1295 Virtual Fracture Clinic: An Audit of Referral Quality and Service Effectiveness

Aim

Assessment of referral quality to the virtual fracture clinic (VFC) at the Liverpool University Hospital foundation trust compared to the standards set out by the Glasgow virtual fracture clinic pathway. As a secondary aim the effectiveness of the VFC in diverting patients not requiring further clinical management away from face-to-face specialist physical fracture clinics (PFC) was assessed.

Method

Outcomes of 1st attendances were collected for standard PFC's before the implementation of the VFC at our centre. This data was comparatively analysed to the outcomes of 1st ‘attendances' of VFCs post-service implementation. To assess VFC referral quality fracture type was recorded and compared to the standard set out by the Glasgow virtual fracture pathway which states that a selection of simple stable fractures should be discharged from ED directly with patient advice and telephone support.

Results

We analysed 529 PFC first attendances and 402 VFC first attendances. We saw a variety of simples stable fractures (21%) in the VCF including: Distal radial, Fifth metatarsal, Minor radial head, Fifth metacarpal, Mallet finger, which could have been managed with direct ED discharge and telephone support. 19.4% of PFC attendance resulted in discharge without a change in management as compared to 22.1% of 1st attendances for the VFC.

Conclusions

The VFC clinic has shown itself as an effective service in re-directing patients from face-to-face appointments, evidenced by the comparative rates of patient discharge on first attendance. This study has laid the foundation for improving referral quality to the VFC. Collaborative efforts between Orthopaedics and ED could improve VFC clinic efficiency further.

Intention to Quit Tobacco Use and its Determinants Among Adolescent Tobacco Users Residing in Slum Areas of Bhubaneswar, India: A Cross-Sectional Study

Introduction Intention to quit is the initial step and a strong predictor of quitting tobacco use.

Objective The aim of this study was to estimate the prevalence and determinants of intention to quit tobacco use among adolescent tobacco users residing in the slum areas of Bhubaneswar, India.

Materials and Methods A community-based cross-sectional study was performed during the year 2017–2018 involving 152 adolescent tobacco users residing in the slums of Bhubaneswar. Multistage cluster random sampling was used to select the study areas.

Results Ninety-three (61.2%) adolescents had the intention to quit tobacco use. Multivariate logistic regression analysis revealed that the odds of intention to quit tobacco use was significantly higher in adolescents who used it for less than 5 years' duration (adjusted odds ratio (aOR): 2.59; 95% confidence interval [CI]: 1.14–5.87), those used first tobacco of the day between 31 and 60 minutes after waking up in the morning (aOR: 2.60; 95% CI: 1.17–5.79) or more than 60 minutes after waking up (aOR: 6.69; 95% CI: 2.28–19.61), and those who noticed anti-tobacco messages in any media in the past 30 days (aOR: 2.70; 95% CI: 1.02–7.14).

Conclusion The prevalence of intention to quit tobacco use among slum adolescents of Bhubaneswar is 61.2%, which can be enhanced by incorporating the determinants of the intention to quit tobacco use in the existing anti-tobacco schemes.

Oral cancer awareness in patients attending university dental clinics: A scoping review of Australian studies

This scoping review was carried out to evaluate the important role Australian university-based dental teaching clinics and dental students might have in promoting oral cancer awareness in their patients. Four Online database (PubMed, OVID, Scopus and Emcare) were searched for studies that assessed oral cancer awareness amongst patients attending Australian university-associated (teaching) clinics. A total of five articles were retrieved for full-text analysis. All studies showed significant variation in patient awareness and understanding regarding the principal risk factors associated with oral cancer development. Smoking was predominantly identified as a significant risk factor, but alcohol consumption was less frequently recognized as relevant. Non-healing ulceration was most commonly identified as a symptom of concern, whilst red and/or white mucosal patches were infrequently recognized as potentially malignant conditions. Our review confirms that a significant lack of patient awareness regarding oral cancer risk and the signs /symptoms of early malignancy or potentially malignant disease exist in patients attending dental teaching clinics. Important opportunities exist to involve dental students proactively in raising oral cancer awareness, delivering smoking cessation interventions and safe alcohol consumption advice to their patients. Incorporation of established health educational models might deliver effective support for such student-delivered patient education.

Microbe defines the efficacy of chemotherapeutic drug: a complete paradigm

The human body harbors a diverse microbiome that regulates host physiology and disease development. Several studies have also been reported where the human microbiome interferes with the efficacy of chemotherapeutics. Reports have also suggested the use of microbes in specific targeting and drug delivery. This review mainly focuses on the alteration in the efficacy of the drug by human microbiota. We have also discussed how the diversity in microbes can determine the therapeutic outcomes of a particular drug. The pathways involved in the alteration are also focused, with some highlights on microbes being used in cancer therapy.

Total eyelid complex sparing orbital exenteration for mucormycosis

Orbital exenteration is a radical surgery which involves complete removal of the orbital contents along with all or parts of the eyelid. However, the eyelid complex can be totally spared in cases of necrotising disease such as mucormycosis without compromising on exposure, or fear of devascularisation of the lids. We describe a total eyelid complex preserving orbital exenteration. Preservation of the total eyelid complex has the potential to speed up the healing process and provide dynamic functional and cosmetic rehabilitation.

Diagnostic efficiency of methylene blue and lugol's iodine double staining method in oral leukoplakia in detecting dysplasia

Objectives

Early detection of dysplasia in oral potentially malignant disorders (PMD) might facilitate screening for possible subsequent malignant transformation. Vital staining is a non-invasive clinical adjunct used for determining the biopsy site, which facilitates early detection of dysplastic changes in PMD. Some authors suggested that double staining method has superior results over staining with a single dye.

Aim

The aim of the study was to evaluate the accuracy of in vivo staining with methylene blue (MB) and Lugol's iodine (LI) double staining method in comparison with MB staining alone.

Materials and Methods

Fifty patients of oral leukoplakia were recruited for the study. After obtaining written informed consent from the patients, the lesions were stained consecutively with 5% MB and 3% LI. The pattern of dye retention of MB alone, followed by MB and LI was noted. Incisional biopsy from the lesion was taken based on the retention of MB and the absence of staining of LI or by clinical judgement in case both stains were not retained. The clinical uptake of the stains was correlated with the degree of dysplasia on histopathological examination.

Results

Out of 50 subjects, MB was retained in 47 cases (94%), while 3 cases (6%) failed to retain the dye. However, out of 47 cases, 20 cases had dark blue stain and were considered as MB positive, while the rest 27 cases had pale blue stain and were considered to be negative for MB staining. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of MB staining were 57.82%, 100%, 100%, 26.53% and 46%, respectively. After applying both stains, i.e., double staining method, the outline of the lesion was better defined. Out of 50 PMD cases, 3 patients retained only LI and showed no dysplasia. Out of 47 cases which showed dysplasia, 27 cases showed pale blue retention of MB (-) and also were negative for LI. The rest 20 cases were positive for MB but negative for LI. The sensitivity, specificity, PPV and NPV with double staining technique were 100%.

Conclusion

The accuracy and reliability of double staining method was superior to MB staining.

Clinical Relevance

Increased accuracy of double staining method aids in better detection of dysplasia and is of great help to the clinician in deciding the nature of PMD in question.

Differential effects of online signals on sales performance of local brand clothing products

Purpose

Businesses need to make quick decisions and adjustments to fulfill the growing online demand. Previous studies examined various factors affecting the online sales performance of products such as books, electronics and movies; however, they paid limited attention toward the local brand clothing products. The current study investigates the importance of different kinds of seller-generated and consumer-generated signals such as price, discount, product ratings, review volume, review sentiment, number of questions and interaction between some of these factors for predicting the sales performance of clothing products.

Design/methodology/approach

The multiple linear regressions has been employed to investigate the influence of various predictor variables on sales performance. The study also examines the importance of these predictor variables by using different machine learning models, including random forest (RF), neural networks and support vector regression (SVR).

Findings

The findings of the study emphasize the importance of price and discount rates offered on the product. The quantitative characteristics of reviews, such as review volume and average rating, have been found to be more important predictors than sentiment strengths. However, the sentiment strength of reviews with higher helpfulness scores plays a significant role in predicting sales performance.

Originality/value

The study highlights the varying importance of seller-based and consumer-based signals in predicting sales performance. It also investigates the interaction effect of these two kinds of signals. The consumer-generated signals have been further divided into two components based on social influence theory, and the interaction effects of these components have also been examined.

Genome-wide analysis in 756,646 individuals provides first genetic evidence that ACE2 expression influences COVID-19 risk and yields genetic risk scores predictive of severe disease

SARS-CoV-2 enters host cells by binding angiotensin-converting enzyme 2 (ACE2). Through a genome-wide association study, we show that a rare variant (MAF = 0.3%, odds ratio 0.60, P=4.5×10^-13) that down-regulates ACE2 expression reduces risk of COVID-19 disease, providing human genetics support for the hypothesis that ACE2 levels influence COVID-19 risk. Further, we show that common genetic variants define a risk score that predicts severe disease among COVID-19 cases.

Role of culture-specific rights, responsibilities and duties in industry 4.0: comparing Indic and Western perspectives

Purpose

The increasing globalization of business has led to increasing demand for executives who can function in cultural milieus different from their own. This demand has been exacerbated by the fact that globalization has not led to cultural homogenization and hence, for good or bad, executives are not able to universally apply the home country's conceptualizations of rights, responsibilities and duties and must operate within the constraints of host country's cultural environments. Hence, business scholars and global executives increasingly need to reflect on the conceptualization of rights, responsibilities and duties; understand the historical context which has led to different conceptualizations across geographies and appreciate and harness these differences for improving business effectiveness. This paper helps in this endeavor by explaining the differences and similarities that exists between the Indian and Western cultures regarding the concepts of roles, responsibilities and duties. This exposition will help multinational organizations improve their internal practices and employee training methods.

Design/methodology/approach

This study attempts to trace the differences and similarities in the conceptualization of rights, duties and responsibilities between the Western tradition and the Indic tradition by literature review. The Indic tradition refers to the broad cultural paradigm that shapes the thinking of the people of Indian subcontinent. The prominent sources of the Indic tradition include Hinduism and Buddhism. India was a British colony for two hundred years and is home to one of world's largest English-speaking population. There are more Muslims in the Indian subcontinent than in the Middle East (Grim and Karim, 2011). Hence, the Indic tradition has also been substantially influenced by the Western and Islamic traditions.

Findings

The paper argues that Westerners and Indians have different conceptualization of rights, duties and responsibilities and their relative importance. Broadly speaking, Indian ethos focuses on context-specific responsibilities while the Western attitude focuses on universal rights. These differing conceptualizations have been shaped by the cultural history of the two regions and are manifested in the decision-making styles, levels of individual autonomy and views on the ethicality of actions. There is a need to train expatriate Western and Indian managers on these issues to enable smooth functioning.

Research limitations/implications

The cross-cultural literature has tended to lump together all non-Western civilizations under the category of East thereby ignoring significant differences between them. The Far-East countries of China, Korea, Taiwan and Japan have been highly influenced by the Confucian ethics. India-specific social systems like the caste system, division of human life span into stages with specific responsibilities, enduring worship of nature and Western influence through colonization have been absent in these countries or much less marked. The paper aims to bring forward the distinguishing features in Indian thought that contributes to its distinctive attitude toward rights, responsibilities and duties; contrast it with the Western views on rights and duties and identify the relevance of the discussion to the business context.

Practical implications

The cross-cultural training needs to emphasize both conflict resolution and behavioral aspects. For example, the conflict resolution process in Western countries can be more algorithmic with conflicts being rationally determined by consistent application as well-defined rules (as nature of duties is more universal in Western tradition). On the other hand, conflict resolution practices in India need to be contextual and may require appeals to higher ideals (as nature of duties is more contextual and idealistic in Eastern tradition).

Social implications

The differences in attitudes regarding rights, responsibility and duties between the West and India suggest the need for cross-cultural training of managers and contextual conflict resolution techniques. The need is exacerbated by the increase in the number of multinational corporations (MNCs). Earlier, most MNCs were headquartered in the West and hence cross-cultural training was primarily geared to help Western expatriates fit into the host country culture (Nam et al., 2014). The growth of Asian MNCs has increased the need of cross-cultural training for Asian expatriates (Nam et al., 2014).

Originality/value

The training processes can be customized to supplement cultural strengths and promote behaviors that are culturally inhibited. Employees in India can be trained to emphasize the value of assertiveness in communication, the need to articulate one's personal success and appreciate the rigid nature of rules in Western contexts. Similarly, Westerners can be trained to emphasize the importance of context in business interactions, the need to forge personal relations for business success and the importance of paternalistic behavior in securing employees commitment.

Should COVID-19 patients >75 years be Ventilated? An Outcome Study

BACKGROUND

Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population are limited.

AIM

To delineate the adverse factors associated with outcomes of COVID-19 patients ≥75 years of age.

DESIGN

Retrospective cohort study.

METHODS

Patients were classified into mild/moderate, severe/very severe and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality.

RESULTS

A total of 355 patients aged ≥75 years hospitalized with COVID-19 between 19 March and 25 April 2020 were included.Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease: 17.4%, severe/very severe disease: 71.3%, critical disease: 94.9%, P < 0.001).Increased age, dementia, and severe/very severe and critical disease groups were independently associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR: 0.12, 95% CI: 0.02-0.60, P < 0.05). None of the cardiovascular comorbidities were significantly associated with mortality.

CONCLUSION

Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.

A catalog of associations between rare coding variants and COVID-19 outcomes

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease-19 (COVID-19), a respiratory illness that can result in hospitalization or death. We investigated associations between rare genetic variants and seven COVID-19 outcomes in 543,213 individuals, including 8,248 with COVID-19. After accounting for multiple testing, we did not identify any clear associations with rare variants either exome-wide or when specifically focusing on (i) 14 interferon pathway genes in which rare deleterious variants have been reported in severe COVID-19 patients; (ii) 167 genes located in COVID-19 GWAS risk loci; or (iii) 32 additional genes of immunologic relevance and/or therapeutic potential. Our analyses indicate there are no significant associations with rare protein-coding variants with detectable effect sizes at our current sample sizes. Analyses will be updated as additional data become available, with results publicly browsable at https://rgc-covid19.regeneron.com.

Jellyfish venom proteins and their pharmacological potentials: A review

Several research in the organisms of marine invertebrates to assess the medicinal ability of its bio-active molecules have yielded very positive results in recent times. Jellyfish secreted venoms are rich sources of toxins intended to catch prey or deter predators among invertebrate species, but they may also have harmful effects on humans. The nematocyst, a complex intracellular system that injects a venomous mixture into prey or predators that come into contact with the tentacles or other parts of the body of cnidarians, determines the venomous existence of cnidarians. Nematocyst venoms are mixtures of peptides, proteins and other components that in laboratory animals can induce cytotoxicity, blockade of ion channels, membrane pore formation, in vivo cardiovascular failure and lethal effects. There are also valuable pharmacological and biological aspects of jellyfish venoms. In the present review, overviews of the variety of possible toxin families in cnidarian venoms are addressed in this analysis and these potential toxins are surveyed with those from other cnidarians that offer insight into their potential functions such as anti-oxidant, anti-cancer activity and much more. This research review will provide awareness of the growing repertoire of jellyfish venom proteins and will help to further isolate and classify particular proteins to understand its structure and functional relationship.

Saphenous nerve to posterior tibial nerve transfer: A new approach to restore sensations of sole in diabetic sensory polyneuropathy

BACKGROUND

Loss of sensations in the sole following diabetic sensorimotor polyneuropathy (DSPN) leads to diabetic foot ulcers and its sequelae. We hypothesized that sensory reinnervation of sole by transfer of saphenous nerve (SN) to sensory fascicles of posterior tibial nerve (PTN) in these patients may reverse the neuropathy.

METHODS

This prospective interventional case series included patients with advanced DSPN and intact sensory supply of SN. PTN was neurotized by transfer of SN nerve in the tarsal tunnel and postoperatively sensations of the sole were tested. Any existing ulcers on sole were noted and their healing was monitored.

FINDING

A total of 17 patients (22 feet), 9 male and 8 female, were included. Seven patients had ulcers in the feet. At 6 months follow-up all patients developed protective sensation in the sole. The average 2 PD improved from 60 mm to 45.5 mm, average vibration perception improved from 34.12 V to 24.33, Medical Research Council (MRC) score improved from S0 in 12 feet and S1 in 10 feet to S3+ in 13 feet, S3 in 5 feet, and S2 in 2 feet at 6 months along with healing of ulcers in all 7 feet.

INTERPRETATION

Transfer of SN to PTN for sensory neurotization is an innovative and simple option to prevent complications of DSPN. This procedure has the potential to change the natural history of DSPN.

Second-hand smoke exposure and its determinants among nonsmoking adolescents residing in slum areas of Bhubaneswar, India

Background

Second-hand exposure (SHS) is a significant public health problem and accounts for over 600,000 deaths among non smokers worldwide every year. The study aimed to estimate the prevalence and determinants of SHS exposure among nonsmoking adolescents residing in slum areas of Bhubaneswar, India.

Methods

Multistage cluster random sampling was used to select 259 nonsmoking adolescents from eleven slum areas. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using multivariable logistic regression model to identify factors associated with SHS exposure.

Results

Of the 259 adolescent participants, 67 (25.9%) were exposed to SHS inside home and 97 (37.5%) were exposed outside home. About 47.5% adolescents were exposed to anti-smoking media messages and 22.8% were unaware of the harmful effects of exposure to SHS. SHS exposure inside home was associated with smokeless tobacco use (adjusted odds ratio [aOR]: 10.64; 95% confidence interval (CI): 2.57-43.48), illiteracy of father (aOR: 5.40; 95% CI: 1.51-19.32), non-exposure to antismoking media messages (aOR: 3.53; 95% CI: 1.06-11.72), and absence of knowledge regarding harmful effects of SHS (aOR: 3.72; 95% CI: 1.15-12.05). Also, variables like male gender (aOR: 10.31; 95% CI: 4.50-23.81), smokeless tobacco use (aOR: 2.43; 95% CI: 1.05-5.65), illiteracy of father (aOR: 4.58; 95% CI: 1.23-17.14), and non-exposure to antismoking media messages (aOR: 4.04; 95% CI: 1.49-10.89) had increased SHS exposure outside home.

Conclusion

The findings underscore the urgent need to implement comprehensive smoke-free policies to reduce SHS exposure among slum adolescents.

New device permitting non-invasive reversal of fetal endoscopic tracheal occlusion: ex-vivo and in-vivo study

OBJECTIVE

One of the drawbacks of fetal endoscopic tracheal occlusion (FETO) for congenital diaphragmatic hernia is the need for a second invasive intervention to re-establish airway patency. The 'Smart-TO' device is a new balloon for FETO that deflates spontaneously when placed in a strong magnetic field, therefore overcoming the need for a second procedure. The safety and efficacy of this device have not yet been demonstrated. The aim of this study was to investigate the reversibility, local side effects and occlusiveness of the Smart-TO balloon, both in a simulated in-utero environment and in the fetal lamb model.

METHODS

First, the reversibility of tracheal occlusion by the Smart-TO balloon was tested in a high-fidelity simulator. Following videoscopic tracheoscopic balloon insertion, the fetal mannequin was placed within a 1-L water-filled balloon to mimic the amniotic cavity. This was held by an operator in front of their abdomen, and different fetal and maternal positions were simulated to mimic the most common clinical scenarios. Following exposure to the magnetic field generated by a 1.5-T magnetic resonance (MR) machine, deflation of the Smart-TO balloon was assessed by tracheoscopy. In cases of failed deflation, the mannequin was reinserted into a water-filled balloon for additional MR exposure, up to a maximum of three times. Secondly, reversibility, occlusiveness and local effects of the Smart-TO balloon were tested in vivo in fetal lambs. Tracheal occlusion was performed in fetal lambs on gestational day 95 (term, 145 days), either using the balloon currently used in clinical practice (Goldbal2) (n = 5) or the Smart-TO balloon (n = 5). On gestational day 116, the presence of the balloon was assessed by tracheoscopy. Deflation was performed by puncture (Goldbal2) or MR exposure (Smart-TO). Six unoccluded fetal lambs served as controls. Following euthanasia, the lung-to-body-weight ratio (LBWR), lung morphometry and tracheal circumference were assessed. Local tracheal changes were measured using a hierarchical histologic scoring system.

RESULTS

Ex vivo, Smart-TO balloon deflation occurred after a single MR exposure in 100% of cases in a maternal standing position with the mannequin at a height of 95 cm (n = 32), 55 cm (n = 8) or 125 cm (n = 8), as well as when the maternal position was 'lying on a stretcher' (n = 8). Three out of eight (37.5%) balloons failed to deflate at first exposure when the maternal position was 'sitting in a wheelchair'. Of these, two balloons deflated after a second MR exposure, but one balloon remained inflated after a third exposure. In vivo, all Smart-TO balloons deflated successfully. The LBWR in fetal lambs with tracheal occlusion by a Smart-TO balloon was significantly higher than that in unoccluded controls, and was comparable with that in the Goldbal2 group. There were no differences in lung morphometry and tracheal circumference between the two balloon types. Tracheal histology showed minimal changes for both balloons.

CONCLUSIONS

In a simulated in-utero environment, the Smart-TO balloon was effectively deflated by exposure of the fetus in different positions to the magnetic field of a 1.5-T MR system. There was only one failure, which occurred when the mother was sitting in a wheelchair. In healthy fetal lambs, the Smart-TO balloon is as occlusive as the clinical standard Goldbal2 system and has only limited local side effects. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Tobacco consumption and its socio-demographic correlates among adolescents residing in slum areas of Bhubaneswar, India

Background: Tobacco use is an emerging public health problem among adolescents worldwide. The objectives of the study were to determine the prevalence and pattern of tobacco use among adolescents and assess the factors associated with its use in urban slums of Bhubaneswar, Odisha. Materials and Methods: A community-based cross-sectional study was carried out in 11 randomly selected urban slums of Bhubaneswar during the year 2017–2018 among 297 adolescents using a pretested semi-structured schedule. Data were analyzed using SPSS version 21.0; risk analysis was done using odds ratios with 95% confidence intervals (CIs). Results: Ninety-one (30.6%) adolescents were current tobacco users; 40 (44%) were consuming smoking form and 67 (73.6%) smokeless form. Betel quid was the most predominant form of smokeless tobacco (35.8%) and the cigarette was the most common smoking form (55%) used. Only 16.5% of adolescents had tried to quit tobacco during the past year, whereas 65.9% showed a desire to quit tobacco in future. Multivariate analysis revealed that tobacco use was significantly associated with older age(adjusted odds ratio [aOR]: 5.5; 95% CI: 2.8–10.6), male gender (aOR: 5.9; 95% CI: 2.9–12.0), employment (aOR: 7.4; 95% CI: 3.6–15.4), illiterate mother (aOR: 3.3; 95% CI: 1.7–6.3), tobacco use by family member (aOR: 3.7; 95% CI: 2.0–6.9), tobacco use by peers (aOR: 6.5; 95% CI: 2.9–14.3), and easy accessibility (aOR: 4.1; 95% CI: 1.5–11.2). Conclusion: The prevalence of tobacco use was high among adolescents of slums in Bhubaneswar. Existing schemes for controlling the tobacco epidemic among slum adolescents could be strengthened by incorporating these determinants.

Perceived Status and Care Practices among Complete Denture Wearers

Background:

Oral health is neglected even today. This can be evidently seen in the low utilization rates and poor oral health status. Conventional dentures are the most common treatment option in the restoration of lost teeth. Without appropriate denture care practices, there is an elevated risk of developing a multitude of problems. The aim of this study was to assess the perceived status and care practices among complete denture wearers in Modern Dental College and Research Centre, Indore, Madhya Pradesh, India.

Materials and Methods:

A cross-sectional study was conducted in the Department of Prosthodontics at the Modern Dental College and Research Centre, Indore, Madhya Pradesh, India. Patients with self-care optimum overall health who were using either single or full complete dentures for more than 1 year from the commencement of the study were requested to participate in the study. A total of 1000 study participants were given a self-administered questionnaire on their denture care practices followed by clinical examination of the denture status. Data were statistically analyzed using the Statistical Package for the Social Sciences software for Windows, version 20.0.

Results:

Maximum denture wearers informed that they cleaned their dentures once a day, with brush and water, and had the habit of removing the dentures before sleeping at night. Almost 90% of the participants reported their denture status to be good or fair. Clinical examination revealed that slightly more than half of the participants had poor denture status.

Conclusion:

This study signifies the importance for improvement in patient oral health education and counseling with respect to the maintenance of dentures and upkeep of denture hygiene. It also emphasizes the need for educating patients on how to evaluate the status of their dentures.

Outcomes in patients with severe COVID-19 disease treated with tocilizumab: a case-controlled study

BACKGROUND

COVID-19 is an ongoing threat to society. Patients who develop the most severe forms of the disease have high mortality. The interleukin-6 inhibitor tocilizumab has the potential to improve outcomes in these patients by preventing the development of cytokine release storm.

AIMS

To evaluate the outcomes of patients with severe COVID-19 disease treated with the interleukin-6 inhibitor tocilizumab.

METHODS

We conducted a retrospective, case-control, single-center study in patients with severe to critical COVID-19 disease treated with tocilizumab. Disease severity was defined based on the amount of oxygen supplementation required. The primary endpoint was the overall mortality. Secondary endpoints were mortality in non-intubated patients and mortality in intubated patients.

RESULTS

A total of 193 patients were included in the study. Ninety-six patients received tocilizumab, while 97 served as the control group. The mean age was 60 years. Patients over 65 years represented 43% of the population. More patients in the tocilizumab group reported fever, cough and shortness of breath (83%, 80% and 96% vs. 73%, 69% and 71%, respectively). There was a non-statistically significant lower mortality in the treatment group (52% vs. 62.1%, P = 0.09). When excluding intubated patients, there was statistically significant lower mortality in patients treated with tocilizumab (6% vs. 27%, P = 0.024). Bacteremia was more common in the control group (24% vs. 13%, P = 0.43), while fungemia was similar for both (3% vs. 4%, P = 0.72).

CONCLUSION

Our study showed a non-statistically significant lower mortality in patients with severe to critical COVID-19 disease who received tocilizumab. When intubated patients were excluded, the use of tocilizumab was associated with lower mortality.

Erratum: Evolution of π^{0} Suppression in Au+Au Collisions from sqrt[s_{NN}]=39 to 200 GeV [Phys. Rev. Lett. 109, 152301 (2012)]

This corrects the article DOI: 10.1103/PhysRevLett.109.152301.

The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery

Objective:

To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons.

Methods:

Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups.

Results:

More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures.

Conclusion:

Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology.

Level of evidence:

Level IV

First report of isolation of Aeromonas taiwanensis from India

Genus Aeromonas consists of facultative anaerobic, Gram negative Bacilli which are primary environmental inhabitants worldwide. A recently reported strain of the genus, Aeromonas taiwanensis, was found while studying the presence of infectious marine microbes in a lacustrine wetland in India, making this the first isolation report from the country.

Does potassium iodide application following silver diamine fluoride reduce staining of tooth? A systematic review

OBJECTIVES

To assess if using potassium iodide (KI) immediately after application of silver diamine fluoride (SDF) significantly reduces the staining of tooth structure.

DATA SOURCE AND SELECTION

Four online databases (OVID, Scopus, PubMed and Google Scholar) were searched (June 2019). Additional studies were sought through grey literature search and hand searching the reference list of included articles. All studies that analysed the effect of KI on SDF staining of tooth structure with access to full text in English language were included.

DATA SYNTHESIS

Of the six articles included in the review, five reported stain reduction in the teeth treated with application of KI to carious tooth structure following the application of SDF while one article reported no significant beneficial effect on reducing staining, when compared to SDF alone. Of the materials selected to restore SDF + KI treated teeth, resin-modified glass ionomer was found to produce the lightest results, followed by glass ionomer cement and composite resin. An in vivo case report also revealed some staining after six months, even with SDF + KI treatment.

CONCLUSIONS

Although some studies reported a positive effect, insufficient evidence exists supporting a tangible clinical benefit of SDF + KI treatment on the tooth staining, mainly due to methodical variations within the current literature.

Tibialis posterior (TP) tendon transfer for foot drop: A single center experience

BACKGROUND

Foot drop defined as a significant weakness of ankle and toe dorsiflexion. It leads to high stepping gait, functional impairment and deformity of the foot. Objective of this study was to assess the functional outcome of tibialis posterior (TP) transfer for patient with foot drop in a single center.

METHODS

This is a retrospective study included 20 patients operated for foot drop of >1 year duration in the last 5 years. Preoperative assessment of muscles of all the three compartment of leg along with radiological assessment of ankle to rule out tarsal disintegration and ankle instability was done. Postoperatively gait, active dorsi/plantar flexion and the range of movement of the ankle and toes were assessed.

RESULTS

Tibialis posterior transfer was performed on 20 patients (16 males and 4 females, mean age 31.4 years). Commonest cause of foot drop was Hansen's disease followed by post traumatic peroneal nerve damage and post injection sciatic neuropathy. At mean follow-up of 2 years, all patients, except one, could walk with heel-toe gait without any orthotic support. There was no pain, ruptures or infections of the transferred tendons. 19 of the 20 operated ankles had mean active dorsiflexion of 7.5°, the active plantar flexion of 36.25°, and the total range of movement 43.75°. The active dorsiflexion of the toes ranged from 5-20°.

CONCLUSION

Dynamic tibialis posterior transfer gives good results in terms of normal gait, high patients' satisfaction with minimal donor site morbidity and low complication rate.

Nuclear Dependence of the Transverse Single-Spin Asymmetry in the Production of Charged Hadrons at Forward Rapidity in Polarized p+p, p+Al, and p+Au Collisions at sqrt[s_{NN}]=200 GeV

We report on the nuclear dependence of transverse single-spin asymmetries (TSSAs) in the production of positively charged hadrons in polarized p^{↑}+p, p^{↑}+Al, and p^{↑}+Au collisions at sqrt[s_{NN}]=200  GeV. The measurements have been performed at forward rapidity (1.4<η<2.4) over the range of transverse momentum (1.8<p_{T}<7.0  GeV/c) and Feynman x (0.1<x_{F}<0.2). We observed positive asymmetries for positively charged hadrons in p^{↑}+p collisions, and significantly reduced asymmetries in p^{↑}+A collisions. These results reveal a nuclear dependence of TSSAs for charged-hadron production in a regime where perturbative techniques are applicable. These results provide new opportunities to use p^{↑}+A collisions as a tool to investigate the rich phenomena behind TSSAs in hadronic collisions and to use TSSAs as a new handle in studying small-system collisions.

Delayed Onset Sciatic Nerve Palsy Secondary to Wound Hematoma following Anticoagulant Therapy Post-Bipolar Hemiarthroplasty - an Uncommon Complication: A Case Report

A 58-year old female patient presented to us with a three months’ old fracture of the neck of femur. She underwent bipolar hemiarthroplasty. In the immediate postoperative period, she developed deep vein thrombosis for which she was started on anticoagulant therapy. Patient had persistent discharge from the wound since then and underwent regular dressings. On the eighth post-op day, she developed sciatic nerve palsy secondary to wound haematoma. The haematoma was decompressed immediately and she had a dramatic improvement in pain but her neurological deficit persisted. The wound healed completely without any complications. At three months follow up, she had recovered completely with grade 5/5 power in ankle and foot and full sensory recovery in the sciatic nerve distribution. She was ambulating comfortably with a walker. At final follow up around 20 months post-operation, she was pain-free and walking without any support. The wound had healed completely.

Acute ischaemic stroke: challenges for the intensivist

PURPOSE

To provide an update about the rapidly developing changes in the critical care management of acute ischaemic stroke patients.

METHODS

A narrative review was conducted in five general areas of acute ischaemic stroke management: reperfusion strategies, anesthesia for endovascular thrombectomy, intensive care unit management, intracranial complications, and ethical considerations.

RESULTS

The introduction of effective reperfusion strategies, including IV thrombolysis and endovascular thrombectomy, has revolutionized the management of acute ischaemic stroke and transformed outcomes for patients. Acute therapeutic efforts are targeted to restoring blood flow to the ischaemic penumbra before irreversible tissue injury has occurred. To optimize patient outcomes, secondary insults, such as hypotension, hyperthermia, or hyperglycaemia, that can extend the penumbral area must also be prevented or corrected. The ICU management of acute ischaemic stroke patients, therefore, focuses on the optimization of systemic physiological homeostasis, management of intracranial complications, and neurological and haemodynamic monitoring after reperfusion therapies. Meticulous blood pressure management is of central importance in improving outcomes, particularly in patients that have undergone reperfusion therapies.

CONCLUSIONS

While consensus guidelines are available to guide clinical decision making after acute ischaemic stroke, there is limited high-quality evidence for many of the recommended interventions. However, a bundle of medical, endovascular, and surgical strategies, when applied in a timely and consistent manner, can improve long-term stroke outcomes.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.