A Comparative Evaluation of Marginal Accuracy of Co-Cr Metal Copings Fabricated Using Traditional Casting Techniques and Metal Laser Sintering.

AIMS AND OBJECTIVES: The aim and objective of the study were to determine the amount of marginal discrepancy produced by cobalt-chromium (Co-Cr) copings fabricated using two different fabrication methods, i.e., traditional casting and direct metal laser-sintering (DMLS), and compare the values obtained between each fabrication technique and to evaluate if the fabrication technique can produce prosthesis that is within the standards of clinical acceptance of marginal discrepancy. MATERIALS AND METHODS: Twenty metal copings each were fabricated by laser sintering and traditional casting method. The marginal gap at the buccal, lingual, mesial, and distal areas was measured using the silicone replica technique. The stereomicroscope and optical microscope were used to measure the marginal discrepancy between the working die and the copings. Statistical analysis was done using a t-test using Open-epi calculator software. RESULTS: The values indicate that the marginal gap was less for the copings fabricated using Co-Cr alloy crowns that were fabricated with direct metal laser-sintered technique than Co-Cr alloy crowns fabricated with conventional casting technique. HOW TO CITE THIS ARTICLE: Gautam N, Khajuria RR, Ahmed R, et al. A Comparative Evaluation of Marginal Accuracy of Co-Cr Metal Copings Fabricated Using Traditional Casting Techniques and Metal Laser Sintering. Int J Clin Pediatr Dent 2021;14(1):128-132.

Laboratory reporting of framingham risk score increases statin prescriptions in at-risk patients.

BACKGROUND: The under-utilization of cardiovascular preventative therapy with statins warrants novel interventions to optimize prescriptions in at-risk patients. We investigated the role of a laboratory generated Framingham Risk Score (FRS) provided to primary care clinicians in changing statin use in a primary care setting. METHODS: Data was acquired from the electronic medical records of 1573 anonymized patients undergoing routine lipid testing. Follow-up statin use and low-density lipoprotein cholesterol levels were obtained for 2 years post intervention. FRS parameters were entered into a laboratory information system, and provided to ordering physicians along with the cholesterol profile and the appropriate current Canadian Dyslipidemia treatment recommendation in a single report. Statin prescription rates following the intervention were compared with historical use 6 months prior to the study. RESULTS: A total of 1283 participants (mean age of 60 ± 11 years) had an FRS report and were considered for analysis. Two hundred individuals filled a statin prescription in the 6 months prior to their index lipid test, and an additional 84 filled a statin prescription following the intervention (42% increase). The relative and absolute increase in statin prescription was 47.3% and 13.6% in the high-risk group p < 0.001, 53.3% and 8.1% in the intermediate-risk group p < 0.001, and 17.0% and 1.42% in the low-risk group p = 0.008, respectively. CONCLUSION: The use of the laboratory reported FRS was associated with a significant increase in the rate of statin prescription across all risk groups. The expansion of FRS reporting across other health regions would improve cardiovascular risk prevention.

Patterns of Left-Ventricular Function Assessment in Patients With Acute Coronary Syndromes.

BACKGROUND: In patients with acute coronary syndromes (ACS), guidelines recommend the assessment of left-ventricular ejection fraction (LVEF). Many patients with ACS undergo multiple assessments of LVEF, the clinical value of which is unknown. METHODS: Patients with ACS undergoing cardiac catheterization between 2012 and 2016 were evaluated and assessments of LV function identified. To evaluate changes in LVEF over time, available echocardiograms were reviewed in a subsample of patients with LVEF data available (n = 3221). Patients with ACS were classified into 3 groups: group 1 (LVEF > 50%), group 2 (LVEF 35% to 50%), and group 3 (LVEF < 35%). RESULTS: Our cohort consisted of 8327 patients with ACS (76% men), presenting with a mean age of 62.4 ± 12.4 years. At index presentation, 66% of patients had an LVEF > 50%, 27% had an LVEF between 35% and 50%, and 7% had severely reduced LVEF of < 35%. More than half of the cohort (n = 4600) had follow-up assessment of LV function, performed over an average of 2.71 ± 1.31 years. In the subsample of 3221 patients, only 1.1% of those in group 1, and 5.1% of those in group 2, deteriorated to an LVEF < 35%. CONCLUSIONS: Patients with ACS often undergo multiple assessments of LV function. Those with initially preserved EF rarely demonstrate a decline in EF to < 35%. A reduction in low-value cardiac tests may be an important first step in improving the quality of care for patients with ACS.

CONTEXTE: En cas de syndrome coronarien aigu (SCA), les lignes directrices recommandent d'évaluer la fraction d'éjection ventriculaire gauche (FEVG). Beaucoup de patients présentant un SCA subissent plusieurs évaluations de la FEVG, une pratique dont on ne connaît pas la valeur clinique. MÉTHODOLOGIE: Nous avons examiné les dossiers de patients atteints d'un SCA ayant subi un cathétérisme cardiaque entre 2012 et 2016 afin de relever les évaluations de la fonction ventriculaire gauche. Pour évaluer l'évolution de la FEVG au fil du temps, nous avons examiné les échocardiogrammes d'un sous-échantillon de patients pour lesquels des données sur la FEVG étaient disponibles (n = 3 221). Les patients présentant un SCA ont été divisés en trois groupes : groupe 1 (FEVG > 50 %), groupe 2 (FEVG de 35 à 50 %) et groupe 3 (FEVG < 35 %). RÉSULTATS: Notre cohorte comprenait 8 327 patients présentant un SCA (proportion d'hommes : 76 %), dont l'âge moyen était de 62,4 ± 12,4 ans. Au moment de la manifestation de référence, 66 % des patients avaient une FEVG > 50 %, 27 %, une FEVG de 35 à 50 % et 7 %, une FEVG gravement réduite < 35 %. Plus de la moitié des patients de la cohorte (n = 4 600) ont subi une évaluation de suivi de la fonction ventriculaire gauche, effectuée sur une période de 2,71 ± 1,31 ans en moyenne. Dans le sous-échantillon de 3 221 patients, seulement 1,1 % des patients du groupe 1 et 5,1 % de ceux du groupe 2 ont vu leur FEVG se détériorer à une valeur < 35 %. CONCLUSIONS: Les patients présentant un SCA subissent souvent plusieurs évaluations de la fonction ventriculaire gauche. Ceux dont la fraction d'éjection était initialement préservée ont rarement présenté une réduction de la fraction d'éjection en deçà de 35 %. Une réduction du nombre d'évaluations cardiaques offrant peu de valeur pourrait constituer un premier pas important vers l'amélioration de la qualité des soins prodigués aux patients présentant un SCA.

Clinical Utility of Pharmacogenomic Data Collected by a Health-System Biobank to Predict and Prevent Adverse Drug Events.

INTRODUCTION: Medication-related harm represents a significant issue for patient safety and quality of care. One strategy to avoid preventable adverse drug events is to utilize patient-specific factors such as pharmacogenomics (PGx) to individualize therapy. OBJECTIVE: We measured the number of patients enrolled in a health-system biobank with actionable PGx results who received relevant medications and assessed the incidence of adverse drug events (ADEs) that might have been prevented had the PGx results been used to inform prescribing. METHODS: Patients with actionable PGx results in the following four genes with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines were identified: HLA-A*31:01, HLA-B*15:02, TPMT, and VKORC1. The patients who received interacting medications (carbamazepine, oxcarbazepine, thiopurines, or warfarin) were identified, and electronic health records were reviewed to determine the incidence of potentially preventable ADEs. RESULTS: Of 36,424 patients with PGx results, 2327 (6.4%) were HLA-A*31:01 positive; 3543 (9.7%) were HLA-B*15:02 positive; 2893 (7.9%) were TPMT intermediate metabolizers; and 4249 (11.7%) were homozygous for the VKORC1 c.1639 G>A variant. Among patients positive for one of the HLA variants who received carbamazepine or oxcarbazepine (n = 92), four (4.3%) experienced a rash that warranted drug discontinuation. Among the TPMT intermediate metabolizers who received a thiopurine (n = 56), 11 (19.6%) experienced severe myelosuppression that warranted drug discontinuation. Among patients homozygous for the VKORC1 c.1639 G>A variant who received warfarin (n = 379), 85 (22.4%) experienced active bleeding and/or international normalized ratio (INR) > 5 that warranted drug discontinuation or dose reduction. CONCLUSION: Patients with actionable PGx results from a health-system biobank who received relevant medications experienced predictable ADEs. These ADEs may have been prevented if the patients' PGx results were available in the electronic health record with clinical decision support prior to prescribing.

Impact of land use land cover changes on ecosystem service value - A case study of Guangdong, Hong Kong, and Macao in South China.

The rapid increase in anthropogenic activities, socioeconomic development, and land use land cover (LULC) changes since the opening of economic reforms (1978), have changed the ecosystem service value (ESV) in Guangdong, Hong Kong, and Macao (GKHM) region located in South China. This leads to the requirement of a significant tailored analysis of ecosystem services regarding incisive and relevant planning to ensure sustainability at regional level. This study focuses on the use of Landsat satellite imagery to quantify the precise impact of LULC changes on the ecosystem services in GHKM over the past three decades (1986-2017). The most renowned established unit value transfer method has been employed to calculate the ESV. The results show that the total ecosystem service value in GHKM has decreased from 680.23 billion CNY in 1986 to 668.45 billion CNY in 2017, mainly due to the decrease in farmland and fishponds. This overall decrease concealed the more dynamic and complex nature of the individual ESV. The most significant decrease took place in the values of water supply (-22.20 billion CNY, -14.72%), waste treatment (-20.77 billion CNY, -14.63%), and food production (-7.96 billion CNY, -33.18%). On the other hand, the value of fertile soil formation and retention (6.28 billion CNY, +7.26%) and recreation and culture (5.09 billion CNY, +12.91%) increased. Furthermore, total ESV and ESV per capita decreased significantly with the continuous increase in total gross domestic product (GDP) and GDP per capita. A substantial negative correlation exists between farmland ESV and GDP indicating human encroachment into a natural and semi natural ecosystems. The results suggest that in the rapidly urbanizing region, the protection of farmland and to control the intrusion of urban areas has marked an important societal demand and a challenge to the local government. This required a pressing need for smart LULC planning and to improve policies and regulation to guarantee ecosystem service sustainability for acceptable life quality in the study area and other fast expanding urban areas in China.

A Comparative Study to Evaluate the Accuracy of Various Spacer Thickness for Polyvinyl Siloxane Putty-wash Impression Techniques: An In Vitro Study.

INTRODUCTION: An accurate impression is one of the prime factors for success of any restoration, more so in field of fixed prosthodontics. The critical aspect is to reproduce fine surface details along with ease of use. Knowledge of impression materials and the techniques to which each is best suited is essential in achieving consistent results. OBJECTIVE OF THE STUDY: The purpose of this study is to evaluate the accuracy of various putty-wash techniques in a laboratory model that simulated the clinical practice. MATERIALS AND METHODS: A metal master model, containing three full crowns fixed partial denture (FPD) abutment preparations, was fabricated. A perforated custom tray was fabricated that can be placed in the same position on the master model for each impression. For each technique, 10 impressions of the master model were made and poured using a die stone. The measurements were made of the models using a measuroscope and the accuracy of the impressions was recorded. RESULTS: The statistical comparison between groups I, II, III, and IV casts measurements by using the Mann-Whitney test showed highly significant statistical difference between the various groups from each other (p < 0.001). CONCLUSION: The accuracy of the working casts obtained from group III impression (two-step using 1 mm coping) was the best, whereas it was least with group II impression (two-step using polyethylene spacer). HOW TO CITE THIS ARTICLE: Gautam N, Ahmed R, Sharma S, et al. A Comparative Study to Evaluate the Accuracy of Various Spacer Thickness for Polyvinyl Siloxane Putty-wash Impression Techniques: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(5):536-542.

The association of GSTM1 and GSTT1 polymorphisms with squamous cell carcinoma of cervix in Pakistan.

Gene deletions in GSTM1 and GSTT1 may result in tempering the activation and detoxification of several carcinogens and thereby may increase the risk of cancer pre-disposition. This study aims to investigate the clinical impact of glutathione-S-transferase GSTM1 and GSTT1 polymorphisms on squamous cell carcinoma of cervix (SCCA).The GSTM1 and GSTT1 polymorphisms were analyzed in cervical cancer patients and healthy controls. Touch down multiplex polymerase chain reaction (PCR) strategy was adopted for genotyping of GSTM1 and GSTT1 polymorphisms. The null genotype of GSTM1 exhibited a significantly higher percentage in patients with SCCA (74 %) than in the control group (34.0 %). However, no significant difference was observed in the null genotype of GSTT1 among SCC patients and healthy subjects, respectively. GSTM1 exhibited a significant association with increased risk of squamous cell carcinoma (p < 0.001). The odds ratio for the GSTM1 null genotype was also calculated (odds ratio 3.7484; 95 % confidence interval 1.6562-84834). This suggests that GSTM1 null genotype in cervical cell samples may be associated with more severe precancerous lesions of the cervix.