Category: Nevin Manimala

Intern Med J. 2025 Sep 24. doi: 10.1111/imj.70204. Online ahead of print.

ABSTRACT

Aspirin resistance (AR) is linked to increased morbidity and mortality after cardiovascular and neurovascular procedures but has not been investigated after total hip arthroplasty (THA) and total knee arthroplasty (TKA). To investigate the incidence of AR in high-risk patients after elective THA/TKA, we conducted a prospective cohort study of elective THA/TKA in patients with thromboembolic risk factors: obesity (body mass index [BMI] ≥30 kg/m²), diabetes and/or advanced age (≥65 years) who were administered aspirin for venous thromboembolism prophylaxis. AR was confirmed using a platelet function analyser. Forty patients were included with a mean±standard deviation age of 66.1±10.4 years and BMI of 32.2±6.0 kg/m² and eight (20.0%) had diabetes. Overall, 52.5% of patients were aspirin resistant, with no statistically significant relationships between patient variables and AR (P > 0.05). AR after THA/TKA was an observed phenomenon; however, larger trials are required to determine the clinical consequences of AR and to guide prophylaxis strategies in this population.

PMID:40990050 | DOI:10.1111/imj.70204

Europace. 2025 Sep 1;27(9):euaf200. doi: 10.1093/europace/euaf200.

ABSTRACT

AIMS: Atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death. Therefore, the effect of an implantable cardioverter-defibrillator (ICD) may be greater in patients with AF. We examined the long-term effects of primary prevention ICD implantation vs. usual clinical care according to AF status in DANISH.

METHODS AND RESULTS: Outcomes were analysed according to AF status at baseline (history and/or on enrollment ECG). The primary outcome was all-cause death, and secondary outcomes were cardiovascular and sudden cardiovascular death. Of the 1116 patients with non-ischaemic heart failure with reduced ejection fraction randomized in DANISH, 418 (37.5%) had AF at baseline, of whom 24.2% had paroxysmal AF, 17.0% persistent AF, and 58.9% permanent AF. AF status did not significantly modify the effect of ICD implantation on all-cause death, although there was a suggestion of a greater effect in patients with [hazard ratio (HR) 0.78 (95% CI, 0.59-1.03)] vs. without AF [HR 0.98 (0.75-1.27)] (Pinteraction = 0.15). AF status significantly modified the effect of ICD implantation on cardiovascular death, such that ICD implantation was associated with a lower rate of this outcome in patients with AF [HR 0.67 (0.48-0.94)], but not in those without AF [HR 1.04 (0.76-1.41)] (Pinteraction = 0.04). Although AF status did not significantly modify the effect of ICD implantation on sudden cardiovascular death, there was a suggestion of a greater effect in patients with [HR 0.45 (0.24-0.82)] vs. without AF [HR 0.76 (0.41-1.38)] (Pinteraction = 0.20).

CONCLUSION: In the DANISH trial, the presence of AF was associated with a greater effect of ICD implantation on cardiovascular death, and although similar trends were observed for all-cause and sudden cardiovascular death, the treatment-by-subgroup interaction was not statistically significant for these outcomes.

REGISTRATION: URL: https://www.clinicaltrials.gov; unique identifier: NCT00542945.

PMID:40990042 | DOI:10.1093/europace/euaf200

Dement Neuropsychol. 2025 Sep 19;19:e20250284. doi: 10.1590/1980-5764-DN-2025-0284. eCollection 2025.

ABSTRACT

Dementia significantly impairs cognitive function and severely affects daily living activities. To support independent mobility in older adults and individuals with dementia, home modification strategies, such as safety adaptations, have been identified as critical interventions.

OBJECTIVE: To explore caregivers’ perspectives on the potentials of digital interventions in enhancing independent mobility for PwD in mild to moderate stages of the condition. The aim is to determine if digital intervention could help PwD to effectively use existing home safety interventions and to safely move around their environment.

METHODS: A cross-sectional survey was used to gather insights from 121 professional caregivers and family members providing care for PwD. Participants aged 18 years and above were eligible for inclusion. Responses were analysed using R software, employing descriptive statistics, contingency tables, and graphical charts. χ² tests (p<0.05) assessed the relationships between categorical variables, with Cramér’s V measuring association strength (weak relationship if ≤0.30). Cronbach’s alpha demonstrated reliability for mobility factors (0.87, 95%CI 0.810-0.908).

RESULTS: The study revealed that PwD made limited use of existing home safety interventions, with statistically significant findings (p<0.05) across the four mobility factors evaluated. This indicates that the effectiveness of these interventions could be undermined particularly for individuals living alone.

CONCLUSION: The study found that digital interventions can support PwD in using existing home safety interventions and navigating their environments more independently. It could help the target population know when and how to these interventions thereby increasing the overall goal of their implementations.

PMID:40990005 | PMC:PMC12452096 | DOI:10.1590/1980-5764-DN-2025-0284

Clin Kidney J. 2025 Aug 26;18(9):sfaf268. doi: 10.1093/ckj/sfaf268. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: The ANCA Renal Risk Score was updated in 2023 to the ANCA Kidney Risk Score (AKRiS) to improve clinicopathological prognostication in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and kidney involvement. Our study aimed to assess whether incorporating recently identified predictors of kidney survival in AAV could further refine the prognostic accuracy of AKRiS in our multicentric cohort.

METHODS: We retrospectively reviewed all incident AAV with kidney biopsy from 2005 to 2020. Cox regression analysis examined factors [AKRiS, dialysis within 4 weeks, urine protein-creatinine ratio (UPCR) and hematuria at baseline, C3 deposits, renal arteritis on biopsy, estimated glomerular filtration rate (eGFR), UPCR and hematuria after induction] associated with kidney failure. These factors in combination with AKRiS were analyzed using the area under the receiver operating characteristic curve (AUROC) for prediction of kidney failure.

RESULTS: The cohort included 115 patients (age 64 years, 55% male, 57% myeloperoxidase-ANCA, baseline creatinine 3.6 mg/dL, eGFR 16 mL/min/1.73 m²), with 34 (30%) dialysed within 4 weeks. During a median 6.4-year follow-up, 39 (34%) patients progressed to kidney failure, and 13 (11%) died. Cox analysis identified AKRiS, dialysis within 4 weeks, C3 deposits, renal arteritis on biopsy, lower eGFR after induction and higher UPCR after induction as unadjusted risk factors for kidney failure. After adjusting for AKRiS, dialysis within 4 weeks [hazard ratio (HR) 6.20 (95% confidence interval 2.76 to 13.95), P ≤ .001], eGFR after induction [HR 0.94 (0.89 to 0.99), P = .03] and UPCR after induction [HR 1.62 (1.02 to 2.58), P = .04] remained significantly associated with kidney outcome. The AUROC for kidney failure prediction was 0.77 for AKRiS, increasing to 0.82, 0.80 and 0.79 when adding dialysis within 4 weeks, eGFR and UPCR after induction, respectively.

CONCLUSION: Dialysis within 4 weeks, eGFR after induction and UPCR after induction are able to predict long-term kidney outcome in AAV patients. Adjusting AKRiS for these variables modestly enhances its predictive power. We propose using them as placeholder endpoints for kidney failure in future studies.

PMID:40989994 | PMC:PMC12451443 | DOI:10.1093/ckj/sfaf268

Int J Clin Pediatr Dent. 2025 Aug;18(8):1031-1038. doi: 10.5005/jp-journals-10005-3171. Epub 2025 Sep 4.

ABSTRACT

AIMS AND BACKGROUND: An optimal pulp capping material should promote the formation of reparative dentin, preserve pulpal vitality, and create an effective barrier against bacterial infiltration. Due to issues like disintegration and tunnel defects, mineral trioxide aggregate (MTA) has become a preferred recent alternative to calcium hydroxide (Ca(OH)₂) for indirect pulp capping in primary teeth. In the literature, there have been conflicting opinions regarding the selection of materials for indirect pulp capping. Hence, the aim of this systematic review was to evaluate and compare the effectiveness of MTA and Ca(OH)₂ as indirect pulp capping agents in deep carious lesions of primary molars.

METHODS: This review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The databases searched included MEDLINE (via PubMed), Google Scholar, and Cochrane. Randomized clinical trials published until January 31, 2024, without year restrictions, were included. The systematic review assessed the effectiveness of MTA and Ca(OH)₂ as indirect pulp capping agents in primary molars.

RESULTS: The search resulted in 412 published studies. Four hundred and five articles that did not meet the inclusion criteria, were duplicates, or were not in English were excluded. A total of seven studies were included in the systematic review to assess clinical and radiographic effectiveness, and five studies were selected for meta-analysis (radiographic effectiveness). MTA showed greater reparative dentin formation as compared to the Ca(OH)₂ group with a standardized mean difference of 0.45; however, the difference between the two groups was not statistically significant.

CONCLUSION: Both MTA and Ca(OH)₂ can be effectively utilized as indirect pulp capping agents in deep carious lesions of primary molars.

CLINICAL SIGNIFICANCE: This systematic review and meta-analysis highlights the effectiveness of MTA and calcium hydroxide [Ca(OH)₂] as indirect pulp capping agents in primary molars with deep carious lesions, providing valuable evidence-based guidance for pediatric dentists in selecting the most suitable pulp capping agent.

HOW TO CITE THIS ARTICLE: CK A, Ninawe NS, Sawant S, et al. Clinical and Radiographic Evaluation of Indirect Pulp Capping with Mineral Trioxide Aggregate and Calcium Hydroxide in Primary Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2025;18(8):1031-1038.

PMID:40989989 | PMC:PMC12451570 | DOI:10.5005/jp-journals-10005-3171

Int J Clin Pediatr Dent. 2025 Aug;18(8):1051-1057. doi: 10.5005/jp-journals-10005-3232. Epub 2025 Sep 4.

ABSTRACT

INTRODUCTION: Telemedicine and teledentistry have become a necessity for the community these days. So, for better implementation, it is essential to recognize the existing state of knowledge, beliefs, attitudes, and practice about it among the dental professionals; hence, this survey was planned.

MATERIALS AND METHODS: A self-designed online questionnaire consisting of 19 questions divided into three sections was sent to graduate and postgraduate dental professionals practicing in North India through e-mail and WhatsApp. The responses were stored in Microsoft Excel 2007 (Microsoft, Redmond, Washington) and analyzed using Statistical software SPSS version 20.0. Descriptive statistics and frequency distribution were examined using Pearson’s Chi-squared test. A p-value < 0.05 was considered statistically significant.

RESULTS: A total of 384 dental professionals completed the questionnaire. In total, 327 (85.2%) respondents were aware of the term teledentistry. Only 33 (8.6%) individuals were able to mark all nine components of teledentistry whereas all others identified only a few components indicating lack of awareness. Only 29 (7.6%) participants have received some formal training on teledentistry. In total, 88% of participants are willing to attend training on teledentistry if provided a chance. In total, 306 (79.7%) respondents were willing to use teledentistry in the future.

DISCUSSION: The overall attitude toward teledentistry was overwhelmingly positive. Despite the positive attitudes and belief in the benefits of teledentistry, significant barriers to its widespread adoption were identified, including inadequate access to technology, lack of formal training, and concerns about the accuracy of diagnoses. Dental professionals demonstrated a high willingness to engage in further training and adopt teledentistry if provided with the necessary resources and support.

HOW TO CITE THIS ARTICLE: Sikka N, Gupta S, Arya L, et al. Assessment of Knowledge, Attitude, Practice, and Barriers to the Use of Teledentistry by Dental Professionals of India: A Cross-sectional Survey. Int J Clin Pediatr Dent 2025;18(8):1051-1057.

PMID:40989985 | PMC:PMC12451562 | DOI:10.5005/jp-journals-10005-3232

Int J Clin Pediatr Dent. 2025 Aug;18(8):977-981. doi: 10.5005/jp-journals-10005-3197. Epub 2025 Sep 4.

ABSTRACT

AIMS AND BACKGROUND: Pulpectomy is a procedure that is done by removing the entire coronal and radicular pulp of primary teeth. To achieve an optimal outcome in dental treatment, a combination of scientific knowledge and technical skills is required. Sufficient simulated practice is needed for dental students before performing treatment on patients as they get better hand-eye-foot coordination. The main aim of the study is to assess undergraduate training in pulpectomy using the typodont model and extracted natural teeth.

MATERIALS AND METHODS: The study included 100 final-year Bachelor of Dental Surgery (BDS) students, with 50 practicing pulpectomy on typodont teeth and 50 on extracted natural teeth. All students then performed pulpectomy on pediatric teeth. Clinical performance was assessed based on access cavity preparation, biomechanical preparation (BMP), obturation, and procedural efficiency. Data were analyzed using Statistical Package for the Social Sciences (SPSS) to compare the effectiveness of training on model vs natural teeth.

RESULTS: Regarding obturation, students trained with extracted teeth showed better results, with an optimal obturation (91 vs 96%). Group II (extracted natural teeth) outperformed group I (artificial teeth) in BMP. Canal cleaning adequacy was higher (91 vs 87%), and shaping accuracy improved (93 vs 87%), likely due to the realistic anatomical challenges of natural teeth. Errors in over- or underpreparation were also fewer in group II (6 vs 18%), indicating enhanced judgment in canal preparation.

CONCLUSION: In conclusion, the study demonstrated that training with extracted natural teeth resulted in superior performance in key pulpectomy procedures, such as access cavity preparation, BMP, and obturation, compared to training with model teeth.

CLINICAL SIGNIFICANCE: This study evaluates the effectiveness of model and natural teeth training in enhancing student competency for pediatric pulpectomy, aiding improvements in dental education and clinical outcomes.

HOW TO CITE THIS ARTICLE: Venkatraj R, Gurunathan D. Assessment of Undergraduate Training in Pulpectomy Using Model Teeth and Extracted Natural Teeth. Int J Clin Pediatr Dent 2025;18(8):977-981.

PMID:40989982 | PMC:PMC12451599 | DOI:10.5005/jp-journals-10005-3197

Int J Clin Pediatr Dent. 2025 Aug;18(8):946-955. doi: 10.5005/jp-journals-10005-3192. Epub 2025 Sep 4.

ABSTRACT

INTRODUCTION: Stem cell therapy has been used in a variety of clinical procedures. When introduced into a specific part of the body, these cells differentiate into a target cell type and help replace damaged tissue and improve function. This experimental study was conducted to evaluate the effect of combining various natural biomimetic materials on stem cells from human exfoliated deciduous teeth (SHED).

MATERIALS AND METHODS: After isolation and culturing of SHED to the fifth passage, cells were treated with a regular culture medium (Group I-negative control), osteoinduction medium (Group II-positive control), a combination of mineral trioxide aggregate plus coral (MC, group III), and a combination of Biodentine plus coral (BC, group IV). Viability was assessed using MTT assay on the 7th, 14th, and 21st days. Mineralization was evaluated by Alizarin Red S staining to detect calcium deposits at the same intervals. The anti-inflammatory potential for expression of MMP-9 and MMP-2 was analyzed using gelatin zymography. One-way ANOVA followed by post hoc Bonferroni test was applied for statistical comparison (p < 0.05).

RESULTS: MC showed better cell viability than BC on the 14th and 21st days. However, BC demonstrated significantly better cytodifferentiation potential (p < 0.001) and anti-inflammatory effect (p < 0.001) than MC.

CONCLUSION: With the addition of coral, the properties of both commercially available biomimetic materials were enhanced, resulting in improved osteoinductive properties of mineral trioxide aggregate and Biodentine. The MC combination showed better cell viability and proliferation, while BC showed superior cytodifferentiation and anti-inflammatory properties. Coral, as a natural material, enhanced both formulations significantly.

HOW TO CITE THIS ARTICLE: Dahake PT, Bhamare S, Kale YJ, et al. The Combination of Biomimetic Materials Enhances the Functional Differentiation of Stem Cells Exfoliated from Human Deciduous Teeth. Int J Clin Pediatr Dent 2025;18(8):946-955.

PMID:40989981 | PMC:PMC12451560 | DOI:10.5005/jp-journals-10005-3192

Int J Clin Pediatr Dent. 2025 Aug;18(8):1039-1045. doi: 10.5005/jp-journals-10005-3120. Epub 2025 Sep 4.

ABSTRACT

BACKGROUND: Bruxism is a parafunctional habit affecting the stomatognathic system, with possible detrimental effects on the cervical spine position and, consequently, the head posture.

OBJECTIVES: The present study aimed at assessing the association between bruxism and cervical spine position in human subjects.

SEARCH METHODS: Two researchers, SHS and LNM, independently searched articles using appropriate keyword combinations in four search engines: PubMed, Cochrane Library, Semantic Scholar, and Google Scholar. Conflicts, if any, were resolved by AMJ. Studies either reported in English or with complete translations available in English were selected.

SELECTION CRITERIA: Observational studies reporting bruxism and cervical position from cephalometric to photographic parameters were considered. Interventional studies were included only to collect the baseline observational data.

DATA COLLECTION AND ANALYSIS: From 22 studies, a total of nine studies were included in the systematic review and five in the meta-analysis (three with cephalometric and two with photographic parameters). 1. CVT-HOR Angle between tangent (CVT) to the cervical vertebra (CV4) and horizontal line (HOR); 2. OPT-HOR Angle between the tangent (OPT) to odontoides (CV2) and horizontal line (HOR); 3. CVT-VV Angle between tangent (CVT) to the cervical vertebra (CV4) and vertical line (VV); 4. OPT-VV Angle between the tangent (OPT) to odontoides (CV2) and vertical line (VV) (cephalometric), and craniocervical angle (photographic) were considered as dependent variables for the analyses; bruxism being the independent variable.

RESULTS: Three studies (120 subjects) showed changes in the cephalometric parameters, and two studies (45 subjects) showed changes in the photographic parameters. Using Fixed Effect Model (FEM), standardized mean difference [SMD (95% CI)] for variables CVT-HOR [-0.62 (-0.99, -0.24)], OPT-HOR [-0.67 (-1.04, -0.29)], and OPT-VV [0.76 (0.38, 1.14)] were all statistically significant with low heterogeneity (I² = 25, 0, 0). The Risk of Bias (ROB) across studies assessed using the AXIS tool was low. These parameters show a statistically significant difference in head posture between individuals with bruxism and without bruxism, relating to anterior positioning of the cervical spine in individuals with bruxism.

CONCLUSION: Association exists between bruxism and cervical spine position in human subjects with respect to the aforementioned variables of interest.

PROSPERO REGISTRATION: CRD42023433635.

HOW TO CITE THIS ARTICLE: Solanke SH, Mistry LN, Jawdekar AM. Association between Bruxism and Cervical Spine Position in Human Subjects: A Systematic Review and Meta-analysis of Observational Studies. Int J Clin Pediatr Dent 2025;18(8):1039-1045.

PMID:40989979 | PMC:PMC12451578 | DOI:10.5005/jp-journals-10005-3120

Int J Clin Pediatr Dent. 2025 Aug;18(8):982-985. doi: 10.5005/jp-journals-10005-3198. Epub 2025 Sep 4.

ABSTRACT

BACKGROUND: Enduring research in pediatric endodontics has resulted in the development of many file systems with increased efficacy and advantages. The rotary system was created to improve treatment quality and reduce manual dexterity, resulting in a better treatment protocol.

AIM: The purpose of the research involves the evaluation and comparison of efficiency as well as subsequent obturation quality of the Kedo-S and Kedo-SH files during pulp canal therapy in deciduous molars.

MATERIALS AND METHODS: Children of 4-8 years requiring pulpectomy in forty deciduous lower molars were randomly divided into two different groups: Kedo-SH file (Group I) and Kedo-S file (Group II). A stopwatch was utilized for documentation of instrumentation time, and Coll and Sadrian criteria were utilized for observation of obturation quality. Statistical analysis of the obtained data was analyzed using the independent t-test and Chi-square test.

RESULTS: Mean instrumentation time in group I was 207.2 seconds, which was far more than group II (150.8 seconds), with p-value < 0.0001. No statistically significant variance was observed in obturation quality.

CONCLUSION: Kedo-S group resulted in less instrumentation time when compared to Kedo-SH with better obturation quality.

HOW TO CITE THIS ARTICLE: Dewangan B, Ukey A, Surana P, et al. Efficiency and Obturation Quality Outcomes between Kedo-S Rotary Files and Kedo-SH Manual Files Instrumentation during Pulpectomy in Primary Molars. Int J Clin Pediatr Dent 2025;18(8):982-985.

PMID:40989977 | PMC:PMC12451586 | DOI:10.5005/jp-journals-10005-3198