Perceptions of Dental Undergraduates Towards Online Education During COVID-19: Assessment from India, Nepal and Sri Lanka.

PURPOSE: The social distancing mandates instituted during COVID-19 pandemic mark the sudden transition in the mode of dental education's delivery to the virtual instruction. It is vital to assess students' perceptions towards virtual learning environments, particularly among those gaining education in resource-strained countries. This cross-sectional study aims to assess the perceptions of dental undergraduates towards online education, environment and transferable skills and patient care during COVID-19 in India, Nepal, and Sri Lanka. MATERIALS AND METHODS: Dental preclinical and clinical undergraduate students from India, Nepal and Sri Lanka were recruited from November 2020 to March 2021 through a 47-item web-based survey consisting of psychometrically valid subscales of Dundee Ready Educational Environment Measure (DREEM) and Transferable Skills Questionnaire. The mean scores of students' perceptions of learning, environment, and patient care skills were compared among preclinical and clinical students of the participating countries. RESULTS: Of total 930 participants, 44.4% were from India, 26.1% from Sri Lanka and 29.5% responses from Nepal. Sri Lanka reported the highest mean scores across all domains of perception indicative of positive attitude. Clinical students from all participating countries had statistically significantly higher positive perception of transferable skills in patient care as opposed to their preclinical counterparts. On the contrary, perception towards learning was higher among preclinical students as opposed to clinical students. These differences were statistically significant for Nepal and Sri Lanka. CONCLUSION: The findings of this study underscore the need to develop and implement effective online dental educational interventions to foster academic growth and essential practical skills without compromising academic rigor and continuity in the dental education curriculum.

Effect of Hand Held Vibrating Tools on Nerve Conduction Study in Dental Residents.

BACKGROUND: Repetitive exposure to vibration has been shown to induce peripheral nerve dysfunction. Dentists are exposed to handheld vibrating tools in their daily clinical practice. Most of the studies are done in dentists who have symptoms such as paresthesia and numbness of the hands. Thus, we conducted the study to explore the effect of vibration on nerve conduction variables in apparently healthy asymptomatic dental residents. METHODS: This cross-sectional study enrolled 22 dental residents and age matched 22 medical residents as controls. Nerve conduction study was performed in median and ulnar nerves of both hands. RESULTS: Anthropometric and cardiorespiratory variables were comparable between the groups. There were no statistically significant differences between dental and medical residents in the sensory conduction variables (right median onset latency=2.05±0.27 vs 1.91±0.21, p value=0.07; right median amplitude =27.80±8.11 vs 29.55±7.04, p=0.45; right median conduction velocity = 59.54±7.05 vs 61.06±5.15, p= 0.42) and motor conduction variables (right median distal latency = 2.87±0.38 vs 2.87±0.38, p= 0.94; right median distal amplitude=10.71±2.19 vs 11.10±2.37, p=0.58; right median conduction velocity= 70.57±13.16 vs 68.53±7.73, p= 0.54) of median and ulnar nerves. Further, there was no significant difference between the dominant and non-dominant hands of dental residents. CONCLUSIONS: Hand held vibration tools did not alter nerve conduction study parameters of dental residents.

Prevalence of Different Types of Apical Root Canal Morphology and their Treatment Recommendations in an Institute.

INTRODUCTION: Canals can be of different shapes in cross section including round canals, oval canals, long oval canals or ribbon shaped canals. Recesses of nonround canals may not be included in the round preparation created by rotary instruments and thus they remain unprepared. The aim of this study included determination of shape and taper of the apical root canal based on diameter at different levels. Measurement of the diameter of the root canal at one, two and three mm cross sections from the apex of the tooth were done such that apical instrumentation in root canal treatment could be modified based on the results obtained. METHODS: This was a cross sectional study which used convenient sampling technique to determine the sample size. Seventy extracted teeth were sectioned horizontally at one, two and three millimeter from the apex using the diamond disc which was observed under trinocular research microscope for the determination of diameter of root canal under 10x magnification. Digital images of the sections were taken by a camera attached to the research microscope and analysis done using DigiPro 4.0 software. RESULTS: The most common canal configuration was oval. The taper of the canals was 25% in mesial root and 20% in distal in bucco-lingual orientation and 14% in mesial root and 15% in distal in mesio-distal orientation. CONCLUSIONS: The most prevalent canal configuration in this study was non round, however, most of the rotary instruments tend to prepare root canals into round shape making their use questionable. The taper of the root canals was found to be higher in our study than what most of the shaping instruments have to offer. So it would be advisable to consider this fact while selecting instruments and preparing these non-round canals as far as the Nepalese subpopulation is considered.

Rare Association of Klippel-Trenaunay Syndrome with Large Pulmonary Embolism and Asymmetrical Emphysematous Bullae.

Klippel-Trenaunay syndrome is a rarely encountered congenital disease characterized by a triad of enlarged arteries and veins, limb hypertrophy and capillary malformations. We are presenting an interesting case of a 23-year male who had been previously diagnosed to have Klippel-Trenaunay syndrome. The patient presented with large pulmonary embolism after having undergone laser surgery for varicose veins. The diagnostic chest computed tomography (CT) performed also revealed the co-existence of severe destructive pulmonary parenchymal disease involving large areas of the pulmonary parenchyma and formation of large emphysematous bullae having an asymmetric involvement of the left lung field. The patient was managed with thrombolysis with a bolus fibrinolytic agent and subsequently underwent an inferior vena cava (IVC) filter implantation to prevent further episodes of embolism in the presence of a compromised lung. The association of Klippel-Trenaunay syndrome with recurrent pulmonary embolism and unexplained pulmonary parenchymal disease leading to almost complete destruction of large areas of lung fields is interesting and has never been previously described.

Thrombolysis With Single Bolus Tenecteplase Compared With Streptokinase Infusion in the Treatment of Acute Pulmonary Embolism: A Pilot Study.

OBJECTIVE: This study was planned to compare the efficacy of bolus regimens of tenecteplase (TNK) and 24 hours infusion of streptokinase (STK) in acute pulmonary embolism (APE) in a resource-poor setting. INTERVENTIONS: In all, 25 patients received injection of TNK, and 75 patients received infusion of STK over 24 hours. RESULTS: Pulmonary artery systolic pressure and right ventricular function were improved separately and significantly (P = .01) in both the study groups of patients from baseline at 24 hours or at seventh day and was comparable among the TNK and STK groups of patients. Mean duration of stay in intensive care unit was significantly less (2.2 ± 0.8 vs 3.2 ± 1.3 days; P = .04), and bleeding risk was also found to be nonsignificantly less in the TNK group. CONCLUSION: These results suggest that a 24-hour infusion regimen of STK is as effective as bolus TNK in the treatment of patients with APE in countries with limited resources.

Absent pulmonary valve: a case with rare presentation treated with bioprosthetic valve replacement.

Congenital absence of the pulmonary valve is a rare congenital cardiac malformation, usually seen in association with tetralogy of Fallot. Patients generally present early in life with respiratory distress or recurrent respiratory tract infections, failure to thrive, cyanosis, infective endocarditis, or heart failure. Isolated absent pulmonary valve is quite rare and may be discovered in older age-group as in our patient, a nine-year-old male child who presented with atypical symptoms of exertional chest pain. Unusual echocardiographic features in this case include intact ventricular septum and prominent trabeculations of the right ventricle. Surgical implantation of a bioprosthetic valve was followed by hemodynamic and symptomatic improvement.

An atypical presentation of an extremely late stent thrombosis after more than 7 years (2634 days) of DES implantation in a patient without obvious risk factors on regular dual antiplatelet therapy.

Very late stent thrombosis is a rare complication of percutaneous coronary intervention in the era of dual antiplatelet therapy. The risk factors for stent thrombosis are drug default, age, diabetes, renal dysfunction, left ventricular dysfunction, smoking or procedure-related factors and complications. We are describing the case of a 55-year-old non-smoker patient without the conventional risk factors for stent thrombosis maintaining good compliance with dual antiplatelet (aspirin and clopidogrel) drugs in standard doses. The patient had a history of having received a Cypher stent more than 7 years (2634 days) ago in the left circumflex artery for the management of in-stent restenosis of a bare metal stent implanted previously. He was referred with acute stent thrombosis with an atypical presentation of non-ST elevation myocardial infarction having unexplainable spontaneous resolution of electrocardiographic changes. The patient was successfully managed with newer generation drug-eluting stents reimplantation. The presence of acute onset of symptoms and thrombus containing soft lesion as documented during intervention supported the diagnosis of acute stent thrombosis. To the best of our knowledge this case is one of the longest duration of presentation with acute stent thrombosis after stent implantation ever reported in literature and is also unique in its unusual mode of presentation.

Gemella morbillorum endocarditis in hypertrophic cardiomyopathy: a rare organism causing a large vegetation and abscess in an uncommon setting.

Mitral valve endocarditis complicating hypertrophic cardiomyopathy is rare especially in the absence of significant mitral regurgitation. The occurrence of large vegetation and an abscess formation is even rarer. Endocarditis occurs predominantly on the left ventricular aspect of the anterior mitral leaflet. We report a case of a 34-year-old woman with asymptomatic obstructive hypertrophic cardiomyopathy who developed mitral valve endocarditis with large vegetation and subsequently an abscess caused by a rare organism Gemella morbillorum, following dental extraction. The patient underwent antibacterial therapy followed by successful mitral valve replacement for severe mitral regurgitation and her postoperative course has been asymptomatic so far. This case is unique in describing endocarditis by a rare organism as a cause of large vegetation and an abscess on an unusual site on the mitral valve leaflet without predisposition of haemodynamically significant mitral regurgitation and illustrates the potential lifesaving role of timely intervention.