Comparison of Magnesium Pre-treatment With Two Different Doses of Rocuronium in Rapid Sequence Intubation: A Randomized Controlled Trial.

Introduction Magnesium is recognized for its ability to reduce the onset time of rocuronium while simultaneously extending its duration of action. This study aims to assess the efficacy of magnesium pre-treatment in decreasing the onset time with two different doses of rocuronium in patients undergoing rapid sequence intubation. Materials and methods This randomized prospective double-blind clinical study involved 50 patients classified as American Society Of Anesthesiologists (ASA) I/II, with no preoperative indications of difficult intubation, undergoing elective surgery under general anesthesia. The patients were divided into two groups: group A received 60 mg/kg of magnesium 15 minutes before intubation with 1.2 mg/kg of rocuronium, and group B received 60 mg/kg of magnesium before 0.6 mg/kg of rocuronium. Intubating conditions were assessed and graded at loss of last twitch after administration in both groups, considering ease of intubation, vocal cord position, and response to the insertion of the tracheal tube. Simultaneously, hemodynamic variations were recorded just before intubation, at one minute and five minutes post-intubation. Results Intubating conditions with 0.6 mg/kg of rocuronium were comparable or equally good compared to 1.2 mg/kg of rocuronium with magnesium pre-treatment. Conclusions Magnesium pre-treatment enhances the neuromuscular blocking effect of rocuronium, reducing its onset time without clinically significant prolongation of the duration of the block.

Comparative assessment of cephalometric with its analogous photographic variables.

Objective: The purpose of this study was to evaluate the accuracy of photographic measurements and compare it with its analogous cephalometric variables. Materials and Methods: Lateral cephalograms and standardized facial profile photographs were obtained from a sample of 120 subjects (92 females, 28 males; age 12-22 years with mean age of 17.5 years). A total of 4 linear and 7 angular measurements along with 3 ratios analogous to one another were measured on both. Descriptive statistics for all measurements were computed. Pearson's correlation coefficients were computed between analogous measurements, and regression analysis was done for each variable measured on the photograph to accurately predict the cephalometric variable. Results: The reliability of the standardized photographic technique was satisfactory. Most photographic measurements showed highly significant correlations (P < 0.001) with cephalometric variables. Among all measurements used, the A'N'B' angle was the most effective in explaining the variability of its analogous cephalometric (r2= 0.35). The Frankfort-mandibular plane angle' angle showed best results for vertical assessment (r2= 0.81) along with anterior face height (AFH) and lower anterior facial height (r2= 0.859) and ratio lower posterior facial height/AFH (r2= 0.702). Conclusions: Although we cannot rule out lateral cephalogram as the primary record in orthodontics, photographic assessment can always be used through proper standardization, as an alternative diagnostic aid, and also for large-scale epidemiological purposes and places with unavailability of cephalostat.

Effectiveness of virtual training for medical officers and community health officers in the critical care management of COVID-19 patients in the intensive care unit.

BACKGROUND AND AIMS: The coronavirus disease -19 has changed various aspects of education and training in all fields, and e-learning has now become the preferred mode of training and teaching. The aim of this study was to assess the impact of online training and to overcome the limitations of e-learning. METHODS: A total of 176 medical officers (MOs) and 720 community health officers (CHOs) were trained in four batches by using seven training modules with online videos and lecture series. Each batch received two days of training. A pre-test and post-test were conducted which consisted of 25 multiple-choice questions of 4 marks each. There was no negative marking. Candidates obtaining >80 marks were declared as having passed. The results of the pre-test and post-tests were compared. RESULTS: There was remarkable improvement in the knowledge regarding critical care management after virtual training, as evidenced by the test results. None of the MOs scored more than 80% in the pre-test; however, 153 MOs scored more than 80% in the post-test. The average score improved from 47.82 (pre-test) to 89.05 (post-test). The difference was statically significant (P < 0.0001). Similarly, 123 CHOs scored more than 80% in the pre-test, while 378 CHOs scored more than 80% in the post-test. Improvement in average marks was also seen: 90.5 in the post-test as compared to 62.76 in the pre-test. The difference was statically significant (P < 0.0001). CONCLUSION: Online training is beneficial for many candidates from various locations within a short period. The interactive sessions after training are also helpful, and well-designed pre- and post-tests are adequate for assessment.

A Multicentric, Randomized, Controlled Phase III Study of Centhaquine (Lyfaquin®) as a Resuscitative Agent in Hypovolemic Shock Patients.

INTRODUCTION: Centhaquine (Lyfaquin®) showed significant safety and efficacy in preclinical and clinical phase I and II studies. METHODS: A prospective, multicentric, randomized phase III study was conducted in patients with hypovolemic shock, systolic blood pressure (SBP) ≤ 90 mmHg, and blood lactate levels ≥ 2 mmol/L. Patients were randomized in a 2:1 ratio to the centhaquine group (n = 71) or the control (saline) group (n = 34). Every patient received standard of care (SOC) and was followed for 28 days. The study drug (normal saline or centhaquine 0.01 mg/kg) was administered in 100 mL of normal saline infusion over 1 h. The primary objectives were to determine changes (mean through 48 h) in SBP, diastolic blood pressure (DBP), blood lactate levels, and base deficit. The secondary objectives included the amount of fluids, blood products, and vasopressors administered in the first 48 h, duration of hospital stay, time in intensive care units, time on ventilator support, change in acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), and the proportion of patients with 28-day all-cause mortality. RESULTS: The demographics of patients and baseline vitals in both groups were comparable. The cause of hypovolemic shock was trauma in 29.4 and 47.1% of control group and centhaquine group patients, respectively, and gastroenteritis in 44.1 and 29.4%, respectively. Shock index (SI) and quick sequential organ failure assessment at baseline were similar in the two groups. An equal amount of fluids and blood products were administered in both groups during the first 48 h of resuscitation. A lesser amount of vasopressors was needed in the first 48 h of resuscitation in the centhaquine group. An increase in SBP from baseline was consistently higher up to 48 h (12.9% increase in area under the curve from 0 to 48 h [AUC0-48]) in the centhaquine group than in the control group. A significant increase in pulse pressure (48.1% increase in AUC0-48) in the centhaquine group compared with the control group suggests improved stroke volume due to centhaquine. The SI was significantly lower in the centhaquine group from 1 h (p = 0.032) to 4 h (p = 0.049) of resuscitation. Resuscitation with centhaquine resulted in a significantly greater number of patients with improved blood lactate (control 46.9%; centhaquine 69.3%; p = 0.03) and the base deficit (control 43.7%; centhaquine 69.8%; p = 0.01) than in the control group. ARDS and MODS improved with centhaquine, and an 8.8% absolute reduction in 28-day all-cause mortality was observed in the centhaquine group. CONCLUSION: Centhaquine is an efficacious resuscitative agent for treating hypovolemic shock. The efficacy of centhaquine in distributive shock is being explored. TRIAL REGISTRATION: Clinical Trials Registry, India; ctri.icmr.org.in, CTRI/2019/01/017196; clinicaltrials.gov, NCT04045327.

Soft tissue growth changes from 8 to 16 years of age: A cross-sectional study.

OBJECTIVE: The present cross-sectional study was conducted to evaluate and compare the soft tissue growth changes between males and females of two groups from 8 to 16 years. MATERIALS AND METHODS: One hundred sixty skeletal class I lateral head cephalograms were screened aged between 8 to 16 years-Subjects were divided into two groups. Group I (8 to 12 years) and Group II (12 to 16 years) and further these groups were subdivided into male and female subgroups. Total eight linear and four angular parameters were studied. RESULTS: All the parameters increased in their dimension while angle of total facial convexity including nose and Nasolabialangle decreases. Among the linear variables, Noseheight, Lip thickness at laberale inferious, Lip thickness at B point, Soft tissue chin thickness and Measurements of lips to E-plane were found significant for both subgroups. While rest of the linear variables like Upper lip height, Lower lip height, Nose depth and Sagittal depth also increased but this increase wasfound non-significant. Among the angular parameters angle of total facial convexity including nose and Nasolabialangle decreases and angle of facial convexity excluding nose, and Nose inclination increases with the age, and these changes were found non-significant. CONCLUSION: In this study, we observed that males showed a greater value of all parameters in comparison to females, and with the advancement of age, all the parameters increased, except for angle of total facial convexity and nasolabial angle.

Management of a Patient with Impacted Maxillary Canine, Peg-Shaped Lateral Incisors and Transmigrated Mandibular Canine: A Case Report.

To treat morphological abnormalities, impaction, and severe malposition of the teeth, the lateral incisors are sometimes extracted, followed by orthodontic space closure. This procedure often requires special consideration, not only with regard to esthetics but also for functional issues. However, thusfar, few reports that have performed a functional evaluation in such cases. The purpose of this article is to report the successful treatment of a 23 year-old male patient with the complaint of irregular placement and abnormal shape of his teeth. The patient had an impacted maxillary unilateral left canine, peg shaped lateral incisor, and transmigrated mandibular canine. Patient was treated with extraction of the upper lateral incisors and eruption of the impacted canines was guided to the place of the lateral incisor and extraction of the transmigrated mandibular canine.

Single Wire with Helices to Guide Different Labially Impacted Canine Eruption -Technique Clinic.

Impacted canines vary greatly in the inclination and location and can lead to resorption of neighboring teeth depending on their location. Occasionally labial impaction of the maxillary canine may occur over the maxillary lateral incisor, over the first premolar, and sometimes over the alveolus in between the lateral incisor and premolar. In this article, we will discuss a multipurpose single wire with 3 helices or 2 helices to guide the labially impacted canine, positioned in different inclinations and located differently on the labial side, so as to provide traction force in proper direction.

Modified Transpalatal Arch (m-TPA) for Vertical Control and Anchorage.

Transpalatal arch (TPA) is commonly used, but it has some limitations; like, it can be used as an anchorage appliance in extraction cases with minimal to moderate anchorage requirement, but, for maximum anchorage cases TPA needs to be supported by extraoral traction. In cases where expansion greater than 1-2 mm is required, other expansion appliances seem to be more efficient. To overcome the drawbacks of TPA we designed modified transpalatal arch (m-TPA) for various purpose.

Synergistic Approach with Twin Block and Fixed Appliance Therapy in Class II Div 2 Malocclusion: A Case Report.

This case report describes the orthodontic treatment of a male, aged 13.2 years, with permanent aentition, sagittal skeletal Class II division 2 malocclusion. His chiefcompliant was the position of the maxillary incisors, displaced too palatally, and an impaired facial profile. Twin block and 0.022 x 0.028 inch pre-adjusted-edge wise appliance, were used to correct the sagittal discrepancy and to improve the attractiveness of the impaired facial profile. The total treatment duration was decreased with the use of synergistic approach.

Evaluation of mixed dentition analyses in north Indian population: A comparative study.

INTRODUCTION: Mixed dentition regression equations analyses (Moyers, Tanaka-Johnston) are based on European population, reliability of these methods is questionable over other population. MATERIALS AND METHODS: The present study was conducted on total 260 study models. This study was done in two phases. In the first phase, linear regression equations were made. In the second phase, comparison of actual values of sum of mesiodistal width of canine, first and second premolars with the predicted values proposed by Moyers, Tanaka-Johnston, and the new proposed mixed dentition analysis for North Indian population were made. RESULTS: Set of four linear regression equations for predicting sum of mesiodistal width of permanent canine, first premolar and second premolar in North Indian population from sum of mesiodistal width of mandibular incisors and mandibular first molars, were proposed as; (a) for males, maxillary arch, Y = 2.9 + 0.40X, (b) mandibular arch Y = 3.91 + 0.37X (c) for females, maxillary arch Y = 0.56 + 0.45X (d) mandibular arch Y = 1.14 + 0.42X. Moyers and Tanaka-Johnston, mixed dentition analysis, is found to be overestimating the mesiodistal width of unerupted canine and premolars in North Indian population.

Interdisciplinary approach for the management of bilaterally impacted maxillary canines.

Interdisciplinary approach for the management of malocclusion provides a holistic approach of patient management. Prudent treatment planning is necessary to achieve the various treatment goals. This case report describes the orthodontic management of a 16-year-old adolescent female patient with bilateral labially impacted maxillary canines. The problems associated with impacted maxillary canines and the biomechanical interventions used for this patient are discussed. The treatment protocol involved surgical intervention, followed by sequential traction of the impacted teeth. An interdisciplinary approach to treatment with different mechanical strategies led to the achievement of the desired esthetic, functional, and occlusal treatment goals.

A newer simultaneous space creation, eruption, and adjacent root control spring for the management of impacted tooth.

USUALLY, TREATMENT OF IMPACTION INCLUDES: Welcome preparation (to create space), surgical exposure and attachment to the impacted tooth and the orthodontic guidance for the eruption of the impacted tooth. Sometimes, due to deficiency of space, creation of space for impacted tooth requires first, and space regaining efforts may require the distal movement of posterior teeth and or mesial movement of anterior teeth in the arch, but it may create some problems. To overcome the unwanted problem in this clinical situation and to reduce overall treatment duration of the patient, we have developed the Simultaneous space creation, Eruption and Adjacent root control spring to control crown as well as root movement.

A comparison of shear bond strength of orthodontic brackets bonded with four different orthodontic adhesives.

OBJECTIVES: The objective of this study is to compare the shear bond strength (SBS) of stainless steel (SS) orthodontic brackets bonded with four different orthodontic adhesives. MATERIALS AND METHODS: Eighty newly extracted premolars were bonded to 0.022 SS brackets (Ormco, Scafati, Italy) and equally divided into four groups based on adhesive used: (1) Rely-a-Bond (self-cure adhesive, Reliance Orthodontic Product, Inc., Illinois, USA), (2) Transbond XT (light-cure adhesive, 3M Unitek, CA, USA), (3) Transbond Plus (sixth generation self-etch primer, 3M Unitek, CA, USA) with Transbond XT (4) Xeno V (seventh generation self-etch primer, Dentsply, Konstanz, Germany) with Xeno Ortho (light-cure adhesive, Dentsply, Konstanz, Germany) adhesive. Brackets were debonded with a universal testing machine (Model No. 3382 Instron Corp., Canton, Mass, USA). The adhesive remnant index (ARI) was recordedIn addition, the conditioned enamel surfaces were observed under a scanning electron microscope (SEM). RESULTS: Transbond XT (15.49 MPa) attained the highest bond strength. Self-etching adhesives (Xeno V, 13.51 MPa; Transbond Plus, 11.57 MPa) showed clinically acceptable SBS values and almost clean enamel surface after debonding. The analysis of variance (F = 11.85, P < 0.0001) and Chi-square (χ(2) = 18.16, P < 0.05) tests revealed significant differences among groups. The ARI score of 3 (i.e., All adhesives left on the tooth) to be the most prevalent in Transbond XT (40%), followed by Rely-a-Bond (30%), Transbond Plus with Transbond XT (15%), and Xeno V with Xeno Ortho (10%). Under SEM, enamel surfaces after debonding of the brackets appeared porous when an acid-etching process was performed on the surfaces of Rely-a-Bond and Transbond XT, whereas with self-etching primers enamel presented smooth and almost clean surfaces (Transbond Plus and Xeno V group). CONCLUSION: All adhesives yielded SBS values higher than the recommended bond strength (5.9-7-8 MPa), Seventh generation self-etching primer Xeno V with Xeno Ortho showed clinically acceptable SBS and the least amount of residual adhesive left on the enamel surface after debonding.

Double bonding system for deeply impacted tooth--a technic clinic.

Close eruption technique is preferred in deep, buried, intraosseous and labially impacted teeth to provide healthy and fuinctional attached gingiva but in this technique failure of bonded attachment usually means, repeat exposure of the impacted tooth. This article describes an innovative method for bonding two attachments (Double Bonding System) in combination instead of one. It provides the safe and determinate system for ortho-eruption, avoid the trauma of patient from re-exposure and enhance the comfort as well the confidence of the operator.

Management of impacted all canines with surgical exposure and alignment by orthodontic treatment.

Canine impaction is a dental problem very often encountered in orthodontic practice. After the third molar, the canine is the most frequently impacted tooth. Bringing the impacted canine into a normal position is important for functional occlusion and the final esthetics of the orthodontic treatment. This article illustrates a peculiar case, in which all four permanent canines maintained their unerupted status at age of 16 years. All four impacted canines were surgically exposed, attachment bonded, traction given with K-9 spring and ideally positioned with fixed orthodontic mechanotherapy.

Comparison of esthetic outcome after extraction or non-extraction orthodontic treatment in class II division 1 malocclusion patients.

INTRODUCTION: The extraction of premolars as a practical form of orthodontic therapy has been accepted for many years, but there remains a controversy regarding the effect of premolar extraction to improve esthetics as well as dentoskeletal relationship. The esthetic impact of the soft-tissue profile might play a major role in deciding on premolar extraction or non-extraction treatment, particularly in borderline patients. This cephalometric study was undertaken to compare the post-treatment soft-tissue profiles of successfully managed Class II, Division 1 malocclusions treated with either all first premolar extractions or treatment with a non-extraction therapy. MATERIALS AND METHODS: The sample consisted of 100 post-pubertal female patients of Class II Division I malocclusion. Group 1, treated with four first premolar extractions, consisted of 50 female patients with a mean age of 14 years 1 month. Group 2, treated without extractions, consisted of 50 patients with a mean age of 13 years 5 months. Pre-treatment and post-treatment lateral cephalometric radiographs were evaluated. The pre-treatment to post-treatment stage comparison and the intergroup comparison of the treatment changes were conducted between extraction and non-extraction groups of Class II malocclusion samples with t-tests. RESULTS: The soft-tissue facial profiles of the extraction and non-extraction samples were the same following active treatment except for a more retruded lower lip and a more pronounced lower labial sulcus in those patients subjected to extraction. CONCLUSIONS: The extraction or non-extraction decision, if based on sound diagnostic criteria, seems to have no systematic detrimental effects on the facial profile.

Management of pseudo Class III malocclusion--synergistic approach with fixed and functional appliance.

Class III malocclusion has been divided into two subtypes: skeletal and pseudo-Class III. A pseudo Class III malocclusion should be treated as early as possible to reduce the functional shift of the mandible and increase maxillary arch length. A case of pseudo-Class III malocclusion was presented here. A 11-year-old boy came with an anterior cross bite, the treatment was done with Fixed appliance (Roth prescription) and Reverse Twin block therapy. This case demonstrated that an anterior cross bite was corrected after 10 months of treatment.

A new modified tandem appliance for management of developing Class III malocclusion.

Most developing Class III patients display a retruded maxilla. Early intervention in mixed dentition is associated with better patient compliance and possibly a better orthopedic response, which can produce favorable results. The aim of this article is to present the fabrication of the new modified tandem appliance and its use in management of developing Class III malocclusion. The therapeutic results of a new modified tandem appliance are presented in an 8 year-old male patient with anterior cross bite and retrognathic maxilla at the mixed dentition stage. Anterior cross bite was corrected in 3 months and the positive overjet of 4 mm after continued use of the appliance for 1 year. There was a significant improvement in profile of the patient. The use of this appliance in this type of malocclusion enabled the correction of malocclusion in a few months and encouraging favorable skeletal growth in the future.