Categories
Nevin Manimala Statistics

Characterization of Treatment Modalities for Patients with Syndromic Craniosynostosis in Relation to Degree of Midface Hypoplasia and Patient’s Age using Longitudinal Follow-Up Data

J Craniofac Surg. 2021 Nov 9. doi: 10.1097/SCS.0000000000008373. Online ahead of print.

ABSTRACT

The purpose of this study was to investigate the type and frequency of use of treatment modalities (Tx-Mods) in patients with syndromic craniosynostosis (SC) using longitudinal follow-up data. A total of 28 patients with SC (24 Crouzon, 2 Apert, and 2 Antley-Bixler syndromes), who were treated at the Department of Orthodontics, Seoul National University Dental Hospital, Seoul, South Korea between 1998 and 2020, was included. According to the degree of midface hypoplasia (MH) at the initial visit (T1), the patients were divided into the mild-MH (78°≤SNA < 80°, n = 8), moderate-MH (76°≤SNA < 78°, n = 7), and severe-MH (SNA < 76°, n = 13) groups. T1-age and Tx-Mods, including calvarial surgery (CALS), orthopedic treatment (OPT), fixed orthodontic treatment, and midface advancement surgery in childhood (MAS-child) and adulthood (MAS-adult), were investigated. Complexity of MAS-adult was graded as follows: 0, no surgery; 1, orthognathic surgery; 2, distraction osteogenesis (DOG); 3, combination of distraction osteogenesis and orthognathic surgery. Then, statistical analysis was performed. Percentage distribution of Tx-Mods was 71.4% in CALS, 21.4% in MAS-child, 42.9% in OPT, 100% in fixed orthodontic treatment, and 89.3% in MAS-adult. 92.9% of patients underwent MAS more than once. The number of MAS increased according to the severity of MH (P < 0.05). The complexity of MAS-adult increased as T1-age and severity of MH increased (all P < 0.05); whereas it decreased when CALS and OPT were performed (all P < 0.05). However, MAS in childhood did not guarantee the avoidance of additional MAS in adulthood (P > 0.05). These findings may be used as basic guidelines for successful treatment planning and prognosis prediction in patients with SC.

PMID:34753869 | DOI:10.1097/SCS.0000000000008373

Categories
Nevin Manimala Statistics

Week 2 Adalimumab Levels Predict Short-term Clinical Remission in Patients With Inflammatory Bowel Disease

J Clin Gastroenterol. 2021 Nov 10. doi: 10.1097/MCG.0000000000001636. Online ahead of print.

ABSTRACT

BACKGROUND AND GOALS: The role of early proactive therapeutic drug level monitoring for anti-tumor necrosis factor therapies is unclear. We aimed to determine whether a week 2 serum trough level in patients with inflammatory bowel disease (IBD) using adalimumab may predict clinical outcomes.

MATERIALS AND METHODS: This was a retrospective study of consecutive IBD patients with a week 2 serum adalimumab level available. Receiver operating characteristic curve analysis was conducted to determine an optimal week 2 threshold level for adalimumab. Patients above the threshold were compared for the primary outcome of week 12 clinical remission (CR) and the secondary outcome of short-term endoscopic healing. Multivariate logistic regression analysis was performed to evaluate the relationship between week 2 adalimumab level and CR.

RESULTS: Forty-six patients had a week 2 adalimumab level performed. Receiver operating characteristic curve analysis suggested an optimal adalimumab level of 11.9 mcg/mL based on the area under the curve. Patients with week 2 adalimumab levels >11.9 mcg/mL had higher odds of week 12 CR than those with levels below or equal to this threshold (odds ratio=3.34, 95% confidence interval: 1.01-12.11, P=0.04). Other covariates were not found to have a significant association with the primary outcome. The rate of short-term endoscopic healing was numerically higher in patients with adalimumab week 2 levels above 11.9 mcg/mL; however, was not statistically significant (71.4% vs. 28.5%, P=0.11).

CONCLUSIONS: Serum adalimumab levels at week 2 appears to be a predictor of short-term CR. Further research should explore whether patients with a week 2 adalimumab level equal to or below 11.9 mcg/mL benefit from early dose optimization.

PMID:34753872 | DOI:10.1097/MCG.0000000000001636

Categories
Nevin Manimala Statistics

Analysis of Remineralization Potential of Three Different Remineralizing Pastes on Demineralized Enamel: A Comparative Study

J Contemp Dent Pract. 2021 Aug 1;22(8):939-942.

ABSTRACT

AIM: Aim of this research was to evaluate the remineralizing potential of three different remineralizing pastes on enamel that has been demineralized.

MATERIALS AND METHODS: Sixty healthy mandibular single-rooted human premolars extracted for orthodontic reasons from subjects between 18 and 25 years of age were included in this research. An area of 4 mm × 4 mm (window) was marked on the buccal surfaces of teeth samples, coated with nail varnish except for the window, which was scrutinized for changes in the values subsequent to demineralization as well as remineralization. Samples were kept in demineralizing solution for 96 hours to produce the artificial lesion in the enamel. Consequent to this process of demineralization, the 60 premolar teeth were randomly allocated to the following three groups (20 in each group) depending on the remineralizing paste used for application as group I: bioactive glass constituting remineralizing paste; group II: tricalcium phosphate (TCP) comprising remineralizing paste; and group III: calcium sucrose phosphate (CaSP) remineralizing paste. Following the pH-cycling process, the confocal laser scanning microscope was used to assess the area of demineralization and remineralization.

RESULTS: The mean areas of demineralization were slightly more (133.24 ± 0.09) in the remineralization paste comprising bioactive glass seconded by the remineralization paste having CaSP (131.39 ± 0.18), and lastly the remineralizing paste constituting TCP (129.59 ± 0.14). Maximum areas of remineralization were found in the pastes that had CaSP group (96.14 ± 0.04), next by the paste having bioactive glass group (102.18 ± 0.17), and then the remineralization paste constituting TCP (118.37 ± 0.21). The difference was statistically significant among the three remineralization pastes used.

CONCLUSION: Amid the confines of this in vitro research, a conclusion that the remineralization pastes comprising CaSP exhibited enhanced remineralization capacity in comparison to the group having bioactive glass and TCP was established.

CLINICAL SIGNIFICANCE: Caries is a highly prevalent multifactorial disease, but its progression can be prevented in the initial stage of demineralization through remineralization. Significantly increasing attention to the treatment of carious lesions that are not cavitated by employing noninvasive remineralization methods to achieve restoration of enamel has been rendered in the field of research.

PMID:34753848

Categories
Nevin Manimala Statistics

Sclerostin Immunohistochemical Staining in Aggressive Maxillofacial Giant Cell Lesions: Initial Results and Potential Therapeutic Target

J Craniofac Surg. 2021 Nov 9. doi: 10.1097/SCS.0000000000008344. Online ahead of print.

ABSTRACT

INTRODUCTION: Maxillofacial (MF) giant cell lesions (GCLs) are benign, often locally aggressive lesions with potential for recurrence. Systemic treatments have included interferon alpha, calcitonin, bisphosphonates, and denosumab. Sclerostin (SOST) is typically thought to be a negative regulator of bone metabolism and anti-SOST agents have been used to treat osteoporosis; however, its role in central giant cell granuloma is unknown. The purpose of this study was to evaluate the expression of SOST in MF GCLs.

MATERIALS AND METHODS: This was a retrospective study of patients with MF GCLs treated at a single institution between 1993 and 2008 with a minimum follow-up of 6 months. Representative tissue was used to create a tissue microarray and SOST immunohistochemical (IHC) staining and grading was performed. The primary outcomes were IHC staining of the stromal cells and giant cells. The secondary outcomes included correlation of IHC staining and patient predictor variables including clinically benign and aggressive lesions. All analyses were completed using univariate statistical tests.

RESULTS: A total of 37 subjects were included (29 clinically aggressive and 8 clinically benign). Sclerostin staining was present in 30 of 37 subjects (81%). Of these, 22 (60%) had stromal cell staining and 28 (76%) had giant cell staining. The presence or absence of staining, of either cell type, was not associated with aggressiveness, presence of clinical symptoms, tumor size, previous interferon therapy, previous surgery, or the race or age of the patient.

DISCUSSION: Maxillofacial GCLs have an overall high level of SOST staining; however, the role of SOST in treatment and prognosis is unknown and warrants further study.

PMID:34753866 | DOI:10.1097/SCS.0000000000008344

Categories
Nevin Manimala Statistics

Evaluation of Effectiveness of Three New Gingival Retraction Systems: A Comparative Study

J Contemp Dent Pract. 2021 Aug 1;22(8):922-927.

ABSTRACT

AIM: To analyze the clinical effectiveness of three new gingival retraction systems: knitted retraction cord, expanding polyvinyl siloxane, and aluminium chloride containing paste.

MATERIALS AND METHODS: Twenty patients were enrolled with age-group of more than 18 years and who required fixed prosthesis with minimum of two abutments. A preliminary impression of the arch was made with a stock metal tray and irreversible hydrocolloid impression material. Group WR-impression without retraction, Group A-impression after retraction with gingival retraction cord, Group B-impression after retraction with expanding polyvinyl siloxane, and Group C-impression after retraction with aluminium chloride containing paste. A total of four impressions were made for each abutment tooth. Each impression was given a label 1WR, 1A, 1B, 1C-20WR, 20A, 20B, 20C: where 1 denoted the sample number. Comparison of the stereomicroscopic images was done using image analysis software. Time required from start of placement of gingival displacement agents till completion was recorded in seconds with the help of a stop clock.

RESULTS: The mean gingival retraction was found to be the highest for subjects of Group C followed by Group A, Group B, and Group WR. This difference was found to be statistically significant. Highly significant mean difference in time of placement was observed between Group A and Group B, between Group B and Group C, and between Group C and Group A.

CONCLUSION: The aluminium chloride containing paste was found effective in almost all the variables considered.

CLINICAL SIGNIFICANCE: The choice of particular gingival retraction system/technique is dependent upon the clinical variables and on operator’s preference.

PMID:34753845

Categories
Nevin Manimala Statistics

Association between Parity and Dental Caries Experience among US Women: Findings from the National Health and Nutrition Examination Survey

J Contemp Dent Pract. 2021 Aug 1;22(8):933-938.

ABSTRACT

AIM AND OBJECTIVE: This study aims to investigate the association between parity and dental caries among US women.

MATERIALS AND METHODS: National Health and Nutrition Examination Survey (NHANES 2001-2004) data for parous women aged 20-45 years were used for our analysis (n = 1,914). The association between parity (number of pregnancies resulted in live births) and caries experience [the decayed, missing, and filling teeth (DMFT) index] was analyzed using bivariate and multivariate regression analyses. SAS software version 9.1 was used for the statistical analyses. We used survey procedures (e.g., SURVEYFREQ, SURVEYMEANS, and SURVEYREG) that incorporate information on the appropriate weights to account for NHANES’s complex sampling design.

RESULTS: The bivariate analysis showed a trend of increase in dental caries experience among parous women as the number of live births increased (p = 0.007). After adjusting for confounders, such as age, socioeconomic status (SES), dental care coverage, and utilization, a significant association was still observed between parity level and dental caries experience (p = 0.009).

CONCLUSION: Our results suggest that higher parity can be associated with dental caries experience among US women of reproductive age.

CLINICAL SIGNIFICANCE: Clinicians should be aware of this finding to promote better oral health care and education among women with increased parity.

PMID:34753847

Categories
Nevin Manimala Statistics

Efficacy of Licorice on Salivary Streptococcus mutans Levels vs Chlorhexidine Mouthwash in High Caries Risk Patients: A Randomized Clinical Trial

J Contemp Dent Pract. 2021 Aug 1;22(8):914-921.

ABSTRACT

AIM: To evaluate the efficacy of an innovative herbal licorice mouthwash on reducing salivary Streptococcus mutans levels versus chlorhexidine mouthwash in high caries risk patients.

METHODOLOGY: A total number of 52 high caries risk patients were assigned to this study. Patients were randomly divided into two groups (n = 26) according to the type of mouthwash (G): Patients in group G1 used the mouthwash containing chlorhexidine, while patients in group G2 used the mouthwash containing the innovative licorice extract. Afterward, each group was further divided into three subgroups according to the time (T): T0 represents the baseline, T1 represents the time immediately after using the mouthwash, and T2 represents the time 1 week after using the mouthwash. Furthermore, pH and plaque index were recorded. Data were statistically analyzed using a Chi-square test for categorical data, Shapiro-Wilk test for numerical data, and one-way repeated measures ANOVA followed by Bonferroni post hoc test for intragroup comparisons. The significance level was set at p ≤0.05 for all tests. Statistical analysis was performed with IBM® SPSS® Statistics version 26 for Windows.

RESULTS: It was found that in high caries risk patients, there was no significant difference between licorice and chlorhexidine mouthwashes regarding Streptococcus bacterial count. Moreover, it was found that licorice mouthwash stimulates salivary flow, and thus, it raises salivary pH in patients with high caries risk. However, the plaque index of chlorhexidine showed better results. Additionally, there was a positive weak correlation between bacterial count and plaque index.

CONCLUSIONS: Licorice mouthwash may demonstrate a promising antibacterial effect that can be a suitable alternative for current synthetic mouthwashes.

CLINICAL SIGNIFICANCE: Natural herbal mouthwash could be incorporated in dental preventive measures and could be used as cavity-fighting compound. It introduces a minimal health hazard substitute for conventional synthetic preventive measures.

PMID:34753844

Categories
Nevin Manimala Statistics

Maxillary Incisor Intrusion Using Two Conventional Intrusion Arches and Mini Implants: A Prospective Study

J Contemp Dent Pract. 2021 Aug 1;22(8):907-913.

ABSTRACT

AIM AND OBJECTIVE: This study aimed to compare cephalometrically the rate of maxillary incisor intrusion using mini implants, Connecticut intrusion arches, and segmental intrusion arches.

MATERIALS AND METHODS: Thirty-two adult patients with deep bite were divided into three groups: 10 patients in mini implant and Connecticut intrusion arch group each and 12 patients in segmental intrusion arch group. Bilateral mini implants were used for intrusion in Group 1. Connecticut intrusion arch and Burstone’s three-piece intrusion arch were used for intrusion in Group 2 and Group 3, respectively. Intrusion was carried out in all the patients for 4 months. Lateral cephalograms were taken just after alignment and leveling (T1) and after 4 months of intrusion (T2).

RESULTS: The mean amount of intrusion observed was 1.7 mm (0.425 mm/month) in mini implant group, 1.4 mm (0.35 mm/month) in Connecticut intrusion arch group, and 1.66 mm (0.415 mm/month) in segmental intrusion arch group. No statistically significant difference was found in the extent of incisor intrusion in the three groups (p <0.05).

CONCLUSION: The study failed to reject the null hypothesis, and there was no statistically significant difference in the amount and rate of incisor intrusion achieved among the three groups (p >0.05).

CLINICAL SIGNIFICANCE: Significant amount of incisor intrusion was carried out by all the three methods. There was no statistically significant difference in the amount and rate of incisor intrusion achieved by the three methods. Clinically, mini implants can be considered superior to the conventional techniques as it provides absolute anchorage which eliminates unwanted effects of incisor intrusion.

PMID:34753843

Categories
Nevin Manimala Statistics

Peptide GAM immunoadsorption in anti-PLA2 R positive autoimmune membranous nephropathy. The PRISM trial

J Clin Apher. 2021 Nov 9. doi: 10.1002/jca.21949. Online ahead of print.

ABSTRACT

Membranous nephropathy associated with anti-PLA2 R autoantibody is a significant cause of nephrotic syndrome worldwide. Treatment remains empiric with a significant side-effect burden despite an increase in our understanding of the disease. We studied the effect of selectively removing this pathogenic autoantibody using immunoadsorption in adult patients with biopsy proven anti-PLA2 R membranous nephropathy. This was a multicenter, single-arm prospective clinical trial carried out in the United Kingdom. Twelve patients underwent five consecutive sessions of peptide GAM immunoadsorption with 12 months follow-up. Primary outcome was anti-PLA2 R titer at week 2. Secondary outcomes were safety and tolerability of therapy, antibody profile, and change in proteinuria, renal excretory function, serum albumin, total immunoglobulin, and quality of life at weeks 12, 24, and 52. Patients were also stratified by the presence or absence of the high-risk allele (heterozygous or homozygous for HLA-DQA1*05). Median pretreatment anti-PLA2 R was 702.50 U/mL, 1045.00 U/mL at week 2 (P-value .023) and 165.00 U/mL at week 52 (P-value .017). The treatment was well tolerated and safe. Two patients required rescue immunosuppression during the follow-up period. There was a significant improvement in serum albumin with a median at baseline of 20.50 g/L rising to 25.00 g/L at week 52 (P-value <.001). There was no statistical difference over the follow-up period in proteinuria or renal function. Patients in possession of a high-risk allele saw improvement in anti-PLA2 R titers, possibly representing a cohort more likely to benefit from immunoadsorption. Immunoadsorption therapy is a safe treatment and well-tolerated treatment in anti-PLA2 R positive autoimmune membranous nephropathy.

PMID:34753218 | DOI:10.1002/jca.21949

Categories
Nevin Manimala Statistics

Impact of the French COVID-19 pandemic lockdown on newly diagnosed melanoma delay and severity

J Eur Acad Dermatol Venereol. 2021 Nov 9. doi: 10.1111/jdv.17802. Online ahead of print.

ABSTRACT

The COVID-19 pandemic has had a profound impact on the healthcare system worldwide, which led to a decrease in the number of melanoma diagnosis,1 but the consequences of lockdown on newly diagnosed melanomas severity have not been widely reported. We aimed to evaluate how the first lockdown in France impacted the incidence and prognostic characteristics of new melanomas, in our skin cancer center in the Parisian region, highly affected by the pandemic.

PMID:34753221 | DOI:10.1111/jdv.17802