Thoracolumbar Injury Classification and Severity Score Is Predictive of Perioperative Adverse Events in Operatively Treated Thoracic and Lumbar Fractures

Methods@#We performed a retrospective review of 199 patients with surgically treated thoracolumbar fractures operated between January 2007 and January 2018. The potential risk factors for the development of AEs as well as the development of common complications were evaluated by univariate analysis, and a multivariate logistic regression analysis was performed to identify independent risk factors predictive of the above. @*Results@#The overall rate of AEs was 46.7%; 83 patients (41.7%) had nonsurgical AEs, whereas 24 (12.1%) had surgical adverse events. The most common AEs were urinary tract infections in 43 patients (21.6%), and hospital-acquired pneumonia in 21 patients (10.6%). On multivariate logistic regression, a Thoracolumbar Injury Classification and Severity (TLICS) score of 8–10 (odds ratio [OR], 6.39; 95% confidence interval [CI], 2.33–17.51), the presence of polytrauma (OR, 2.64; 95% CI, 1.17–5.99), and undergoing open surgery (OR, 2.31; 95% CI, 1.09–4.88) were significant risk factors for AEs. The absence of neurological deficit was associated with a lower rate of AEs (OR, 0.47; 95% CI, 0.31–0.70). @*Conclusions@#This study suggests the presence of polytrauma, preoperative American Spinal Injury Association score, and TLICS score are predictive of AEs in patients with surgically treated thoracolumbar fractures. The results might also suggest a role for minimally invasive surgical methods in reducing AEs in these patients.

Assessment of Prevalence and Pattern of Mandibular 3rd Molar Impaction: A Cross-Sectional Study

Background: Impacted teeth, if left untreated, have a potentialto induce various complications. The mandibular third molar isthe most frequently impacted tooth with incidence varies from9.5% to 68% in different populations. The aim of the presentcross-sectional study was to assess the prevalence andpattern of mandibular 3rd molar impaction.Materials and Methods: A retrospective cross-sectional studywas conducted over the period of 1 year in which 270 cases ofpatients aged between 20 and 50 years were selected for thestudy. Parameters studied into the study were an age group,gender, location of the impacted third molar, angulation,position, and level of the impacted tooth. The data analysiswas done using the Statistical Package SPSS version 22.0.Results: In the present study total patients were 270 in which61.48% were males and 38.51% were females. Impacted teethwere maximum in both males and females in the age group 20-30 years. Mesioangular kind of impaction was maximum inboth males and females. According to Pell and Gregoryclassification at level B impactions were maximum (66.3%) andclass II impactions were maximum (51%).Conclusion: Our study concluded that the prevalence ofmandibular impactions were common in males than females.The study also noted that mesioangular impactions were themost common type of impaction. The least common form ofimpactions was the transverse types.

Evaluation and comparison of stress distribution around periodontally compromised mobile teeth splinted with different materials: Three-dimensional finite element analysis

Background: Progressive attachment loss around the teeth because of periodontal disease can result in increased tooth mobility. This adversely affects patient's comfort, function, and esthetics. Periodontal splinting helps in accomplishing stability by redistributing the functional and parafunctional forces. There are various materials that have been used for periodontal splinting. Fiber-reinforced composite, composite resin, and metal-reinforced composite are often used as splinting materials for periodontally compromised teeth. In our study, a comparison was done among these materials for their ability to distribute the stresses at different bone levels in mobile lower incisors splinted together with canines. Materials and Methods: Five patients of age group 25–50 years with Grade 2 and 3 mobile incisors having 40% or more bone loss and firm canines with optimal bone support were selected. From the computed tomography scan of each patient, three models were developed demonstrating splinting of mandibular incisors and canines with metal-reinforced composite, fiber-reinforced composite, and composite resin. So in total, 15 models were developed and each one of them was subjected to vertical and transverse loads of 150 N. Pattern of stress distribution was observed in these models using three-dimensional finite element analysis. Results: After splinting, the stress on the canine increased when bone levels around incisors decreased while stress on incisors reduced. Conclusion: Tested splinting materials were successful in stress distribution, and metal-reinforced composite was found to be better than the other splinting materials.

CoCl2 simulated hypoxia induce cell proliferation and alter the expression pattern of hypoxia associated genes involved in angiogenesis and apoptosis

BACKGROUND/AIMS: Hypoxia microenvironment plays a crucial role during tumor progression and it tends to exhibit poor prognosis and make resistant to various conventional therapies. HIF-1α acts as an important transcriptional regulator directly or indirectly associated with genes involved in cell proliferation, angiogenesis, apoptosis and energy metabolism during tumor progression in hypoxic microenvironment. This study was aimed to investigate the expression pattern of the hypoxia associated genes and their association during breast cancer progression under hypoxic microenvironment in breast cancer cells. METHODS: Cell proliferation in MCF-7 and MDA-MB-231 cell lines treated with different concentration of CoCl2 was analyzed by MTT assay. Flow cytometry was performed to check cell cycle distribution, whereas cell morphology was examined by phase contrast microscopy in both the cells during hypoxia induction. Expression of hypoxia associated genes HIF-1α, VEGF, p53 and BAX were determined by semiquantitative RT-PCR and real-time PCR. Western blotting was performed to detect the expression at protein level. RESULTS: Our study revealed that cell proliferation in CoCl2 treated breast cancer cells were concentration dependent and varies with different cell types, further increase in CoCl2 concentration leads to apoptotic cell death. Further, accumulation of p53 protein in response to hypoxia as compare to normoxia showed that induction of p53 in breast cancer cells is HIF-1α dependent. HIF-1α dependent BAX expression during hypoxia revealed that after certain extent of hypoxia induction, over expression of BAX conquers the effect of anti-apoptotic proteins and ultimately leads to apoptosis in breast cancer cells. CONCLUSION: In conclusion our results clearly indicate that CoCl2 simulated hypoxia induce the accumulation of HIF-1α protein and alter the expression of hypoxia associated genes involved in angiogenesis and apoptosis.

How green is my operation theater?

To ascertain the awareness regarding global warming and the anesthesia practices contributing to it in the city of Delhi. A questionnaire was circulated amongst the qualified anesthesiologists [consultants and senior residents] in the city of Delhi. The initial contact was made through e-mail and the questionnaire was required to be filled and returned electronically. The questionnaire was also made available online at http:/sites.google.com/site/surveydelhi. After 1 month, the forms were distributed physically. Assuming that at least 50% of the approximately 1200 practising anesthesiologists would be able to recognize the greenhouse gases correctly, the target number of responses was 150 with 99% confidence limit. Of the 831 anesthesiologists contacted, only 184 responded. Ninety-eight percent were aware of the greenhouse effect, but only 15.8% [29] could correctly identify all the greenhouse gases. However, 47.28% [87] could identify nitrous oxide and inhalational agents as a cause of greenhouse effect. Ninety percent of the respondents use circle system and 87% use low flows frequently. Ninety-three percent [171] of respondents routinely use nitrous oxide, and 32.1% [59] would, however, not use air even if made available. Seventy-nine percent [145] advocated total intravenous anesthesia as an alternative to reduce the menace. Only 22% were motivated enough to respond to the survey. More than half of these anesthesiologists were not aware about the anesthetic agents contributing to the greenhouse effect. However, their clinical practices inadvertently do not add to the environmental pollution

Quality of Life in Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is associated with significant cardiovascular and cerebrovascular morbidity and mortality. Usual parameters studied in sleep laboratory are unable to measure overall impact of OSA on human life. Consequently, it is important to measure Quality of Life (QoL) in OSA. QoL can be measured with generic instruments like SF-36 or OSA specific questionnaires like Calgary Sleep Apnea Quality of Life (SAQLI) questionnaire. Most of the studies suggest that there is significant impairment of QoL in patients of OSA. But the present evidence suggests that impairment in QoL is not proportional to severity of OSA. There is no consensus on the question of improvement in QoL with Continuous Positive Airway Pressure (CPAP) therapy. A recent Cochrane review concluded that CPAP improves QoL in people with moderate and severe OSA.