Chance Of Deterioration Research Articles

Deterioration of anterior resin composite restorations in moderate to severe tooth wear patients: 3-year results

ObjectivesDeterioration in anterior resin composite restorations placed in tooth wear patients was investigated after 36 months.Materials and methodsData collected prospectively for 47 participants of the Radboud Tooth Wear Project were used (41 ± 8 years, 90% male, n = 270 restorations). Restorations were individually evaluated using intraoral photographs and 3D scans to rate modified FDI scores and to record the presence of degradation features. Four groups with distinct combinations of composites and techniques were assessed, and multivariable logistic regression models were used to analyze the data (p < 0.05).ResultsFor all groups together, early degradation signs were present at 1 month: irregularities (41.5%) and ditching (7.4%) were observed at the surface and adhesive interfaces. The frequency of irregularities decreased in the 36-month evaluation (37%), but ditching (12.2%) and fractures (10.7%) were more common. The most frequent deterioration (based on photographs) was observed for staining (44%) and loss of luster (31%). In 3D scans, the most frequent were for wear (25%), marginal adaptation (24%), and the presence of irregularities (19%). Canines had 5.5 times more chances of deterioration by ditching than incisors (p < 0.001). The differences between composites and restorative techniques were minor.ConclusionsA continuous degradation process of restorations placed in tooth wear patients was observed in anterior teeth restored with different composites, with a progression of the deterioration over 36 months.Clinical relevanceWhen placing anterior resin composite restorations in tooth wear patients, it could be important to establish realistic expectations and the need for checkup appointments.

MO1045: Incidental Finding of Dextrocardia with Situs Inversus and the Absent Left Kidney in a 55-Year-Old Nepali Woman: A Case Report

Abstract BACKGROUND AND AIMS Dextrocardia is an abnormal congenital positioning of the heart: instead of the heart forming in the foetus on the left side, it flips over and forms on the right side. Situs inversus is a congenital condition in which the main visceral organs are reversed or mirrored from their usual positions. If both conditions are present, it is called situs inversus totalis. The prevalence of situs inversus is about 0.01%. It is generally an autosomal recessive genetic condition, although it can be X-linked. 25% of people with this condition have an underlying primary ciliary dyskinesia. We are reporting a case of a 55-year-old woman who was found to have a situs inversus totalis with an absent left kidney. No case report has been published yet. METHOD 54-year-old G5P4(2213) woman, government worker presented to an outpatient clinic with complaints of dysuria, frequency, hesitancy, suprapubic burning sensation and mild chest pain in January 2016. The patient did not have any cardiopulmonary symptoms like chronic coughs, nasal congestion and palpitations. Physical examination of the cardiovascular system revealed a normal pulse rate of 70 beats/min and her blood pressure was 100/60 mmHg. Her lungs were clear on auscultation. There was no pedal oedema or any signs of fluid overload. Routine urine analysis revealed protein 1+, with no sugar, no white cell count and negative nitrites. Renal function test showed mildly elevated creatinine of 138.0 umol/L with estimated glomerular filtration rate (eGFR) of 49mL/min using Cockcroft-Gault equation, sodium of 141.0 mEq/L, potassium (K) 5.2 mEq/L, blood urea 9.7mmol/L. Routine chest X-ray revealed heart apex in the right side and gastric air bubble seen below right hemidiaphragm. Abdominal and pelvic ultrasound revealed the liver presented in the left hypochondrium with normal texture. The spleen was noted in the right hypochondrium with normal texture. The right kidney was normal ∼ 9.7cm in size, the outline was smooth and regular with maintained corticomedullary differentiation, with no hydronephrosis. The left kidney was not visualized. The urinary bladder was normal in outline, distensibility and thickness. The uterus was anteverted with a regular outline and normal endometrial echo complex. Computed tomography scan with contrast of abdomen was done which revealed the liver was present in the left hypochondrium and the spleen was present in the right hypochondrium, inferior vena cava on left side and aorta on the right side. The left kidney and ureter were not visualized. Normal right pelvicalyceal system and excretion from the right kidney were noted. RESULTS The above-mentioned patient did not have any cyanosis, cough, sinusitis, or recurrent chest or urinary tract infections. To diagnose situs inversus, thorough physical examination, chest X-ray, ultrasonography, computed tomography, or magnetic resonance imaging are necessary. These imaging modalities help to evaluate the structures of the internal organs, such as the location of cardiac apex, the site of aorta relative to midline, the location of the stomach, the liver and gallbladder, presence and appearance of the spleens and presence of the kidneys and vascular structures. CONCLUSION Dextrocardia with situs inversus is a rare congenital malformation that must be fully evaluated when there is a suspicion because in some cases it can have deadly results. Apart from detailed medical history and physical examinations, imaging modalities should be used for reaching the diagnosis. Routine and regular follow-ups must be arranged for the patients who have this condition. Patients with unilateral renal agenesis must have regular kidney function tests as well as other modalities when necessary to reduce the chance of deterioration in kidney function and kidney damage.

Development and Validation of Prediction Models for Developmental and Intellectual Outcome Following Pediatric Epilepsy Surgery.

To identify predictors of postoperative intelligence and developmental quotients (IQ/DQ) and develop and validate clinically applicable IQ/DQ prediction models. We retrospectively analyzed neuropsychological outcomes and their possible determinants for children treated in Bethel and Utrecht since 1990. We performed separate analyses for patients with IQ and those with only DQ available. We developed prediction models based on presurgical determinants to predict dichotomized levels of performance (IQ ≥85, IQ ≥70, DQ ≥50). IQ/DQ data before and 2 years after surgery were available for 492 patients (IQ n = 365, DQ n = 127). At a cutoff level ±10 points, the chance of improvement was considerably higher than the chance of deterioration (IQ 37.3% vs 6.6% and DQ 31.5% vs 15.0%, respectively). Presurgical IQ/DQ was the strongest predictor of postoperative cognition (IQ r = 0.85, p <0.001; DQ r = 0.57, p <0.001). Two IQ models were developed in the Bethel cohort (n = 258) and externally validated in the Utrecht cohort (n = 102). For DQ, we developed the model in the Bethel cohort and used 10-fold cross-validation. Models allowed good prediction at all 3 cutoff levels (correct classification for IQ ≥85 = 86%, IQ ≥70 = 91%, DQ ≥50 = 76%). External validation of the IQ models showed high accuracy (IQ ≥85: 0.82, confidence interval [CI] 0.75-0.91; IQ ≥70: 0.84, CI 0.77-0.92) and excellent discrimination (receiver operating characteristic curves: IQ ≥85: area under the curve [AUC] 0.90, CI 0.84-0.96; IQ ≥70: AUC 0.92, CI 0.87-0.97). After epilepsy surgery in children, the risk of cognitive deterioration is very low. Presurgical development has a strong effect on the postoperative trajectory. The presented models can improve presurgical counseling of patients and parents by reliably predicting cognitive outcomes. This study provides Class II evidence that for children undergoing epilepsy surgery presurgical IQ/DQ was the strongest predictor of postoperative cognition.

Performance evaluation of evacuated solar collector assisted hybrid greenhouse solar dryer under active and passive mode

The novel hybrid greenhouse solar dryer (HGSD) attached with evacuated tube collector (ETC) is developed for faster drying of high moisture content crops. The slow drying rate of high moisture crops lead to microbial attack on crop surface and have more chance of deterioration. Hence the HGSD is designed and tested for faster drying of crops. The experiments are performed to evaluate the performance of HGSD under active and passive mode. Ginger has been taken as a high moisture crops for the experimentation on two cases. In both the cases the ginger is dried from 79.8% to 9.82% moisture level (wb). In active mode, dryer takes 43.47% less time than the passive mode. The overall efficiency of the dryer in active and passive mode is 4.81% and 3.39% respectively. The lower drying time makes this dryer suitable for rural as well as commercial applications for drying agricultural or non-agro based products.

The cost of clinical management of SARS-COV-2 (COVID-19) infection by level of disease severity in Ghana: a protocol-based cost of illness analysis

BackgroundAs the global strategies to fight the SARS-COV-2 infection (COVID-19) evolved, response strategies impacted the magnitude and distribution of health-related expenditures. Although the economic consequence of the COVID-19 pandemic has been dire, and its true scale is yet to be ascertained, one key component of the response is the management of infected persons which its cost has not been adequately examined, especially in Africa.MethodsTo fill gaps in context-specific cost of treating COVID-19 patients, we adopted a health system’s perspective and a bottom-up, point of care resource use data collection approach to estimate the cost of clinical management of COVID-19 infection in Ghana. The analysis was based on the national protocol for management of COVID-19 patients at the time, whether in public or private settings. No patients were enrolled into the study as it was entirely a protocol-based cost of illness analysis.ResultWe found that resource use and average cost of treatment per COVID-19 case varied significantly by disease severity level and treatment setting. The average cost of treating COVID-19 patient in Ghana was estimated to be US$11,925 (GH¢68,929) from the perspective of the health system; ranging from US$282 (GH¢1629) for patients with mild/asymptomatic disease condition managed at home to about US$23,382 (GH¢135,149) for critically ill patients requiring sophisticated and specialised care in hospitals. The cost of treatment increased by some 20 folds once a patient moved from home management to the treatment centre. Overheard costs accounted for 63–71% of institutionalised care compared to only 6% for home-based care. The main cost drivers in overhead category in the institutionalised care were personal protective equipment (PPEs) and transportation, whilst investigations (COVID-19 testing) and staff time for follow-up were the main cost drivers for home-based care.ConclusionCost savings could be made by early detection and effective treatment of COVID-19 cases, preferably at home, before any chance of deterioration to the next worst form of the disease state, thereby freeing up more resources for other aspects of the fight against the pandemic. Policy makers in Ghana should thus make it a top priority to intensify the early detection and case management of COVID-19 infections.

Scope of herbal mucilage in pharmaceutical formulations. A review

Summary The aim of the article was to obtain maximum information about plant mucilage, its sources and applications in the pharmaceutical industry. This study focuses on the scientific articles and books available in Internet resources and college library that deal with the sources, applications, extraction and isolation of plant mucilage. Mucilage is obtained mainly from plant sources and can be isolated easily. Due to the low cost, easy availability, non-toxicity, non-irritancy, and biocompatibility, mucilage is of great demand in the field of pharmaceuticals. Hibiscus rosa-sinensis L., Trigonella foenum-graecum L., Abelmoschus esculentus L, Plantago ovata Forssk. and Aloe barbadensis L. are some common sources of mucilage. The isolation methods vary depending on the part of the plant where mucilage is present. It is commonly used as gelling agent, suspending agent, binder, and disintegrant. Since it is hydrophilic in nature, chances of deterioration are higher. In this review, different mucilage sources and their isolation methods are discussed in detail. Mucilage is used as excipient in many formulations of tablets, suspensions, gels, etc. The study explores the potential of plant mucilage as an excipient in pharmaceutical formulations. The biodegradable and biocompatible properties of this inexpensive excipient make it more favourable for the newer formulation development.

Decision Analysis in Quest of the Ideal Treatment in Adult Spinal Deformity Adjusted for Minimum Clinically Important Difference

Surgery appears to yield better results in adult spinal deformity treatment when fixed minimum clinically important difference values are used to define success. Our objective was to analyze utilities and improvement provided by surgical versus nonsurgical treatment at 2 years using Oswestry Disability Index with treatment-specific minimum clinically important difference values. From a multicenter database including 1452 patients, 698 with 2 years of follow-up were analyzed. Mean age of patients was 50.95 ± 19.44 years; 580 patients were women, and 118 were men. The surgical group comprised 369 patients, and the nonsurgical group comprised 329 patients. The surgical group was subcategorized into no complications (192 patients), minor complications (97 patients) and major complications (80 patients) groups to analyze the effect of complications on results. Minimum clinically important differences using Oswestry Disability Index were 14.31, 14.96, and 2.48 for overall, surgical, and nonsurgical groups. Utilities were calculated by visual analog scale mapping. Surgical treatment provided higher utility (0.583) than nonsurgical treatment (0.549) that was sensitive to complications, being 0.634, 0.564, and 0.497 in no, minor, and major complications. Probabilities of improvement, unchanged, and deterioration were 38.3%, 39.2%, and 22.5% for surgical treatment and 39.4%, 10.5%, and 50.1% for nonsurgical treatment. Improvement in the surgical group was also sensitive to complications with rates of 40.1%, 39.3%, and 33.3%. Our results suggest that surgical treatment has less disease burden and less chance of deterioration, but equal chances for improvement at 2 years of follow-up. As it appears to be a better modality in the absence of complications, future efforts need be directed to decreasing the complication rates.

A validation study of early warning system in high-risk pregnant women.

High-risk obstetric patients have chances of deterioration which can be detected by any early warning score. This study was aimed to assess the suitability of the Obstetrics National Early Warning System (ONEWS) for the pregnant women. This prospective study was conducted on 500 high-risk pregnant women attending a tertiary care teaching hospital. The ONEWS charts were plotted for each of them. The primary outcome measure was composite adverse maternal outcome (CAMO) in the form of one or more among mortality, severe maternal morbidity and intensive care unit admissions. Of the 500 women who participated, 200 (40%) had a score ≥3 (triggered an intervention). The CAMO among the triggered group [59.5% (n=119)] was significantly higher compared to that in the non-triggered group [13.3% (n=40) (P=0.001)]. The area under the receiver operating characteristic curve was 0.800 (95% confidence interval 0.752-0.847). The sensitivity of the ONEWS in predicting CAMO was 74.8 per cent, specificity 76.2 per cent, positive predictive value 59.5 per cent and negative predictive value 86.7 per cent at a cut-off score of 3. ONEWS appears to be a useful tool for predicting adverse maternal outcomes in high-risk pregnant women.

A peerless method for identification of removable prosthesis

IntroductionForensic Odontology is the branch of dentistry, that plays a very important role in identification of individuals involved in accident, natural and mass disaster, civil unrest and also in genocide crimes. When natural teeth are not present, marking or labeling of removable partial denture plays an important role in the personal identification. The aim of this study was to obtain a denture identification technique that should be easy, less expensive, long lasting, and standardized. Methods & materialsThis poster illustrates an inclusion of the casted individual national identification number that is printed in the patient’s residence or national identity card issued by the ministry of interior of country in the lingual surface of mandibular removable partial denture. ResultThe label used in this method is durable and can withstand high temperature, it has less chances of deterioration, and is visible radio graphically. It provides all important information about an individual that is standardized, reliable, and is also easily accessible from any remote location. ConclusionThis technique is easy, less expensive, long lasting, visible radio graphically, and a standardized method of identification.

High-Risk Features of Delayed Clinical Progression in Cerebral Venous Thrombosis: A Proposed Prediction Score for Early Intervention

Background: Anticoagulation is the mainstay treatment for cerebral venous thrombosis (CVT). A subset of patients might deteriorate despite anticoagulation, and in such cases, endovascular therapy is recommended. Methods: A retrospective review was performed on subjects with CVT from January 2005 to October 2016. The primary outcome was clinical deterioration. Bivariate analysis, multiple logistic regression modeling, and linear discriminant analysis were used to determine a predictive model for deterioration; the results from these models were used to construct a CVT score in order to measure the individual likelihood of deterioration. Results: We identified 147 subjects with CVT. The majority were treated with anticoagulation (n = 109, 74.15%); 38 (25.85%) were found to have deterioration, 12 (8.16%) of whom underwent endovascular intervention. The most important risk factors of deterioration, per bivariate analysis, included decreased level of consciousness (odds ratio [OR] = 5.76; 95% confidence interval [CI] 2.59–12.77) and papilledema (OR = 4.52; 95% CI 1.55–13.18). The final multivariable model also included CVT location score (number of sinuses involved), oral contraceptive pill use, sodium level, platelet count, and seizure activity on presentation. This model had a predictive ability to identify deterioration of 83.2%, with a sensitivity of 71.4% and a specificity of 76.2%. Patients with a CVT score of ≥5 have at least 50% chance of deterioration. Conclusions: Decreased mental status, seizure activity, papilledema, number of involved sinuses, as well as sodium level and platelet count are the most important factors in predicting deterioration after CVT. This group may represent a subset of patients in whom early endovascular therapy may be considered.

Transport of the high-risk neonate

Neonatal transport is continuously evolving and has developed to a cornerstone of modern perinatal medicine. Although the regionalization of perinatal care and delivery of high-risk neonates in appropriately designed centres improves neonatal outcome, neonatal transport represents an invaluable resource in order to guarantee tertiary level care throughout the region. A highly trained, adequately skilled and well-equipped transport team is key in order to provide a good quality of care for a wide variety of clinical disorders and their potential complications. A safe and efficient neonatal transport begins in the referring hospital. An optimal communication between the referring team and the transport team is paramount. Besides collecting information the transport team may advise the referring team about specific steps to undertake until arrival [1]. Adequate resuscitation and effective stabilization improve survival and reduce the chances of deterioration during transport, especially in critically ill neonates with limited physiological reserves [2]. High risk conditions like pneumothorax, congenital diaphragmatic hernia, oesophageal atresia, cardiac malformations, abdominal wall and neural tube defects and hypoxic ischemic encephalopathy (HIE) are still life threatening and require highly specialized care and monitoring [3]. The equipment routinely used for monitoring in the neonatal intensive care unit (NICU) is not specifically designed for transport and may not function properly under transport conditions. However, standard monitoring including temperature, ECG, pulse oximetry and CO2-monitoring should be routinely provided [4]. Delivering adequate ventilatory support including the administration and measurement of iNO may be challenging. A ventilator with an integrated flow sensor is helpful to assess respiratory function. The recommended ventilatory strategies in the NICU like volume-targeted ventilation can minimize lung damage and maintain more stable paCO2 values. There is a strong physiological rationale supporting the use of pre-heated and humidified air in ventilated infants, since it reduces trauma to the respiratory epithelium and is helpful to stabilize the body temperature [5,6]. Pharmacologic management including catecholamines, prostaglandins and analgosedation via multiline infusions may be necessary, thus rendering difficult situations still more complex. Active or passive body cooling in case of HIE is often demanding. Adequate protocols and an optimal temperature control to avoid accidental hyper- or hypothermia are essential [7]. In literature, data on high-risk transports are lacking, likely because of the difficulty to perform randomized studies in this field. Advanced training in resuscitation and stabilization of the neonate, as well as a specific transport and simulation based team training are mandatory for all personnel.

A systematic review and meta-analysis of the impact of native tissue repair for pelvic organ prolapse on sexual function.

The aim of this review was to investigate the impact of native tissue repair for pelvic organ prolapse (POP) on overall sexual function and dyspareunia. Cochrane Incontinence Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and Embase were searched for trials of prolapse surgery assessing sexual function and dyspareunia before and after surgery. We assessed observational studies and randomized controlled trials investigating the impact of surgical correction of POP on sexual function. Surgical interventions assessed were anterior and/or posterior repair with or without a vaginal hysterectomy. Studies including patients undergoing concurrent incontinence surgery or vaginal mesh insertion were excluded from the analysis. Dyspareunia was analyzed separately. We identified 674 potential citations, of which 14 articles assessed sexual function and/or dyspareunia before and after traditional prolapse surgery. The results suggest evidence for significant improvement in sexual function postsurgery, with a standardized mean difference of -0.55, 95 % confidence interval (CI) -0.68 to -0.43 in favor of surgical correction. Dyspareunia rates were also significantly improved postoperatively, with overall odds ratio of at least 2.5 times as likely as the chances of deterioration. Sexual function is significantly improved and dyspareunia significantly reduced following native tissue prolapse surgery. There were several methodological problems with the quality of the primary research, particularly related to study heterogeneity, use of different outcome measures, and absence of well-designed randomized controlled trials.

Evoked potentials in suspected multiple sclerosis: Diagnostic value and prediction of clinical course

Pattern visual, somatosensory and brainstem auditory evoked potentials (EPs) of 14 patients with definite multiple sclerosis, 222 patients suspected of having multiple sclerosis, 26 patients with isolated optic neuritis and 40 patients with a chronic not diagnosed neurologic disorder, were compared with their clinical diagnoses on 2 1 2 - year follow-up. In the MS suspects, an EP abnormality demonstrating a clinically silent lesion in any modality (65 patients) was associated with a 71% chance of clinical deterioration (48% chance of definite MS within the follow-up period). Normal EPs (121 patients) were associated with a 16% chance of deterioration (4% chance of definite MS). EPs in patients in whom the only abnormalities confirmed known lesions (36 patients) did not predict follow-up status. Visual EPs demonstrated clinically silent lesions more frequently than somatosensory and auditory EPs (22%, 12% and 5% of patients). Only one of the patients with optic neuritis and 3 of the chronic not diagnosed group had EPs demonstrating clinically silent lesions. CSF and NMR studies also correlated with follow-up in subseries of the patients.