Global variations in eruption chronology of permanent teeth: A systematic review and meta-analysis.

OBJECTIVES: Population-based variations have been reported in permanent teeth eruption but only sparse literature exists on the same. A systematic review and meta-analysis were performed to assess the global variations in eruption chronology of permanent teeth in children and adolescents and the role of sexes, jaws and classes of socio-economic status (SES) on timing of eruption was explored. METHODS: The protocol for the systematic review was registered in PROSPERO. An extensive search of PubMed, EMBASE, Google Scholar, EBSCO, Cochrane library, and anthropology databases was carried out until April 2023. Additionally, grey literature search and hand-searching of relevant key journals was done. RESULTS: Overall, 3797 cross-sectional and longitudinal studies were retrieved from multiple databases. A total of 939, 191 participants were included from 80 studies of which, 41 were carried out in Asia, 26 in Europe, 5 in Africa, 4 in North America, and 4 in Oceania. The mandibular first molar eruption was found to be as early as 4.09 years while the maxillary second molar erupted as late as 13.45 years. Using a random effects model, 28 forest plots were generated. Meta-regression interpreted tooth eruption to be earlier in females and in the mandible. CONCLUSIONS: The findings of this study show that the ages of permanent teeth eruption was advanced in the European population followed by Africa and Asia.

Global variations in eruption chronology of primary teeth: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to assess global variations in the eruption chronology of primary teeth in children and the role of sexes, jaws, and socio-economic status on eruption timing. DESIGN: An extensive search of electronic databases, grey literature, and hand-searching was carried out until April 2023 RESULTS: A total of 42,109 children, with an age range of 0-83 months were included from 42 studies (22 in Asia, 7 in Europe, 5 in Africa, 4 in North America, 3 in Oceania and 1 in South America). The mandibular central incisor was the first tooth to erupt at 6 months in North America and 13.5 months in Asia while the mandibular second molar erupted at 20.1 months in Europe and 29 months in South America. CONCLUSIONS: The age of primary teeth eruption was advanced in the European population followed by North America, Africa, Oceania, and Asia while it was delayed in the South American population. Meta-analysis showed that tooth eruption was earlier in the left quadrant than the right but the role of other factors (sexes, jaws, and socio-economic status) was insignificant. Population-specific data on primary teeth emergence may serve as a baseline for future research. In clinical practice, these population-based eruption charts can serve as a valuable asset for diagnosis and treatment planning in children.

Current status of nitrous oxide use in pediatric patients.

Nitrous oxide is one of the most commonly used inhalational anesthetic agents used in practice. It is a cost-effective, pleasant, safe, and versatile anesthetic agent with many desirable properties like good quality analgesia, decreased awareness, accelerated induction and recovery from anesthesia, and reduced utilization of other expensive inhalational agents with potential cost savings. The use of nitrous oxide has been questioned by a lot of studies and case reports perceiving its adverse systemic, hematological, immune, and neurologic adverse effects. However, the literature in the recent past has tried to resolve the controversies related to its use. The concerns over an increase in cardiovascular complications and mortality following nitrous oxide use have been negated by recent data. However, its use in certain vulnerable populations like children with cobalamin and folate deficiency or defects in their metabolic pathways remains a cause of concern for its toxic effects. In this narrative review, we aim to discuss the pharmacological properties of nitrous oxide, the potential advantages and drawbacks of the use of nitrous oxide in children, address the neurodevelopmental and other systemic effects, and throw light on the evidence regarding the safety of nitrous oxide use and its current role in pediatric procedural sedation and anesthesia practice. The literature related to its use in the pediatric population for painful procedures and surgeries has been summarized.

Evaluating the Impact of Intraoperative MRI in Neuro-Oncology by Scientometric Analysis.

(1) Objective-Intraoperative Magnetic Resonance Imaging (IOMRI) guided surgery has revolutionized neurosurgery and has especially impacted the field of Neuro-Oncology, with randomized controlled trails demonstrating improved resection, fewer postoperative deficits and enhanced survival rates. Bibliometric analysis allows for analysing chronological trends and measuring the impact and directions of research in a particular field. To the authors' knowledge, this is the first Bibliometric analysis conducted on IOMRI. (2) Methods-a title specific search of the Web of Science database was executed using the keywords 'intraoperative MRI', 'intraoperative magnetic resonance imaging', and "IOMRI' on 23rd April 2021. Results-663 articles met the inclusion criteria and were included in the final analysis. In addition, the 100 most cited were analysed as well. Among these 100 articles, 76 were original research papers, while 14 others were review articles. Amongst all the authors, Ganslandt contributed the maximum number of articles, with USA being the largest single source of these articles, followed by Germany. Interestingly, a shift of trends from "Image guided surgery' and 'accuracy' in the early 2000s to 'extent of resection', 'impact', and 'survival' in the later years was noted. (3) Conclusions-IOMRI has now become an integral part of neurosurgery, especially in neuro-oncology. Focus has now shifted from implementation to refinement of technique in the form of functional and oncological outcomes. Therefore, future research in this direction is imperative and will be of more impact that in any other sub-field related to IOMRI.

Virtual Reality in Neurosurgery: Beyond Neurosurgical Planning.

BACKGROUND: While several publications have focused on the intuitive role of augmented reality (AR) and virtual reality (VR) in neurosurgical planning, the aim of this review was to explore other avenues, where these technologies have significant utility and applicability. METHODS: This review was conducted by searching PubMed, PubMed Central, Google Scholar, the Scopus database, the Web of Science Core Collection database, and the SciELO citation index, from 1989-2021. An example of a search strategy used in PubMed Central is: "Virtual reality" [All Fields] AND ("neurosurgical procedures" [MeSH Terms] OR ("neurosurgical" [All Fields] AND "procedures" [All Fields]) OR "neurosurgical procedures" [All Fields] OR "neurosurgery" [All Fields] OR "neurosurgery" [MeSH Terms]). Using this search strategy, we identified 487 (PubMed), 1097 (PubMed Central), and 275 citations (Web of Science Core Collection database). RESULTS: Articles were found and reviewed showing numerous applications of VR/AR in neurosurgery. These applications included their utility as a supplement and augment for neuronavigation in the fields of diagnosis for complex vascular interventions, spine deformity correction, resident training, procedural practice, pain management, and rehabilitation of neurosurgical patients. These technologies have also shown promise in other area of neurosurgery, such as consent taking, training of ancillary personnel, and improving patient comfort during procedures, as well as a tool for training neurosurgeons in other advancements in the field, such as robotic neurosurgery. CONCLUSIONS: We present the first review of the immense possibilities of VR in neurosurgery, beyond merely planning for surgical procedures. The importance of VR and AR, especially in "social distancing" in neurosurgery training, for economically disadvantaged sections, for prevention of medicolegal claims and in pain management and rehabilitation, is promising and warrants further research.

A Comparative Scientometric Analysis of the 100 Most Cited Articles of Acta Neurochirurgica (Wien) and World Neurosurgery.

BACKGROUND: Acta Neurochirurgica (ANCH) and World Neurosurgery (WN), are 2 journals of significant importance in the neurosurgical community and have been associated with international federations. These journals carry a similar impact factor. The difference is the years they have been active (ANCH starting publication in 1973 and WN in 2010). This factor allows for a unique opportunity to delve deep into comparative, scientometric parameters, to understand the evolution of neurosurgical research. METHODS: A title-specific search of the Web of Science database using the keywords "Acta Neurochirurgica," "Acta," "Neurochirurgica," "World Neurosurgery," "World," and "Neurosurgery" was performed and arranged according to number of citations. The title of the articles, authors, corresponding authors, country of origin, journal of publication, year of publication, citation count. and journal impact factor were assessed. RESULTS: The average citation for ANCH was 170.1 citations, most being original articles (83/100). The articles of WN garnered nearly 70.48 citations, averaging 8.3 citations per publication. Most corresponding authors in ANCH originated from Germany with neuro-oncology, followed by neurotrauma and vascular as subjects. In contrast, the United States followed by China were the most common countries of origin for WN, with endoscopy and skull base being the topics achieving high impact. CONCLUSIONS: Neurotrauma and consensus guidelines have been shown to have maximal citations for ANCH whereas endoscopy and skull base lesions garnered the most for WN. Author subspecialization and increased collaboration across specialties with more articles on refinement of technique and outcome have emerged as recent trends.

Mycoplasma pneumoniae co-infection with SARS-CoV-2: A case report.

We report co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Mycoplasma pneumoniae in a patient with pneumonia in India. Atypical bacterial pathogens causing community-acquired pneumonia may share similar clinical presentations and radiographic features with SARS-CoV-2 making a thorough differential diagnosis essential. The co-infection of SARS-CoV-2 and M. pneumoniae is infrequently reported in the literature. Broader testing for common respiratory pathogens should be performed in severe COVID-19 cases to rule out other concurrent infections. Early identification of co-existing respiratory pathogens could provide pathogen-directed therapy, and can save patient lives during the ongoing COVID-19 outbreak.

Development of in-bore magnetostrictive transducer for ultrasonic guided wave based-inspection of steam generator tubes of PFBR.

An in-bore magnetostrictive transducer is designed for the steam generator tubes of Prototype fast breeder reactor for the generation of L(0,2) modes of frequencies in the range of 250-350 kHz. Towards this, axi-symmetric finite element models are developed to optimize the coil parameters. The optimized length of the transmitter and the receiver coils turns out to be 10 mm (~half the wavelength) for the frequency of 300 kHz. The optimized width of the coils turns out to be 0.46 mm. FE models also show the generation, propagation and reception of L(0,2) modes in the frequency range of 250-350 kHz. The role of skin effect in the magnetostrictive based-generation of L(0,2) modes with frequency is also discussed. A transducer is designed based on the FE results. The transducer is tested for the generation of L(0,2) mode in the frequency range of 250-350 kHz in a 1 m long steam generator tube segment. A good agreement is observed between FE and experimental normalized amplitudes and the times of flight for different frequencies. L(0,2) modes are found to generate and propagate and received, as predicted by the finite element simulations. An excellent agreement is observed between the experimentally measured group velocities with those obtained from the dispersion curves in this frequency range. Experiments show the signal to noise ratio to be better than 15 dB. To ascertain the utility of the transducer in steam generator tubes for the long range testing, L(0,2) mode at 300 kHz frequency is propagated in a 1.5 m long tube. The resulted multiple end reflections amount to the propagation of 51 m distance. To check the capability of detection of defects, a short tube with a full circumferential defect of depth 0.46 mm (20%WT) and a short tube with a pin hole of 1.5 mm diameter are considered. Further, FE results for the case of the axi-symmetric circumferential defect are validated experimentally. For the case of the pinhole (non-axi-symmetric), the experimental signal to noise ratio turns out to be 6 dB, which is only 6 dB lower as compared to that obtained using a piezo based ultrasonic transducer of frequency 300 kHz coupled to the end of the tube.

Pneumothorax following serratus anterior plane block.

Serratus anterior plane blocks may provide analgesia for rib fractures, thoracic surgery and breast surgery. There remains uncertainty regarding the location of injection, be it superficial or deep to the serratus anterior muscle. We describe the case of a 63-year-old ASA physical status 3 woman undergoing a wire-guided wide local excision of a right breast lump. A modified right serratus anterior plane block was performed under ultrasound guidance, injecting 20 ml of bupivacaine 0.25% deep to the serratus anterior muscle. No immediate complications were noted. Intra-operatively the patient developed arterial desaturation associated with high airway pressures. A subsequent chest radiograph in the post-anaesthetic care unit demonstrated a large right-sided pneumothorax which was treated with immediate needle decompression and chest drain insertion. This is the first case of pneumothorax reported from this approach to serratus anterior plane blockade and serves as a reminder of a potential serious complication.

Permanent Anterior Teeth Fractures and its Impact on Oral Health-Related Quality of Life among 8-15-Year-Old Schoolchildren of Chennai City - A Cross-Sectional Survey.

BACKGROUND: Tooth fracture is not only a distressing experience on the physical level of a child, but it may also have an effect on emotional and psychological levels. This study aims to assess the permanent anterior teeth fractures and their impact on Oral Health-Related Quality of Life (OHRQoL) among 8-15-year-old schoolchildren of Chennai city. MATERIALS AND METHODS: Thirty schools were randomly selected by stratified random sampling. All school-going children aged 8-15 years were invited to participate. A total of 7247 children were screened and 628 children with permanent anterior teeth fractures were included. Data were collected using Child Oral Health Impact Profile questionnaire. In addition, questionnaire addressing sociodemographic data and factors influencing permanent anterior teeth fractures were recorded. Descriptive statistics was performed to characterize the sample. One-way analysis of variance and Tukey's honestly significant difference post hoc tests was applied for multiple pair-wise comparisons. RESULTS: The prevalence of permanent anterior teeth fracture was found to be 8.7%. The type of school had highly significant (P < 0.001) influence on the impact of permanent anterior teeth fracture on OHRQoL with negative OHRQoL among the corporation schools. The study participants of corporation schools had negative OHRQoL with significant difference in oral health well-being (P < 0.001) and self-image (P = 0.014). CONCLUSION: All the children reporting with tooth fractures had negative OHRQoL. The study stresses the importance of promoting good oral health-care practices to prevent oral disease in children and to meet children's unmet oral health-care needs.

Laparoscopic Puestow Procedure for Chronic Pancreatitis in Children.

Chronic pancreatitis (CP) is a sequelae characterized by recurrent attacks of pancreatitis leading on to fibrosis and calcification of both ductal and parenchymal elements of the pancreas. Most of these, if left untreated at the right time, will lead on to burnt-out pancreas with complete atrophy of the parenchyma, leading on to endocrine/exocrine insufficiency. The pain in such patients is most likely due to ductal hypertension, parenchymal hypertension, and head mass causing perineural inflammation. Puestow procedure (longitudinal pancreaticojejunostomy) is the surgery of choice in selected patients with ductal hypertension where decompression of the duct provides symptomatic relief. Performance of such procedures in children by minimal access laparoscopic method is still evolving. We report a series of three patients (aged 10, 12, and 16 years) diagnosed with CP and successfully managed by laparoscopic Puestow procedure.

Association of COL1A2 (PvuII) gene polymorphism with risk and severity of dental fluorosis - A case control study.

INTRODUCTION: Dental fluorosis is a foremost public health problem in many countries, including India. Very few studies investigated gene polymorphism and risk of dental fluorosis. Genetic polymorphisms in Collagen Type I, alpha 2 (COL1A2) gene, found to be linked with bone pathogenesis, may affect the tooth formation resulting in the vulnerability to dental fluorosis. AIM: To assess the association between COL1A2 (PvuII) gene polymorphism and risk as well as severity of dental fluorosis. METHODS: The present case control study was conducted among participants with (n = 60) and without (n = 60) dental fluorosis. Dental fluorosis was assessed using Modified Dean's fluorosis index (1942). The PvuII polymorphisms (in exon 25) inside the COL1A2 gene were genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) procedure. Statistical analysis were carried out with Chi-square test and Odds Ratio (OR) was determined with multivariate logistic regression analysis. RESULTS: The genetic polymorphism in COL1A2 PvuII was found to be associated with the risk of dental fluorosis which was highly significant (p < 0.001). The odds ratio was 31.4 times [OR = 31.9, 95% CI: 3.9-48.7] higher for the homozygous PP genotype group and 4.0 times [OR = 4.0, 95% CI: 1.0-10.7] higher for the heterozygous Pp genotype. CONCLUSION: Genetic polymorphism of COL1A2 was found to be associated with dental fluorosis. The present study provides an insight for identification of the population who may subsist at risk of developing dental fluorosis in their later life.

Development of ultrasonic guided wave inspection methodology for steam generator tubes of prototype fast breeder reactor.

An ultrasonic guided wave based methodology is developed for inspection of steam generator tubes of the prototype fast breeder reactor. To this aim, axisymmetric longitudinal mode (L(0,2)) at the frequency of 250 kHz is optimized using 3D-finite element simulation and experiments. The group velocity of mode L(0,2) at 250 kHz is found to be 5387 m/s. First, the long range propagation of the L(0,2) mode at 250 kHz is examined and the mode is found to propagate over a distance of 45.6 m with a sufficiently good SNR. Secondly, the detection of multiple defects such as circumferential, axial, partial-pinholes and tapered defects lying in the same line of sight is investigated using 3D-finite element simulation and the results obtained are validated experimentally for the first three cases. The sensitivities achieved are 0.23 mm depth (10%WT) for circumferential, axial and tapered defects and for partial-pinholes: 1 mm diameter and 1.38 mm depth (60%WT). Thirdly, 3D-FE simulations with ID and OD pinhole defects are performed which show that the ID and OD defects are detected by L(0,2) with a fairly similar sensitivity. Finally, study on the thermal expansion bend (with three successive bends) shows that the bend does not have much influence on the mode and the multiple circumferential defects considered in the bend are detected with good sensitivity.

Poly-4-Hydroxybutyrate (P4HB) Scaffold Internal Support: Preliminary Experience with Direct Implant Opposition During Complex Breast Revisions.

BACKGROUND: The GalaFLEX scaffold is a mesh composed of resorbable poly-4-hydroxybutyrate (P4HB) monofilament fibers that aids in providing immediate internal soft tissue support, similar to that offered by an underwire bra, after breast reduction, lift, or augmentation. OBJECTIVES: Our goal was to explore the possibility of using GalaFLEX as an internal support to prevent future sagging, predominantly in the lower pole of the breast. This preliminary study investigated GalaFLEX as a direct alternative to implants in a variety of complex revisional breast cases. Our intention was to establish a safety and efficacy profile in an effort to promote further investigation. METHODS: A retrospective case series of 5 patients over 2 years were evaluated. Inclusion criteria were capsular contracture with concerns over soft tissue coverage and future ptosis, along with complicated muscle coverage deficits secondary to plane switching. RESULTS: A retrospective review of photographs taken at the most recent follow-up consistently showed retention of implant position and soft implants. Additionally, patients presented with a mean ± SD Baker Grade Contraction score of 2.8 ± 0.9189 preoperatively compared with a score of 1 ± 0 postoperatively. CONCLUSIONS: This preliminary study shows the initial safety of GalaFLEX but indicates the need for a multicenter, exhaustive study. Its versatility for complex revisional cases combined with acceptable aesthetic outcomes makes GalaFLEX an invaluable tool for plastic surgeons to consider.

A porcine-cholecyst-derived scaffold for treating full thickness lacerated skin wounds in dogs.

In regenerative medicine, despite the chances of graft-rejection, scaffolds prepared from extracellular matrices of various mammalian organs/tissues are widely used. Graft-assisted healing of full thickness skin-wounds is a major use of these bioscaffolds. Therefore, considering its prospective clinical use as a wound healing matrix, this study evaluated the healing potential of porcine cholecyst-derived scaffold (CDS) prepared by a non-detergent/enzymatic method for treating naturally occurring full thickness lacerated wounds in dogs. The CDS caused, in comparison with a commercial-grade bioscaffold prepared out of bovine dermal collagen (BDC), faster healing with respect to the wound healing parameters like peripheral tissue oedema, necrosis (amount and type), indurations, granulation tissue formation and the extent of re-epithelialisation. After 28 days of the treatment, the wound area (mean + SE) reduced from 27.60 ± 8.96 cm2 to 0.19+ 0.18 cm2 and 21.39 ± 5.48 to 6.59 ± 2.60 cm2 in CDS and BDC treated animals, with a reduction in wound sizes by 98.95 ± 2.09% and 54.53 ± 15.90 respectively. By this time, complete wound healing was observed in at least 75% of the former and 25% of the later groups. The CDS was deemed as a candidate bioscaffold for treating full thickness lacerated skin wounds in dogs.

Extended Release Liposomal Bupivacaine Injection (Exparel) for Early Postoperative Pain Control Following Palatoplasty.

INTRODUCTION: Liposomal bupivacaine (LB) is a long-acting local anesthetic reported to decrease postoperative pain in adults. The authors demonstrate the safe use of LB in pediatric patients with improved pain control following palatoplasty. MATERIALS AND METHODS: Retrospective patient series of all single-surgeon palatoplasty patients treated at a tertiary craniofacial center from August 2014 to December 2015 were included. All patients received 1.3% LB intraoperatively as greater palatal nerve and surgical field blocks in 2-flap V-Y pushback palatoplasty. Postoperative oral intake, opioids administered, duration of hospitalization, and FLACC (face, legs, activity, cry, consolability) pain scores were measured. RESULTS: Twenty-seven patients (16 males and 11 females, average age of 10.8 months, weight 8.8 kg) received 2.9 ±â€Š0.9 mL (2.6 ±â€Š1.9 mg/kg) 1.3% LB. Average FLACC scores were 2.4 ±â€Š2.2/10 in the postanesthesia care unit and 3.8 ±â€Š1.8/10 while inpatients. Oral intake was first tolerated 10.3 ±â€Š11.5 hours postoperatively and tolerated 496.4 ±â€Š354.2 mL orally in the first 24 hours postoperatively. Patients received 8.5 ±â€Š8.4 mg hydrocodone equivalents (0.46 ±â€Š0.45 mg/kg per d hydrocodone equivalents) and were discharged 2.1 ±â€Š1.3 days postoperatively. Opioid-related adverse events included emesis in 7.4% and pruritis in 3.7% of patients. CONCLUSIONS: The LB may be used safely in pediatric patients. Intraoperative injection of LB during palatoplasty can yield low postoperative opioid use and an early and adequate volume of oral intake over an average hospital stay. Further cost-efficacy studies of LB are needed to assess its value in pediatric plastic surgery.