Nevin Manimala

Indian J Crit Care Med. 2024 Jun;28(6):587-594. doi: 10.5005/jp-journals-10071-24737.

ABSTRACT

AIM AND BACKGROUND: Sarcopenia is a substantial contributor to intensive care unit (ICU)-acquired weakness and is associated with significant short- and long-term outcomes. It can, however, be mitigated by providing appropriate nutrition. Indirect calorimetry (IC) is believed to be the gold standard in determining caloric targets in the dynamic environment of critical illness. We conducted this study to compare the effect of IC vs weight-based (25 kcal/kg/day) feeding on quadriceps muscle thickness (QMT) by ultrasound in critically ill patients.

MATERIALS AND METHODS: A prospective study was conducted on 60 mechanically ventilated patients randomized to two groups [weight-based equation (WBE) group or the IC group] in medical ICU after obtaining institutional ethics committee approval, and fed accordingly. The right QMT measurement using ultrasound and caloric targets were documented on day 1, 3 and 7 and analyzed statistically. The IC readings were obtained from the metabolic cart E-COVX Module^TM.

RESULTS: The baseline demographics, APACHE-II, NUTRIC score, and SOFA scores on day 1, 3, and 7 were comparable between the two groups. The resting energy expenditure (REE) obtained in the IC group was significantly less than the WBE energy targets and the former were fed with significantly less calories. A significantly less percent reduction of QMT in the IC group compared with the WBE group was observed from day 1 to day 3, day 3 to day 7, and day 1 to day 7.

CONCLUSION: From our study, we conclude that IC-REE-based nutrition is associated with lesser reduction in QMT and lesser calories fed in critically ill mechanically ventilated patients compared from WBE. CTRI registration-CTRI/2023/01/049119.

HOW TO CITE THIS ARTICLE: Chandrasekaran A, Pal D, Harne R, Patel SJ, Jagadeesh KN, Pachisia AV, et al. Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial. Indian J Crit Care Med 2024;28(6):587-594.

PMID:39130394 | PMC:PMC11310671 | DOI:10.5005/jp-journals-10071-24737

J Clin Exp Dent. 2024 Jun 1;16(6):e707-e713. doi: 10.4317/jced.61608. eCollection 2024 Jun.

ABSTRACT

BACKGROUND: The aim of this study was to compare the fracture strength of two different Ribbond Fiber (Ribbond, Ribbond Inc., Seattle, WA, USA) restoration strategies in 5 mm deep standardized MOD cavities without interaxial dentin.

MATERIAL AND METHODS: 34 extracted human molars were randomly divided into two groups and restored as follows: Group 1 restoration with Ribbond Fiber placed at the cavity floor incorporated in Estelite Bulk-Fill Flow Universal composite (Tokuyama Dental Corporation Inc., Tokyo, Japan); Group 2 restoration with RF placed at 3 mm from the occlusal plane over a 2mm layer of Estelite Bulk-Fill Flow. The occlusal plane in both groups was restored with Ceram.x Spectra ST (Dentsply Sirona, Ballantyne Corporate Pl, Charlotte, NC, USA). The restored teeth were subjected to thermal cycling by immersing them for 30 seconds in hot water (55±2°C) followed by 30 seconds in cold water (5±2°C), for 2000 cycles.Their fracture strength was then evaluated using an Instron device. Data were analyzed with Two-sample T Test statistical test to compare fracture strength among groups. Finally, a descriptive analysis of the failure location was performed.

RESULTS: A statistically significant difference was found between groups 1 and 2 (P<0.001) in terms of fracture strength. Group 2 exhibited a higher percentage of recoverable fractures compared to group 1. Group 1 had a mean fracture load of 833N and a SD of 248 while group 2 had a mean fracture load of 1286N and SD of 447.

CONCLUSIONS: RF placed at 3 mm depth from the occlusal plane, on a 2 mm layer Estelite Bulk-Fill Flow Universal composite (Tokuyama Dental Corporation Inc., Tokyo, Japan) contributes to improve fracture resistance in vital teeth without interaxial dentin and reduces the risk of non-recoverable fractures compared to when it is placed at a 5 mm depth. Key words:Ribbond fiber, composite restoration, fracture resistance, Instron machine.

PMID:39130368 | PMC:PMC11310981 | DOI:10.4317/jced.61608

J Clin Exp Dent. 2024 Jun 1;16(6):e733-e739. doi: 10.4317/jced.61352. eCollection 2024 Jun.

ABSTRACT

BACKGROUND: This research aimed to analyze the influence of root canal taper on the accuracy of two Electronic Apex Locators (EALs).

MATERIAL AND METHODS: Twenty-five disto-vestibular roots from extracted human upper molars belonging to the tooth bank were used in this study. To determine the File Position (FP), access was made using a spherical diamond tip #1014, and the crowns were sectioned using a diamond tip #3080. The initial anatomic file used was a size K #10, which was introduced into the root canal until its tip was visualized (foraminal patency) with the aid of a clinical microscope (16X magnification). Teeth without foraminal patency and calcifications were excluded from the study. Odontometric readings were performed using two different EALs (Root ZX II and Romiapex A-15), considering the electronic reference point 0.0 (apex) for each device. All measurements were taken in triplicate, and the arithmetic mean of the three values was used. Digital calipers were used to record the measurements, which were then entered into an Excel spreadsheet. After visual verification using file K #10, the canals were instrumented with a #25.01 file to standardize the apical region, then successively instrumented with files #25.02, #25.04, #25.06, #25.08, #25.10, and #25.12, with electronic odontometry checked after each instrumentation using #25.02. Measurement 0.0 was adopted, with error margins of ±0.5 and ±1.0. Discrepancies between visual and electronic readings were statistically analyzed using ANOVA and Bonferroni tests, with significance considered when P<0.05.

RESULTS: Using the 0.0 mark and a ±1.0 error margin, it was observed that readings from the devices were similar in canals with different tapers (P>0.05), showing a tendency towards underestimation. However, when using the measurement variation margin of ±0.50, a statistically significant difference was found in the Romiapex A-15 group (P=0.0248) when comparing the results of the two EALs.

CONCLUSIONS: Therefore, it was concluded that the canal taper did not significantly influence the accuracy of the evaluated EALs, using the reference point 0.0. When using the ±0.5 variation margin, the Romiapex A-15 device showed greater accuracy, and finally, at the ±1.0 error margin, both EALs exhibited excellent precision. Key words:Endodontics, Odontometry, Eletronic Apex Locator, Root Canal Preparation.

PMID:39130363 | PMC:PMC11310975 | DOI:10.4317/jced.61352

J Clin Exp Dent. 2024 Jun 1;16(6):e749-e754. doi: 10.4317/jced.61703. eCollection 2024 Jun.

ABSTRACT

BACKGROUND: To evaluate the thermal insulation of protective liners and glass ionomer cement during light-curing procedures.

MATERIAL AND METHODS: Human third molars underwent Class I preparations with dimensions 5 mm long × 4 mm wide × 4 mm deep in a standardized manner ensured a consistent ±0.5 mm dentin thickness at the pulpal floor. The teeth were attached to a customized oral cavity chamber simulator with a circulating bath at a standardized temperature of 34.2 ± 1oC. The temperature variations at the pulpal floor were captured in real-time by video using an infrared thermal camera (FLIR ONE Pro, FLIR Systems). The materials evaluated were: Dycal (Dentsply), TheraCal LC (Bisco), Activa (Pulpdent), and Fuji II LC (GC). All light-activation procedures were performed with the same light-curing unit (Valo Grand, Ultradent) in standard mode, 1000 mW/cm2, and time of exposure following manufacturer instructions. A power analysis was conducted to determine the sample size considering a minimal power of 0.8, with α=0.05. Statistical analyses were performed using ANOVA and Tukey’s test for multiple comparisons.

RESULTS: The temperature at the pulpal floor increased above the 5.5 ºC safety threshold difference for clinical scenarios tested. None of the materials provided proper thermal insulation for light-curing procedures (p = 0.25). The higher the number of light-cured steps, the longer the pulp remained above the 5.5 ºC temperature threshold.

CONCLUSIONS: The materials tested provided improper thermal insulation (Δ > 5.5 ºC). Thus, prolonged or multiple light-curing exposures can be harmful to the pulp tissues. Therefore, for indirect pulpal capping procedures, self-cured materials or a reduced number of steps requiring light curing must be adopted to reduce the amount of time the pulp remains above the 5.5 ºC safety temperature threshold. Key words:Dental Pulp Capping, Calcium hydroxide, Bioactive, Thermal Damage.

PMID:39130362 | PMC:PMC11310984 | DOI:10.4317/jced.61703

J Clin Exp Dent. 2024 Jun 1;16(6):e740-e748. doi: 10.4317/jced.61624. eCollection 2024 Jun.

ABSTRACT

BACKGROUND: Maxillary sinuses may present a wide spectrum of anatomical variations and pathological lesions whose recognition is mandatory for the clinician, especially prior to any surgical intervention in the area, such as in cases of sinus floor elevation. The goal of this study was the evaluation, mapping and prevalence of sinus anatomical variants and pathoses in Cone Beam Computed Tomography (CBCT) scans of dental patients.

MATERIAL AND METHODS: 660 CBCT examinations of adult patients involving both sinuses were obtained (between 2017 and 2023) and analyzed. The following anatomic variants and pathologic findings were evaluated: antral septa (AS), posterior superior alveolar artery (PSAA), sinus hypoplasia, sinusitis, odontogenic cysts, retention cysts, antroliths, and various less common lesions (e.g.: benign fibro-osseous dysplastic lesions, neoplasms etc.). Investigation of the association of the findings with patients’ age and gender was performed using the Chi-square test (X2), Fisher’s exact test, t-test, and ANOVA (P<0.05). Differences in prevalence between findings, based on their location (right and/or left sinus), were investigated using z-test and t-test.

RESULTS: AS were found in 38.6%, and PSAA was identifiable in 90.2% (mean distance from the sinus floor=6.44 mm) of the patients respectively. 3% of patients had hypoplasia, 15.6% sinusitis, 2.7% odontogenic cysts, 16.1% retention cysts, 8.6% antroliths, and 1.7% uncommon lesions (e.g. malignant neoplasms and fibrous dysplasia). A statistically significant association was found between gender and PSAA diameter, PSAA distance from the sinus floor, hypoplasia, sinusitis, and retention cysts, as well as a statistically significant association between age and PSSA diameter and sinusitis.

CONCLUSIONS: The prevalence of various anatomical variants and pathologic findings of the maxillary sinus did not differ based on their location. However, some of these findings appear to be related to either gender or age. CBCT is a valuable diagnostic tool to identify various anatomical variants and pathological findings of the maxillary sinus. Key words:Sinus, anatomy, pathology, CBCT.

PMID:39130358 | PMC:PMC11310974 | DOI:10.4317/jced.61624

Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3088-3093. doi: 10.1007/s12070-024-04607-w. Epub 2024 Mar 16.

ABSTRACT

AIM: The aim of the study was (1) to investigate the development of identification of environmental sounds in children with Cochlear Implantation (CI) within four months from switch on (i.e. at 0, 2 and 4 months) and (2) to see the effect of family type in the perception of environmental sounds.

MATERIALS AND METHODS: A longitudinal study design was utilized on a total of 18 children using CI within the chronological age range of 3 to 7 years. All participants underwent a closed set test of Environmental Sound Perception (ESP) to measure the longitudinal outcomes of ESP, at 0 (within 1 week of switch on), 2 months and 4 months of implant age. They were asked to identify the sounds by pointing at the picture representing the sound.

RESULTS: Results using One-way and Two-way ANOVA demonstrated that at 0 month of implant age, the scores were 0%. At 2 months of implant age the scores ranged from 0 to 25% and at 4th month the scores ranged from 0 to 40%. There was a statistically significant improvement observed in ESP at every 2 months of testing from 0 to 4 months of implant age. However, effect of family type revealed no significant differences between the performances across the implant age.

CONCLUSION: The current study reveals that identification of environmental sounds are one of the foremost benefits and early outcomes of CI in children. The perception of environmental sounds are constantly but gradually developing with increasing implant age. This information is useful to predict the performance of CI during rehabilitation and to set the therapy goals accordingly.

PMID:39130335 | PMC:PMC11306886 | DOI:10.1007/s12070-024-04607-w

Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3418-3423. doi: 10.1007/s12070-024-04708-6. Epub 2024 Apr 23.

ABSTRACT

INTRODUCTION: Rhinosinusitis disability index (RSDI) questionnaire is used to assess the severity of chronic rhinosinusitis (CRS) from the patient’s perspective. The severity of CRS can be measured objectively with the endoscope and computed tomogram (CT) using the Lund-Kennedy endoscopic score and Mackay-Lund scores respectively. The objective of the study is to evaluate whether baseline RSDI and Lund-Kennedy (LK) endoscopy scoring can help predict the Mackay-Lund CT (MKLCT) scores after medical treatment in patients with CRS.

METHODOLOGY: This is a prospective, observational study, carried out from 1st October 2017 to 30th September 2019 in the ENT out- patient department at a tertiary hospital in Northern India. 90 patients diagnosed with CRS were enrolled consecutively in the study. RSDI questionnaire was filled out for all the participants. They all underwent a diagnostic endoscopy and CRS was graded according to the Lund-Kennedy endoscopic scores. All participants were given medical treatment. Patients underwent CT of the paranasal sinuses after medical treatment and the MLKCT scores were calculated. The baseline RSDI and Lund-Kennedy scores were correlated with the MKLCT scores using Spearman’s Rank correlation tests. The diagnostic ability of the RSDI and LK endoscopy scores to predict the least MKLCT scores was compared using the receiver operator characteristics curves (ROC).

RESULTS: A statistically significant correlation was seen with LK endoscopy scores and MKLCT scores (r = 0.396, p < 0.001) Among the individual parameters of the LK endoscopy scores only the polyp score had a statistically significant correlation with MKLCT scores (r = 0.593, p < 0.001). A weak negative correlation (r = – 0.058, p = 0.586) was seen between the RSDI scores and MKLCT scores. AUC in ROC curves for a LK endoscopy scores and RSDI scores were 0.690 and 0.462 respectively. Cut-off for predicting a MKLCT score of one or more for RSDI score was 25, with a sensitivity of 61% and specificity of 38.5%. Similarly, the cut-off for LK endoscopic score was 4.5, with a sensitivity of 68.8% and specificity of 61.5%.

CONCLUSION: Statistically significant (p < 0.001) association was found between baseline Lund-Kennedy endoscopic scores and Mackay-Lund CT scores post medical treatment. No significant association was found between RSDI scores and Mackay-Lund CT scores. ROC analysis indicated that Lund- Kennedy endoscopy score is a more accurate tool than RSDI score to predict a Mackay-Lund CT scores after medical treatment.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-024-04708-6.

PMID:39130314 | PMC:PMC11306677 | DOI:10.1007/s12070-024-04708-6

Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3390-3395. doi: 10.1007/s12070-024-04697-6. Epub 2024 Apr 12.

ABSTRACT

Present study is a comparative evaluation of the financial impact on choice of flap, clinical results as well as post resection quality of life assessment of cancer patients reconstructed with anterolateral thigh(ALT) flap and pectoralis major myo-cutaneous(PMMC) flap. Ethical clearance was obtained from institutional ethical committee. In this non-randomised, prospective study design among 49 oral squamous cell carcinoma cases, 39 cases were reconstructed using PMMC flap and 10 using ALT flap from year 2020 to 2022. These 2 flaps were compared in terms of parameters like time utilised for reconstruction, hospital stay, overall survival and Washington University Quality of Life index(UW-QOL) for head and neck cancer. Patients were followed regularly for post-operative complications. The University of Washington Quality of Life score (UW-QOL) questionnaire, version 4, was completed at six months post-operatively. Obtained data was statistically analysed using IBM^® SPSS^Ⓡ. Washington University Quality of Life index scores and esthetics are better with Antero-lateral thigh flap, with less overall post-operative complications. On the other hand Pectoralis myocutaneous flap has less surgical time and more salvage potential. Despite of Antero-lateral thigh flap having Good Washington University Quality of Life index scores, lesser post-operative complications and better esthetics; scale of developing nations is still tipping towards economical, less time consuming and less technique sensitive Pectoralis major myocutaneous flap.

PMID:39130307 | PMC:PMC11306680 | DOI:10.1007/s12070-024-04697-6

Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3379-3385. doi: 10.1007/s12070-024-04694-9. Epub 2024 Apr 12.

ABSTRACT

Keloids are fibroproliferative disorders caused due to injury to skin. The recurrence rate has been found to be as high as 100% even after surgical excision. The high recurrence rate has led to the need for various adjuvant therapies as a single approach alone has not been found to be efficient in preventing recurrence. This attributes to the need for a multimodal approach. Steroids are found to be useful in preventing recurrence. To evaluate the efficacy of the combination of hyaluronidase with corticosteroid injection compared to corticosteroid injection alone in the prevention of recurrence of keloid after surgical excision. This randomized controlled study was conducted in the Department of Otorhinolaryngology among 50 patients with ear keloids who underwent surgical excision. Patients were divided into two groups. One group was given Triamcinolone injection alone and the other was given Triamcinolone with Hyaluronidase on postoperative weeks 1, 2, and 3. Patients were followed up for 6 months and recurrence was noted and compared. Statistical analysis was done and the results were considered significant with a p-value of less than 0.05. Of the total 50 patients, there were a total of eight male and 39 female patients. In a single therapy group, recurrence was noted in one patient after 3 months and in three more patients after 6 months. In the group with combination therapy, there was no recurrence after 3 months but three patients had recurrence after 6 months. Triamcinolone and hyaluronidase injection protected from recurrence for about 3 to 5 months after which patients had recurrence. Further studies are recommended with prolonged duration of hyaluronidase injection.

PMID:39130304 | PMC:PMC11306477 | DOI:10.1007/s12070-024-04694-9

Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3353-3363. doi: 10.1007/s12070-024-04687-8. Epub 2024 Apr 29.

ABSTRACT

Otosclerosis is a complex skeletal condition that originates from both hereditary and environmental factors. Gradual conductive hearing loss is the main character. Aim to contrast and assess the postoperative results, such as hearing improvement, following the use of bone cement to fix the Titanium versus Teflon stapes piston. 50 patients who had endoscopic stapedotomy with different prostheses insertions were included in this prospective, randomized research. They were splitted into two groups in the: group A consisted of 25 ears in which titanium prostheses with bone cement were applied, while group B consisted of 25 ears Teflon prostheses with bone cement were used. A statistically significant difference was observed in average air conduction (better hearing) between groups A and B at 3, 6, and 12 months postoperatively based on audiometric results. When comparing groups B and A after 3, 6, and 12 months after surgery, the average air bone gap (ABG) was greater in group B, and this difference was statistically significant. Between the two groups, there was no discernible variation in any of the preoperative metrics. 96% of groups A and B were successful. Using bone cement in primary stapedotomy may help fix the procedure and reduce the chance of persistent hearing loss in patients with otosclerosis. This is especially true when titanium is used, as titanium has the ideal mass and stiffness to support acoustic transmission with a low rate of adverse effects and better average ABG.

PMID:39130295 | PMC:PMC11306481 | DOI:10.1007/s12070-024-04687-8