Clinical applications and performance of intelligent systems in dental and maxillofacial radiology: A review

Intelligent systems (i.e., artificial intelligence), particularly deep learning, are machines able to mimic the cognitive functions of humans to perform tasks of problem-solving and learning. This field deals with computational models that can think and act intelligently, like the human brain, and construct algorithms that can learn from data to make predictions. Artificial intelligence is becoming important in radiology due to its ability to detect abnormalities in radiographic images that are unnoticed by the naked human eye. These systems have reduced radiologists' workload by rapidly recording and presenting data, and thereby monitoring the treatment response with a reduced risk of cognitive bias. Intelligent systems have an important role to play and could be used by dentists as an adjunct to other imaging modalities in making appropriate diagnoses and treatment plans. In the field of maxillofacial radiology, these systems have shown promise for the interpretation of complex images, accurate localization of landmarks, characterization of bone architecture, estimation of oral cancer risk, and the assessment of metastatic lymph nodes, periapical pathologies, and maxillary sinus pathologies. This review discusses the clinical applications and scope of intelligent systems such as machine learning, artificial intelligence, and deep learning programs in maxillofacial imaging.

Comparison of clonidine versus midazolam in monitored anesthesia care during ENT surgery: a prospective, double blind, randomized clinical study

Monitored anaesthesia care [MAC] typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs which is a common practice during various ENT surgical procedures. To compare the effectiveness and safety profile of clonidine against midazolam as an intravenously administered agent for MAC. Settings and design: Randomized, double blind, prospective study. Sixty patients undergoing ENT surgery under MAC were divided into two groups of 30 patients each. The patients in Group C received clonidine 2 mcg/kg IV and in Group M received midazolam 20 mcg/kg IV over 10 min. Ramsay sedation score, requirement of intraoperative rescue sedation [propofol] and analgesic [diclofenac infusion], postoperative visual analogue score and analgesic requirement [tramadol], adverse effects, recovery profile [Aldrete Score] and satisfaction scores of patients and surgeon were recorded. Data were analysed by chi-square, student t test and analysis of variance using Epi info 6 with p value <0.05 as significant. Mean Ramsay sedation score [RSS] was significantly more in Group M [2.50 +/- 0.73] as compared to Group C [1.80 +/- 0.85], p = 0.001. Intraoperative rescue sedation with propofol infusion [if RSS<3] was required by significantly higher number of patients in Group C [n=19, 63.4%] than in Group M [n=6, 20%], P=0.001. Intraoperative rescue analgesic requirement was significantly more in Group M [n =21, 70%] as compared to Group C [n=11, 36.6%], p=0.009. Intraoperative bleeding score was significantly less in Group C [1.93 +/- 0.80] than in group M [2.43 +/- 0.73], P=0.014. Postoperative VAS score was also significantly less in Group C than in Group M [2.28 +/- 1.9 vs. 3.28 +/- 1.81, P=0.041]. Both patients and surgeon were more satisfied in Group C than in Group M [p=0.010 and 0.019 respectively]. All patients had Aldrete score of 10 at the end of surgery in both groups. We conclude that clonidine along with rescue sedation using propofol infusion can be a better alternative to midazolam in MAC since it provides a calm patient with better intraoperative and postoperative analgesia, and a bloodless surgical field leading to increased satisfaction of both patient and surgeon

Achalasia Cardia Subtyping by High-Resolution Manometry Predicts the Therapeutic Outcome of Pneumatic Balloon Dilatation

BACKGROUND/AIMS: High-resolution manometry (HRM) with pressure topography is used to subtype achalasia cardia, which has therapeutic implications. The aim of this study was to compare the clinical characteristics, manometric variables and treatment outcomes among the achalasia subtypes based on the HRM findings. METHODS: The patients who underwent HRM at the Asian Institute of Gastroenterology, Hyderabad between January 2008 and January 2009 were enrolled. The patients with achalasia were categorized into 3 subtypes: type I - achalasia with minimum esophageal pressurization, type II - achalasia with esophageal compression and type III - achalasia with spasm. The clinical and manometric variables and treatment outcomes were compared. RESULTS: Eighty-nine out of the 900 patients who underwent HRM were diagnosed as achalasia cardia. Fifty-one patients with a minimum follow-up period of 6 months were included. Types I and II achalasia were diagnosed in 24 patients each and 3 patients were diagnosed as type III achalasia. Dysphagia and regurgitation were the main presenting symptoms in patients with types I and II achalasia. Patients with type III achalasia had high basal lower esophageal sphincter pressure and maximal esophageal pressurization when compared to types I and II. Most patients underwent pneumatic dilatation (type I, 22/24; type II, 20/24; type III, 3/3). Patients with type II had the best response to pneumatic dilatation (18/20, 90.0%) compared to types I (14/22, 63.3%) and III (1/3, 33.3%). CONCLUSIONS: The type II achalasia cardia showed the best response to pneumatic dilatation.

Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi—a large single center experience.

Aim Large pancreatic ductal calculi and pain are a feature of chronic calcific pancreatitis (CCP) in the tropics. This large single center study evaluates the role of extracorporeal shock wave lithotripsy (ESWL) in fragmentation of large pancreatic stones and relief of pain in patients with CCP. Methods Patients with CCP presenting with pain and large pancreatic duct (PD) calculi (>5 mm diameter) not amenable to extraction at routine endoscopic retrograde cholangio pancreatography (ERCP) were taken up for ESWL using a 3rd generation lithotripter. Stones in the head and body of pancreas were targeted at ESWL; 5,000 shocks were given per session. The calculi were fragmented to <3 mm size and then cleared by endotherapy. Pancreatic duct stents were deployed when indicated. A total of 1,006 patients underwent ESWL. Complete clearance was achieved in 762 (76%), partial clearance in 173 (17%) and unsuccessful in the rest. More than 962 (90%) of patients needed less than three sessions of ESWL. At 6 months, 711 (84%) of 846 patients who returned for follow up had significant relief of pain with a decrease in analgesic use. Complications were mild and minimal. Conclusion ESWL is an effective and safe modality for fragmentation of large PD calculi in patients with CCP.