Findings from an OMFS journal club: is COVID-19 the catalyst we have needed to embrace technology?

The COVID-19 outbreak has rapidly progressed into a worldwide pandemic, and the need for social distancing has changed the way we learn and work. Our monthly OMFS journal club has been no different, and is currently meeting on the video conferencing application Microsoft Teams. The use of a virtual setting for training in medicine and dentistry is not new and, as in the case of our recent move to a virtual medium, it may be that COVID-19 has fast-tracked this digital transformation. There are of course disadvantages to online teaching that traditional face-to-face teaching overcomes. We conducted a survey to examine how trainees' attitudes and experiences have altered with this change, and to understand whether some elements of this new style of training may be advantageous in the post-pandemic world. We aimed to assess trainees' attitudes towards online teaching, and which elements, if any, would be beneficial once face-to-face teaching becomes possible again. A survey was created for all trainees taking part in journal club meetings at Bradford Teaching Hospitals. Multiple-choice and Likert scale questions were designed to ascertain the differences in experience between online and face-to-face settings. A Wilcoxon matched pairs signed test was used to analyse the results. Responses were kept anonymous. Results showed that the majority of trainees found it easier to attend the online journal club, and also indicated that the most found Microsoft Teams easy to use, though we did not have another online application for comparison. There was no significant difference in participation comfort between the two settings, though trainees felt that the online setting considerably improved learning effectiveness. Furthermore, 79% (11/14) thought that online tutorials and meetings should replace traditional face-to-face meetings in the future. The use of internet technology such as video conferencing is not new, and although journal clubs are typically held in academic institutions, online and virtual clubs are flourishing. With an array of advantages, there is no shying away from the trend to move our teaching to a virtual medium. COVID-19 may have just provided the stimulus that has forced this transformation to accelerate.

Evaluation of Mineral Trioxide Aggregate and Biodentine as pulpotomy agents in immature first permanent molars with carious pulp exposure: A randomised clinical trial.

AIM: There is insufficient evidence on the outcome of pulpotomies in carious exposed young permanent molars with newer biomaterials. This study aimed to compare Mineral Trioxide Aggregate (MTA) and Biodentine as pulpotomy materials in carious exposed vital immature mandibular first permanent molars. MATERIALS AND METHODS: Study design: Sixty immature first mandibular permanent molars, with carious exposure were randomly assigned to an MTA or Biodentine group in a split-mouth design. After the amputation of the coronal pulp, the pulp stumps were covered with one of the study materials and coronal restorations placed. Blinded clinical and radiographic evaluations were performed at baseline. Following this there were evaluations at 6, 12 and 18 months where comparisons between and within the two groups were made. RESULTS: A high success was observed in both groups for all outcome measures for clinical success, with no significant difference between them. The mean survival time for the Biodentine and MTA groups was (17.8 and 18 months) with 95% confidence interval (17.4-18.2) and (18 .0-18.0) months respectively. Similarly, there were no significant differences between the Biodentine and MTA groups for radiographic success (P<0.001) with an increase in root length and increasing apical closure observed in both groups. CONCLUSIONS: Both materials were equally effective in the treatment of cariously exposed vital immature mandibular first permanent molars.

Randomised double-blind comparison of bolus phenylephrine or ephedrine for treatment of hypotension in women with pre-eclampsia undergoing caesarean section.

Treatment of post-spinal hypotension during caesarean section assumes special concern in pre-eclamptic patients due to a compromised fetoplacental circulation and increased risk of placental hypoperfusion. Phenylephrine and ephedrine are the most commonly used vasopressors, although the best choice is still not clear. We studied 80 pre-eclamptic women with a singleton pregnancy who underwent caesarean section with spinal anaesthesia, and who developed hypotension defined as a decrease in systolic arterial pressure ≥ 20% from baseline or absolute value < 100 mmHg. Women were randomly allocated to receive phenylephrine 50 µg or ephedrine 4 mg boluses for treatment of hypotension. Blood pressure changes following vasopressor administration were similar in both groups, but heart rate remained higher after ephedrine at all time-points. The primary outcome measure of umbilical artery pH was 7.26 (0.11) in the phenylephrine group and 7.25 (0.09) in the ephedrine group (p = 0.86). The incidence of neonatal acidosis (umbilical artery pH < 7.20) was 9 (22.5%) in the phenylephrine group and 11 (27.5%) in the ephedrine group (p = 0.80). Other secondary outcome measures were comparable. In conclusion, phenylephrine 50 µg and ephedrine 4 mg, administered as intravenous boluses to treat post-spinal hypotension during caesarean section in pre-eclamptic patients, resulted in similar fetal acid-base values, were equally effective in treating hypotension and were associated with good maternal and neonatal outcome.

Safe transportation of biomedical waste in a health care institution.

INTRODUCTION: The chances of health care waste (Biomedical waste) coming in contact with the health care workers, patients, visitors, sanitary workers, waste handlers, public, rag pickers and animals during transportation are high. MATERIALS AND METHODS: The study was conducted over a period of seven months (April 2013-October 2013) in a 500-bedded hospital where the average quantum of biomedical waste is 0.8 kg/bed/day. The issues related to transportation of health care waste from 39 generation sites to the health care waste storage site inside the hospital (intramural transfer) were addressed and analysed in a predesigned proforma. RESULTS: The biomedical waste management team inspected the generation sites in the hospital on a daily basis and conformance to the procedures was checked. It was found that waste was collected at scheduled timings in 99.6% occasions; however, compliance to wearing personal protective equipment (PPE) was poor and ranged from 1.22-1.84%. CONCLUSION: Transportation of health care waste is a crucial step in its management. Regular training program for all the sections of health care workers with special emphasis on waste handlers is needed.

Cupriavidus pauculus (Ralstonia paucula) concomitant meningitis and septicemia in a neonate: first case report from India.

Ralstonia paucula (formerly classified as CDC (Centre for Disease Control) group IVc-2, Wautersia paucula; recently renamed as Cupriavidus pauculus) is an environmental Gram-negative bacillus isolated from water sources and can cause serious human infections. Patients recover bacteriologically indicating low virulence. A total of 32 cases have been reported world-wide, but no isolation has ever been reported from cerebrospinal fluid or in India. The first case of R. paucula meningitis and septicemia is being reported here along with the brief summary of cases reported world-wide.

Cytoprotective role of the aqueous extract of Terminalia chebula on renal epithelial cells.

PURPOSE: Kidney stone is one of the most prevalent diseases worldwide. Calcium oxalate (CaOx) has been shown to be the main component of the majority of stones formed in the urinary system of the patients with urolithiasis. The present study evaluates the antilithiatic properties of Terminalia chebula commonly called as ″harad ″ which is often used in ayurveda to treat various urinary diseases including kidney stones. MATERIALS AND METHODS: The antilithiatic activity of Terminalia chebula was investigated on nucleation and growth of the calcium oxalate crystals. The protective potency of the plant extract was also tested on oxalate induced cell injury of both NRK-52E and MDCK renal epithelial cells. RESULTS: The percentage inhibition of CaOx nucleation was found 95.84 % at 25µg/mL of Terminalia chebula aqueous extract which remained almost constant with the increasing concentration of the plant extract; however, plant extract inhibited CaOx crystal growth in a dose dependent pattern. When MDCK and NRK-52E cells were injured by exposure to oxalate for 48 hours, the aqueous extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant extract, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: Our study indicates that Terminalia chebula is a potential candidate for phytotherapy against urolithiasis as it not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role.

Cytoprotective role of the aqueous extract of Terminalia chebula on renal epithelial cells

PURPOSE: Kidney stone is one of the most prevalent diseases worldwide. Calcium oxalate (CaOx) has been shown to be the main component of the majority of stones formed in the urinary system of the patients with urolithiasis. The present study evaluates the antilithiatic properties of Terminalia chebula commonly called as "harad" which is often used in ayurveda to treat various urinary diseases including kidney stones. MATERIALS AND METHODS: The antilithiatic activity of Terminalia chebula was investigated on nucleation and growth of the calcium oxalate crystals. The protective potency of the plant extract was also tested on oxalate induced cell injury of both NRK-52E and MDCK renal epithelial cells. RESULTS: The percentage inhibition of CaOx nucleation was found 95.84% at 25µg/mL of Terminalia chebula aqueous extract which remained almost constant with the increasing concentration of the plant extract; however, plant extract inhibited CaOx crystal growth in a dose dependent pattern. When MDCK and NRK-52E cells were injured by exposure to oxalate for 48 hours, the aqueous extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant extract, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: Our study indicates that Terminalia chebula is a potential candidate for phytotherapy against urolithiasis as it not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role.

Direct inoculation on Phoenix panels for identification and antimicrobial susceptibility from positive BACTEC cultures: first study from India.

PURPOSE: This was a prospective study planned in a super-specialty hospital in Delhi to reduce turnaround times of identification-susceptibility results of positive blood cultures. MATERIALS AND METHODS: One hundred consecutive single morphology non-duplicate cultures were inoculated on Becton Dickinson Phoenix™ panels by growth recovered directly from liquid BACTEC™ media and after pure growth on solid media. RESULTS: Complete concordance was observed in 72.4% of gram-negative and 45.8% of gram-positive isolates. For gram-negative isolates, categorical agreement (CA) was >83% and essential agreement (EA) was >96% among all antibiotics tested, very major errors (VME) were 0.13%, major errors (ME) 0.54%, and minor errors (MiE) were 3.01%. For gram-positive isolates, VME was 0.73%, 1.10% MiE and no ME. It was observed that average time from receipt of specimen to release of reports was 30:34 h and 32 h for gram-negative and gram-positive isolates if reports of "Direct" panels were to be released. CONCLUSIONS: By direct panel inoculation, a decrease of at least 18-20 h in turnaround time was observed compared with the standard method. This helps early change to effective antibiotic therapy and also reduces the expenditure incurred for a patient's hospital stay by average Rs 20,000 ($443) per day.

Case of sparganosis: a diagnostic dilemma.

Sparganosis, also known as larval diphyllobothriasis, is a rare disease of humans as man is not a natural host in the life cycle of Spirometra spp. Diagnosis of the latter is difficult as it mimics other conditions that commonly cause subcutaneous or visceral fluid collection. Clinical diagnosis of this particular case was also erroneously labelled as tuberculosis but later labelled as a case of sparganosis. To the best of our knowledge, this is the first case from India where a sparganum-like parasite was isolated in drain fluid from the perinephric area.

Acanthamoeba keratitis with Curvularia co-infection.

We report a case of Acanthamoeba keratitis with Curvularia co-infection. Acanthamoeba and fungal co-infection have been uncommonly reported in literature, worldwide. A classical history with a strong clinical suspicion and experienced laboratory personnel with systematic examination of corneal scrapings for bacterial, viral, parasitic and fungal causes are imperative for accurate diagnosis. Early diagnosis of Acanthamoeba keratitis or fungal infection followed by aggressive and appropriate treatment with effective agents is critical for the retention of good vision. Acanthamoeba keratitis is difficult to diagnose and, despite improvement in treatment options, may culminate in prolonged morbidity and significant loss of visual acuity. This case emphasizes the important role played by clinical microbiologists in making prompt diagnosis which can ultimately reduce visual morbidity.

Female genital TB and HIV co-infection.

HIV-induced immunosuppression paves the way for several infections, tuberculosis being very common in our country. Female genital tuberculosis (FGTB), presenting as menstrual irregularities, is a diagnostic challenge in an adolescent female when these may be considered normal. The present case is of a young female who presented with menstrual irregularities, diagnosed subsequently as a case of genital tuberculosis. Microbiological relapse after anti-tubercular treatment of six months caused suspicion of a co-existing immunodeficiency and investigations revealed HIV co-infection; thus emphasizing the need of HIV testing in all patients of tuberculosis for timely diagnosis and treatment support thereafter.

Recent outbreak of meningococcal meningitis--a microbiological study with brief review of literature.

Meningococcal disease presents in various clinical forms, most common being meningitis and meningococcemia. A spurt of meningococcal cases was seen in medicine and pediatric wards of Dr. Ram Manohar Lohia Hospital during the recent outbreak from Dec 2005 - June 2006. These had presented either with the classical features of acute purulent meningitis or as fever with rash. The patients were investigated microbiologically for the causative organism which was identified as Neisseria meningitidis in 257 out of 531 cases (48.39%). The classic finding of gram negative diplococci on gram stain remained the mainstay of diagnosis. N. meningitidis isolates from culture were sensitive to all commonly used antibiotics.

Preimplantation B-type natriuretic peptide concentration is an independent predictor of future appropriate implantable defibrillator therapies.

OBJECTIVE: To assess prospectively whether preimplantation B-type natriuretic peptide (BNP) and C reactive protein (CRP) concentrations predict future appropriate therapies from an implantable cardioverter-defibrillator (ICD). DESIGN AND SETTING: Prospective cohort study conducted in a tertiary cardiac care centre. METHODS: 345 consecutive patients undergoing first time ICD implantation were prospectively studied. Serum BNP and CRP concentrations were obtained the day before ICD implantation. Patients were followed up with device interrogation to assess for appropriate shocks or antitachycardia pacing. Inappropriate therapies were excluded. Mean (SD) follow up was 13 (5) months. RESULTS: Patients had ischaemic (71%), primary dilated (17%), and valvar or other cardiomyopathies (12%). About half (52%) had ICDs implanted for primary prevention. Sixty three (18%) received appropriate ICD therapies. Serum creatinine, beta blocker, statin, and angiotensin converting enzyme inhibitor usage did not differ between therapy and no therapy groups. By univariate comparison, ejection fraction (p = 0.048), not taking amiodarone (p = 0.033), and BNP concentration (p = 0.0003) were risk factors for ICD therapy. However, by Cox regression multivariate analysis, only BNP above the 50th centile was a significant predictor (hazard ratio 2.19, 95% confidence interval 1.07 to 4.71, p = 0.040). Median BNP was 573 ng/l versus 243 ng/l in therapy and no therapy patients, respectively (p = 0.0003). More patients with BNP above the 50th centile (27% v 10%, p = 0.006) received ICD therapies. CONCLUSIONS: A single preimplantation BNP concentration determination is independently predictive of ICD therapies in patients with cardiomyopathies undergoing first time ICD implantation. CRP was not independently predictive of ICD therapies when compared with BNP.

Prenatal ethanol exposure has differential effects on fetal growth and skeletal ossification.

There is increasing evidence suggesting that the intrauterine environment may influence long-term bone health and the risk of developing osteoporosis in later life. Alcohol (ethanol) is one factor whose presence in the prenatal environment has long-term consequences for the offspring, including permanent growth retardation. Moreover, prenatal ethanol exposure retards both fetal and postnatal bone development. It is unknown if ethanol's effects on skeletal development result from generalized growth retardation or effects specific to skeletal development. Furthermore, the level of ethanol exposure required to produce skeletal effects is unknown. The objectives of this study were to determine (1) if ethanol exerts specific effects on fetal skeletal development that are independent from its effects on general growth, and (2) the level of prenatal ethanol exposure required to affect fetal growth and skeletal ossification. Rats were fed isocaloric diets with ethanol (15%, 25%, or 36% ethanol-derived calories (EDC), approximating low, moderate, and high exposure levels), or without ethanol (pair-fed, PF, or control, C groups), prior to and throughout 21 days of gestation. The degree of E-induced delay in development was determined by comparison of E fetuses on d21 gestation to C fetuses on d17-d21 gestation. Prenatal ethanol exposure at 36% EDC decreased fetal body weight, length, and skeletal ossification compared with PF and C fetuses on d21 gestation. Importantly, effects on ossification, but not body weight or length, were also seen at the more moderate dose of 25% EDC, and the number of bones affected and the severity of effects on ossification tended to increase with dose of ethanol. Comparison of E fetuses on d21 gestation with C fetuses from d17 to 21 gestation indicated that the ethanol-induced delay in development differed for weight and skeletal ossification, and was not uniform among skeletal sites. Taken together, these data suggest that prenatal ethanol exposure has effects on fetal skeletal development that are independent of those on overall fetal growth, and that these effects occur even at moderate levels of maternal drinking. Effects of prenatal ethanol exposure on fetal skeletal development could potentially increase the offspring's risk of osteoporosis later in life.

Depressive symptomatology in childhood and adolescence.

Antecedents of depressive symptomatology in childhood and adolescence were examined in a prospective longitudinal study of at-risk youth (n = 168) from families of lower socioeconomic status. Relations between family context factors, maternal depressive symptoms, and depressive symptoms in childhood and adolescence were examined, with a focus on early family relationship factors rarely available for analysis in longitudinal data sets. Results suggest the possibility of etiological differences between depressive symptoms in childhood and in adolescence. Depressive symptomatology in childhood was predicted by the overall family context. Cumulative effects of maternal depressive symptomatology, early care lacking in emotional supportiveness, abuse, and family stressors were observed. Depressive symptomatology in adolescence, on the other hand, was specifically associated with maternal depression and early care lacking in emotional supportiveness. Moreover, an intriguing sex difference emerged: maternal depressive symptomatology was strongly associated with depressive symptomatology in adolescence for females, but for males supportive early care appeared more relevant.

Assessment of life stress in adolescents: self-report versus interview methods.

OBJECTIVE: To compare the investigator-based Life Events and Difficulties Schedule (LEDS) with a self-report measure (Life Events Checklist [LEC]) for the purpose of measuring life stress in adolescents with and without a diagnosis of major depressive disorder (MDD). METHOD: Adolescents (aged 13-18 years) with a recent episode of MDD based on DSM-III-R (n = 35) and normal controls free of any Axis I lifetime psychiatric disorder (n = 35) were assessed using both the LEC and the LEDS. RESULTS: Both measures predicted membership in the depressed and nondepressed groups of adolescents. Adolescents in the depressed group were more likely to report a severe event on the LEDS (97%) than adolescents in the nondepressed group (66%) (p = .001). Similarly, subjects in the depressed group endorsed a greater number of negative events (mean = 8.1) on the LEC than subjects in the nondepressed group (mean = 3.0) (p = .0001). An examination of potential provoking agents for episodes of major depression revealed that the LEC captured only 32% of preonset severe events and 36% of preonset major difficulties identified by the LEDS. CONCLUSIONS: Interpreted in light of relative advantages and disadvantages, the results suggest that checklist and interview measures each have distinct advantages depending on the purpose for which they are being used.

Recovered memory of childhood sexual trauma: a documented case from a longitudinal study.

A case of recovered memory of childhood trauma is reported with documented sexual trauma in early childhood, chronicled evidence of the absence of memory for traumatic experience over a period of time, and substantial evidence of 'spontaneous' recovery of memory. This account contains the first available prospective report of memory loss in a case in which there is both documented evidence of trauma and evidence of recovery of memory. The case emerged as part of a broadband, large-scale study of children followed closely from birth to adulthood which was not focused on memory for trauma. Prospective data gathered in a neutral research context, corroborated and supplemented by retrospective information, circumvent many limitations of previous retrospective accounts of recovered memories.