Post Insertion Research Articles

Time Dependent Oral Microflora Changes in Removable Partial Denture Wearers

Background: Denture prostheses are significant interventions in oral environment for restoring lost formand function due to tooth loss. Little is known about change in microflora in removable partial denturewearers with age and time since denture delivery. Therefore, the present study was conducted to evaluateand compare the oral microbial flora pre and post insertion of removable partial denture at different timeintervals and age groups.Materials and Method: A sample of 60 patients wearing removable partial denture was included inthe study, 30 of age group 40-50 years (Group 1) and 30 of age group 50-60 years (Group 2).Sample ofunstimulated saliva was collected from the patient’s mouth from the distal most edentulous area using threesterile cotton swabs by one investigator. Colony count and identification of microorganisms was done.Results: The difference among mean colony counts between group 1 and 2 were not statistically significantat any of the three timeintervals. A statistically significant difference in colony counts was seen betweenbaseline, 1 month and 3 months in whole sample as well as both the age groups. Among various aerobicmicroorganisms, Streptococcus mitis, Diphtheroids and Candida Albicanswere the most prevailing aerobicmicro organism after 3 months of denture use, while among anaerobic organisms, Prophyromonasgingivaliswas the most prevalent microorganism after three months.Conclusion: A significant difference in colony count as well as colonizing microorganisms has been foundin the present study. This difference according to time is an important component in the affect of removablepartial denture on oral health of denture wearers. Age group was not a significant factor affecting microbialhealth in RPD wearers.

PREVENTIVE MEASURES IMPLEMENTATION AMONG LIBYAN GENERAL DENTISTS AND PROSTHODONTISTS DURING COVID-19 OUTBREAK IN TRIPOLI: A CROSS-SECTIONAL STUDY.

Introduction: The available knowledge about Covid-19 mandate applying set of strict preventive measures for medical and dental professions. Dental health personnel are considered among high risk occupation group during the pandemic. Objective: This study aimed to assess the level of adherence to the preventive measures against the coronavirus disease and infection control among prosthodontists and general dentists in Tripoli, Libya. Methods: A questionnaire consisting of 8 questions was distributed among dentists who are working in private clinics or public health centers during Covid-19 pandemic, in Tripoli. Dentists were selected randomly to participate in this survey. Results: This study included a total of 70 dentists forming a response rate of about 87,5% (70 dentists participated out of 80 dentists), a total of 19 were prosthodontists and 51 were general dentists. The results showed that only 32% had attended lectures regarding COVID-19. The percentage of dentists who wear PPE during fixing post insertion complete denture complains and during fixing high spots before final cown/ bridge cementation were (60%, and 61.4%) respectively. During dental treatment, all dentists reported they do keep frequent hand hygiene by using ABHR or water and soap, (72.8%) ask their patients for pre procedural mouth rinse before starting the treatment, (62.8%) stated that they use rubber dam during aerosol generating procedures.. Conclusions: Libyan dentists in this study showed practicing of moderate infection control procedures to minimize transmission of Covid-19, limited comprehension of what constitutes as emergency dental procedures was recognized. Dentists are required for attending awareness days and workshops in this respect. Keywords: COVID-19, Dentists, Preventive measures, Infection control.

Traumatic Ulcerations Frequencies and Postinsertion Adjustment Appointments in Complete Denture Patients.

Background and Aim:The patient who is wearing a denture after missing teeth faces traumatic ulceration very frequently. This ulceration creates difficulties in denture wearing. Hence, this study aimed to evaluate the most common locations of traumatic injuries in form of ulcerations, their frequency, and also the duration and number of adjustment visits required to achieve patient comfort following placement of complete removable dentures.Materials and Methods:Eighty edentulous patients were selected from a private clinic. Complete removable dentures were fabricated for all patients. All patients were evaluated for their complaints after denture insertion. Patients were followed up till the problem persisted. Descriptive analysis was done. Chi-squared test was used to differentiate the associations between lesions, postinsertion visits, and gender.Results:About 85.62% of patients need denture adjustment because of mucosal injuries during their first visit following. Approximately four appointments are needed for maxillary and six appointments needed for mandibular denture. Male and female have no difference in the number of mucosal injuries in the anatomical area evaluated in the maxilla and mandible using Fisher's exact test (P > 0.05). Mandibular dentures need more appointments than maxillary dentures after post insertion (P < 0.001).Conclusion:The vestibule was the most common site for mucosal injuries which can be corrected by proper extension of denture flanges during border molding. Pressure indicator ink (arti spot) and paste is used to correct the overextended denture flanges.

A SYSTEMATIC NON-INVASIVE APPROACH FOR REHABILITATION OF TRAUMATIZED MAXILLARY LATERAL INCISOR – A CASE REPORT.

Coronal fractures of permanent anterior teeth by trauma are the most common type of injury. Many factors are considered in the attempt to provide optimal mechanical properties, aesthetic, and longevity. Discomfort, serious psychological, esthetic, functional, and phonetic problems are related with anterior crown fracture, this may also affect social communications and it poses a challenge for the dentist, to save these teeth. The restoration of traumatically injured teeth with substantial loss of coronal structure necessitates endodontic treatment followed by post insertion into canal space so that foundation restoration can be strengthened to receive the crown. In this case report, such case is described with fiber-reinforced post and core system.

Study of clinical indication, difficulties and complications of DJ stenting in urological procedure at a tertiary hospital

Background: Urolithiasis is one of the major causes of morbidity in our society as our country is located near to equatorial distribution of stone disease Indwelling ureteral stents provide free drainage from the kidney to the bladder, reduce or eliminate urinary leakage and provide ureteral stenting. The present study was designed to observe indications, difficulties and complications of indwelling double J ureteral stenting. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients undergoing DJ stenting URS/ESWL (stone size &gt; 2cm), willing to participate in study. The data collected was entered into Microsoft excel and analyzed. Statistical analysis was done using descriptive statistics. Results: In the present study, we assessed prospectively the effectiveness of DJ stent insertion for treatment of ureteral stones in 100.patients. Gender distribution in the current study was 65% male and 35 % female. 65 % patients were between the age 10 to 40 years; 20 patients have lower ureteric calculi, 37 patient having mid ureteric calculi and 8 patients having upper ureteric calculi. In current study out of 100 patients 32 patients have stone between the range of 6-10 mm, 42 patients have stone size range between 11-16 mm and only 26 patient have stone size more than 16 mm. 32 patients having mid ureteric calculi in which 30 patients DJ stent procedure successfully completed, remaining 2 patients had ureteric stricture treated with URSL. 27 patients having lower ureteric calculi in which 25 patients DJ stent procedure successfully completed, remaining 2 patient had ureteric stricture treated with ESWL followed by cystoscopy removal. 8 patients having bilateral ureteric calculi in which 6 patients DJ stent procedure successfully completed, remaining 2 patient have impacted stone treated with URSL with PCNL. 100% success rate in DJ stent insertion in patients with stone size 11-16mm followed by in 93% with stone size 6-10mm and in 76% with stone size &gt;16mm. Conclusion: Most of the ureteral DJ stent related complications can be managed by surgical procedures hence they should be removed as soon as their purpose solves. The proper follow up from patients can help to early identification of post insertion complications of DJ stent and timely management of them.

The educational experiences and needs of patients with an internal cardiac defibrillator: An interpretive phenomenological study

<h2>ABSTRACT</h2><h3>Background</h3> Internal cardiac defibrillators (ICD) are the treatment option for primary and secondary prevention of sudden cardiac arrest and potential death. The majority of research to date has focused on the psychological and physical outcomes affecting patients, such as fear, anxiety, depression, and changes in quality of life post ICD insertion. There is, however, limited research exploring the adequacy of their educational preparation by nurses and other health care professionals. <h3>Aim</h3> The aim of this study was to understand the educational experiences and needs of adult patients with ICDs within a metropolitan tertiary hospital in Queensland. <h3>Methods</h3> An interpretive phenomenological approach was chosen to explore the everyday educational experiences and needs of patients with an ICD or Subcutaneous Internal Cardiac Defibrillator (S-ICD). Semi-structured interviews were conducted with a purposive sample of ten participants until data saturation was reached. Thematic analysis was used to analyse the data. <h3>Findings</h3> Five themes emerged and these were ‘understanding the information needs of patients'; ‘psychological aspects'; ‘fearful of the ICD shock'; ‘physical concerns'; and ‘importance of family inclusion'. <h3>Discussion</h3> The study's findings revealed that patients with ICD/S-ICDs had unmet educational needs that are important for nurses to understand and address. These specifically related to education and the relevance to each individual's particular needs. These included addressing their anxiety levels explaining changes to everyday activities and including family in the education sessions. Discharge care via telemonitoring may be useful for follow-up care for this unique and vulnerable patient group. <h3>Conclusion</h3> Interpretive phenomenology was used to understand the experiences and needs of people living with an ICD/S-ICD. This study has provided knowledge about the patient's desire for clarity of information relevant to their individual needs. The research found that patients with ICD/S-ICDs did not perceive the education that they received regarding the device to be adequate, nor did it address their specific needs. The research highlighted that nurses caring for patients undergoing ICD/S-ICD insertion need to provide education that is both patient and family specific, and that it continues for at least two months post-hospital discharge.

Discontinuation of implants use and associated factors among women attending health facility clinics in Hawassa City, Southern Ethiopia, 2019; cross sectional study

BackgroundDespite improving the availability and use of Implants, discontinuation is becoming a public health concern. A significant proportion of women discontinuing the service before its due date, which is of concern in the health system and its consequence may lead to a program failure. This might have also social and economic consequences for users. Only 8% of married women in Ethiopia use implants. Apart from its low utilization, premature removal is common for unknown reasons. However, there is paucity of information on discontinuation of implants use and associated factors in the study area.ObjectiveThe study was aimed to assess discontinuation of implants use and associated factors among women attending health facility clinics in Hawassa city, southern Ethiopia, from March, 01-April, 01/2019.MethodsFacility based cross sectional study design was used. Out of 16 health facilities, 9 of them were selected for this study using simple random sampling. Total sample size of this study was determined to be 351. Data were collected from study subjects using pretested, structured questionnaire through a face-to-face interview. Data was analyzed using descriptive statistics and logistic regression. The result is presented using the Crude Odds ratio as well as Adjusted Odds Ratio with the corresponding 95% confidence level.ResultOut of 351 study participants, the overall proportion of implants discontinuation was 49.3%(95% CI: 44.2–55.0). Lack of counseling about side effects (AOR = 2.394; 95% CI: 1.422–4.030), developing side effects (AOR = 6.325; 95% CI: 3.719–10.757) and lack of post insertion follow-up (AOR = 2.241; 95% CI: 1.186–4.234) the major factors associated with discontinuation of Implants.Conclusion and recommendationIn this study, the overall proportion of discontinuation of Implants among women who were using Implants was high. Health professionals could give pre-insertion counseling about side effects and post insertion dates for follow-up to improve of utilization of implants.

A Severely Damaged Mandibular First Molar Restoration with CAD/CAM Customized Hybrid Ceramic Post and Core by Direct Intraoral Impression: A Case Report

The outcome of the teeth with coronal restoration may be unforeseeable when they need root canal therapy due to apical periodontitis, especially at the existence of a post. This case report describes a digital restoration strategy for the preservation of a serious defect tooth (left mandibular first molar). Tooth #36 with 10 years of a crown and post restoration needed root canal therapy due to apical periodontitis. After removal of the crown and cast post, the residual tooth showed fragility, and the distal root canal was seriously destroyed due to the post insertion. Selecting a suitable post was significant for the retention of the core to support the coronal restoration after the completion of the root canal therapy and apical barrier. The prefabricated fiber post and metal cast post were not good selections for the distal root canal. Therefore intraoral scanning was performed on the tooth and digitized to design a three-dimensional model of customized post-core and full crown by the Computer-Aided Design/Computer- Assisted Manufacture (CAD/CAM) technique. A 14-month follow-up showed a promising clinical and radiographic outcome. The digital CAD/CAM technique converted the concave surface of the root canal into the convex surface of the post, and fabricated an anatomical post and core using hybrid ceramic material close to the elastic modulus of natural dentin. It improved the biomechanics of this tooth #36 and reduced the occurrence of root fracture.

A one-year cohort study of complications, continuation, and failure rates of postpartum TCu380A in Tanzania

BackgroundLess than 1% of married women in Tanzania use an Intrauterine Contraceptive Device (IUD) for contraception. An initiative by the International Federation of Gynecology and Obstetrics (FIGO) has been in progress since 2015 resulting in escalated method uptake in implementing hospitals. This study investigates failure rate, complications, and risk factors for one-year continuation of TCu380A IUD when used for immediate postpartum contraception under the initiative in Tanzania.MethodologyA prospective cohort study of women who had TCu380A insertion within 48 h of delivery in 6 hospitals in Tanzania between 1st December 2017 and 18th April 2018 was conducted. Face to face post insertion interviews were made with 1114 clients before discharge and later through phone calls up to the beginning of 13th month postpartum. Postpartum Intrauterine Device (PPIUD) continuation status, complications, duration of time they stayed with the IUD and the currently used method if PPIUD was discontinued were enquired. The outcome variable was PPIUD continuation at one year of IUD insertion. Data were analyzed using Statistical Product and Service Solutions software (SPSS) for Windows version 20 (IBM SPSS Statistics, Chicago, IL, USA).ResultsIn total 511(45.8%)clients had consented and availed to complete the one-year follow-up. Out of these, 440 still had IUD, giving a one-year continuation rate of 86.1%. Most (63%) IUD discontinuations occurred in the period between 7th week and 6 months of insertion. One-year method expulsion rate was 2.1%. There was one reported pregnancy that gives a method failure rate of about 2 per 1000. The independent risk factors in favor of method continuation at one year were absence of medical or social problem, being a youth (16–24 years), and delivery by Cesarean section.ConclusionsThe continuation rate when CuT380A is used for immediate postpartum contraception is high, with low complication and failure rates. Some medical and social factors are important for method continuation, hence the need to consider in training, counselling and advocacy.

Reducing 30-day post gastrostomy insertion mortality with a feeding issues multidisciplinary team meeting

Decision-making regarding percutaneous endoscopic gastrostomy (PEG) insertion can be complex both medically and ethically. Thirty-day mortality following (PEG) insertion is an important quality indicator for endoscopy accreditation and for service evaluation. It also forms part of the measures assessed within the 'Getting It Right First Time' programme (GIRFT). We aimed to assess the impact of a newly adopted Feeding Issues MDT (FIMDT) and the clinical application of the Royal Free Gastrostomy Score (RFGS). We adopted a retrospective observational methodology to assess the impact of a feeding issues MDT within our trust. The included study period ran from January 2016 to December 2019 (4 years). This formed part of a quality improvement (QI) project initiated upon receipt of the GIRFT report for our NHS trust. Statistical analysis and QI methodology was used to interpret and present the data. Two hundred and sixty eight PEG insertions occurred during the study period. 188 PEGs were inserted prior to the start of FIMDT and 45 following its inception. On average there were 66 PEGs performed per year. There was no significant difference in age for those undergoing PEG insertion pre (68 years) and post (69 years) FIMDT adoption. Prior to FIMDT those that died within 30 days post PEG were significantly older than those who did not (p<0.001), whilst following FIMDT adoption there was no such difference. Prior to FIMDT the 30-day post PEG mortality was 10.64%, whilst following adoption of the FIMDT the mortality rate fell to 6.6% (p=0.04). The mean number of procedures performed between a 30-day mortality occurring rose from 7.5 to 13.6. Furthermore, the mean number of days between a 30-day post insertion mortality occurring also rose from a mean of 53.0-111.8, pre and post FIMDT adoption. The Royal Free Gastrostomy Score (RFGS) for those discussed at FIMDT and declined for PEG insertion was significantly higher than those accepted for PEG insertion (p=0.01). Over the entire study period those who died within 30 days following PEG insertion had a significantly greater RFGS (p<0.0001). In our trust the adoption of a FIMDT has significantly reduced the 30-day mortality for PEG insertion. We have also demonstrated the clinical utility to assess mortality risk of the RFGS when making decisions around patient suitability for PEG insertion.

IATROGENIC PNEUMOTHORAX AFTER NASOGASTRIC TUBE PLACEMENT

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Nasogastric tubes (NGT) are frequently used in the Intensive Care Unit (ICU). They have multiple indications and is a common procedure that usually goes without complication. However, adverse reaction rates can vary from 0.3% to 15% which are usually seen after chest trauma or mechanical ventilation. CASE PRESENTATION: 64-year old male, with no past medical history was admitted to the ICU, intubated, mechanically ventilated due to altered mental status secondary to intracerebral hemorrhage (ICH). Non-surgical management and strict blood pressure control was achieved, and patient was extubated after six days. Nevertheless, patient failed swallow evaluation test, and insertion of Dobhuff tube for enteral nutrition was performed. Immediately after insertion, patient became agitated, tachycardic, tachypneic, hypoxic with O2 saturation of 89% on 80% FiO2 on high flow nasal cannula. Emergent chest X-Ray (CXR) showed a large right sided pneumothorax, and chest tube placement was placed. Follow up CXR showed slight improvement of pneumothorax, but subjacent emphysema and severe diffuse saphenous emphysema were noticed. Due to patient’s acute hypoxic respiratory failure, emergent reintubation was required complicating his ICU stay by extensive subcutaneous emphysema and pneumomediastinum. DISCUSSION: Nasogastric tube has a key role in the management of hospitalized patients, particularly the critically ill. It is a common procedure done and its use is both diagnostic and therapeutic. Significant complications include pneumonia, pneumothorax, subcutaneous emphysema, and respiratory failure. Risk factors for complications include altered mental status, absence of a gag reflex, presence of an endotracheal tube, supine position, and head and neck surgery. Our patient developed an iatrogenic pneumothorax secondary to misplaced NGT that prolonged his ICU stay. Given the compromise of patient’s airway reflexes, swallowing mechanism, and neurologic state, he was unable to report shortness of breath or chest discomfort after NGT placement. Other predisposing factors such as multiple attempts and blind insertion along with stylet-stiffened feeding tube also play a role. There are several techniques to confirm proper placement of NGT and should be enforced after every placement. Although, air insufflation and epigastric auscultation are commonly used, there are not 100% reliable and misinterpretation can occur. CXR post NGT insertion is the gold standard confirmatory test. It must be done right after the procedure to rule out life-threatening complications such as pneumothorax and extensive subcutaneous emphysema. CONCLUSIONS: Misplaced NGT pose a serious threat to patient safety which can complicate patient’s hospital course and increase length of stay. Although it is a simple procedure, it can have serious complications that warrants careful assessment with CXR to assure adequate placement. Reference #1: Agha R, Siddiqui MR. Pneumothorax after nasogastric tube insertion. JRSM Short Rep. 2011;2(4):28. Published 2011 Apr 6. doi:10.1258/shorts.2011.010142 Reference #2: Pejin E, Bee S, Yuh S. Nasogastric tube placement confirmation: where we are and where we should be heading. Proceedings of Singapore Healthcare. Volume: 26 issue: 3, page(s): 189-195. Published 2017 Sept 1. Reference #3: Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and Mediastinal Emphysema: Pathophysiology, Diagnosis, and Management. Arch Intern Med. 1984;144(7):1447–1453. doi:10.1001/archinte.1984.00350190143024 DISCLOSURES: No relevant relationships by Adriana Briceno Bierwirth, source=Web Response No relevant relationships by ahmad hamdan, source=Web Response No relevant relationships by Gabriela Orellana, source=Web Response No relevant relationships by Carlos Perez, source=Web Response

Causes and Pattern of Non Compliance with Instructions given after Fitting of Removable Partial Dentures (RPDs) among Patients in a Nigerian Teaching Hospital

Objective: The study was carried out to assess the pattern of non compliance with instructions given after fitting of RPDs and to evaluate the reasons for non compliance.Patients and method: The study was a cross-sectional study among consecutive denture wearers in a Nigerian teaching Hospital. An interviewer administered questionnaire was used to assess the pattern and causes of noncompliance with post denture insertion instructions. Data collected were imputed into a personal computer and analyzed using SPSS version 16. Chisquare was used to test association between categorical variables. The level of significance was set at p&lt;0.05.Results: Two hundred and thirty two patients, participated in the study. One hundred and twenty nine patients did not comply with brushing the denture with brush and soft soap. The proportion of males (56.9%) and patients above 40 years (61. 0%) that did not comply was greater than the proportion of females (54.3%) and patients 40 years and below (41.2%) respectively. There was a statistically significant relationship between the age of the patient and non compliance with cleaning the denture with soft soap. One hundred and ninety four patients did not comply with twice annual routine visit to dentist. The proportion of males (84.5%) and patients above 40 years (84.1%) that did not comply was greater than the proportion of females (82.8%) and patients 40 years and below (82.4%) respectively. The reasons for non compliance with cleaning denture with brush and soft soap included; more convenience (4.3%), detest the taste of soap (5.6%), while the reasons for non compliance with routine visit to dentist included no time (15.1%), financial problem (12.1%), and "I see no need for it when there was no dental problem" (44.0%).Conclusion: Non compliance is more common among male patients and patients above forty years. Dentists should lay more emphasis on post denture insertion instructions especially for male patients.&#x0D;

Parental fatigue before and after ventilation tube insertion in their children.

To determine if there is a difference in fatigue for caregivers of children with otitis media pre and post ventilation tube insertion (VTI). Consecutive parents presenting with children at a pediatric otolaryngology practice at an academic medical center with recurrent otitis media who met criteria for VTI or who were following up within 6weeks of VTI were surveyed with the Chalder Fatigue Scale (CFQ), a Visual Analogue Fatigue Scale (VAS-F), and demographic questions. No significant demographic differences were found (P<0.05) in the preop versus postop groups. 101 parents participated, 88 mothers and 13 fathers. 59.4% were married or cohabitating, 18.8% were single, 10.9% were divorced, and 10.9% declined to answer. 45.5% were aged 18-29years, 50.1% were 30-39years, 2.9% were 40+ years, 1.0% declined to answer. 53.0% were college graduates. 46 (45.5%) were preop and 55 (54.5%) were postop. There were no statistical differences between these groups for age, gender, marital status, education level or number or children in the household. Mean VAS-F, with 0 being worst fatigue and 10 being normal, was 5.256 in the preop group and 6.777 in the postop group (p<0.001). Mean CFQ, with higher numbers meaning worse fatigue, was 15.749 in the preop group and 11.804 in the postop group (p=0.002). Parental fatigue can have significant effects on the family. Fatigue in parents whose children have otitis media has not been previously described. VTI for recurrent otitis media in children is associated with improved fatigue in their parents.

Do different cone beam computed tomography exposure protocols influence subjective image quality prior to and after root canal treatment?

ObjectivesThe current study aimed to evaluate different CBCT exposure protocols and influencing factors affecting the subjective image quality of scans taken for endodontic indications.Materials and methodsTwelve extracted teeth, comprising of two sets of maxillary molars, premolars, canines and incisors, mandibular premolars, and molars, were endodontically treated, and either received a fiber or metal post. The teeth were scanned by CBCT imaging before and after root canal treatment, and after post insertion. Each scan was performed thrice, using an ultra low dose (ULD), standard (SM), and high-resolution mode (HR), respectively. Twelve observers—4 endodontists, 4 periodontists, and 4 radiologists—assessed the subjective image quality using visual analogue scales (VAS). Potential influencing factors were evaluated including acquisition mode, observer specialty, stage of treatment, type of post, and type of tooth, using one-way ANOVA and T test.ResultsTeeth scanned with the ULD had the highest average VAS score (72.5), followed by HR (70.2), and SM (69.0) for values pooled from all teeth and observers. CBCT acquisition mode was not a significant influencing factor on the VAS scores. Observer specialty, stage of treatment, type of post, and type of tooth were significant influencing factors.ConclusionsBased on the present in vitro data, a low-dose CBCT mode seems not to negatively affect the perception of image quality.Clinical relevanceThe findings from this in vitro study demonstrate that a low-dose CBCT mode might have potential for diagnostics prior to or following endodontic treatment.

Are you on the right trach? A hybrid simulation package for tracheostomy emergency management

Tracheostomies are commonly carried out in a critical care or head and neck surgery setting for prolonged intubation or airway protection in case of postoperative swelling. However, they have a well-recognised incidence of morbidity and mortality. Significant complications occurring post insertion have been identified by the National Confidential Enquiry into Patient Outcome and Death in 2014. A principal recommendation was that bedside staff involved in the care of tracheostomy patients should be competent in recognising and managing airway complications.

Assessment of efficacy of post placental and intra-cesarean insertion of intrauterine contraceptive devices

Assessment of efficacy of post placental and intra-cesarean insertion of intrauterine contraceptive devices

SAT-638 An Academic Center Experience with the Eversense Continuous Glucose Monitoring System and Assessment of Intrapatient Variability with Repeated Same-Pocket Insertion

BACKGROUND:The Eversense continuous glucose monitoring (ECGM) system is a 90-day implantable device approved for patients with diabetes. The manufacturer recommends alternating arms each subsequent insertion to ensure adequate healing. To date, the intra-patient sensor variability using the same subcutaneous pocket has not been evaluated. We aim to assess change in glucometrics upon continuous use and the use of the same insertion pocket.Methods:Retrospective study (October 2018-October 2019), that included all patients using the ECGM. Demographics, and glucometrics data: transmitter wear time (TWT), average glucose (AG [mg/dL]), coefficient of variation (CV), time in range (TIR), time below range (TBR) and time in serious hypoglycemia (SH) data were obtained. Paired T-test was used to compare means (±SD) of the initial 90 days of sensor data (P1) with data of subsequent device insertions, grouped by periods of data time: period 2, 3 and 4 (P2, P3, P4). Analysis was done as a group, by insertion period, and by cohorts: cohort 1: same subcutaneous pocket, cohort 2: alternating insertion site.Results:Nine female, 7 male patients, age 37±11 years old, weight 85±10 Kg. Fourteen with T1DM, one with T2DM and one from pancreatectomy. There were 7 patients in each cohort, 2 patients had only one device inserted resulting in only 1 period of 3-month data; 7 patients had 2 consecutive devices inserted i.e. 2 consecutive 3-month periods of data (P1 and P2), 4 had 3 consecutive devices inserted, three 3-month periods of data (P1, P2 and P3) and 3 had 4 consecutive devices inserted, i.e. four 3-month consecutive periods of data (P1, P2, P3 and P4).Baseline, first insertion, initial 3-month period of data (P1) showed TWT 69.7±23 for the entire group, AG 175±30 mg/dL, CV 36.7±7.6, TIR 52.6±17, TBR 2.69±2.5, SH 1.5±2.3.We found no statistical significance for TWT, AG, CV, and TIR, as a whole and when analyzed by cohorts and period of data: P1 vs P2, P1 vs P3, P1 vs P4. TBR and SH decreased with continuous ECGM use. TBR mean difference comparing P1 vs P2, P3 and P4 was -0.15±0.9 (p=0.9), 1.16±1.8 (p=0.02), and 1.8±1.6 (p=0.001) and for SH -0.05±0.8 (p=0.8), 0.6±1.3 (p=0.09), and 0.9 ±1 (p=0.004).There were 3 device failures; 2 post first insertion, one post repeat insertion in the same pocket. No infections, or serious bleeding were observed.Conclusions:Continuous ECGM use decreased time below range and time in serious hypoglycemia, without change in TWT, AG, TIR and CV. There was no significant intrapatient variability comparing consecutive device insertions regardless of whether patients elected to use the same pocket or alternate arms, suggesting that using the same insertion pocket may have the same efficacy as placement into a fresh insertion site, while decreasing the number of punctures, pain, procedure time, risk of bleeding and infection.

Clinical assessment of post insertion complications and satisfaction encountered among complete denture wearers

Introduction: Edentulous patients are still a matter of concern in countries like India due to less awareness of oral health care. Majority prefer complete denture for rehabilitation but here the primary challenge for a dentist is to satisfy the patient needs with successful management. The objective of the present study was to assess the post insertion complications encountered by complete denture patients and the level of satisfaction among them. Materials and Methods: 100 elderly patients provided with a new set of complete denture for both arches were selected and examined. The data was collected as per the need of customized design questionnaire. Results: Among post-insertion complaints from patients pain was the most common and almost present in more than 50% of patients. Difficulty in mastication and slurring of speech was also one of the major problems reported in denture wearers. Conclusion: Patient satisfaction is a critical determinant in the success or failure of complete denture therapy. A Prosthodontist should communicate well to adjust the treatment and pace according to the need of patient. Behavioral therapy during the visits can have a positive effect in relieving anxiety and pain of the patient. Keywords: Complete denture, Complications, Edentulous, Post-insertion, Satisfaction.

Therapeutic hypothermia reduces cortical inflammation associated with utah array implants

Objective. Neuroprosthetics hold tremendous promise to restore function through brain-computer interfaced devices. However, clinical applications of implantable microelectrodes remain limited given the challenges of maintaining neuronal signals for extended periods of time and with multiple biological mechanisms negatively affecting electrode performance. Acute and chronic inflammation, oxidative stress, and blood brain barrier disruption contribute to inconsistent electrode performance. We hypothesized that therapeutic hypothermia (TH) applied at the microelectrode insertion site will positively modulate both inflammatory and apoptotic pathways, promoting neuroprotection and improved performance in the long-term. Approach. A custom device and thermoelectric system were designed to deliver controlled TH locally to the cortical implant site at the time of microelectrode array insertion and immediately following surgery. The TH paradigm was derived from in vivo cortical temperature measurements and finite element modeling of temperature distribution profiles in the cortex. Male Sprague-Dawley rats were implanted with non-functional Utah microelectrodes arrays (UMEA) consisting of 4 × 4 grid of 1.5 mm long parylene-coated silicon shanks. In one group, TH was applied to the implant site for two hours following the UMEA implantation, while the other group was implanted under normothermic conditions without treatment. At 48 h, 72 h, 7 d and 14 d post-implantation, mRNA expression levels for genes associated with inflammation and apoptosis were compared between normothermic and hypothermia-treated groups. Main results. The custom system delivered controlled TH to the cortical implant site and the numerical models confirmed that the temperature decrease was confined locally. Furthermore, a one-time application of TH post UMEA insertion significantly reduced the acute inflammatory response with a reduction in the expression of inflammatory regulating cytokines and chemokines. Significance. This work provides evidence that acutely applied hypothermia is effective in significantly reducing acute inflammation post intracortical electrode implantation.

Implant-supported distal extension mandibular partial overdenture: comparison of two attachment types effect on mandibular posterior residual alveolar bone (five year retrospective study)

Purpose: This study aimed to compare effect of implant supported removable partial denture (IS RPD) with locator versus ball attachments on mandibular posterior residual alveolar ridge after 5 year period. Materials and Methods: From available data base of class I partially edentulous mandibular arches modified by bilateral distal implants in 2nd molar region against edentulous maxilla treated with IS RPDs against a maxillary denture. 18 patients were randomly selected and allocated in two equal groups, 9 patient each, as follows; G1, B&S Group, using a ball and socket attachment and G2, locator group, using locator attachment. The posterior mandibular ridge resorption was evaluated in the form of change in posterior area index (∆PAI) on digital panoramic radiographs over 5 year period. Also the relation of ∆PAI to implant marginal bone changes (MBC) and other patient's data as age, edentulous period, prosthesis use period, ridge length, initial ridge height number of relines and attachment maintenance. Results: locator significantly reduce the ∆PAI (0.032) compared to B&S (0.064) with non-significant difference in MBC of distal implants. Conclusion: The IS RPD using locator attachments offer better mandibular posterior ridge preservation versus the B&S attachment. Carful follow-up and proper post insertion service help to avoid any harmful effect on implant and/or residual ridge, maintaining the prosthesis/attachment/ tissue relation to assure proper functional load distribution.