Comparative evaluation of the clinical and radiographic efficacy of 0.05% zoledronate gel as local drug delivery system in treating intrabony defects in stage III grade B periodontitis patients with and without type-2 diabetes mellitus-A randomized split-mouth clinical trial.

BACKGROUND: This 6-month randomized split-mouth and placebo-controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type-2 diabetes mellitus (DM). METHODS: A total of 120 infrabony sites were divided into two groups: Group-1 (non-diabetic periodontitis) and Group-2 (periodontitis + DM). A total of 60 sites in each group were randomized to receive treatment with SRP + placebo gel (control) or SRP + 0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone-beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months. RESULTS: Group-1 showed significant reduction in PI (0.56 ± 0.15 and 0.52 ± 0.19 from 0.67 ± 0.17), mSBI (0.7 ± 0.60 and 0.47 ± 0.57 from 0.9 ± 0.48), PPD (4.6 ± 0.85 and 3.43 ± 0.63 from 6.5 ± 1.04) and gain in RAL (7.03 ± 0.85 and 5.93 ± 0.69 from 8.9 ± 1.09) in the ZLN-treated sites than the placebo sites and also from Group-2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group-1 and 22.20% in Group-2 at ZLN sites was seen compared to placebo sites of both groups. CONCLUSION: ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non-diabetic patients compared to diabetic periodontitis patients.

Effect of platelet rich fibrin on stability of dental implants: A systematic review and meta-analysis.

Objective: The aim of the study is to provide a systematic review of the potential evidence for the effect of platelet rich fibrin (PRF) on stability of dental implants. Methods: A systematic review was performed based on the Preferred Reporting Items for Systematic review and Meta-analysis. An extensive and comprehensive electronic search was carried out from January 2000 to March 2021, independently by author in PUBMED, Cochrane Central Register of Controlled Trials, Google Scholar, Scopus, Embase, and Web of Science irrespective of publication status, date, or language. For any registered ongoing or completed but unpublished trial, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and Cochrane Oral Health's Trials Register websites were searched. Randomized, controlled, and clinical trials which assessed the stability of implant with and without use of PRF using Osstell device by radiofrequency analysis were selected. Results: The electronic and manual search yielded 630 studies. In all the eight included studies implant stability was measured using same ISQ units by Osstell device. Meta-analysis was carried out in six studies that had similar comparisons and reported the same outcomes at same time interval. Random effect models have shown pooled mean difference of 4.49 (95% CI 1.22-7.76) for 1-week post-insertion, 3.65 (95% CI 2.21-5.09) for 4-week post insertion, 3.25 (95% CI 0.03-6.47) for 8-week post-insertion, and 2.79 with 95% CI of 0.48, 5.10 for 12-week post-insertion. Conclusions: The present systematic review suggests that PRF is effective in improving secondary implant stability with certain limitations and displays possible implication for clinical practice.

Comparative evaluation of effect of injectable platelet-rich fibrin with collagen membrane compared with collagen membrane alone for gingival recession coverage.

BACKGROUND: Collagen membrane and platelet-rich fibrin (PRF) have emerged as vital biomaterials in the field of periodontal regeneration. Minimally invasive techniques are being preferred by most periodontists, as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques. Thus, in this study we have evaluated the effect of injectable PRF (i-PRF) with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access (VISTA) technique for gingival recession coverage. AIM: To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage. METHODS: A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study. The sites were randomly assigned to control group (VISTA using collagen membrane alone) and the test group (VISTA using collagen membrane with i-PRF). The clinical parameters assessed were pocket depth, recession depth (RD), recession width (RW), relative attachment level, keratinised tissue width (KTW), keratinised tissue thickness (KTT), and percentage root coverage. RESULTS: RD showed a statistically significant difference between the test group at 3 mo (0.5 ± 0.513) and 6 mo (0.9 ± 0.641) and the control group at 3 mo (0.95 ± 0.51) and 6 mo (1.5 ± 0.571), with P values of 0.008 and 0.04, respectively. RW also showed a statistically significant difference between the test group at 3 mo (1 ± 1.026) and 6 mo (1.65 ± 1.04) and the control group at 3 mo (1.85 ± 0.875) and 6 mo (2.25 ± 0.759), with P values of 0.008 and 0.001, respectively. Results for KTW showed statistically significant results between the test group at 1 mo (2.85 ± 0.489), 3 mo (3.5 ± 0.513), and 6 mo (3.4 ± 0.598) and the control group at 1 mo (2.45 ± 0.605), 3 mo (2.9 ± 0.447), and 6 mo (2.75 ± 0.444), with P values of 0.04, 0.004, and 0.003, respectively. Results for KTT also showed statistically significant results between test group at 1 mo (2.69 ± 0.233), 3 mo (2.53 ± 0.212), and 6 mo (2.46 ± 0.252) and the control group at 1 mo (2.12 ± 0.193), 3 mo (2.02 ± 0.18), and 6 mo (1.91 ± 0.166), with P values of 0.001, 0.001, and 0.001, respectively. The test group showed 91.6%, 81.6%, and 67% root coverage at 1 mo, 3 mo, and 6 mo, while the control group showed 82.3%, 66.4%, and 53.95% of root coverage at 1 mo, 3 mo, and 6 mo, respectively. CONCLUSION: The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller's class-I and class-II defects.

Evaluation and optimization of antibiotic usage in upper respiratory tract infections in children at a tertiary care outpatient department: A clinical audit.

INTRODUCTION: Inappropriate antibiotic (ab)use contributes to antimicrobial resistance. Upper respiratory tract infection (URTI) is the most common reason for antibiotic prescription in an outpatient department (OPD). Several factors influence the high and unjustified antibiotic use in a common ailment. MATERIALS AND METHODS: A clinical audit was performed to assess antibiotic prescription rate (APR) for URTI in the pediatric OPD against the available benchmark. The prescription pattern was assessed, and interventions were formulated to improve prescription behavior. Data of all children attending OPD and fulfilling the criteria for URTI group were collected from the online hospital management system and analyzed. Interventions, in the form of discussions, presentations, posters, and guidelines (Indian Ministry of Health Guidelines for URTI) regarding etiology of URTI, and indications for antibiotic prescription were implemented. Data were monitored and feedback to consultants was given. RESULTS: The baseline APR was 14.7%. There was wide variation in APR (4.1%-53.1%) among consultants. Three consultants had a rate of 53.1%, 29.7%, and 28.6%, which was very high. Postintervention, the average APR decreased to 8.7%, a reduction of 40.8%. There was a reduction in APR among consultants with high APR as well. There was reduction in the use of azithromycin, a drug recommended for patients with penicillin allergy, from 21.2% to 14.4% (32.1% reduction). Amoxycillin plus clavulanic acid combination and amoxicillin alone continued to be the most prescribed antibiotics. CONCLUSION: Interventions through clinical audit were useful in reducing APR. The APR of 8.7% achieved in this study postintervention can be used as a benchmark by other institutions to assess APR in children with URTI.

Respiratory performance of humans exposed to moderate levels of carbon dioxide.

In a business as usual scenario, atmospheric carbon dioxide concentration (CO2 ) could reach 950 parts per million (ppm) by 2100. Indoor CO2 concentrations will rise consequently, given its dependence on atmospheric CO2 levels. If buildings are ventilated following current standards in 2100, indoor CO2 concentration could be over 1300 ppm, depending on specific ventilation codes. Such exposure to CO2 could have physiological and psychological effects on building occupants. We conducted a randomized, within-subject study, examining the physiological effects on the respiratory functions of 15 persons. We examined three exposures, each 150 min long, with CO2 of: 900 ppm (reference), 1450 ppm (decreased ventilation), and 1450 ppm (reference condition with added pure CO2 ). We measured respiratory parameters with capnometry and forced vital capacity (FVC) tests. End-tidal CO2 and respiration rates did not significantly differ across the three exposures. Parameters measured using FVC decreased significantly from the start to the end of exposure only at the reduced ventilation condition (p < 0.04, large effect size). Hence, poor ventilation likely affects respiratory parameters. This effect is probably not caused by increased CO2 alone and rather by other pollutants-predominantly human bioeffluents in this work-whose concentrations increased as a result.

PYCR2 Mutation Causing Hypomyelination and Microcephaly in an Indian Child.

Hypomyelinating leukodystrophy (HLD) represents a group of clinically overlapping but genetically heterogeneous diseases. This group of disorders has the improper formation of myelin sheaths in the central nervous system (CNS), resulting in abnormal white matter, with characteristic MRI findings and clinical presentations of mostly motor dysfunction with variable cognitive and language impairment. We report a case of a three-year-old boy with global developmental delay, dysmorphic facies, motor signs, progressive microcephaly, and failure to thrive. The child was born of a non-consanguineous marriage. All basic investigations and metabolic tests were normal. Magnetic resonance imaging (MRI) of the brain showed hypomyelination of the deep and subcortical white matter, appearing as hyperintense T2 and isointense T1-weighted images, cerebral atrophy with the thinning of the corpus callosum, with normal cerebellum, brainstem, and deep grey nuclei. Further genetic testing in the form of clinical exome sequencing revealed compound heterozygous mutation of the PYCR2 gene and matching the clinical phenotype with the genotype. Therefore, a final diagnosis of hypomyelinating leukodystrophy-10 was made. There is a wide range of aetiologies for debilitating neurologic disorders, which have common and overlapping clinical presentations. Advances in the field of genetics, growing awareness, and availability of genetic tests help in a better workup of complex neurological cases. A precise diagnosis is useful in outlining the course, treatment (if available), and prognosis of the disease to parents and plays a vital role in planning future pregnancies.

Impact of Cognitive Tasks on CO2 and Isoprene Emissions from Humans.

The human body emits a wide range of chemicals, including CO2 and isoprene. To examine the impact of cognitive tasks on human emission rates of CO2 and isoprene, we conducted an across-subject, counterbalanced study in a controlled chamber involving 16 adults. The chamber replicated an office environment. In groups of four, participants engaged in 30 min each of cognitive tasks (stressed activity) and watching nature documentaries (relaxed activity). Measured biomarkers indicated higher stress levels were achieved during the stressed activity. Per-person CO2 emission rates were greater for stressed than relaxed activity (30.3 ± 2.1 vs 27.0 ± 1.7 g/h/p, p = 0.0044, mean ± standard deviation). Isoprene emission rates were also elevated under stressed versus relaxed activity (154 ± 25 µg/h/p vs 116 ± 20 µg/h/p, p = 0.041). The chamber temperature was held constant at 26.2 ± 0.49 °C; incidental variation in temperature did not explain the variance in emission rates. Isoprene emission rates increased linearly with salivary α-amylase levels (r2 = 0.6, p = 0.02). These results imply the possibility of considering cognitive tasks when determining building ventilation rates. They also present the possibility of monitoring indicators of cognitive tasks of occupants through measurement of air quality.

Improvement in Successful Extubation in Newborns After a Protocol-driven Approach: A Quality Improvement Initiative.

OBJECTIVE: To reduce extubation failure rate by implementing protocol-driven ventilation and extubation strategies. METHODS: Quality improvement project in a level II neonatal care unit from April 2017 to January 2018. Ventilation and extubation protocols implemented from 1 August, 2017. 18 ventilated newborns in the pre-protocol period, 16 in Plan-do-check-act (PDCA) cycle I and 17 in PDCA cycle II. Primary outcome was extubation failure within the first 72 h of extubation. RESULTS: Extubation failure rate reduced from 41.7% (pre-protocol period) to 23.8% (PDCA 1 and 2, OR 0.44, 95% CI 0.12 to 1.59, P = 0.21). Median time to first extubation attempt significantly decreased (71.5 h to 38 h, P=0.046). CONCLUSIONS: A protocolized approach through quality improvement initiative demonstrated a sustained improvement in successful extubation with a significant reduction in the median time to first extubation attempt in ventilated newborns.

Association of cord serum albumin with neonatal hyperbilirubinemia among term appropriate-for-gestational-age neonates.

INTRODUCTION: Neonatal jaundice affects nearly 60% of term and 80% of preterm neonates during the first week of life. Although early discharge of healthy term newborns is a common practice, neonatal hyperbilirubinemia (NH) is the most common cause for readmission during the early neonatal period. OBJECTIVE: To determine the association of cord serum albumin with serum bilirubin levels and whether it can be used as a risk indicator for the development of NH. METHOD: In this observational study, cord blood was collected from healthy term newborns for serum albumin level measurements. Total serum bilirubin and direct serum bilirubin were measured during 72-96 h of life. Newborns were clinically assessed daily for NH or for any other complication during the study period. RESULT: Among the study cohort of 300 babies, 35 had a total serum bilirubin level of ≥17 mg/dl after 72 h and were considered to have NH. They were grouped as Group 1, Group 2, and Group 3 according to the cord serum albumin level ≤2.8 g/dl, 2.9-3.3 g/dl, and ≥3.4 g/dl, respectively. Statistical analysis was conducted to assess the correlation of cord serum albumin with NH. The results showed that a cord serum albumin level ≤2.8 g/dl is critical, as it was seen in 95% of term newborns who developed NH. In the group where cord serum albumin was ≥3.4 g/dl, none of the term newborns developed NH. CONCLUSION: Term neonates with hyperbilirubinemia with a total serum bilirubin level ≥17 mg/dl had levels of cord serum albumin of ≤2.8 g/dl, and this can be used as a risk indicator to predict the development of NH.

Environmental measures in domicilliary interventions of asthmatic children.

OBJECTIVE: To evaluate the impact of environmental interventions and lifestyle management on respiratory symptoms, concurrent changes in asthma management and whether any observed health benefit could be attributed to these interventions. METHODS: A longitudinal single cohort pre-post study was conducted on children between 5­14 y with moderate to severe asthma in an outpatient clinic at Jamshedpur over 2 y. History was noted using the pre-intervention questionnaire covering a period of 3 mo prior to enrolment. Participants were followed for 6 mo post- intervention. A childhood asthma severity (CHAS) scale was made and statistical analysis such as Wilcoxon rank sum tests and Mcnemar's test performed to validate the outcomes. Principal component analysis was performed to classify the participants having no, mild and severe symptoms. RESULTS: There was significant reduction in symptoms and need for medical care post-intervention. Mean of the respiratory symptom score decreased from 7.4 to 2.4 (p < 0.0001) and mean of the health care utilization score decreased from 4.1 to 1.7 (p < 0.0004) in the wilcoxon rank sum tests. Mcnemar's test was used for the analysis of individual item of the asthma symptoms. A significant reduction in wheeze and cough (p < 0.001), slowing down physical activity (p < 0.001), diurnal symptoms (p < 0.000), school absence (p < 0.000), rescue therapy requirement (p < 0.1) and hospitalization (p < 0.000) was seen. PCA was used successfully to classify the participants on the basis of their severity of asthma. CONCLUSIONS: Respiratory symptoms decreased significantly among asthmatic children following environmental interventions.