Repurposing surgical wards in pandemics - An appraisal of outcomes of COVID-19 patients treated in Orthopaedic wards.

Background: The COVID-19 pandemic resulted in a shift in the way healthcare resources were used. While India faced limited effects in the first COVID wave primarily due to strict lockdown of the county, it was one of the worst affected in the second wave and at one time reported the highest number of daily cases. To address the lack of intensive care units (ICU) beds, the surgical wards of our institute were repurposed to take care of patients requiring supplementary oxygen and other supportive care till either they improved or an ICU bed was available. The medical personnel in charge of the surgical wards were entrusted with the care of patients with support from intensive care support teams (ICST). Aims: We aimed to examine the clinical details of patients admitted in the repurposed orthopaedic wards during the second COVID wave and to evaluate the factors that might affect the clinical outcomes in such patients. Methods: This was a retrospective review of records of patients admitted in the repurposed orthopaedic wards between 16 April 2021 and 20 May 2021. Details related to demography, COVID-19 presentation, COVID-19-related management and clinical course, including transfers to ICUs, and outcomes in terms of either discharge to home or death were recorded. They were analysed using statistical software. Results: One hundred and twenty three patients were treated during the said period. Twenty patients died during treatment, resulting in a mortality rate of 16.3%. Age, gender, RT-PCR status, pre-existing comorbidities, SpO2 at admission, method of supplemental oxygen supply, total leukocyte counts, haemoglobin values, serum C-reactive protein, Lactate dehydrogenase (LDH) and creatinine values had no statistically significant association with death of a patient during treatment. Conclusion: Based on the results, one can state that clinicians of surgical specialities having background knowledge of internal medicine from undergraduate education can manage patients of COVID-19 with support from ICST with reasonable outcomes. In case of future pandemics, surgical wards can be repurposed to tide over exigencies. Additionally, primary care physicians, who are often the first point of contact for patients, can allay their apprehensions adequately in future pandemics, thus preventing widespread panic and burdening of healthcare resources.

Musculoskeletal pain affecting undergraduate nursing students: A cross sectional study on the prevalence and the associated factors.

BACKGROUND: Musculoskeletal pain conditions (MSP) affect not only professional nurses but nursing students too. Long standing pain conditions affecting young individuals in their productive years can impact their work efficiency and can have economic impacts. Effective interventions to decrease the effect of MSP conditions are essential for a healthy professional nursing force which form the backbone of the healthcare system. PURPOSE: We conducted this study with an aim to estimate the prevalence and patterns of MSP conditions in undergraduate nursing students. Additionally, we attempted to evaluate the associated factors and identify the predictors of MSP conditions in them. METHODS: This cross-sectional study was conducted using a web-based electronic questionnaire on nursing students at a tertiary level teaching hospital. The questionnaire prepared on Kobo Toolbox was circulated among the students of each class by their class representative using WhatsApp and e-mail. Two reminders were sent at 24-hour intervals. The data were analysed to identify the prevalence of MSP and evaluate the probable associated factors. RESULTS: One hundred and seventy-nine out of 255 (70.2 %) participants responded and 173 consented for participation. Around 53.2 % participants had suffered from MSP in the past year. A total of 43.9 % of the participants had previously suffered from musculoskeletal pain even earlier than the past one-year in question. Those in their 2nd academic year had higher odds of suffering from MSP. Factors related to self-study after the formal teachings at the school/ college of nursing like the place, duration, and posture, and the pattern of usage of electronic devices like smartphones and laptop computers had no significant association with the MSP conditions. Lack of physical exercise, attending clinical placements, and the factors related to such placements like duration and frequency of placements, and the duration of breaks during any placement were noted to have an influence on MSP. CONCLUSION: More than 50 % students reported to be affected by MSP over a year. Association with factors like inadequate physical activity, and strenuous clinical placements identified in this study indicate that modifications in the nursing curriculum are required. Encouraging physical activity on one hand, while minimising exhaustive, and taxing clinical placements might be the way forward for improving the musculoskeletal health of aspiring nurses.

Changes in the Status of Spastic Diplegic Children in Terms of Gross Motor Function Classification System and Functional Mobility Scale Following Surgical Intervention: A Single Centre Experience.

Introduction Most centers in low- to mid-income countries (LMICs) lack facilities for a comprehensive instrumented gait analysis (IGA) which is often considered the preferred method for assessment of the functional results of surgery in children with spastic diplegia. We aimed to study if there were any changes in the Gross Motor Function Classification System (GMFCS) levels and Functional Mobility Scale (FMS) scores after surgery and whether they can be used as an indirect indicator of change in the functional status of a child. Methods This prospective study was conducted at the Pediatric Orthopedic unit of a teaching hospital on spastic diplegic children requiring surgical intervention. GMFCS levels and FMS scores were recorded before the surgery and at each follow-up visit, with the latest record being two years post-surgery. The change in the scores was indicated as an improvement, deterioration, or no change from the baseline and compared to the score of the preceding visit. In addition, it was examined whether the age at surgery had any effect on the temporal change in the scores. Results A total of 25 children were included for analysis after excluding those who failed to fulfill the predefined inclusion and exclusion criteria. Both the GMFCS levels and FMS scores improved from the third month to one-year post-surgery, after which a few patients had a worsening of their scores at the two years follow-up visit. The age at which surgery was performed had no significant effect on the pattern of change in the scores. Most children sought consultations with the physical therapy department only when they visited the surgical team for follow-up. Conclusion This study shows that surgical interventions do improve the functional outcomes in children with spastic CP when assessed using FMS scores while maintaining an undeteriorated GMFCS level in most children. While a peak improvement can be expected one year after surgery in most patients, possible of worsening from baseline scores do exist, and the parents must be informed of the same. Any decision for surgery must involve the parents, and the usefulness of postoperative physical therapy must be impressed upon them before the surgery and during each follow-up visit too.

Presence of entry receptors and viral markers suggest a low level of placental replication of hepatitis B virus in a proportion of pregnant women infected with chronic hepatitis B.

The transplacental route of vertical transmission of Hepatitis B Virus (HBV) has been known for over a decade. Here we present evidence which suggest HBV can replicate in placenta. Forty-one HBsAg positive and 10 control pregnant women were enrolled in the study after obtaining informed consent. HBV positives were further divided in the High Viral Load (HVL) Group and Low Viral Load (LVL) Group according to INASL guidelines 2018. The Presence of the HBV DNA and expression of NTCP in the placenta was analyzed by qPCR/RT-qPCR and/or immunohistochemistry (IHC). The presence of cccDNA was assessed using Digital Droplet PCR while the presence of pre-genomic (pg) RNA was assessed through qRT-PCR and sequencing. The presence of HBeAg and HBcAg in the placenta was assessed by IHC. Immunostaining of NTCP, HBeAg and HBcAg on trophoblasts along with the presence of total HBV DNA, cccDNA and pgRNA indicated, that these cells are not only susceptible to HBV infection but may also support viral replication. This is further supported by the finding that trophoblasts of the several HBeAg seronegative samples harbored the HBeAg. Although, we did not find any correlation in NTCP expression and viral markers with viral load indicates placental replication may not aping hepatocytes. The presence of the HBV receptor, NTCP along with the presence of cccDNA, pgRNA, and HBeAg in placenta of HBV infected females without circulating HBeAg suggest that placenta act as a replication host.

Neck pain among undergraduate medical students in a premier institute of central India: A cross-sectional study of prevalence and associated factors.

CONTEXT: Competitive exams conducted for undergraduate and postgraduate medical courses in India are tough. The undergraduate course is additionally taxing to the students' health. Lack of physical activity, the stress of studies, and universal adoption of different gadgets make the undergraduate medical students prone to develop musculoskeletal pain-related issues. AIMS: This study aimed to evaluate the prevalence of neck pain and the associated factors including gadget use among undergraduate medical students of a premier medical college in central India. SETTINGS AND DESIGN: All undergraduate medical students including the interns of our institute were enrolled for this cross-sectional study. METHODS AND MATERIALS: A self-explanatory internet-based questionnaire prepared using Kobo Toolbox was circulated via WhatsApp and email by the class representative of each batch of students. The responses obtained were analyzed using Statistical Package for the Social Sciences (SPSS). STATISTICAL ANALYSIS USED: Proportions and means were calculated. Chi-square test and univariable logistic regression analysis were used. RESULTS: Three hundred thirty-one valid responses out of 423 responses were analyzed. In total, 58.3% of 331 students suffered from neck pain within the last one year. Students in the 3rd and 4th year had 2.9 times higher odds of current neck pain in comparison to 1st-year students. History of neck pain before joining the course was associated with a higher risk of having current neck pain. Self-perceived aggravation of pain from gadget use had significantly higher odds of contributing to the current episode of neck pain. CONCLUSIONS: Neck pain is not uncommon among undergraduate medical students. History of previous neck pain including that during schooling makes a student prone for the current episode of pain. Academic stress, smartphone and laptop use tend to aggravate the pain in those who have neck pain.

Evaluation of Sealing Ability of Three Root Canal Sealers: An In Vitro Study.

AIM: To evaluate the sealing ability of three different types of sealers using confocal laser microscopy. MATERIALS AND METHODS: Sixty extracted single-root premolars were selected and divided into three groups (20 teeth in each group) according to the type of sealer used, namely, mineral trioxide aggregate (MTA) Fillapex, AH Plus, and Bio C Sealer. Root canal preparation and obturation were done in all the samples. Roots was dissected transversely in apical plane. Percentage of gap from region to canal circumference was calculated using a confocal laser microscope. Samples were subjected to statistical analysis. RESULTS: High dye penetration was seen with AH Plus compared to MTA Fillapex and least with Bio C Sealer. The AH Plus is the best sealer with respect to seal ability of all the three. CONCLUSION: This study helps to appraise the sealing ability of the different types of sealers using confocal laser microscopy which is useful for the success of root canal treatment. CLINICAL SIGNIFICANCE: As sealer has to seal voids, foramina, and canals, it should have good penetration for the success of root canal treatment.

Evaluation of Eruption Pattern and Caries Occurrence among Children Affected with Fluorosis.

AIM: The aim of this study was to evaluate eruption pattern and occurrence of caries in children affected with fluorosis. MATERIALS AND METHODS: One hundred and fifty subjects (75 each with/without fluorosis) with age group of 7-8 years were selected. Dental fluorosis assessed on the buccal surfaces of the permanent incisors and molars and scored using the Thylstrup and Fejerskov index. The tooth were scored as emerged when at least one cusp of the tooth was visible in the mouth. Caries attack rate in primary and permanent teeth were estimated using DMFS and defs index in fluorosis patient. The findings were subjected to statistical analysis. The data were analyzed using Student "t" test and ANOVA "F" test. RESULTS: There was statistically highly significant difference found in the incidence of occlusal, mesioproximal, and distoproximal caries between fluorotic and nonfluorotic patients (p < 0.001). The result of present study showed a nonsignificant association between fluoride exposure parameter and median emergence ages of permanent incisors and molar teeth. On the other hand, caries occurrence shows a significant association with fluorosis. CONCLUSION: In this study, a significant positive correlation exists in the prevalence of caries and fluorosis. It is concluded that occlusal and proximal caries are less pronounced in fluorosis patients. CLINICAL SIGNIFICANCE: Dental caries is a public health problem. In this study, we study the fluoride effect since the predominant cariostatic effect of fluoride is beneficial in extensive caries reduction without a concomitant risk of dental fluorosis. How to cite this article: Trivedi S, Trivedi A, Banda NR, et al. Evaluation of Eruption Pattern and Caries Occurrence among Children Affected with Fluorosis. J Contemp Dent Pract 2019;20(10):1217-1222.

Correlation of Blood Glucose Levels, Salivary Glucose Levels and Oral Colony Forming Units of Candida albicans in Type 2 Diabetes Mellitus Patients.

AIM: The study aims to correlate salivary glucose, blood glucose levels and oral colony forming units of Candida albicans and to evaluate whether saliva can be used as noninvasive means to measure glycemic status in type II diabetics without the need for the invasive procedure. MATERIALS AND METHODS: The study included 100 type II diabetic patients (group I) of both genders with age 40 years and above and100 healthy patients (group II), age and sex matched with the study group. Group I includes uncontrolled and controlled diabetics as groups IA and IB, respectively. Salivary glucose measurement was done using the enzymatic colorimetric method and blood glucose levels measured by doing venepuncture and centrifuged. The oral candidal carriage was calculated by incubation in Sabouraud's dextrose agar supplemented with chloramphenicol and incubated aerobically for 48 hours. To compare the mean values Z test was applied. To determine the relationship between two variables Pearson's correlation coefficient was used. RESULTS: The salivary glucose levels showed a significant correlation with blood glucose levels. The salivary candida carriage was higher in uncontrolled as compared to controlled diabetics and healthy individuals. CONCLUSION: Positive correlation was obtained between salivary glucose and blood glucose in diabetics and candidal carriage has a positive correlation with blood glucose levels. This salivary glucose and blood glucose levels correlation confirms its use to find glycemic status in diabetic patients. CLINICAL SIGNIFICANCE: The positive correlation of salivary glucose with blood glucose shows that it can be utilized as a noninvasive tool for monitoring glycemic status in diabetic patients.

Evaluation of Effect of Connector Designs in Implant Tooth-supported Fixed Partial Denture: A Two-dimensional Finite Element Analysis.

AIM: The aim of this study was to evaluate the effect of connector designs on scale and distribution pattern of the stress generated in the supporting bone of implant tooth-supported three-unit fixed partial denture in distal extension situation. MATERIALS AND METHODS: Three-unit fixed partial denture geometric models with implant abutment in second molar, pontic in first molar, and second premolar as mesial abutment in distal extension situations were evaluated using a two-dimensional (2D) finite element analysis. Three models were designed and constructed with mesial and distal rigid connectors, mesial nonrigid connector, and distal nonrigid connector respectively, using the software ANSYS, version 10.0 (University Intermediate). The models were analyzed to determine the maximum equivalent von Mises stress at five critical zones (maximum value) under static axial loading (240 N) after meshing and assigning the material properties. RESULTS: The maximum stress concentration values at mesial and distal alveolar crest of the implant-supporting bone were 60.59 and 68.57 MPa, respectively, in Model No 1. The high equivalent von Mises stress concentration values at the mesial and distal alveolar crest of the implant-supporting bone were 1.65 and 0.747 MPa with 0.1 mm vertical movement and 7.88 and 9.34 MPa with 0.5 mm vertical movement of the connector respectively, in Model No 2. The high equivalent von Mises stress concentration values at mesial and distal alveolar crest of the implant-supporting bone were 10.45 and 3.43 MPa with 0.1 mm vertical movement and 4.50 and 5.71 MPa with 0.5 mm vertical movement of the connector respectively, in Model No 3. CONCLUSION: In the supporting bone around the implant in Model No 1, the maximum von Mises stress concentrations were displayed in the crestal zones. In the supporting bone around the implant abutment, the von Mises stress concentrations were minimal toward the apical third zone in all the models. The stress concentrations were minimal in the supporting bone around the implant and the natural tooth in the models with nonrigid connector. CLINICAL SIGNIFICANCE: When implant is used as distal abutment in three-unit implant tooth-supported fixed partial denture with pontic at first molar in distal extension situation, it is recommended to place the nonrigid connector in the mesial side of the distal implant abutment.

Comparative Evaluation of Fracture Strength of Different Types of Composite Core Build-up Materials: An in vitro Study.

AIM: The aim of the study was to evaluate the fracture strength of three types of composite core build-up materials. The objectives were to study and evaluate the fracture strength and type of fracture in composite core build-up in restoration of endodonti-cally treated teeth with or without a prefabricated metallic post. MATERIALS AND METHODS: A total of 60 freshly extracted mandibular premolars free of caries, cracks, or fractures were end-odontically treated and restored with composite core build-up with prefabricated metallic posts cemented with resin luting cement (group I) and without a post (group II). This was followed by a core build-up of 10 teeth each with three different types of composite materials: Hybrid composite, nanocomposite, and ormocer respectively. The samples were mounted on polyvinyl chloride block and then loaded in the universal load frame at 90° to the long axis of tooth. The fracture strength of the samples was directly obtained from the load indicator attached to the universal load frame. RESULTS: Analysis of variance (ANOVA) test revealed that teeth restored with post exhibited highest fracture strength (1552.32 N) and teeth restored without post exhibited lowest fracture strength (232.20 N). Bonferroni's test revealed that values for hybrid composite (Z-100, 3M ESPE) with post, nanocomposite (Z-350, 3M ESPE) with post, ormocer composite (Admira-VOCO) with post, and nanocomposite (Z-350, 3M ESPE) without post were not significantly different from each other. CONCLUSION: Teeth restored with post and core using hybrid composite yielded the highest values for fracture strength. Teeth restored with ormocer core without post exhibited the lowest values. Teeth restored with nanocomposite core without post exhibited strength that was comparable with hybrid composite core but higher than that of ormocer. CLINICAL SIGNIFICANCE: Mutilated endodontically treated teeth can be prosthetically rehabilitated successfully by using adhesive composite core build-up along with post to meet anatomical, functional, and esthetic demands.

Actinomycotic osteomyelitis of palate masquerading periapical pathology: A rare case report.

Osteomyelitis is an infection that is challenging to manage due to the poor vascularization of bone that favors the proliferation of microorganisms. We report a case of osteomyelitis occurring in endodontically treated teeth in the maxillary palatal region. Clinically and radiographically, it was initially diagnosed as osteomyelitis and was treated accordingly with antibiotics for 1 year with no reported healing. Later, biopsy was done and the findings were consistent with that of chronic osteomyelitis in association with infection by Actinomyces organisms. Thus, the case highlights the rare occurrence of actinomycotic osteomyelitis in maxilla and the importance of biopsy and histopathology which will help in correct diagnosis and rapid resolution through appropriate antibiotic therapy.

Retained Intra-uterine Foetal Bones Resulting in Secondary Infertility: A Case Report.

Termination of pregnancy (abortion) is a reasonably safe procedure when properly performed. However, even after being performed with due precautions, complications may occur. Retention of fetal products following a mid-trimester abortion is a rare complication of abortion which can then result in secondary infertility. We are here presenting the case of a young woman who underwent an abortion in the 15th week of gestation due to anencephaly in the fetus and who then failed to conceive for the next five years. Transvaginal ultrasonographic examination suggested the presence of bone-like structures in the uterine cavity which were removed hysteroscopically. The patient was able to conceive after the hysteroscopic removal of bony fragments. Retained bony fragments from a previous mid-trimester abortion should thus be kept in the list of differentials of secondary infertility.