SMaRT-PCR: sampling using masks and RT-PCR, a non-invasive diagnostic tool for paediatric pulmonary TB

BACKGROUND

Key challenges in paediatric TB diagnosis are invasive sampling and poor sensitivity of standard methods. This study demonstrates the diagnostic potential of non-invasive sampling of bioaerosols from children using SMaRT-PCR, comprising mask sampling combined with reverse transcriptase-polymerase chain reaction (RT-PCR) for TB.

METHODS

Exhaled bioaerosols were captured on modified N-95 masks in a 10-min talk-cough-breathe process from 51 children (30 with TB confirmed using standard sampling methods and 21 without TB) aged 2-15 years. All mask samples were tested using in-house RT-PCR for 16s and rpoB RNA transcripts. Additional mask samples from children with TB were tested using Xpert® MTB/RIF (n = 3) and Xpert® MTB/RIF Ultra (n = 27).

RESULTS

SMaRT-PCR sensitivity for detecting TB among treatment-naïve children was 96% if 16s or rpoB was present, and 75% if both genes were present, comparable to standard methods (71%) in the same cohort. Specificity was better for both genes, at 95%, than 85% for a single gene detection. Mask sampling with Xpert MTB/RIF or Ultra had a sensitivity of only 13%.

CONCLUSION

This is the first study to provide evidence for testing bioaerosols as a promising alternative for detecting paediatric TB. Sampling is non-invasive and simple, with the potential for point-of-care applications. This pilot study also suggests that RNA transcript-based detection may improve TB diagnostic sensitivity in children; however, further investigation is required to establish its adaptability in clinical settings..

Nasal Morphology as an Indicator of Maxillomandibular Skeletal Pattern

OBJECTIVE

To determine the correlation of nasal morphology with maxillary and mandibular patterns.

STUDY DESIGN

Descriptive cross-sectional study. Place and Duration of the Study: Department of Orthodontics, Liaquat College of Medicine and Dentistry and Qamar Dental Hospital, Karachi, Pakistan, , Liaquat College of Medicine & Dentistry and Darul Sehat Hospital Karachi, Pakistan from January to June, 2022.

METHODOLOGY

The pre-treatment lateral cephalograms of 120 patients, aged 18-35 years were included in the study. Eleven nasal parameters were traced on lateral cephalograms and correlated with four maxillary and mandibular skeletal parameters by Pearson correlation coefficient test using SPSS version 26.0.

RESULTS

Nasal bone length and nasal base angle showed a negative correlation with maxillary and mandibular position. Nasal upward tip angle was correlated positively with maxillary position whereas nasal tip angle was found to be negatively correlated with maxillary length. A negative correlation was observed between nasolabial angle and mandibular position. Nasal bone angle depicted a positive correlation with maxillary position and a negative correlation with jaw lengths and mandibular inclination.

CONCLUSION

Nasal morphology has a strong correlation with maxillary as well as mandibular base lengths and position but not with inclination of the jaws. The acquaintance of the relationship of different nasal parameters with jaw parameters might be helpful in diagnosis and treatment planning and to attain the favourable treatment outcomes in patients undergoing orthodontic treatment, orthopedic interventions, orthognathic, genioplasty, rhinoplasty, profiloplasty and other procedures.

KEY WORDS

Nasal morphology, Maxillomandibular skeletal pattern, Jaw length, Jaw position, Jaw inclination.

THE STUDY OF VDR FOKI RS2228570 SNP IN AUTOIMMUNE THYROIDITIS

Autoimmune thyroid disease (AITD) is a common organ-specific autoimmune disease. A strong influence of genetic and epigenetic modifications has been demonstrated to take part in the development and progression of autoimmune thyroid diseases. The linkage between the Vitamin D receptor (VDR) polymorphism and several autoimmune disorders, including the AITD. In this article, we aim to investigate the Frequency of VDR Fokl (rs2228570) genotypes (CC, CT, TT) and alleles (C,T) in autoimmune thyroiditis. The investigation of VDR Fokl (rs2228570) was conducted on 150 samples (control (75 healthy women) and diseased women (75 diseased with autoimmune thyroiditis)) patients from the Adjara (Georgia) Population. It also examined some clinical and laboratory characteristics of the study population. Autoimmune thyroiditis's disease was diagnosed by measuring blood antibodies, determining the level of thyroperoxidase, and conducting an ultrasound examination. Anti-TPO and TSH were studied using the ELISA method. The genomic DNA was extracted from the peripheral blood. The polymerase chain reaction was evaluated to examine the VDR Fokl rs2228570 SNP polymorphism. According to VDR Fokl (rs2228570) genotypes (CC; CT, TT) frequency, in the control group, the Frequency of CC-genotype is 48%, CT-heterozygous genotype is 29.33%, and TT-genotype is 22.67%; in the diseased population, the Frequency of CC-genotype is 57.33%, CT-genotype is 34.67%, and TT-genotype is 8%. According to VDR Fokl (rs2228570) alleles (C, T), the Frequency of the C-allele is high, and the Frequency of the T-allele is low in both populations. The Frequency of the CC and CT genotypes of VDR Fokl (rs2228570) is high in the population with autoimmune thyroiditis compared to the control group; the TT genotype is relatively low in the population suffering from autoimmune thyroiditis; According to VDR Fokl (rs2228570) alleles (C, T), the Frequency of C-allele is high both population.

Robot assisted radical prostatectomy in fit older patients compared to a standard population: Clinical characteristics, surgical, oncological and functional outcomes

INTRODUCTION

To compare robotic assisted radical prostatectomy (RARP) in well-selected older patients with clinically localized prostate cancer, compared to a younger population. Primary endpoint was perioperative outcomes comparison and secondary endpoint were oncological and functional outcomes comparison to a younger population.

METHODS

Single tertiary center cohort of consecutive patients treated with RARP (2017-2020) with retrospective analysis. Patients were classified by age in two groups: <75: control group (CG) and ≥75: study group (SG). Patients aged ≥75 had a comprehensive geriatric assessment (CGA) and only patients classified Balducci ≤2 were admitted to surgery.

RESULTS

Two hundred and sixty-nine patients were included, 56 in SG and 213 in CG. Median follow-up was 9.8 months. Univariate analysis showed no statistically significant (SS) difference between the groups for patients' characteristics (PSA, digital rectal examination -DRE- and biopsy Gleason Score), perioperative data (operative time, hospitalization length, transfusions rate, immediate complications, Clavien-Dindo complications, 30-days re-interventions and 30-days re-hospitalisation), oncological (TNM, margins, extraprostatic extension, postoperative PSA, BCR, metastases, overall survival -OS- and cancer specific survival -CSS-) and functional outcomes. Median perioperative blood loss was lower in the SG: 200.00 cc IQR [100.00, 300.00] vs 200.00cc IQR [100.00, 400.00] in the CG (P<0.05). A multivariate regression considering age>75, DRE, GS, PSA, cardiovascular history and diabetes showed none of variables associated with early BCR. Limitations are retrospective design, small number of patients and short follow-up.

CONCLUSIONS

RARP shows similar perioperative, oncologic and functional outcomes for older patients selected by a CGA when compared to younger patients. The SG shows a minor perioperative bleeding.

LEVEL OF EVIDENCE

IV.

Do health care physician need to risk their own lives? Time to change our own attitude towards recommended physical activity

Background

Cardiovascular diseases are the leading cause of death around the world,South Asian population are at higher risk of atherosclerotic coronary artery diseases (CAD) comparatively. There is a recommended physical activity level to prevent atherosclerotic cardiovascular disease (ASCVD). Health care professionals especially doctors are main advisors to prescribe the exercise protocols among general population. Hence we conducted a survey among doctors of Pakistan to identify their physical activity as well as their knowledge and attitude toward recommended physical activity.

Methodology

An online questionnaire was shared with doctors of various specialties working in private and public healthcare system of the Pakistan. It consisted of consent for participation,followed by information regarding demographic profile, preexisting co-morbid conditions, opinion regarding importance of physical activity to prevent ASCVD (5 point scale), perceived physical activity level (4 point scale), knowledge regarding ACC recommended physical activity level for primary prevention of ASCVD, lifestyle, and barriers in following recommended physical activity level. Collected data were entered and analyzed using SPSS version 21.0, participants were categorized into two groups as “cardiologists” and “non-cardiologists” and results were compared between the two groups.

Results

A total of 159 doctors participated in the survey, out of whom 97 (61%) were cardiologist and remaining 62 (39%) were affiliated with other specialties. Male participants (72.3%) were predominant and mean age was 30.44±23.16 years. More than 60% (61.6%) of the participants were free of preexisting co-morbid condition, most common ASCVD risk factor was positive family history (26.4%) followed by smoking (7.5%) and hypertension (6.3%). According to BMI, 21.4% (34) were obese and 40.3% (64) were overweight. A total of 74.8% (119) of the participants claimed to know about ACC recommended physical activity level but 65.5% (78) were actually aware of recommended 150 min of moderate-intensity or 75 min of vigorous-intensity aerobic activity level. According to the lifestyle activities only 26.4% (42) of the participants were found to follow the ACC recommended physical activity level per week, this proportion was same between cardiologists and non-cardiologists, 25.8% vs. 27.4% respectively. Lack of time from daily routine (71.7%) was found to be most commonly stated reason for physical in activeness followed by overburden/over stress at workplace (33.3%) and lack of resources (14.5%).

Conclusion

Knowledge and adherence to the ACC recommended physical actively level was poor among both cardiologists and non-cardiologists even after considering it important for the primary prevention of ASCVD. Majority of doctors were overweight and obese.Lake of time and resources and over stressed work life of doctors are the key barriers in following recommended physical activity level.

Funding Acknowledgement

Type of funding sources: None.

Évaluation médico-economique de l’impact de mesures d’adaptation au virage de la chirurgie robot-assistée en urologie

INTRODUCTION

The development of robot-assisted urological surgery is held back by the lack of robust medico-economic analyses and their heterogeneity. We conducted a medico-economic study to evaluate the implementation of measures to optimize the transition to robotic surgery.

METHOD

We carried out a single-center, controlled study from the point of view of the public healthcare establishment for 4 years. Economic data collection was based on a micro-costing method and revenues from stay-related groups. Clinical data corresponded to mean lengths of stay, operating duration, complications and stays in intensive care. The measures to optimize the transition to robotic, implemented mid-study period, enabled before/after comparison.

RESULTS

Altogether, 668 patients undergoing robotic surgery were included. Robotic activity increased significantly from periods 1 to 2 to 256% (P=<0.001) as did the overall proportion of robotic by 45% to 85% (P=<0.001). The mean lengths of stay fell significantly, 6.8 d vs. 5.1 d (P<0.001). Costs and revenues increased significantly, resulting in a persistent deficit for the activity €226K vs. €382K (P=<0.001). With increased volume of activity, the deficit per operation and the cost per minute of robotic operating room fell significantly, €3,284 vs. €1,474/procedure (P=<0.001) and €27 vs €24/min (P=<0.029), tending towards a break-even point (=zero deficit) at 430 operations per year.

CONCLUSIONS

Robotic-assisted surgery can be significantly optimized by implementing measures for the robotic turn to reach a break-even point at 430 operations per year. A better multidisciplinary case mix could lower the break-even volume of activity in short term.

LEVEL OF EVIDENCE

3.

QT interval in patients receiving HCQ in SARS-CoV-2- A study on risk factors and correlation of baseline QTc with delta QTc in Pakistani population

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hydroxychloroquine(HCQ) use alone or in combination with Azithromycin (AZM) in SARS-CoV-2 infection is associated with QTc prolongation and risk of arrhythmias.

Objectives

To determine changes in QTc interval and factors predictive of extreme QTc prolongation in patients receiving HCQ alone or in azithromycin combination in Pakistani patients.

Methodology

Retrospective review of records of hospitalized patients with SARS-Cov2 RT-PCR positive result who received HCQ or HCQ/Azithromycin in combination from March-May 2020. Baseline ECGs as well as post drug use ECGs data was recorded. Tisdale score was calculated for predicting risk of QTc prolongation,QTc interval was calculated using Bazett formula. Data entry and analysis was done in SPSS version 23. 

Results

A total of 134 patients were included in the study.  82.1%(110) were males and 17.9%(24) were females, mean age was 54.9 ± 13.7 years. 61.2% (82) had severe disease and 38.8 %(52) had non-severe disease. 14.2%(19) had history of cardiac disease, 35.8%(48) had hypertension and 35.1%(47) had diabetes mellitus. 70.1% (94) patients had received HCQ, AZM, or HCQ/AZM in combination. 40(29.9%) patients had not received any drug. Median baseline QTc among controls and non-control group was 383.5 (IQR 342.25-413.75)msec  and 379(IQR 358-402)msec respectively. HCQ alone was administered to 26.9%(36) and HCQ/AZM to 33.6%(45) patients. 55.6% (45/81) developed QTc prolongation(QTc> 480 msec) or delta QTc increase > 60 msec. 6.2%(5/81) had absolute QTc > 500 msec post-drug administration. 55.6%(25/45) and  30.6%(11/36) (p-value 0.024) developed QTc prolongation in combination and HCQ alone groups respectively. Delta QTc increased to >60msec in 42.0% (34/81); 53.3%(24/45) in  combination group and in 27.8%(10/36) of those receiving HCQ alone( p-value 0.021). Median delta change was 63( IQR 25-81) and 48.5(IQR 26.25-66.75) msec; Median Day 2 QTc  was 413.5 msec (IQR 377.5-436) and 413 msec (IQR361-447); and median maximum QTc was 447(IQR391-471) and 429.8(IQR401.5-45.75) msec in those receiving HCQ/AZM combination and HCQ alone respectively. 9%(12/134) had arrhythmias during hospital stay, in  8.9% (4) and 5.6%(2) patients of those receiving HCQ/AZM combination and HCQ alone respectively, no patient developed torsade de pointes, one patient had non-sustained VT. There was no statistically significant association of QTc prolongation  with mortality, acute kidney injury, myocardial injury or severity of disease. Diuretic use was found to be statistically significant association with QTc prolongation(p-value 0.038). There was a weak correlation of baseline QTc with Δ QTc(r = 0.207 and p-value 0.017)

Conclusion

QTc prolongation was observed in a significant population of patients receiving HCQ and HCQ/AZM combination, however, no significant life threating arrhythmias occurred.

A systematic review of immune checkpoint inhibitor-related neurological adverse events and association with anti-neuronal autoantibodies

Introduction: Immune checkpoint inhibitors (ICI) therapy has led to a paradigm shift in cancer drug development and in the clinical evaluation of approaches to combination cancer treatment. Dysregulation of the immune system by ICI therapy may also elicit autoimmune phenomena and consequently manifest clinically as immune-related adverse events (irAEs) including neurological irAEs. Areas Covered: The purpose of this review is to explore the role of autoantibodies in the diagnosis and prediction of neurological irAEs and to evaluate their pathogenicity. We searched Pubmed and Embase for neurological irAEs and associated autoantibodies and found 28 patients with central and peripheral neurological irAEs. Of these patients, up to 40% had encephalitis, 34.4% with myasthenia gravis and 22% of patients with peripheral neuropathy and Guillain-Barre Syndrome had autoantibodies. Expert Opinion: Overall, our survey suggested a causal relationship between neurological irAEs and autoantibodies. Detection of autoantibodies may help to diagnose neurological irAEs and inform their clinical management.

[Outcomes following the triage of patients for urological cancer and non-cancer surgery during Covid-19 pandemic peak]

Introduction

Lors de la première vague épidémique Covid-19, des mesures de triage, sans PCR systématique, étaient mises en place pour sélectionner les patients à opérer. Notre étude a comparé leurs résultats chirurgicaux après triage à ceux d’un groupe contrôle.

Matériel

L’analyse portait sur l’ensemble des patients initialement programmés dans un centre Covid de référence et inclus consécutivement, du 15 mars au 1^er mai 2020 (NCT04352699). Leurs données étaient recueillies prospectivement et ultérieurement comparées à celles des patients opérés 1 an auparavant sur la même période dans ce centre. Le critère d’évaluation principal était l’admission post-opératoire en unité de soins intensifs (USI). La morbidité, la mortalité postopératoire, le report d’interventions, les tests PCR étaient évalués. Des analyses de sous-groupes étaient réalisés pour les patients opérés de cancer.

Résultats

Après triage, 96 des 142 interventions programmées ont dû être reportées. Sur les opérés, 48 (68 %) l’étaient pour cancer. Au total, aucun cas de pneumonie Covid-19 post-opératoire n’a été identifié. Trois patients (4 %) ont été admis en USI, dont un finalement décédé pour sepsis urinaire. Chez ces patients, les RT-PCR étaient négatives. Globalement, comparativement au groupe contrôle, aucune différence d’admission en USI, ni de taux de mortalité post-opératoire n’ont été rapportées.

Conclusions

Le triage de la première vague n’a pas surexposé les patients sélectionnés à un risque de complication ou de décès post-opératoire, particulièrement pas pour ceux opérés pour cancer. En revanche, 67 % des patients ont été reportés, avec un risque associé à des retard de soins pouvant conduire au décès.

Niveau de preuve

3.

Biodegradable dendritic Boltorn™ nanoconstructs: A promising avenue for cancer theranostics

The family of Boltorn™ H40 dendrimers is an imperative subclass of hyperbranched biodegradable polymers (HBPs), which has received mounting attention as a result of its inimitable chemical, physical and biodegradable properties. These properties embrace three-dimensional dendrimeric nanoarchitecture to avert tanglement between polymer branches, adequate spatial cavities for increased encapsulation of guest molecules, good solubility as well as low viscosity to improve processability, and a huge number of surface functional groups for chemical manipulations. Similarly, low toxicity, non-immunogenicity, and natural biodegradation are significant and critical advantages in therapeutic applications as compared to other dendritic polymers. All these characteristics of Boltorn™ H40 are of pronounced importance for planning and developing advanced targeted cargo delivery carriers for cancer therapy. The present review highlights the applications of Boltorn™ H40 HBPs for the transport of chemotherapeutic agents to manage various types of cancers.

The maxillary incisor display at rest: analysis of the underlying components

Introduction:

Maxillary incisal display is one of the most important attributes of smile esthetics.

Objective:

The aim of this study was to determine the relationship between maxillary incisal display at rest (MIDR) and various soft tissue, hard tissue and dental components.

Methods:

A cross-sectional study was conducted on 150 subjects (75 males, 75 females) aged 18-30 years. The MIDR was recorded from the pretreatment orthodontic records. The following parameters were assessed on lateral cephalograms: ANB angle, mandibular plane angle, palatal plane angle, lower anterior and total anterior facial heights, upper incisor inclination, upper anterior dentoalveolar height, and upper lip length, thickness and protrusion. The relationship between MIDR and various skeletal, dental and soft tissue components was assessed using linear regression analyses.

Results:

The mean MIDR was significantly greater in females than males (p = 0.011). A significant positive correlation was found between MIDR and ANB angle, mandibular plane angle and lower anterior facial height. A significant negative correlation was found between MIDR and upper lip length and thickness. Linear regression analysis showed that upper lip length was the strongest predictor of MIDR, explaining 29.7% of variance in MIDR. A multiple linear regression model based on mandibular plane angle, lower anterior facial height, upper lip length and upper lip thickness explained about 63.4% of variance in MIDR.

Conclusions:

Incisal display at rest was generally greater in females than males. Multiple factors play a role in determining MIDR, nevertheless upper lip length was found to be the strongest predictor of variations in MIDR.

Evaluation of conformity of preformed orthodontic archwires and dental arch form

Introduction:

The alterations in the arch form during treatment are dictated by the dimensions of the archwires.

Objective:

This study aimed to determine the mean arch dimensions of a sample of Pakistani subjects and to evaluate the conformity of preformed archwires with mandibular arch form.

Methods:

The dental records of 1,500 adult subjects were evaluated. The mandibular casts of 42 subjects (males = females = 21) with balanced facial profile, Class I occlusion, ideal overjet and overbite were included. Brackets were bonded on all teeth. Arch dimensions were evaluated at canines, first premolars, second premolars, first and second molars, with digital vernier calipers. The arch widths at the level of aforementioned teeth were evaluated on the digitized archwires, using the mean arch depths of the subjects.

Results:

In males, the archwires were found to be wider at canines and premolars, and significantly narrower at first (p< 0.001, 95% CI = 2.03 - 5.74) and second molars (p< 0.001, 95% CI = 2.29 - 7.73) as compared to the arch dimensions of the mandibular casts. In females, the archwires were significantly narrower at canines (p< 0.001, 95% CI = 1.4 - 3.97), and first (p= 0.02, 95% CI = 0.402 - 4.41) and second molars (p< 0.001, 95% CI = 1.76 - 6.13).

Conclusion:

No single commercially available archwires evaluated in the present study conformed to the arch dimensions of our subjects. Utilization of the currently available archwires may result in unwarranted modification of arch form, which may lead to unstable post-treatment teeth position.

The association between palatal rugae pattern and dental malocclusion

Introduction:

Palatal rugae complete its development during early intrauterine life, whereas dental malocclusions in permanent dentition establishes several years into the post-natal life.

Objective:

The objective of present study was to determine if there is an association between the palatal rugae pattern and Angle’s classes of malocclusion.

Methods:

A cross-sectional study was conducted on pretreatment dental casts of 184 patients. The sample was divided into the following groups: Class I, Class II div. 1, Class II div. 2, and Class III. The number of palatal rugae was recorded, bilaterally. The length, pattern and orientation of three anterior-most primary rugae on both sides were recorded.

Results:

The mean age of the study sample was 17.8 ± 5.4 years. The mean number of the palatal rugae was 11.18 ± 2.5, with significant differences among different malocclusion groups. The length of the first rugae on left side and third rugae on both sides varied significantly among the groups (p< 0.05). Similarly, the pattern of palatal rugae was also found to be significantly different among the malocclusion groups. The right sided rugae did not have any significant difference in the orientation in different malocclusion groups; however, the left sided rugae showed significant differences among the four malocclusion groups (p< 0.001).

Conclusions:

The current study showed subtle differences in the palatal rugae pattern among the Angle’s classes of malocclusion. Similarly, the length and orientation of some rugae were also found to be significantly different between malocclusion groups.

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern

INTRODUCTION

Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures.

OBJECTIVE

This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern.

METHODS

A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV).

RESULTS

A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00).

CONCLUSION

The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Cervical Posture and Skeletal Malocclusions – Is there a Link?

Background: The present study was conducted in order to determine cervical posture in different skeletal sagittal malocclusions as well as to assess whether a correlation existed between cervical posture and skeletal relationships. Methods: Cervical curvature and inclination of 63 subjects was assessed using their lateral cephalometric radiographs. Cervical inclination was assessed using the cervicohorizontal postural variables namely OPT/HOR and CVT/HOR whereas cervical curvature was determined by measuring the angle OPT/CVT. Sagittally, the subjects were also categorized into skeletal Class I, II and III based on the angle ANB. One way ANOVA was used for the comparison of cervical posture in different skeletal sagittal malocclusions. Pearson’s correlation was used to evaluate the correlation of cervical posture with different skeletal sagittal jaw relations. Statistical significance level was set at p≤0.05. Results: Statistically significant differences were found between the different skeletal malocclusions for the cervical curvature angle OPT/CVT (p=0.025). A weak correlation of cervical curvature angle OPT/CVT (r=0.305, p=0.016) with sagittal malocclusion was found.  Conclusions: Skeletal sagittal malocclusions differ in their cervical postures, especially  cervical curvature. Skeletal Class III subjects have significantly straighter cervical columns than skeletal Class I subjects. Cervical curvature is correlated with sagittal jaw relations.  Keywords: cervical curvature; cervical posture; skeletal sagittal malocclusions .  

P81 Intraoperative MEP recordings from a urethral sphincter electrode for spinal conus tumour surgery and its importance

Objectives

To emphasise the importance of motor evoked potential (MEP) recordings from a simple urethral sphincter electrode along with routine use of bulbocavernosus reflex recordings, anal sphincter and other lower limb muscle free running and stimulated EMG and MEP’s, and SEP techniques for sphincter preservation.

Design

Case report.

Subjects

Patients with conus or other spinal lesions at risk of postoperative sphincter disturbance.

Methods

Transcranial ‘train of 5’ stimulation (5 pulses, interstimulus interval 4msec, 200 µsec pulse width) was applied, with recordings from the urethral sphincter (small electrode taped to Foley catheter to lie just inside the urethra, referred to nearby needle anteriorly in mons pubis) and anal sphincter (paired needle electrodes in both left and right sides of external sphincter).

Results

Intraoperative stimuli of structures during dissection at one point gave a motor response confined to the urethral sphincter suggesting that these fibres may have been considered non-functional and cut had these not been assessed separately. Urethral sphincter MEP’s during the dissection confirmed that these motor fibres remained in continuity throughout.. The patient was intact after tumour removal.

Conclusions

This is an avant-garde technique by which we managed to save the nerve supply to the urethral sphincter and eventually urinary continence which would have been compromised if separate urethral monitoring was not attempted along with usual intraoperative nerve monitoring. We believe its first in the UK.

Alexithymia Predicts Cognitive Deficits In Patients With Idiopathic Parkinson's Disease

BACKGROUND

Most of the orthodontic cases require a long period of retention which is usually carried out with the help of fixed retainers (FR). One of the downsides of FR is that these are prone to breakages. The aim of the present study was to identify the frequency and factors associated with failure of fixed spiral wire retainers..

METHODS

A retrospective crosssectional study was conducted using orthodontic files and dental casts of 126 patients from dental clinics of a tertiary care hospital. Descriptive statistics were applied to calculate the frequency and most common site of breakages. Chi-square test was applied to compare the frequency of breakages among age groups and different retainer spans. Independent sample ttest was used to compare the mean overbite in retainer breakage and retainer intact groups. A p-value ≤0.05 was considered as statistically significant.

RESULTS

The frequency of retainer breakage was found to be 53.1%. Maxillary retainer breakages were found in 41.3% subjects whereas mandibular retainer failed in 22.2% subjects. The mean survival time of retainer was 8.91±4.57 months. The detachment of the retainer from the tooth surface was the most common occurrence (86%). The most common site of retainer breakage was maxillary canine (32.5%) and mandibular central incisor (12.7%). All the subjects who had retainers extending till maxillary molars encountered breakages..

CONCLUSIONS

A longer retainer span is associated with a greater risk of breakage. Failure rate in the maxillary arch was higher than the mandibular arch. The most common sites were the maxillary canine and mandibular central incisor. The most common pattern was wire detachment.

Improving Metastatic Breast Cancer Care in Kenya Using Information Technology

Background and context: In Africa, up to two thirds of breast cancer patients have been reported to present with an advanced stage of III or IV at diagnosis leading to a disproportionately higher mortality. In Kenya, breast cancer is the most common cancer in females in terms of diagnosis and mortality. Metastatic breast cancer (MBC) patients are an ignored part of the breast cancer community as they are marginalized in many of the breast cancer related initiatives. MBC suffer from clinical depression, anxiety and four out of five of these women do not receive any services, referral or guidance to help them with their emotional distress. Preferred evidence based methods of support desired by women with MBC, include online support. International resources are not always applicable to the local context thus making them unattractive for people from diverse cultures and background, such as those from Africa. Kenya has a high percentage of literate females and highest Internet usage in the area. This provides a unique opportunity in an otherwise limited resource country to reach out to a significant population of MBC patients. The patients voices are a valuable and trustworthy assessment of their actual needs. They have been used frequently in the area of cancer as a first step in designing needs-tailored interventions. We propose to develop a virtual online forum with the aim of providing patients with MBC, and their caregivers an interactive forum for psycho social support, addressing stigmas, seek relevant clinical advice, find links to the nearest healthcare facilities, download helpful information, participate in support group activities and receive links to other important helpful sites that are locally relevant. We also propose that such forum should also reflect the needs of our patients as described by themselves. Aim: Primary aim of this project is developing a virtual online interactive support forum where MBC patients and their caregivers can access information on social, psychological, spiritual, religious and clinical needs. The purpose is to be partly achieved by assessing the patient needs by needs assessment survey and to evaluate the impact of such intervention on patient knowledge and satisfaction with care. Strategy/Tactics: Web site development is the key component of the project. Patients would be asked to fill out the Supportive Care Needs Survey/The Knowledge Assessment Tool. The surveys will take place at four major cancer treatment hospitals in Kenya. Postlaunch promotion and awareness about Web site will be made and, usage data and knowledge tool to be used to assess the impact and acceptability. Web site updated regularly to address issues identified. Program/Policy process: Information gathered would be made part of policy on national cancer strategy, recommendations to factor in identified patient needs in policy. What was learned: Ongoing process.

Evaluation Of Apical Root Resorption In Endodontically Treated And Vital Teeth In Adult Orthodontic Subjects

BACKGROUND

External apical root resorption (EARR) is one of the detrimental outcomes of an orthodontic treatment. The study was aimed to compare the mean EARR between endodontically treated and its contralateral vital tooth in adult orthodontic subjects.

METHODS

A total of 30 subjects were included in the study. EARR was evaluated on pretreatment and post-treatment orthopantomograms using Rogan Delft View Pro-X software. Equal number of endodontically treated and their contralateral vital teeth were evaluated. Linge and Linge method was used to evaluate the pretreatment and post-treatment root lengths. For comparison of EARR between genders, treatment type and vital versus endodontically treated teeth, Mann-Whitney U Test was applied. Spearman correlation was applied to determine the correlation of EARR with age of the patient, duration of treatment and pretreatment root length. A probability value of ≤0.05 was kept as statistically significant.

RESULTS

Vital teeth showed more root resorption as compared to endodontically treated teeth and in females as compared to males. A weak positive correlation was found between the root resorption and patient's age & pretreatment root length. In vital teeth, a weak negative correlation was appeared between root resorption and duration of the treatment. However, none of these correlations were significant.

CONCLUSIONS

EARR appeared to be greater in vital as compared to the root filled teeth and in females as compared to the males. However, EARR was not significantly correlated with duration of treatment, age of patient and pretreatment root length.

Factors affecting treatment decisions for Class I malocclusions

INTRODUCTION

Orthodontic treatment planning requires skill and expertise with considerable practice variations. The aims of this study were to review retrospectively the pretreatment records of patients with Class I malocclusion and to identify variables that could play a role in the treatment decision.

METHODS

From the available records of 1500 orthdontic patients, the pretreatment records of 202 patients were selected at random. Inclusion and exclusion criteria were applied, and the surviving records were divided into extraction (n = 92) and nonextraction (n = 92) treatment groups. Skeletal, dental, and soft tissue measurements were obtained from pretreatment lateral cephalograms and dental casts of subjects with bilateral Class I molar relationships. Data were statistically analyzed by binary logistic regression tests.

RESULTS

The results showed that the variables of lower anterior facial height, E-plane to upper lip, and maxillary and mandibular incisor inclinations were significantly increased in the extraction group (P <0.05), whereas spacing in the mandibular arch and increased overbite were statistically significant in the nonextraction treatment group (P <0.05). According to the model, the odds of nonextraction treatment are 1.29 and 1.24 times that of extraction treatment for every 1-mm increase in overbite and spacing in the mandibular arch, respectively.

CONCLUSIONS

Vertical facial pattern, overbite, mandibular tooth size-arch length discrepancy, lip position, and maxillary and mandibular incisor inclinations are a few of the important variables that should not be overlooked when planning orthodontic treatment. The findings of this study could facilitate the treatment planning process for patients with Class I malocclusion.

Assessment of skeletal maturity using the calcification stages of permanent mandibular teeth

INTRODUCTION

Knowledge of the growth status of patients is essential to formulate and initiate a precise treatment plan. This study aimed at determining the role of calcification of permanent mandibular teeth for the assessment of skeletal maturity.

METHODS

A cross-sectional study was conducted using lateral cephalograms and dental panoramic radiographs of 360 patients (ages 7-18 years) equally divided into six groups according to cervical vertebral maturation stages. Skeletal age was determined using Baccetti et al. method and dental age was calculated using Nolla and Demirjian methods.

RESULTS

Mean chronological stage at CS5 revealed a significant difference between male and female subjects (p= 0.003), which showed that the latter achieved skeletal maturity one year earlier than the former. A significant difference (p= 0.007) was found for dental age using Nolla's stages at CS3, which showed females demonstrated a dental age of 1.4 years less than males. Mandibular canine showed the highest correlation with Demirjian index (DI) in males (rho = 0.818) and females (rho = 0.833). Mandibular second premolar showed the highest correlation with Nolla's stages in males (rho = 0.654) and females (rho = 0.664).

CONCLUSION

Comparisons between sexes revealed that females are skeletally and dentally advanced. The DI indicated stage F and Nolla's stages identified stages 9, 10 to be indicative of CS2-3 for the mandibular canine and stages F and G and 9-10 for CS2-3 for the first premolars, second premolars and second molars, respectively.

Reliability and validity of maxillary and sphenoid Sinus morphological variations in the assessment of Skeletal maturity

BACKGROUND

The present study aimed at assessing the relationship between growth changes in maxillary (MS) and sphenoid sinus (SS) and cervical vertebral maturation (CVM) and to evaluate their reliability and validity in assessing the skeletal maturity of an individual.

METHODS

A crosssectional study was conducted on the pretreatment lateral cephalograms of 224 patients (males=116, females=108) aged 8-17 years. MS and SS heights, widths and indices were evaluated. The subjects were classified according to six stages based on CVM using Baccetti's method. Kruskal-Wallis test was applied to compare MS and SS measurements at different cervical stages for each gender. Kappa statistics, positive predictive value, negative predictive value, sensitivity and specificity were calculated to test the diagnostic accuracy of MS and SS indices.

RESULTS

The MS and SS indices varied significantly (p<0.001) at different cervical stages for both gender. Kappa statistics showed significant agreement using MS (p<0.001) and SS indices (p<0.05). The diagnostic performance of MS index (Sensitivity ≥71%) was found to be better than SS index (Sensitivity ≥65%)..

CONCLUSIONS

The MS height, width and index in genders and SS height, width and index in males and only SS width and index in females were significantly associated with the CVM stages. The validity of MS and SS indices were comparable for females; whereas, the MS index offers significant advantage over SS index for the assessment of growth status of males.

Prevention of chemotherapy toxicity by agents that neutralize or degrade cell-free chromatin

Background

Toxicity associated with chemotherapy is a major therapeutic challenge and is caused by chemotherapy-induced DNA damage and inflammation. We have recently reported that cell-free chromatin (cfCh) fragments released from dying cells can readily enter into healthy cells of the body to integrate into their genomes and induce DNA double-strand breaks, apoptosis and inflammation in them. We hypothesized that much of the toxicity of chemotherapy might be due to release of large quantities of cfCh from dying cells that could trigger an exaggerated DNA damage, apoptotic and inflammatory response in healthy cells over and above that caused by the drugs themselves.

Methods

We tested this hypothesis by administering cfCh neutralizing/degrading agents namely, anti-histone antibody complexed nanoparticles, DNase I and a novel DNA degrading agent-Resveratrol-Cu concurrently with five different chemotherapeutic agents to examine if chemotherapy-induced toxicity could be minimized.

Results

We observed (i) significant reduction in chemotherapy-induced surge of cfCh in blood; (ii) significant reduction in chemotherapy-induced surge of inflammatory cytokines CRP, IL-6, IFNγ and TNFα in blood; (iii) abolition of chemotherapy-induced tissue DNA damage (γH2AX), apoptosis (active caspase-3) and inflammation (NFκB and IL-6) in multiple organs and peripheral blood mononuclear cells; (iv) prevention of prolonged neutropenia following a single injection of adriamycin and (v) significant reduction in death following a lethal dose of adriamycin.

Conclusion

Our results suggest that toxicity of chemotherapy is caused to a large extent by cfCh released from dying cells and can be prevented by concurrent treatment with cfCh neutralizing/degrading agents.

Factors Affecting Treatment Duration - A Dilemma In Orthodontics

BACKGROUND

One of the first concerns of new orthodontic patients, apart from the outcome, is the duration of treatment. A better understanding of orthodontic treatment duration as well as factors affecting the treatment duration is useful for efficient patient counselling and improved clinical practice. Hence, the objectives of this study are to compare the treatment durations of subjects with Class I and Class II division 1 (II/1) malocclusions, and to identify the factors affecting the treatment duration of these malocclusions.

METHODS

This was a chart review conducted in the orthodontic department of the Aga Khan University Hospital, Karachi. The study sample comprised of 120 subjects and data were recorded from their treatment records. ANOVA and Bonferroni post-hoc were performed to determine the difference in treatment durations of Class I and Class II/1 malocclusions, whereas multiple linear regression was applied to identify the factors affecting the treatment duration. A level of significance (p≤0.05) was used for the statistical tests.

RESULTS

A statistically significant difference was found between the treatment durations of Class I and Class II/1 non-extraction (p=0.007), Class I non-extraction and Class II/1 extraction (p=0.001), and Class I and II/1 extraction (p=0.004) groups. The factors significantly increasing the treatment duration included missed appointments, breakages, and lower incisor proclination.

CONCLUSIONS

Orthodontic treatment of Class II/1 malocclusion lasts longer than that of Class I malocclusion. Prolonged treatment time is associated with missed appointments, band/bracket debonds and increased lower incisor inclination. The variance in treatment time can be explained most significantly by number of missed appointments and breakages.

Reliability of overbite depth indicator (ODI) and anteroposterior dysplasia indicator (APDI) in the assessment of different vertical and sagittal dental malocclusions: a receiver operating characteristic (ROC) analysis

Introduction:

Differential diagnosis of skeletal and dental relationships is crucial for planning orthodontic treatment. Overbite depth indicator (ODI) and anteroposterior dysplasia indicator (APDI) had been introduced in the past for assessment of vertical and sagittal jaw relationships, respectively.

Objective:

The objectives of this study were to evaluate the reliability of ODI and APDI in overbite and Angle malocclusions, as well as assess their diagnostic reliability among males and females of different age groups.

Material and Methods:

This study was conducted using pretreatment dental casts and lateral cephalograms of 90 subjects. For ODI, subjects were divided into three groups based on overbite (normal overbite, open bite and deep bite). Likewise, the same subjects were divided for APDI into three groups, based on Angle's malocclusion classification (dental Class I, II and III malocclusions). Mann-Whitney U test was applied for comparison of study parameters regarding sex and different age groups. The mean values of ODI and APDI were compared among study groups by means of Kruskal-Wallis and post-hoc Dunnet T3 tests. The receiver operating characteristic (ROC) curve was applied to test diagnostic reliability.

Results:

Insignificant differences were found for ODI and APDI angles, particularly in regards to sex and age. Significant intergroup differences were found in different overbite groups and Angle's classification for ODI and APDI, respectively (p < 0.001). ROC showed 91% and 88% constancy with dental pattern in ODI and APDI, respectively.

Conclusions:

ODI can reliably differentiate deep bite versus normal overbite and deep bite versus open bite. APDI can reliably differentiate dental Class I, II and III malocclusions.

The duration of pubertal growth peak among three skeletal classes

Introduction:

Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability.

Objective:

The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes.

Methods:

A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. The cervical vertebral maturation stage was recorded by means of Baccetti's method. The mean ages at CS3 and CS4 and the CS3-CS4 age interval were compared between boys and girls and among three skeletal classes.

Results:

Pubertal growth peak occurred on average four months earlier in girls than boys (p = 0.050). The average duration of pubertal growth peak was 11 months in Class I, seven months in Class II and 17 months in Class III subjects. Interclass differences were highly significant (Cohen's d > 0.08). However, no significant difference was found in the timing of pubertal growth peak onset among three skeletal classes (p = 0.126 in boys, p = 0.262 in girls).

Conclusions:

Girls enter pubertal growth peak on average four months earlier than boys. Moreover, the duration of pubertal growth peak is on average four months shorter in Class II and six months longer in Class III subjects as compared to Class I subjects.

Cephalometric evaluation of the effects of the Twin Block appliance in subjects with Class II, Division 1 malocclusion amongst different cervical vertebral maturation stages

Objectives:

To evaluate the cephalometric changes in skeletal, dentoalveolar and soft tissue variables induced by Clark's Twin Block (CTB) in Class II, Division 1 malocclusion patients and to compare these changes in different cervical vertebral maturation stages.

Methods:

Pre- and post-treatment/observation lateral cephalograms of 53 Class II, Division 1 malocclusion patients and 60 controls were compared to evaluate skeletal, dentoalveolar and soft tissue changes. Skeletal maturity was assessed according to cervical vertebral maturation stages. Pre- and post-treatment/observation mean changes and differences (T₂-T₁) were compared by means of Wilcoxon sign rank and Mann-Whitney U-tests, respectively. Intergroup comparisons between different cervical stages were performed by means of Kruskal-Wallis test and Mann-Whitney U-test (p ≤ 0.05) .

Results:

When compared with controls, there was a significant reduction in ANB angle (p < 0.001), which was due to a change in SNB angle in CS-2 and CS-3 (p < 0.001), and in SNA (p < 0.001) and SNB (p = 0.016) angles in the CS-4 group. There was significant increase in the GoGn-SN angle in CS-2 (p = 0.007) and CS-4 (p = 0.024), and increase in Co-Gn and Go-Gn amongst all cervical stages (p < 0.05). There was significant decrease in U1-SN and increase in IMPA amongst all cervical stages (p < 0.05). There was significant retraction of the upper lip in CS-3 (p = 0.001), protrusion of the lower lip in CS-2 (p = 0.005), increase in nasolabial angle in CS-4 (p = 0.006) and Z-angle in CS-3 (p = 0.016), reduction in H-angle in CS-2 (p = 0.013) and CS-3 (p = 0.002) groups. When pre- and post-treatment mean differences were compared between different cervical stages, significant differences were found for SNA, SNB and UI-SN angles and overjet. .

Conclusions:

The Twin-Block along with the normal craniofacial growth improves facial esthetics in Class II, Division 1 malocclusion by changes in underlying skeletal and dentoalveolar structures. The favorable mandibular growth occurs during any of the cervical vertebral maturation stages, with more pronounced effect during CS-3 stage.

Diagnostic performance of various cephalometric parameters for the assessment of vertical growth pattern

Introduction:

Multiple cephalometric analyses are used to diagnose vertical skeletal facial discrepancy. A multitude of times, these parameters show conflicting results, and a specific diagnosis is hard to reach.

Objective:

Hence, this study aimed to identify the skeletal analysis that performs best for the identification of vertical skeletal pattern in borderline cases.

Methods:

The sample consisted of 161 subjects (71 males and 90 females; mean age = 23.6 ± 4.6 years). Y-axis, Sella-Nasion to mandibular plane angle (SN.MP), maxillary plane to mandibular plane angle (MMA), Sella-Nasion to Gonion-Gnathion angle (SN.GoGn), Frankfort to mandibular plane angle (FMA), R-angle and facial height ratio (LAFH.TAFH) were used to evaluate vertical growth pattern on lateral cephalograms. The subjects were divided into three groups (hypodivergent, normodivergent and hyperdivergent groups), as indicated by the diagnostic results of the majority of parameters. Kappa statistics was applied to compare the diagnostic accuracy of various analyses. To further validate the results, sensitivity and positive predictive values (PPV) for each parameter were also calculated.

Results:

SN.GoGn showed a substantial interclass agreement (k = 0.850). In the hypodivergent group, MMA showed the highest sensitivity (0.934), whereas FMA showed the highest PPV (0.964). In the normodivergent group, FMA showed the highest sensitivity (0.909) and SN.GoGn had the highest PPV (0.903). SN.GoGn showed the highest sensitivity (0.980) and PPV (0.87) in the hyperdivergent group.

Conclusions:

SN.GoGn and FMA were found to be the most reliable indicators, whereas LAFH.TAFH is the least reliable indicator in assessing facial vertical growth pattern. Hence, the cephalometric analyses may be limited to fewer analyses of higher diagnostic performance.

Effect of Clark's twin-block appliance (CTB) and non-extraction fixed mechano-therapy on the pharyngeal dimensions of growing children

Introduction:

Narrow airway dimensions due to mandibular deficiency can predispose an individual to severe respiratory distress. Hence, treatment with mandibular advancement devices at an early age might help improving the pharyngeal passage and reduce the risk of respiratory difficulties. Therefore, the aim of the current study was to evaluate the mean changes in the pharyngeal dimensions of children with mandibular deficiency treated with Clark's twin-block appliance (CTB) followed by fixed orthodontic treatment.

Methods:

Orthodontic records of 42 children with mandibular deficiency were selected. Records comprised three lateral cephalograms taken at the start of CTB treatment, after CTB removal and at the end of fixed appliance treatment, and were compared with 32 controls from the Bolton-Brush study. Friedman test was used to compare pre-treatment, mid-treatment and post-treatment pharyngeal dimensions. Wilcoxon signed rank test was used to compare the airway between pre-treatment and post follow-up controls. Mann-Whitney U test was applied to compare the mean changes in pharyngeal dimensions between treatment group and controls from T₂ to T₀. Post-hoc Dunnet T3 test was used for multiple comparisons of treatment outcomes after CTB and fixed appliances, taking a p-value of ≤ 0.05 as statistically significant.

Results:

Superior pharyngeal space (p < 0.001) and upper airway thickness (p = 0.035) were significantly increased after CTB, and the change in superior pharyngeal space remained stable after fixed mechano-therapy.

Conclusion:

CTB can have a positive effect in improving pharyngeal space and the resultant increase in airway remains stable on an average of two and a half years.

Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity

INTRODUCTION

Various methods have been proposed to evaluate a patient's developmental status. However, most of them lacked precision and failed to give a reliable estimate of skeletal maturity. The aims of this study were to evaluate the association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity and to determine its validity in assessing the different stages of the adolescent growth spurt.

METHODS

A cross-sectional study was performed on the pretreatment lateral cephalograms of 252 subjects aged 8 to 21 years. The sample was divided into 6 groups based on the cervical vertebral maturation stages. The frontal sinus index was calculated by dividing the frontal sinus height and width, and the cervical stages were evaluated on the same radiograph. The Kruskal-Wallis test was applied to compare frontal sinus index values at different cervical stages, and the post hoc Dunnett T3 test was applied to compare frontal sinus index values between adjacent cervical stages for each sex. The Kendall tau-b values were computed to assess the correlation between the cervical stages and the sinus index. A P value of ≤0.05 was considered statistically significant.

RESULTS

The height and width of the frontal sinus were significantly larger in the male subjects than in the females. A significant association was found between the frontal sinus height and width and cervical stages (P ≤0.001) in both sexes. However, the changes in the frontal sinus index across the different cervical stages were found to be significant (P ≤0.001) in male subjects only. Similarly, a weak negative correlation was found between the sinus index and the cervical stages in male subjects (tau-b = -0.271; P <0.001), whereas no correlation was found in female subjects (tau-b = -0.006; P <0.928). However, the post hoc analysis showed that the values of the sinus index were comparable between any 2 adjacent cervical stages.

CONCLUSIONS

The frontal sinus index cannot be used to identify the prepubertal, pubertal, and postpubertal stages of the adolescent growth spurt. Therefore, it cannot be used as a reliable maturity indicator.

Exploration of variations in positions of upper and Lower incisors, overjet, overbite, and irregularity Index in orthodontic patients with dissimilar depths of Curve of spee

BACKGROUND

The position and arrangement of teeth as well as the entire scheme of occlusion differs from one individual to the other .The purpose of this study was to examine differences in position and inclination of incisors, overjet, overbite and lower arch crowding in subjects with different depths of curve of Spee and to determine correlations between depth of curve of Spee and these variables.

METHODS

The sample comprised of 114 patients (55 females and 59 males) with fully erupted permanent second molars (age 12-25 years), having no history of previous orthodontic treatment, no craniofacial anomalies, and no missing permanent teeth. Study parameters were assessed by using pretreatment lateral cephalograms and dental casts of orthodontic patients. The entire sample was divided into three groups according to depth of curve of Spee (mild Spee=38, moderate Spee=38, severe Spee=38). Descriptive statistics were calculated. Differences between the Spee groups were assessed by analysis of variance. In addition, correlation coefficients were calculated between curve of Spee and other parameters.

RESULTS

Statistically significant differences were found in upper incisor inclination (p=0.000), lower incisor inclination (p=0.003), Steiner's mandibular plane angle (p=0.000), overjet (p=0.001), overbite (p=0.000) and irregularity index (p=0.008) among the Spee groups. Moreover, statistically significant positive correlations were found between curve of Spee and overjet, overbite and irregularity index. Upper and lower incisor inclinations as well as mandibular plane angle were found to have statistically significant but negative correlations with curve of Spee.

CONCLUSIONS

Overjet and overbite in severe Spee group are larger than in mild and moderate Spee groups. There is negative correlation between curve of Spee depth and inclinations of upper and lower incisors. There is positive correlation between curve of Spee depth and severity of lower anterior crowding and Steiner's mandibular plane angle.

Occlusal Outcome Of Non-Extraction And All First Premolars Extraction Treatment In Patients With Class-I Malocclusion

BACKGROUND

Class-1 malocclusion commonly presents with crowding and poses an aesthetic concern to patients. An orthodontist may encounter a variety of dental problems and must handle them strategically to establish adequate occlusal relationships. Hence, this study was conducted to evaluate the occlusal characteristics of patients who have undergone non-extraction or all first premolars extraction treatment for class I malocclusion using the peer assessment rating (PAR) index.

METHODS

The pre-treatment and post treatment dental casts of 94 subjects with class-I malocclusion were retrospectively screened. The sample was distributed into two groups, i.e., nonextraction and all first premolars extraction groups. The Mann Whitney-U test was used to compare the mean percentage improvement in the PAR scores between the two groups. A p-value of ≤0.05 was considered statistically significant.

RESULTS

The mean percentage improvement in the non-extraction group was 74.28% in the non-extraction group and 74.5% in the all first premolars extraction group. A significant difference (p=0.04) was found between the pretreatment PAR scores for the two treatment modalities. There was no significant difference between the post treatment PAR scores (p=0.45) and the mean percentage improvement in PAR scores (p=0.41) between the treatment groups.

CONCLUSIONS

The improvement in occlusal characteristics in patients who underwent non-extraction treatment and all first premolar extraction treatment was comparable as assessed through mean percentage improvement in PAR scores.

Deep Bite Malocclusion: Exploration Of The Skeletal And Dental Factors

BACKGROUND

Correction of deep bite is crucial for maintenance of dental hard and soft tissue structures and for prevention of temporomandibular joint disorders. Exploration of underlying skeletal and dental factors is essential for efficient and individualized treatment planning. To date etiological factors of dental and skeletal deep bite have not been explored in Pakistani orthodontic patients. The objectives of this study were to explore frequencies of dental and skeletal etiological factors in deep bite patients and to determine correlations amongst dental and skeletal etiological factors of deep bite.

METHODS

The study included a total of 113 subjects (males=35; females=78) with no craniofacial syndromes or prior orthodontic treatment. Pre-treatment orthodontic records were used to evaluate various dental and skeletal parameters. Descriptive statistics of each parameter were calculated. The various study parameters were correlated using Pearson's Correlation.

RESULTS

Deep curve of Spee was most frequently seen factor of dental deep bite (72.6%), followed by increased coronal length of upper incisors (28.3%), retroclined upper incisors (17.7%), retroclined lower incisors (8%) and increased coronal length of lower incisors (5.3%). Decreased gonial angle was most commonly found factor of skeletal deep bite (43.4%), followed by decreased mandibular plane angle (27.4%) and maxillary plane's clockwise rotation (26.5%). Frankfort mandibular plane angle and gonial angle showed a strong positive correlation (r=0.66, p=0.000).

CONCLUSIONS

Reduced gonial angle is most frequently seen skeletal factor, signifying the importance of angulation and growth of ramus in development of deep bite. Deep curve of Spee is most frequently seen dental etiological component in deep bite subjects, hence signifying the importance of intruding the lower anterior teeth.

Stability of Palatal Rugae as a Forensic Marker in Orthodontically Treated Cases

The palatal rugae have been used as a reference landmark and identification marker by orthodontists and forensic analysts. However, the reliability of palatal rugae as a forensic marker remains questionable once an individual is subjected to orthodontic treatment. This study aimed at evaluating the changes in the rugae pattern after nonextraction, extraction, and maxillary expansion orthodontic treatment. The lengths and shapes of palatal rugae were evaluated on the pretreatment and post-treatment dental casts of 168 subjects using the Thomas and Kotze classification. Extraction treatment significantly reduced the second and third rugae lengths (p < 0.05), whereas the third rugae length was significantly increased after palatal expansion (p < 0.05). The shape of rugae remained consistent in all the study groups which may be used as a reliable forensic marker in subjects undergoing orthodontic treatment. However, the use of the lengths of palatal rugae in forensic odontology must be made with caution.

RELIABILITY OF VARIOUS SKELETAL INDICATORS IN ASSESSING VERTICAL FACIAL SOFT TISSUE PATTERN

BACKGROUND

Angle's paradigm has ruled the orthodontic diagnosis and treatment planning for past several decades, but the recent introduction of the soft tissue paradigm has significantly changed the dynamics of orthodontic practice. This study was designed to identify skeletal analyses that best correlates with the parameters use to assess facial soft tissue profile that may lead to an accurate diagnosis and efficient treatment plan.

METHODS

A total of 192 subjects (96 males and 96 females; mean age 22.95 ± 4.75 years) were included in the study. The total sample was distributed into three equal groups (i.e., long, normal and short face) on the basis of soft tissue vertical pattern. Pre-treatment lateral cephalograms were used to assess various vertical linear and angular parameters. Various skeletal analyses and soft tissue parameters were correlated using the Pearson's correlation in different vertical groups, separately for males and females.

RESULTS

In males, a weak positive correlation (r = 0.485) was found between skeletal anterior facial height ratio (Sk. LAFH/TAFH) and soft tissue anterior facial height ratio (LAFH/TAFH'), whereas in females maxillary-mandibular plane angle (MMA) showed a weak positive correlation (r = 0.300). In the long face group, a positive but a weak correlation (r = 0.349) was present between cranial base angle (SN-GoGn) and LAFH/TAFH'.

CONCLUSIONS

Skeletal analyses (MMA, Sk. LAFH/TAFH) significantly correlated to soft tissue parameters. Males andlong faced individuals showed a higher correlation between skeletal and soft tissue parameters as compared to that of the females.

FACIAL SOFT TISSUE ANALYSIS AMONG VARIOUS VERTICAL FACIAL PATTERNS

BACKGROUND

The emergence of soft tissue paradigm in orthodontics has made various soft tissue parameters an integral part of the orthodontic problem list. The purpose of this study was to determine and compare various facial soft tissue parameters on lateral cephalograms among patients with short, average and long facial patterns.

METHODS

A cross-sectional study was conducted on the lateral cephalograms of 180 adult subjects divided into three equal groups, i.e., short, average and long face according to the vertical facial pattern. Incisal display at rest, nose height, upper and lower lip lengths, degree of lip procumbency and the nasolabial angle were measured for each individual. The gender differences for these soft tissue parameters were determined using Mann-Whitney U test while the comparison among different facial patterns was performed using Kruskal-Wallis test.

RESULTS

Significant differences in the incisal display at rest, total nasal height, lip procumbency, the nasolabial angle and the upper and lower lip lengths were found among the three vertical facial patterns. A significant positive correlation of nose and lip dimensions was found with the underlying skeletal pattern. Similarly, the incisal display at rest, upper and lower lip procumbency and the nasolabial angle were significantly correlated with the lower anterior facial height.

CONCLUSION

Short facial pattern is associated with minimal incisal display, recumbent upper and lower lips and acute nasolabial angle while the long facial pattern is associated with excessive incisal display, procumbent upper and lower lips and obtuse nasolabial angle.

The Tulip GT® airway versus the facemask and Guedel airway: a randomised, controlled, cross-over study by Basic Life Support-trained airway providers in anaesthetised patients

We performed a randomised, controlled, cross-over study of lung ventilation by Basic Life Support-trained providers using either the Tulip GT® airway or a facemask with a Guedel airway in 60 anaesthetised patients. Successful ventilation was achieved if the provider produced an end-tidal CO2 > 3.5 kPa and a tidal volume > 250 ml in two of the first three breaths, within 60 sec and within two attempts. Fifty-seven (95%) providers achieved successful ventilation using the Tulip GT compared with 35 (58%) using the facemask (p < 0.0001). Comparing the Tulip GT and facemask, the mean (SD) end-tidal CO2 was 5.0 (0.7) kPa vs 2.5 (1.5) kPa, tidal volume was 494 (175) ml vs 286 (186) ml and peak inspiratory pressure was 18.3 (3.4) cmH2 O vs 13.6 (7) cmH2 O respectively (all p < 0.0001). Forty-seven (78%) users favoured the Tulip GT airway. These results are similar to a previous manikin study using the same protocol, suggesting a close correlation between human and manikin studies for this airway device. We conclude that the Tulip GT should be considered as an adjunct to airway management both within and outside hospitals when ventilation is being undertaken by Basic Life Support-trained airway providers.