Effect of Meditation, Mindfulness-Based Stress Reduction, and Relaxation Techniques as Mind-Body Medicine Practices to Reduce Blood Pressure in Cardiac Patients: A Systematic Review and Meta-Analysis.

Elevated blood pressure is one of the major risk factors for cardiovascular diseases. Available evidence on mind-body medicine (MBM) techniques on blood pressure is inconclusive and provides conflicting results. The objective of the current systematic review and meta-analysis is to evaluate the effect of MBM techniques on blood pressure in patients with cardiovascular disease. Randomized control trials (RCTs) done between the years 2000 and 2020 on cardiovascular disease, using MBM techniques such as meditation, mindfulness-based stress reduction and relaxation techniques were searched through electronic databases such as PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), EMBASE and Cochrane Library. Three authors independently performed article selection, data extraction and validation. Meta-analysis was performed using a random effect model and standardized mean difference (SMD) with 95% confidence interval (CI) estimated for the effect size. Fifteen RCTs with 927 patients were included in the meta-analysis. Heterogeneity among the studies was very high for all analyses (I2>94%). For studies comparing systolic blood pressure, MBM interventions show a significant (p=0.01) effect when compared to conventional treatment, an overall estimated effect size of SMD - 0.78 (95% CI: -1.36, -0.20). For studies comparing the diastolic blood pressure, MBM intervention did not show any significant effect when compared to the conventional treatment, an overall effect size of SMD -0.26 (95% CI: -0.91, 0.39). The findings of the meta-analysis suggest that MBM interventions may improve systolic blood pressure alone in patients with cardiac diseases. With high heterogeneity and low quality of the included studies, more robust evidence is required before suggesting MBM as an effective treatment modality for reducing blood pressure in cardiovascular diseases.

Effect of massage on blood pressure in patients with hypertension: A meta-analysis.

BACKGROUND: Hypertension (HTN) is a chronic medical condition that affects 1.13 billion people globally. Successful management of HTN is accomplished through both pharmacological and non-pharmacological interventions. Massage therapy, a widely practiced complementary and alternative medicine therapy that alleviates physical discomfort and promotes overall well-being. The current meta-analysis aims to evaluate the effect of massage on blood pressure in patients with HTN. METHODS: Electronic databases, including PubMed, Prospero, Scopus, ClinicalTrials.gov, Embase, and the Cochrane Library, were searched from their inception up to March 2021. All experimental trials that met the (PICO) criteria were included. The primary outcome of the study was blood pressure. A meta-analysis was conducted using a random-effects model to generate a summary of treatment effects, expressed as the effect size (Standardized Mean Difference - SMD), along with a 95% Confidence Interval (CI). RESULTS: Six studies were included in the review, in which 290 patients participated, 148 were in the experimental group and 142 in the control group. Meta-analysis showed a minimal reduction of systolic blood pressure (SMD: -0.65 mmHg, 95% CI: -4.75, 3.55) and diastolic blood pressure (SMD: -0.68 mmHg, 95% CI: -2.43, 1.06) with considerable heterogeneity (I2> 94%). CONCLUSION: The findings demonstrated that massage therapy resulted in a minimal reduction in blood pressure among patients with hypertension. To suggest massage as an effective intervention to reduce blood pressure further randomized control trials are recommended. Additionally, the literature is limited and still emerging, further large prospective studies with long follow-ups are warranted to verify the findings from this meta-analysis.

Does hydrotherapy influence plasma glucose levels in type 2 diabetes? - A scoping review.

BACKGROUND: Hydrotherapy is a commonly used treatment modality to manage various conditions including diabetes in the Naturopathy system of medicine. The objective of the current scoping review is to find the effectiveness of hydrotherapy on plasma blood glucose levels in type 2 diabetes. CONTENT: Arksey and O'Malley's five-stage framework was adopted for this scoping review. The studies which used hydrotherapy intervention for the management of diabetes or the effect of hydrotherapy on plasma glucose levels were considered eligible. PubMed/MEDLINE, EMBASE, Cochrane library, and Google scholar were searched for English- language published articles till December 20, 2022. The following Medical Subject Headings (MeSH) and keyword search terms were used ("diabetes" OR "type 2 diabetes" OR "diabetes mellitus" OR "plasma glucose level") AND ("hydrotherapy" OR "water therapy" OR "balneotherapy"). Two investigators independently assessed the studies for inclusion. Review articles, abstracts, and articles including the aquatic exercises as interventions were excluded. SUMMARY: In total, six studies met the inclusion criteria. Out of six, two studies used hot therapies, two studies cold therapy, and the remaining two used both hot and cold as interventions. The study results showed that hydrotherapy can be used as an effective intervention tool for blood glucose levels in patients with type 2 diabetes. OUTLOOK: Integrating hydrotherapy treatments alongside conventional management can reduce blood glucose levels and thus reduce diabetes-related complications.

Effectiveness of antenatal yoga in reducing intensity of labour pain: A systematic review and meta-analysis.

Background: Yoga during pregnancy was found to be beneficial in various aspects of pregnancy including pain management during the time of labour. The current systematic review and meta-analysis aims to assess the effectiveness of antenatal yoga practices in reducing pain during the time of labour. Methods: We searched electronic databases such as PubMed, Embase, Cochrane Library, and Web of Science, till January 2023. Randomized controlled trials (RCTs) which measured the effects of antenatal yoga practices on pain management during labour were included. The main outcome was the pain intensity measured with any validated questionnaire. The methodological quality of included studies was evaluated by using a risk-of-bias assessment tool developed by the Cochrane Collaboration. For the effect size, standardized mean differences (SMDs) with a 95% confidence interval (CI) were generated with a random effect model using R software (version 4.2.2). Results: Eight studies including 576 antenatal women between the age of 14 and 40 years were included. Results of this meta-analysis showed that yoga is effective in reducing labour pain (SMD: -1.34 95% of CI: -1.86, -0.81) with significant heterogeneity among the studies (I2 73%, p < 0.0008). Conclusion: Antenatal yoga can be a promising intervention in the field of obstetrics to reduce the intensity of labour pain. However, we are still in need of RCT with a large sample size to confirm the reliability of the present meta-analysis.

Effect of platelet-rich fibrin on extraction socket healing in diabetic patients - A split-mouth crossover study: A prospective clinical trial.

Aims: The aim of this study is to evaluate the effectiveness of platelet-rich fibrin (PRF) in postextraction socket healing in diabetic patients. Subjects and Methods: The investigators implemented a randomized, split-mouth study in 100 Type 2 diabetic patients undergoing dental extraction of two or more teeth. Following extraction, the experimental socket was packed with PRF and sutured, while the control socket was sutured without packing. The primary outcome measures were soft-tissue healing (assessed by color, bleeding on palpation, granulation tissue, and incidence of suppuration and dry socket), hard-tissue healing (measured by visual interpretation, area of bone coverage, and grayscale analysis), and visual pain scores. Statistical Analysis: Statistical analysis was done using the independent and paired t-tests, analysis of variance, and Chi-square test. Results: Both soft-tissue healing and hard-tissue healing were significantly better in the experimental socket as compared to the control socket. Pain levels, as measured by the visual analog score, were similar in both the extraction sockets. Conclusions: The use of PRF has beneficial effects in extraction socket healing in diabetic patients.

Development and validation of a formula for objective assessment of cervical vertebral bone age.

BACKGROUND AND AIM: Determination of skeletal maturity and bone age from cervical vertebrae has been well documented. Most methods described use subjective evaluation of morphological characteristics of cervical vertebrae and may be prone to variability and error. A few objective methods have also been developed, specific for certain populations and genders. The aim of this study was to establish and validate an objective method to determine cervical vertebral bone age from lateral cephalometric radiographs, for Asian South Indian patients of both genders. METHODS: Ninety boys and 90 girls between 9 and 15 years of age were recruited, and their lateral cephalograms were taken. Using measurements made from the third and fourth cervical vertebrae, a formula to determine cervical vertebral bone age was derived using stepwise regression analysis. To validate the formula, a separate sample of 30 boys and 30 girls was chosen, and hand-wrist radiographs and lateral cephalograms were obtained. Cervical vertebral bone age (CVBA) was determined by applying the formula derived. Bone age was also calculated using the Tanner-Whitehouse 3 method. The bone ages determined by both methods were compared to each other and chronological age, using one-way ANOVA, Tukey's post hoc analysis, and Pearson's correlation coefficient. RESULTS: The formulae derived in the current study to determine CVBA differed for both genders. No statistically significant difference was found between CVBA, bone age derived by the Tanner-Whitehouse 3 method, and chronological age for both boys (p value = 0.425) and girls (p value = 0.995). A moderate to strong positive correlation was found between CVBA, bone age, and chronological age. CONCLUSION: The formulae derived in this study were validated and are reliable for objectively determining cervical vertebral bone age and skeletal maturation from lateral cephalograms for Asian South Indian patients of both genders.

Rhinocerebral Mucormycosis: A Prospective Analysis of an Effective Treatment Protocol.

OBJECTIVE: The objective of this study was to prospectively analyze the effectiveness of a treatment protocol in patients diagnosed with rhinocerebral mucormycosis. MATERIALS AND METHODS: This series included ten patients who reported with suspicious clinical signs of mucormycosis. The diagnosis was established by histopathology, and computed tomography imaging was used to assess the extent of spread. All patients were treated with immediate radical surgical debridement and antifungal chemotherapy with amphotericin B. Simultaneous correction of the underlying immunosuppressive condition was carried out. The primary outcome assessed was disease-free survival, and the patients were followed up for up to 6 months after discharge. RESULTS: In this series, the cause of immunosuppression was uncontrolled diabetes mellitus in all patients. All the patients responded to the treatment protocol and were free of the disease up to 6 months of follow-up. CONCLUSION: Mucormycosis is an invasive and potentially fatal disease. Prognosis can be improved by early recognition and prompt treatment with aggressive resection, intravenous amphotericin B, and control of the patient's underlying systemic condition.

Is the Vazirani-Akinosi Nerve Block a Better Technique Than the Conventional Inferior Alveolar Nerve Block for Beginners?

PURPOSE: This study was performed to compare the efficacy and comfort of the inferior alveolar nerve (IAN) block and the Vazirani-Akinosi (VA) nerve block when administered by dental trainees. MATERIALS AND METHODS: In this prospective, randomized controlled trial, patients requiring extraction of mandibular teeth received either the conventional IAN block (IAN group) or VA nerve block (VA group). Objective parameters evaluated included ease of locating landmarks, incidence of positive aspiration, and failure rate. Patient comfort during injection was assessed with a visual analog scale. Statistical analysis was performed with the unpaired t test and Fisher exact test. RESULTS: One hundred patients were included in each group. Landmarks were easier to locate in the VA group. The incidence of positive aspiration was higher in the IAN group (0.08%) than in the VA group (0.01%, P < .05). The incidence of failed blocks was higher in the IAN group than in the VA group. Patients appeared to experience less pain with the VA injection than with the IAN injection. CONCLUSIONS: This study showed that the dental trainees found the VA technique more straightforward to perform. It had a higher success rate and lower incidence of positive aspiration and was more comfortable for patients than the conventional IAN block.

Zygomatic Hypoplasia in Patients with Non-syndromic Cleft Lip and Palate: A Case-Control Study.

BACKGROUND: Patients operated for cleft deformities may have zygomatic hypoplasia secondary to impaired growth of the maxilla. This has, however, not been evaluated in the past. SUBJECTS AND METHODS: This study was a prospective, case-control study. This included 32 patients, aged between 19 and 25 years, who were divided into cleft and non-cleft groups. The cleft group was further divided into unilateral clefts, bilateral clefts and isolated palatal clefts. In both groups, the zygoma was assessed and compared on both sides clinically using indirect photogrammetry and radiographically using 3D CT. The results were analyzed statistically using the unpaired t test. RESULTS: There was a significant difference in the zygomatic projection on cleft and non-cleft sides in the unilateral cleft group. There was no significant difference in the zygomatic projection of both sides in the other subgroups and the control group. CONCLUSION: The present study shows that there is a global effect of palato-alveolar cleft repair on the midfacial skeleton. Further studies are required to correlate the impact of age, gender and the technique of palato-alveolar cleft repair with the quantum of malar hypoplasia.

Comparison of the efficacy of venous coupler and hand-sewn anastomosis in maxillofacial reconstruction using microvascular fibula free flaps: a prospective randomized controlled trial.

The venous coupler has emerged as a suitable alternative to hand suturing in the microvascular anastomosis of blood vessels; however, no prospective comparative studies have been performed to date. The aim of this study was to prospectively compare the efficacy of venous anastomosis using a coupler device with hand-sewn anastomosis during reconstruction surgery for maxillofacial defects. A prospective, randomized controlled trial was conducted. Group A patients (n=60) underwent microvascular anastomosis using a venous coupler and group B patients (n=64) with conventional sutures. The primary outcome measure was the incidence of flap thrombosis. Secondary measures included the flap outcome. The mean time taken to complete the anastomosis was 7.9min in group A and 18.5min in group B; this difference was statistically significant. The incidence of venous thrombosis was 1.7% in group A and 7.8% in group B; this difference was not statistically significant. While the time taken to complete the anastomosis is shortened using the coupler device, the clinical outcome remains the same with both techniques. The two techniques would work equally well in the hands of an experienced surgeon, and the cost versus benefit must be determined for each patient.

End Stage Renal Disease: Not a Contraindication for Minor Oral Surgery-Protocol for the Management of Oral Surgery patients with ESRD on Hemodialysis.

OBJECTIVE: To describe a safe and effective protocol for the management of patients with end stage renal disease (ESRD) undergoing minor oral surgery. SUBJECTS AND METHODS: A prospective cohort study was conducted on all patients with ESRD who were referred for dental consultation. A definite protocol was designed in consultation with the nephrologist to minimize the risk of bleeding and wound healing complications during and after the minor surgical procedures. 36 patients consented for the protocol to be followed while 4 patients did not comply with the protocol and in 2 cases the protocol could be followed. The intra operative, post operative bleeding, and the wound healing were assessed in these patients. RESULTS: 36 patients had uneventful extractions as the blood pressure was brought down to pre hypertensive stage following the protocol. 4 patients who did not comply with the protocol had episodes of bleeding in the post operative period. There were two special scenarios where additional precautions had to be taken have been discussed. The wound healing was satisfactory in all these patients. CONCLUSION: The protocol discussed in this article helps us provide safe minor oral surgical treatment in patients with ESRD.

Small cell neuroendocrine carcinoma of the paranasal sinus.

Small cell neuroendocrine carcinoma (SNEC) is an uncommon tumor. This tumor usually occurs in the lungs, the extra-pulmonary form accounts for only about 4% of all cases. Primary SNEC of the paranasal sinuses is extremely rare; only about 76 cases have been reported in literature. Unfortunately due to the rarity of this neoplasm, there are no specific recommendations pertaining to the management, treatment options are generally extrapolated from similar tumors of pulmonary origin. While Surgery was used in the past, upfront chemoradiation now seems to be evolving as the treatment of choice. We report a case of sinonasal SNEC who had undergone definitive concurrent chemoradiation and is currently disease-free for close to 2 years. The clinical presentation, imaging studies, histopathological diagnosis with immunohistochemistry correlation, management protocols, and a brief review of literature of this rare tumor is discussed.

Transmasseteric anterior parotid approach for condylar fractures: experience of 129 cases.

We have evaluated the transmasseteric anterior parotid (TMAP) approach in the treatment of 163 condylar fractures in 129 patients. Ninety-five patients presented with unilateral, and 34 with bilateral, fractures. The inclusion criteria were patient's choice for open reduction and internal fixation, displaced unilateral condylar fractures with occlusal derangement, and displaced bilateral condylar fractures with anterior open bite. Mean (SD) maximum interincisal opening after 3 months was 44(5)mm. There were no differences in lateral movements during the reviews 6 weeks and 3 months postoperatively. Protrusive movement at the end of 3 months was 7(2)mm. All patients achieved functional occlusion identical to the pretraumatic occlusion and good reduction of the condyles. No patient developed temporary or permanent facial palsy, sialocele, salivary fistula, or Frey syndrome. The mean (SD) operating time was 46(11)min. The TMAP approach avoids the complications of incision of the parotid gland, minimises the risk of facial nerve palsy, and offers excellent access to the fractured condyle.

Effectiveness of postoperative antibiotics in orthognathic surgery: a meta-analysis.

PURPOSE: To conduct a systematic review of published clinical trials on the effectiveness of extended postoperative antibiotics in orthognathic surgery. MATERIALS AND METHODS: Electronic databases were searched for randomized clinical trials. Data from relevant articles were extracted and assessed. The primary outcome variable was surgical site infection. Extracted data were analyzed using a meta-analytical program with a random effects model. RESULTS: In total 532 patients were assessed in 8 clinical trials. Wound infection occurred in 30 of 268 patients in the short-term prophylaxis group (frequency, 11.2%) and in 10 of 264 patients in the extended-term group (frequency, 3.8%). Extended antibiotic therapy was more effective in decreasing the risk of postoperative wound infection (odds ratio, 3.2; number needed to treat, 13.5). CONCLUSION: Extended postoperative antibiotic treatment does have a place in decreasing the risk of postoperative wound infection in orthognathic surgery. More trials are needed to standardize a proper regimen.