Analysis of Surface Roughness and 3D Scanning Topography of Zirconia Implants Before and After Photofunctionalisation by 3D Optical Profilometry- An Invitro Study

Introduction: Zirconia is considered as an alternative material for the fabrication of implants. Surface roughness of the implant plays a fundamental role in the initial bone formation. The rationale of using 3D optical profilometry in this study was to evaluate the surface roughness of the zirconia implants before and after Ultraviolet (UV) photofunctionalisation. Also, Moreso 3D optical instruments have a better resolution than the mechanical ones like Atomic Force Microscopy (AFM). Aim: To analyse the surface roughness and topography of zirconia implants after photofunctionalisation using optical profilometry. Materials and Methods: This is an in-vitro study conducted over a period of six months from March 2020 to August 2020. Ten commercially machined Zirconia implants, five each in study and control group, were micro analysed at three different regions (abutment, thread and crest) by optical profilometry. Study group was surface treated by UV radiation for 48 hours. Quantitative morphometric analysis was done between two groups and p-value less than 0.05 was considered statistically significant. The statistical test applied in this study was independent t-test. Results: Scanning micrographs of the study group revealed highest density of summits contributing to increased surface area in the study group. Quantitative analysis of surface roughness showed statistically significant higher mean roughness parameter for photofunctionalised implants in abutment, crest and thread region (p<0.05). Conclusion: Photofunctionalisation is a potentially synergistic technique in producing textured zirconia implants.

The efficacy of Siddha Medicine, Kabasura Kudineer (KSK) compared to Vitamin C & Zinc (CZ) supplementation in the management of asymptomatic COVID-19 cases: A structured summary of a study protocol for a randomised controlled trial

OBJECTIVES

The primary objectives of this study are to determine efficacy of Siddha medicine, Kabasura kudineer in reduction of SARS-CoV-2 viral load and reducing the onset of symptoms in asymptomatic COVID-19 when compared to Vitamin C and Zinc (CZ) supplementation. In addition, the trial will examine the changes in the immunological markers of the Siddha medicine against control. The secondary objectives of the trial are to evaluate the safety of the Siddha medicine and to document clinical profile of asymptomatic COVID-19 as per principles of Siddha system of Medicine.

TRIAL DESIGN

A single centre, open-label, parallel group (1:1 allocation ratio), exploratory randomized controlled trial.

PARTICIPANTS

Cases admitted at non-hospital settings designated as COVID Care Centre and managed by the State Government Stanley Medical College, Chennai, Tamil Nadu, India will be recruited. Eligible participants will be those tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain reaction (RT-PCR) aged 18 to 55 years without any symptoms and co-morbidities like diabetes mellitus, hypertension and bronchial asthma. Those pregnant or lactating, with severe respiratory disease, already participating in COVID trials and with severe illness like malignancy will be excluded.

INTERVENTION AND COMPARATOR

Adopting traditional methods, decoction of Kabasura kudineer will be prepared by boiling 5g of KSK powder in 240 ml water and reduced to one-fourth (60ml) and filtered. The KSK group will receive a dose of 60ml decoction, orally in the morning and evening after food for 14 days. The control group will receive Vitamin C (60000 IU) and Zinc tablets (100mg) orally in the morning and evening respectively for 14 days.

MAIN OUTCOMES

The primary outcomes are the reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR] from the baseline to that of seventh day of the treatment, prevention of progression of asymptomatic to symptomatic state (clinical symptoms like fever, cough and breathlessness) and changes in the immunity markers [Interleukins (IL) 6, IL10, IL2, Interferon gamma (IFNγ) and Tumor Necrosis Factor (TNF) alpha]. Clinical assessment of COVID-19 as per standard Siddha system of medicine principles and the occurrence of adverse effects will be documented as secondary outcomes.

RANDOMISATION

The assignment to the study or control group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and informed consent procedures.

BLINDING (MASKING)

This study is unblinded. The investigators will be blinded to data analysis, which will be carried out by a statistician who is not involved in the trial.

NUMBERS TO BE RANDOMISED (SAMPLE SIZE)

Sample size could not be calculated, as there is no prior trial on KSK. This trial will be a pilot trial. Hence, we intend to recruit 60 participants in total using a 1:1 allocation ratio, with 30 participants randomised into each arm.

TRIAL STATUS

Protocol version 2.0 dated 16^th May 2020. Recruitment is completed. The trial started recruitment on the 25^th May 2020. We anticipate study including data analysis will finish on November 2020. We also stated that protocol was submitted before the end of data collection TRIAL REGISTRATION: The study protocol was registered with clinical trial registry of India (CTRI) with CTRI/2020/05/025215 on 16 May 2020.

FULL PROTOCOL

The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

Evolving consensus on managing vitreo-retina and uvea practice in post-COVID-19 pandemic era

The COVID-19 pandemic has brought new challenges to the health care community. Many of the super-speciality practices are planning to re-open after the lockdown is lifted. However there is lot of apprehension in everyone's mind about conforming practices that would safeguard the patients, ophthalmologists, healthcare workers as well as taking adequate care of the equipment to minimize the damage. The aim of this article is to develop preferred practice patterns, by developing a consensus amongst the lead experts, that would help the institutes as well as individual vitreo-retina and uveitis experts to restart their practices with confidence. As the situation remains volatile, we would like to mention that these suggestions are evolving and likely to change as our understanding and experience gets better. Further, the suggestions are for routine patients as COVID-19 positive patients may be managed in designated hospitals as per local protocols. Also these suggestions have to be implemented keeping in compliance with local rules and regulations.

Tetanus of suspected dental causality

Tetanus infection by Clostridium tetani is a major health problem in many developing countries, including India. Significant morbidity and mortality is attributed to lack of awareness, hygiene and incomplete vaccination. The most common cause of tetanus infection follows cutaneous injury or infection. However, a localized point of entry cannot always be determined. Tetanus has been associated with tooth extraction, root canal therapy, gross caries, periodontal abscess and intraoral soft tissue trauma. The classic symptoms of trismus and risus sardonicus may result in an initial presentation to an oral and maxillofacial surgeon. Due to the rarity of this infection, the dentist or the health care provider may fail to corroborate the findings and be unsuspecting of the diagnosis. Prompt recognition is the key in such a scenario due to the inherent risk of rapid progress of symptoms, progressive deterioration of the health condition and catastrophic complications. A sound knowledge of the effects of tetanospasmin, the disease process, prevention and vaccination against tetanus with its management is essential for health care workers. The authors hereby present a case of tetanus with a suspected dental etiology to make the dental fraternity aware of this lurking malady.

All India Ophthalmological Society - Indian Journal of Ophthalmology consensus statement on preferred practices during the COVID-19 pandemic

The COVID-19 pandemic has taken tragic proportions and has disrupted lives globally. In the wake of governmental lockdowns, ophthalmologists need practical and actionable guidelines based on advisories from national health departments on how to conduct their duties during nationwide lockdowns and after these are lifted. In this paper, we present a preferred practice pattern (PPP) based on consensus discussions between leading ophthalmologists and health care professionals in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. In this document, the expert panel clearly defines the range of activities for Indian ophthalmologists during the ongoing lockdown phase and precautions to be taken once the lockdown is lifted. Guidelines for triage, governmental guidelines for use of personal protective equipment from ophthalmologists' point of view, precautions to be taken in the OPD and operating room as well as care of various ophthalmic equipment have been described in detail. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics and should help Indian ophthalmologists in performing their professional responsibilities without being foci of disease transmission.

A tissue-mimicking prostate phantom for 980 nm laser interstitial thermal therapy

Purpose: To develop a phantom with optical and thermal properties matched to human prostate. This phantom will provide a platform for the development and characterization of 980 nm laser interstitial thermal therapy (LITT) systems. Methods: A polyacrylamide gel was doped with Naphthol Green B, Intralipid, and Bovine Serum Albumin (BSA). The necessary concentration of each ingredient was determined by measuring the optical properties via fluence measurements and light diffusion theory. LITT was then performed under the same conditions as a previous clinical trial in which temperature was monitored via a thermal probe. The thermal data and induced coagulation zone were compared to clinical data to illustrate the similarity between the phantom and patient. LITT was also performed under magnetic resonance thermometry (MRT). Results: The requisite concentrations of Naphthol Green B, Intralipid and BSA were found to be 0.144% (w/v), 8.06% (v/v) and 31.4% (v/v) respectively. In the native state, the absorption coefficient and reduced scattering coefficient ( μs' ) were found to be 0.66 ± 0.06 cm^-1 and 8.27 ± 0.50 cm^-1 respectively, with μs' increasing to 17.63 ± 1.41 cm^-1 after coagulation. The thermal response of the phantom was similar to that observed clinically with maximum thermal probe measurements of 64.2 °C and 66.9 °C respectively. The shape of the induced coagulation zone was qualitatively and quantitatively similar to the MRT zone of elevated temperature and the coagulation zone observed clinically. Conclusions: A phantom which simulates optical and thermal response to 980 nm LITT was constructed and demonstrated to be similar to human prostate.

Syntheses and Characterisation of Amide Adducts of Uranyl Bis (β-Diketonates) the Molecular Structure of [UO2(DBM)2.C4H9CON(3-C5H11) (sec-C4H9)]

The first structurally characterised uranyl bis (β-diketonate)-amide adduct compound [UO2(DBM)2. C4H9CON ( 3-C5H11) ( sec-C4H9)] (DBM = dibenzoylmethanate) shows that the amide ligand bonded through its amido oxygen atom to the uranyl group. The average bond distances for U–O(uranyl), U–O(DBM) and U–O(amide) are 1.778(5), 2.346(5) and 2.411(5)Å respectively.

Treatment of acute avulsion of posterior cruciate ligament of left knee with bony fragment by Siddha Varmam therapy and traditional bone setting method

A 42-year-old man with the complaints of left knee swelling, severe pain, difficult to stand was reported to Siddha Varmam division after a road accident. He was diagnosed as acute avulsion of Posterior cruciate ligament (PCL). It was diagnosed based on the history of trauma, knee pain and swelling after trauma, positive posterior drawer test and avulsion fracture shown by radiograph. He was treated with Siddha Varmam therapy and traditional bone setting. After a month of treatment, the PCL avulsion fracture got healed without any surgical interventions and patient able to walk normally. This case report summarises the novel Siddha Varmam therapy and traditional bone setting treatments for acute avulsion of PCL with bony fragment.

Vulvar intraepithelial neoplasia: Risk factors for recurrence

OBJECTIVE

We studied a large population of women with high-grade vulvar intraepithelial neoplasia (VIN) in order to identify patient and treatment-related risk factors for recurrence and progression to cancer.

METHODS

For this retrospective cohort study of women with a histologic diagnosis of VIN within Southern California Permanente Medical Group between 1995 and 2007 medical records were reviewed; clinical, demographic and pathologic data were collected. Statistical analyses included Chi-squared and Student's t-tests, univariate and multivariate logistic regression, and cumulative incidence analysis.

RESULTS

914 patients with high-grade VIN were identified; 784 met inclusion criteria. We found 26.3% recurrences among treated women, with 2.2% progression to cancer (8.2% among those with recurrence). Risk factors for recurrence on multivariate analysis were: age >50years (OR, 1.44; 95%CI 1.01-2.07), immunosuppression (OR 2.08; 95%CI 1.42-3.06), metasynchronous VAIN or CIN (OR 1.76; 95%CI 1.08-2.88) in addition to margin status (OR 8.17; 95%CI 4.60-14.51) and adjacent LSA (OR 9.91; 95%CI 1.53-31.32) or HPV (OR 2.15; 95%CI 1.13-3.37) with excisional treatment. Recurrence rates did not differ significantly by smoking status and treatment modalities. Median time to recurrence was 16.9months; 25% had late recurrences (44-196months). Cumulative incidence analyses of time to recurrence shows a significantly higher risk among patients over age 50 (log-rank p=0.0031).

CONCLUSION

We identified independent risk factors for recurrence including age >50years, immunosuppression, metasynchronous vaginal or intraepithelial neoplasia, positive excision margins, and adjacent lichen sclerosus or human papilloma-virus. Regardless of treatment modality, 25% of recurrences occurred late, highlighting the need for long-term surveillance in women treated for VIN.