β=0.40, OR 1.49, 95% CI 1.04-2.14, P=0.027), followed by family support (β=0.31, OR 1.36, 95% CI 1.23-2.57, P=0.034) and autonomy (β=0.11, OR 1.32, 95% CI 1.11-2.26, P=0.030). The social circle support was found to be non-significant in predicting ANC behavior (P>0.05).

Conclusions:

The policymakers could focus on the identified predictors to strengthen and modify the existing policies for left-behind wives of male outmigrants. The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net. One strategy we suggest is to launch an awareness campaign focusing on husbands (male outmigrants) and family members.
Artificial intelligence in psychiatry, present trends, and challenges: An updated review
Authors: Avula Vijaya Chandra Reddy , Amalakanti Sridhar
Published: October 2023

Artificial intelligence (AI) represents a revolutionary fusion of computer science and human-like problem-solving capabilities. In medicine, AI promises transformative changes, automating medical documentation, streamlining health insurance processes, and enhancing medical image analysis. The rising prevalence of mental illness across the world underscores the need for AI in psychiatry, where innovative approaches, such as speech analysis and real-time mental health assessments, are emerging. However, challenges loom. AI’s performance in radiology remains inconsistent. Biased training data, workflow disruptions, and a lack of validation standards pose hurdles. Speech recognition systems suffer from word errors, impacting clinical notes’ accuracy. The black-box nature of AI algorithms and their opacity in clinical settings require attention, particularly in safeguarding patient safety. Establishing guidelines for responsible AI use in mental health, addressing confidentiality, and handling critical situations is crucial. In conclusion, while AI holds immense promise in revolutionizing psychiatry and medicine, recognizing and addressing its challenges is imperative for its responsible and effective integration into clinical practice.
Sarcoidosis presenting with bicytopenia due to bone marrow granuloma
Authors: Abdulla Mansoor C.
Published: October 2023

A 55-year-old homemaker presented with low-grade fever, fatigue, and loss of weight for 2 months. She had hepatosplenomegaly, mediastinal lymphadenopathy, cytopenias, hypercalcemia with normal parathormone, and noncaseating granulomas in bone marrow and lymph node biopsy. The patient was diagnosed to have sarcoidosis with bone marrow involvement (histopathology showing noncaseating granuloma and high serum angiotensin-converting enzyme after ruling out other causes of granulomatous disorders by appropriate tests). She was managed with prednisolone 20 mg daily which was reduced and stopped after 3 months. On follow-up, she was asymptomatic and her blood counts were normal. Diagnosis of sarcoidosis should be considered always after ruling out other causes since it can mimic lymphoproliferative disorders and granulomatous infections. The initial presentation of sarcoidosis with bicytopenia due to bone marrow granulomas is extremely rare and physicians should have awareness of such atypical presentations.
Knowledge about Rheumatoid Arthritis among Senior Undergraduate Medical Students of a Medical College in South India
Authors: Marwaha Drishti , Kumar N. Ajith , Sreelakshmi Charakkulam Vijay , Priyadarshan Dhevarsh , Surendran Sandeep
Published: October 2023

Background:

Rheumatoid arthritis (RA) is the most common form of autoimmune inflammatory arthritis with an Indian prevalence of around 0.75%. Nearly 55% of Indians resort to primary health-care centers as their first point of contact. MBBS students must be well equipped to diagnose and treat patients with RA within the community and refer the relevant cases appropriately to higher medical facilities.

Materials and Methods:

A cross-sectional study was conducted assessing the basic knowledge of RA in senior medical undergraduate students in two domains. The first domain included assessment, clinical features, and diagnosis of RA while the second domain included treatment, radiological features, and therapeutics of RA. The total score was summed up for each domain. Self-assessment of knowledge was also inquired. The questionnaire was validated after a pilot study. The analysis was done using SPSS software using Pearson’s Chi-square test for correlation and paired t-test for comparison with basic descriptive statistics.

Results:

A total of 142 students participated, classified by year of study. There were 69% of female respondents. The mean self-assessment value was 4.82 ± 1.944, and the mean score in the questionnaire was 7.27 ± 2.183. The mean score out of 9 for Domain A was 5.09 ± 1.63 and for Domain B out of 4 was 2.17 ± 0.977. Students performed better in Domain B. A significant association was found between final assessment score and year of study (P < 0.01) as well as self-assessment and year of study (P < 0.01).

Conclusion:

Participants had less confidence in themselves as compared to how they performed. Female students performed better. Awareness about Domain B was higher, and senior students performed better.
Mosaic Turner Variant Adult Female Presenting with XO/XY Karyotype
Authors: George Sigin , Dagar Vikas Karamchand , Nagaraja N. , Chakrabarty Barun Kumar
Published: October 2023

Turner syndrome (TS) is the most frequently detected chromosomal abnormality in females caused by the partial or complete absence of second X chromosome. Due to varied phenotypical presentation, the diagnosis of TS can create a spectrum of clinical concerns related to morbidity and mortality. At least 10% of Turner females exhibit the presence of Y chromosome or Y-derived sequences. Patients with 45,X/46,XY mosaicism may have a phenotypic variation of the external genitalia and exhibit features ranging from normal male to ambiguous to female genitalia with features of TS. Turner mosaic variants with Y chromosome components have increased risk for gonadoblastoma. Although the risk is not exactly quantifiable, according to the 2016 Cincinnati International TS Meeting Clinical Practice guidelines, bilateral prophylactic gonadectomy is mandatory if Y chromosomal component is identified in mosaic Turner. We describe a rare case of an adult female patient detected as mosaic Turner variant with the presence of Y chromosome and reconfirmed by an aneuploidy FISH probe.
Reproductive Risk Factors Associated with Female Infertility in Sonepat District of Haryana: A Community Based Cross-Sectional Study
Authors: Kataria Deepika , Rani Babita , Punia Anita , Jha S. K. , Narendran M. , Singh Jagmohan
Published: October 2023

Background:

Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.

Aims:

The aim of this study was to estimate the prevalence of infertility and its association with reproductive risk factors amongst women of reproductive age group (18–49 years) in district Sonepat, Haryana.

Settings and Design:

This observational community-based cross-sectional study was conducted amongst 444 reproductive age group (18–49 years) women residing in district Sonepat, from August 2021 to May 2022.

Materials and Methods:

A simple random sampling technique was used to select the study subjects. After taking written informed consent, all the participants were interviewed using a pre-designed, pre-tested semi-structured questionnaire for desired information. Statistical Analysis Used: Mean and standard deviation (SD) were calculated for quantitative data. Percentages and proportions were calculated for qualitative data.

Results:

Out of 444 study population, majority of women were fertile (88.7%), while 6.3% of women were secondary infertile and 5% of women were primary infertile. Most women were aged between 30 and 39 years. The difference of occurrence of infertility in relation to genital discharge (P = 0.049), genital ulcer/sores (P ≤ 0.001), groin swelling (P ≤ 0.001), warts (P = 0.015), menstrual cycle duration (P ≤ 0.001) and menstrual flow amount (P = 0.048) was statistically significant. The mean age of menarche for the female with infertility was 14.34 years (standard deviation = 1.40).

Conclusion:

Almost all of the symptoms of sexually transmitted infection/reproductive tract infection were high amongst infertile females. Awareness generation about the preventable risk factors and provision of infertility care services at primary healthcare facilities will be of use in addressing infertility in Sonepat.
Does the flatting of the curve of spee affect the chewing force distribution in the mandible? (3D finite element study)
Authors: Hasan Lamiaa A. , Al Qassar Sarmad S. Salih , Alrawi Mohammad N. , Alhajar Emad H.
Published: October 2023

OBJECTIVE:

To search the effects of Curve of Spee (COS) flatting on the stresses and displacement on the different mandible landmarks and lower teeth during posterior teeth loading using three-dimensional (3D) finite element analysis.

MATERIALS AND METHODS:

Three-dimensional hemi mandibular model was created from real selected mandible. The lower teeth was aligned originally in a curved form with 2.4 mm depth at the cusp tip of the second premolar. Another replica with flat aligned teeth was formed to confirm the analysis by up righting premolars and molars. A load was applied at mesio-buccal cusp of the lower first molar on both models, and the resultant stresses and displacements on the mandibular landmarks and the lower teeth were tested.

RESULTS:

Von mises over the mandible was higher in flat than in curve model. The highest stress levels were detected at the Mesio-buccal cusp tip of first molar for flat and curved simulation (5053, 3304) Mpa respectively. Mesio-distally, the teeth displacement was higher in curve model than in flat one. The maximum distal displacement, in flat model, was seen in central and lateral incisors. While, in curve model, the maximum distal displacement was grasped within first and second premolars.

CONCLUSIONS:

Flatting the COS magnify the stresses over whole mandible and reduce lower teeth displacement mesio-distally. We speculated that the readjustment of the COS after orthodontic treatment could reduce the stress and displacements on the lower anterior teeth and decrease the lower anterior teeth crowding relapse.
UTILITY OF ULTRASOUND ELASTOGRAPHY IN DIFFERENTIATING BENIGN FROM MALIGNANT THYROID NODULES
Authors: Kulkarni Adway , Maldar Aasim N. , Shingare Awesh , Chauhan Phulrenu H. , Wadhwani Raju
Published: October 2023

Background:

Ultrasound elastography is an imaging technique used for the evaluation of tissue stiffness by measuring the degree of tissue deformation in response to the application of external force.

Methodology:

In this prospective comparative study, a total of 52 thyroid nodules from 44 euthyroid patients undergoing fine needle aspiration cytology (FNAC) were assessed. Elastography was performed by a single experienced sonologist, wherein the nodules were graded as per elastography scoring (ES), and the strain ratio (SR) for each nodule was computed. Final histopathology findings of the patients undergoing surgery were compared to elastography findings, and measures of diagnostic accuracy to differentiate between benign and malignant nodules were determined.

Results:

Thirty (68.2%) females and 14 (31.8%) males, with a mean age of 45.18±11.23 years, were assessed. Fourteen (31.8%) patients underwent thyroidectomy, and histopathology was reported for 18 (34.6%) nodules. In all, nine (17.3%) nodules were malignant, and 43 (82.7%) nodules were considered benign. ES demonstrated a sensitivity of 88.9%, specificity of 88.3%, PPV of 61.5% and NPV of 97.4% to identify benign thyroid nodules. The mean SR for benign nodules was significantly lower as compared to malignant nodules (2.72±0.62 vs. 4.52±0.75, P<0.0001). The optimal cut-point value for SR to differentiate benign and malignant thyroid nodules was determined to be 3.8, with the sensitivity, specificity, PPV, and NPV being 88.9%, 95.4%, 80%, and 94.6%, respectively. Of the six nodules classified as Bethesda category-III or IV on FNAC, histopathological diagnosis was follicular carcinoma in one nodule (Bethesda category-IV), four were diagnosed with follicular adenoma, and one with colloid goitre. The ES of the nodule with follicular carcinoma was malignant, while amongst the rest, two nodules were classified as benign, and three nodules as malignant. The SR of the follicular carcinoma was 4.3, while the mean strain ratio in remaining nodules was 3.48 (P=0.001).

Conclusion:

Ultrasound elastography has good diagnostic efficacy for the differentiation of benign from malignant thyroid nodules. It can potentially reduce the rates of unnecessary fine needle-aspiration biopsy. However, whether elastography score or strain ratio will be useful in diagnosis of nodules which are indeterminate on FNAC is open to further studies.
ATYPICAL PRESENTATION OF THYROID MALIGNANCIES: A CASE SERIES
Authors: Shahanas P. S. , Varikkottil Sajira K. , Surjit Aswin , Rajapurkar Mayuri Mohan , Thomas Joe
Published: October 2023

Introduction:

Differentiated thyroid cancer mainly metastasizes to regional lymph nodes and rarely to distant organs. Papillary thyroid carcinoma can metastasize via lymphatic pathway and follicular thyroid neoplasms through vascular channels. Here we present 3 cases with atypical presentations and synchronous/metachronous primary tumours (non-endocrine).

Case Reports:

Case 1: A 43-year-old female with no known comorbidities presented with right shoulder pain. X-ray showed a missing rib incidentally. A CT thorax suggested metastatic bony mass. PET CT for finding primary malignancy showed uptake in thyroid. Her TFT was normal. FNAC thyroid with bone biopsy confirmed follicular carcinoma thyroid with bone metastasis. Case 2: A 33-year-old male presented with hematuria was diagnosed to have renal cell carcinoma. He underwent right radical nephrectomy. A follow up PET CT as per protocol showed hypermetabolic hypodense nodule in the left lobe of thyroid gland. His TFT showed hypothyroidism, but patient had no related complains. Biopsy confirmed papillary thyroid carcinoma. Case 3: A 48-year-old female came with fever and cervical lymphadenopathy. USG neck showed TIRADS 4 lesion with retrosternal extension. FNAC taken from the lymph node showed chronic granulomatous lymphadenitis suggestive of TB with Mantoux test being positive. She was started on ATT but thyroid lesions still persisting with lymphadenopathy. She underwent total thyroidectomy and biopsy showed infiltrating neoplasm arranged in papillary pattern. Here, her TB was masquareding the thyroid malignancy.

Conclusion:

The clinical presentation of thyroid metastases to uncommon sites are difficult to diagnose. Thyroid malignancies presenting with atypical features are not uncommon, but at times diagnosis and timely management is difficult in such cases.
FACTORS ASSOCIATED WITH THYROID ASSOCIATED ORBITOPATHY DUE TO GRAVES’ DISEASE
Authors: Rafiq Nadeema , Nabi Tauseef
Published: October 2023

Background:

Thyroid associated orbitopathy (TAO) is the principal extrathyroidal manifestation of Graves’ disease (GD). TAO is described as chronic inflammation of orbital and periorbital tissue. Environmental risk factors variably influence development of TAO and risk factors vary with ethnicity and geographical region.

Aims:

To evaluate the clinical factors for TAO in patients with GD.

Setting and Design:

This was a hospital-based cross-sectional study done on consecutive 76 newly diagnosed patients of GD documented by thyroid 99mTechnetium-pertechnetate scan.

Materials and Methods:

Patients were subjected to complete clinical workup and thyroid profile. The diagnosis of TAO was based on the criteria of Bartley and Gorman. Fifty two TAO patients were compared with twenty four non TAO patients (controls) for risk.

Statistical Analysis Used:

All analyses were performed with SPSS software (version 21.0).

Results:

TAO was present in 52 (68%) of patients with GD. TAO was bilateral in 50 (96%) of patients. Majority of patients had mild orbitopathy 34 (65.4%) and none of the patients showed any signs of sight-threatening disease. Clinical activity score (CAS) was active in 13.5% of the study group. There was significant female preponderance in TAO. Current smoking increased the risk of TAO (P = 0.023). Total triiodothyronine (T3) and mean intraocular pressure (IOP) in primary and upward gaze was significantly elevated at baseline in TAO patients. Braley’s sign was seen in 30.7% of patients with TAO and in 8.3% of patients in the control group (P = 0.033). Current smoking, total T3 > 4ng/dl and differential IOP > 6 mmHg were found to be associated with risk of TAO.

Conclusion:

TAO was clinically inactive and of mild severity in most cases. This study identified current smoking, total T3 > 4 ng/dl and differential IOP > 6 mmHg as risk factors for TAO.
VASOSPATIC ANGINA IN GRAVES DISEASE
Authors: Vijayan Sreya
Published: October 2023

Category A

Thyroid hormones play a key role in the growth and metabolism of almost all tissues. Any abnormal increase or decrease of these hormones can cause impairment in functioning of almost all organ systems. Hyperthyroidism has been associated with a number of cardiac manifestations including tachycardia, cardiac arrhythmia especially AF, cardiomyopathy, angina or even myocardial infarction. Here we present a case of a 38 year old female with no known comorbidities who presented to medicine casualty with complaints of recurrent episodes of typical angina lasting 15–20 min or more. Her vitals showed mildly elevated blood pressure of 150/90 mmHg and tachycardia. An ECG taken immediately showed ST segment depression in the anterolateral leads. Cardiac biomarkers were negative. A provisional diagnosis of acute coronary syndrome was made and treatment started. Echo was found to be normal. Patient continued to have recurrent episodes of angina. Coronary angiography was normal. On detailed evaluation patient gave a history of palpitation, loss of weight, diarrhoea and increased sweating in the last 3 months. Detailed physical examination revealed a painless neck swelling. Laboratory tests showed Hb – 12 g/dl, serum K – 4.1 mmol/dl, Ca – 9.2 mg/dl, LFT and RFT normal, fT3 – 22.9, fT4 – 64.2, TSH <0.01 suggestive of hyperthyroidism. On further evaluation she was found to be positive for TSH receptor antibody and was diagnosed with Grave’s disease. She was started on anti-thyroid drugs and propranolol. Nitrates were stopped after 6 months and patient remains asymptomatic on treatment.

Conclusion:

Hyperthyroidism may present in numerous ways and may even be life threatening. This case highlights the importance of checking the thyroid status of patients, especially in the younger age group, with no obvious cause or risk factors presenting with angina. They may not always have classical symptoms of hyperthyroidism. A delay in diagnosis can result in undue complications and unnecessary interventions. Most of these patients were found to lead a normal life with proper medications once diagnosed.