Development and validation of educational multimedia to promote public health literacy about healthy cognitive aging.

OBJECTIVES: Health literacy (HL) about healthy cognitive aging is essential in preventing cognitive decline and promoting cognitive well-being. It is important that one such HL module should be scientifically designed, delivered in a technically sound manner to the audience, and specific to the context. The present study thus aimed at developing and validating educational multimedia about cognitive health. METHODS: The study followed a methodological framework and was carried out across three phases, that is, identification of themes, development and validation of educational script and design, and validation of educational multimedia. The module was scripted based on the Integrated HL framework and the recommendations made during the modified nominal group technique among the research team. Seven speech-language pathologists (SLPs), with expertise in the field of cognitive sciences, and 15 representatives of the general public validated the module using the Educational Content Validation Instrument in Health and the Patient Education Materials Assessment Tool for Audiovisual Materials questionnaire. RESULTS: The scientific content of the educational script received satisfactory agreements among the experts (content validity index [CVI]: 0.93) and representatives of the general public (CVI: 0.86). The technical aspects of the educational multimedia were rated to have high understandability (experts: 92.8%; representatives of general public: 98.8%) and actionability (experts and representatives of general public 100%). CONCLUSION: Overall, the developed educational multimedia scored optimally with respect to the objective, structure, relevance of the content, actionability and understandability of the multimedia. The developed module holds the potential to be used at community and national level health educational programs or awareness campaigns to enhance public knowledge and beliefs pertaining to cognitive health. PATIENT OR PUBLIC CONTRIBUTION: SLPs with expertise in the field of cognitive science and representatives from the general public were included to validate and obtain feedback on the developed educational multimedia.

Clinical integration of patient-reported outcome measures to enhance the care of patients with SLE: a multi-centre prospective cohort study.

OBJECTIVE: To assess the feasibility and impact of integrating electronic patient-reported outcome measures (PROMs) into the routine outpatient care of patients with SLE. METHODS: We conducted a prospective cohort study, utilizing a mixed-methods sequential explanatory design, of SLE outpatients receiving rheumatology care at two academic medical centres. Participants completed electronic PROMs at enrolment and then prior to their next two routine rheumatology visits. PROM score reports were shared with patients and rheumatologists before visits. Patients and rheumatologists completed post-visit surveys evaluating the utility of PROMs in the clinical encounters. Focus groups of patients and interviews with treating rheumatologists were conducted to further explore their experience utilizing PROMs. RESULTS: A total of 105 SLE patients and 17 rheumatologists participated in the study. Patients completed PROMs in 159 of 184 encounters (86%), with 93% of surveys completed remotely. Patients reported that PROMs were 'quite a bit' or 'very' useful (55% of encounters) and beneficial to communication (55% of encounters). In contrast, physicians found PROMs useful (20%) and beneficial to communication (17%) less frequently. There was no significant change in visit length, health-related quality of life or disease activity after implementation of PROMs; however, patient satisfaction improved slightly. Qualitative analyses revealed that patients felt PROMs provided utility primarily by facilitating communication, particularly when physicians discussed the surveys. CONCLUSION: The remote capture and integration of electronic PROMs into clinical care was feasible in a diverse cohort of SLE outpatients. PROMs were useful to patients and enhanced their clinical experience primarily by facilitating communication.

Polaron hopping barriers and rates in semiconducting polymers.

Conjugated polymers are potential next-generation materials for organic electronic devices. The ability of these materials to transport charges is a key factor limiting their performance. Charge carriers in conjugated polymers are localized by disorder and polaronic effects. Charge transport in these materials is often described by thermally activated hopping, with a rate given by Marcus theory. The polaron hopping activation energy determines the temperature dependence of the Marcus rate. This energy barrier is dictated by the transition state, in which the charge carrier is equally divided between the initial and final locations. The prefactor for the polaron hopping rate is set by the charge tunneling rate between the initial and final locations. We use a tight-binding polaron model, in which charge carriers are stabilized by both nuclear reorganization and polarization of the surrounding dielectric, to compute the activation energy, charge tunneling rate and overall rate constant for intrachain and interchain charge hopping processes in poly(3-hexylthiophene) (P3HT) crystalline lamellae and amorphous melts. Charge transport in these two environments is limited by interchain hopping processes. Both hopping barriers and rates predicted by the model are in good agreement with experiments on a variety of crystalline and amorphous P3HT materials. Qualitatively, the barriers largely depend on how well the transition state is stabilized by polarization effects, and on the hopping integral between the initial and final locations, both of which penalize hopping over longer distances.

Pseudomyxoma peritonei: inflammatory responses in the peritoneal microenvironment.

BACKGROUND: Pseudomyxoma peritonei (PMP), a peritoneal mucinous neoplasm of appendiceal origin, is associated with inflammation and fibrosis, which is central to its biology. The significance of the microenvironment in PMP has not been well characterized. METHODS: Immunoassays were used to measure cytokines and C-reactive protein (CRP). Forty-two cytokines were initially measured in 23 PMP ascites and 10 PMP peritoneal washings. On the basis of these results, matching serum and ascites samples were analyzed for ten relevant cytokines (n = 32) and CRP (n = 28). Immunohistochemistry was performed on formalin-fixed tissue sections. Statistical analysis was by Wilcoxon signed rank test, Mann-Whitney U-test, and bivariate analysis. RESULTS: Serum CRP was elevated in PMP and correlated to CRP level in ascites. Interleukin (IL)-6, IL-8 (CXCL8), interferon gamma-induced protein 10 (IP-10), (CXCL10), monocyte chemotactic protein (MCP)-1 (CCL2), and macrophage inflammatory protein (MIP)-1α (CCL3) levels were grossly elevated in ascites but did not correlate with serum levels. Cytokines normally associated with infection or tissue injury (e.g., IL-1, IL-2, interferon gamma) were not elevated. Immunohistochemistry localized IL-6 to stroma, IP-10, and MCP-1 to tumor cells and IL-8 to adipose tissue. There were complex interactions among cytokines. IL-6, in particular, had many significant correlations in ascites. Serum IL-8, MIP-1ß, and CRP were higher in PMP compared to controls. CONCLUSIONS: The pattern of cytokines in PMP is distinct from infection- or injury-associated inflammation. The results support peritoneal synthesis for cytokines. CRP, IL-8, and MIP-1ß are potential serum markers for PMP. IL-6 appears to play a central role in PMP biology. This study provides new details about PMP tumor biology and identifies possible therapeutic targets.

Backbone and Side Group Interchain Correlations Govern Wide-Angle X-ray Scattering of Poly(3-hexylthiophene).

Identifying the origin of scattering from polymer materials is crucial to infer structural features that can relate to functional properties. Here, we use our recently developed virtual-site coarse graining to accelerate atomistic simulations and show how various molecular features govern wide-angle X-ray scattering from a conjugated polymer, poly(3-hexylthiophene) (P3HT). The efficient molecular dynamics simulations can represent the structure and capture the emergence of crystalline order from amorphous melts upon cooling while retaining atomistic details of chain configurations. The scattering extracted from simulations shows good agreement with wide-angle X-ray scattering experiments. Amorphous P3HT exhibits broad scattering peaks: a high-q peak from interchain side-group correlations and a low-q peak from interchain backbone-backbone correlations. During amorphous to crystalline phase transitions, the distance between backbones along the side-group direction increases because of lack of interdigitation in the crystalline phase. Scattering from π-π stacking emerges only after crystallization takes place. Intrachain correlations contribute negligibly to the scattering from the amorphous and crystalline phases.

Kras mutations and p53 overexpression in pseudomyxoma peritonei: association with phenotype and prognosis.

BACKGROUND: Little information exists on Kras mutations and p53 overexpression in pseudomyxoma peritonei (PMP). These genetic alterations are associated with poorer prognoses in colorectal cancer. We postulated that these mutations might be more frequent in high-grade (HG) PMP (peritoneal mucinous carcinomatosis) versus low-grade (LG) PMP (disseminated peritoneal adenomucinosis/peritoneal mucinous carcinomatosis), for which survival differences are well documented. METHODS: We collected data retrospectively on patients with PMP of appendiceal origin tested for Kras mutation (commercial assay) and p53 overexpression (immunohistochemistry). We used Fisher's exact test, chi-square test, and Kaplan-Meier survival curves for analysis. RESULTS: Of 64 cases with Kras mutations, 25 were classified as LG and 39 as HG PMP. Median age at diagnosis was 53 ± 11.5 y. We detected Kras mutations in 37 of 64 patients (57.8%). In LG PMP, 15 of 25 (60%) were Kras mutant versus 22 of 39 (56.4%) in HG PMP (P=0.80). Nearly 89% of mutations were seen in codon 12. We noted overexpression of p53 in 44.3% (86 of 194) of patients overall, which was significantly different between LG PMP and HG PMP: 35.5% (37 of 104) versus 54.4% (49 of 90), respectively (P=0.009). Kras mutations did not affect prognosis. Overexpression of p53 was associated with a worse outcome. CONCLUSIONS: Kras mutation and p53 overexpression rates are comparable to those of colorectal adenomas and mucinous colorectal cancer. Codon 12 mutations may be associated with mucin production. Kras mutation status is not prognostic for overall survival. Overexpression of p53 was significantly correlated with female sex, higher-grade disease, and worse survival.

Comparative evaluation of serum high-density lipoprotein and low-density lipoprotein levels and glycated hemoglobin levels and periodontal status in type 2 diabetic patients: A pilot project.

Background: High levels of cholesterol in the body can be alarming and point toward a possible cardiac or diabetic problem. Current evidence reveals that the harmful low-density lipoproteins (LDL) cholesterol tend to increase in poorly controlled diabetes, whereas the useful high-density lipoprotein (HDL) cholesterol, known for its protective anti-inflammatory and antioxidant activities, is decreased. With a positive evidence of periodontal disease being implicated in diabetes, it was decided to investigate whether there was any association between serum HDL, LDL, glycated hemoglobin (HbA1c) and periodontal status with Type II diabetes mellitus patients. Materials and Methods: A total of 500 nonsmoking patients (males and females) aged between 35 and 55 years with Type 2 diabetes mellitus and no other systemic disease were selected from the diabetic center, Diacon hospital, Bengaluru, Karnataka, India. Periodontal examination consisted of the clinical parameters, namely, attachment loss, gingival index (GI) and plaque index based on which the patients were divided into periodontally healthy and diseased groups. Blood samples were collected from each patient to evaluate the serum levels of HDL, LDL and HbA1c. Results: No significant differences were observed between the HDL, LDL and HbA1c levels in both the periodontal groups (P > 0.05). Linear regression analysis showed significant positive correlations of clinical attachment level with LDL and negative correlation with HbA1c, whereas GI has a positive correlation with LDL and negatively with HDL and Hba1c levels (P < 0.05). Conclusion: Varied associations were found between dyslipidemia, glycemic control and periodontal inflammation. Further longitudinal as well as interventional studies may be beneficial to ascertain the causal relationship between cholesterol levels, periodontal status and diabetes mellitus.

Apprehensions and Optimism among Dental Professionals during the COVID-19 Pandemic-A Nationwide Cross-Sectional Evaluation.

Globally, the pandemic of the coronavirus disease, which started in Wuhan, China, has become a major issue for public health. The COVID-19 epidemic notably causes health professionals to experience significantly more emotional stress than the general populace. The present study proposes to investigate the fear aspect in dentists in the initiation of clinical practice during these times. An online cross-sectional study was conducted among dental practitioners based on a pre-validated questionnaire. The data were expressed as frequency and percentage analyzed using the chi-square test using SPSS version 25. The data was obtained from 271 participants, where clinical practice after the first wave was mostly by freelancers (p-value = 0.01); most of whom were married (p-value = 0.065); 19.1% attached to institutes did not have changes in earnings; 28.1% of private practitioners had less than 10% reduction in cases. A total of 62% of private practitioners are concerned about the vaccine's preventative effects (p-value = 0.026), and 57% of private practitioners worry about being sued for the delay in treatment (p-value = 0.036). Only 33.1% of employees in institutions worry that becoming sick could endanger their family. As dentists continue to work their way through this pandemic, these pressures only occasionally have an impact on them. According to the researchers, this is the first study that has captured the anxiety and apprehensions that dental practitioners experienced during the height of the COVID-19 outbreak in India in April 2021. The study's findings demonstrate that the study population was generally upbeat and confident that they could quickly overcome their fear.

A population-based study of risk factors for stroke after carotid endarterectomy using the ACS NSQIP database.

BACKGROUND: The benefit of carotid endarterectomy (CEA) is heavily influenced by the risk of perioperative stroke. Our objective was to use the American College of Surgeons' 2007 and 2008 National Surgical Quality Improvement Program (NSQIP) database to assess the postoperative stroke and death rate after CEA among the more than 180 NSQIP participating hospitals, and to identify the preoperative risk factors. MATERIALS AND METHODS: Univariate analysis included 56 preoperative variables. Outcomes were studied for 30 d. Multivariate logistic regression was used for assessment of risk factors. RESULTS: Of 13,316 patients, 7503 (56.5%) were asymptomatic, while 5770 (43.5%) were symptomatic. Combined stroke or death was seen in 262 patients (2.0%). Postoperative stroke occurred in 186 patients (1.4%). One hundred patients (0.8%) died within 30 d. In asymptomatic and symptomatic patients, stroke or death was seen in 1.3% and 2.9% of patients; stroke in 0.9% and 2% of patients; and death in 0.5% and 1.1% of patients, respectively (all P < 0.001). On multivariate analysis for symptomatic patients, dialysis dependence, chronic open wound, impaired sensorium, and dependent functional status were risk factors for stroke or death (all P < 0.05). Among asymptomatic patients, acute renal failure, corticosteroid use, COPD, paraplegia, and dependent functional status were risk factors for stroke or death (all P < 0.05). CONCLUSIONS: This prospective database confirms that CEA is currently performed with low peri-procedural stroke rate in participating ACS NSQIP hospitals and provides a contemporary framework for comparison of other treatment modalities to CEA. Identification of the above risk factors may help with risk stratification and patient counseling for CEA.

Necrotic ulcerative changes in Fanconi's anaemia: a case report.

SUMMARY: This case report is of a rare occurrence of necrotic ulcerative changes in a female patient with Fanconi's anaemia and its successful periodontal management. BACKGROUND: The response of the periodontium to certain genetic and haematological disorders may vary from bleeding, ulcerations and necrosis to a more severe form of periodontitis. Periodontal management in such conditions still remains an enigma with respect to the timing of the periodontal intervention with regard to the systemic wellbeing of the patient. METHODS: Necrotising ulcerative lesions in a patient with Fanconi's anaemia (FA) progressed rapidly in a week's time necessitating early preliminary periodontal care, which included scaling and root planning using ultrasonic equipment supplemented with hydrogen peroxide irrigation, in conjunction with systemic antibiotics and blood transfusion. RESULTS: Following 1 unit (500ml) of fresh whole blood transfusion 24 hours preoperatively, basic periodontal therapy, comprising of removal of necrotic slough and thorough scaling was done. There was marked resolution of the necrotic ulceration and related symptoms when the patient was followed up for a period of 1 month. CONCLUSION: This report reconfirms most oral manifestations of Fanconi's anaemia and is the first of its kind to associate necrotic ulcerative changes of the gingiva with FA. It also goes a step further to emphasise the clinical significance of multidisciplinary approach towards successful patient management, which was the primary objective.

Targeting receptor-ligand chemistry for drug delivery across blood-brain barrier in brain diseases.

The blood-brain barrier (BBB) is composed of a layer of endothelial cells that is interspersed with a series of tight junctions and characterized by the absence of fenestrations. The permeability of this barrier is controlled by junctions such as tight junctions and adherent junctions as well as several cells such as astrocytes, pericytes, vascular endothelial cells, neurons, microglia, and efflux transporters with relatively enhanced expression. It plays a major role in maintaining homeostasis in the brain and exerts a protective regulatory control on the influx and efflux of molecules. However, it proves to be a challenge for drug delivery strategies that target brain diseases like Dementia, Parkinson's Disease, Alzheimer's Disease, Brain Cancer or Stroke, Huntington's Disease, Lou Gehrig's Disease, etc. Conventional modes of drug delivery are invasive and have been known to contribute to a "leaky BBB", recent studies have highlighted the efficiency and relative safety of receptor-mediated drug delivery. Several receptors are exhibited on the BBB, and actively participate in nutrient uptake, and recognize specific ligands that modulate the process of endocytosis. The strategy employed in receptor-mediated drug delivery exploits this process of "tricking" the receptors into internalizing ligands that are conjugated to carrier systems like liposomes, nanoparticles, monoclonal antibodies, enzymes etc. These in turn are modified with drug molecules, therefore leading to delivery to desired target cells in brain tissue. This review comprehensively explores each of those receptors that can be modified to serve such purposes as well as the currently employed strategies that have led to increased cellular uptake and transport efficiency.

Effect of full-mouth disinfection on insulin sensitivity in type 2 diabetes patients with and without chronic periodontitis.

OBJECTIVE: To explore the effect of full-mouth disinfection (FMD) on glycemic control and insulin resistance in type 2 diabetes mellitus (DM). METHOD AND MATERIALS: Sixty dentate patients who were never-smokers with type 2 diabetes mellitus were recruited for the study. Based on clinical examination they were divided into two groups: one with chronic periodontitis and the other without chronic periodontitis. Periodontal parameters Plaque Index (PI), Gingival Index (GI), and probing pocket depth (PPD) were evaluated. Blood samples were assessed for the levels of fasting glucose (FG), insulin, and C-reactive protein (CRP), and insulin glucose ratio was calculated using a mathematical equation (HOMA-IR). All parameters were assessed at baseline, and at 3 months and 6 months after FMD. RESULTS: The results showed a significant reduction in PI, GI, PPD, FG, and HOMA-IR from baseline to 6 months. The CRP levels were constant throughout the study period. CONCLUSION: Within the limitations of the present study it can be concluded that FMD contributes to significant reduction in insulin resistance, thereby improving the glycemic control in type 2 diabetes mellitus patients.

Poly(ester amide)s from Soybean Oil for Modulated Release and Bone Regeneration.

Designing biomaterials for bone tissue regeneration that are also capable of eluting drugs is challenging. Poly(ester amide)s are known for their commendable mechanical properties, degradation, and cellular response. In this regard, development of new poly(ester amide)s becomes imperative to improve the quality of lives of people affected by bone disorders. In this framework, a family of novel soybean oil based biodegradable poly(ester amide)s was synthesized based on facile catalyst-free melt-condensation reaction. The structure of the polymers was confirmed by FTIR and (1)H -NMR, which indicated the formation of the ester and amide bonds along the polymer backbone. Thermal analysis revealed the amorphous nature of the polymers. Contact angle and swelling studies proved that the hydrophobic nature increased with increase in chain length of the diacids and decreased with increase in molar ratio of sebacic acid. Mechanical studies proved that Young's modulus decreased with decrease in chain lengths of the diacids and increase in molar ratio of sebacic acid. The in vitro hydrolytic degradation and dye release demonstrated that the degradation and release decreased with increase in chain lengths of the diacids and increased with increase in molar ratio of sebacic acid. The degradation followed first order kinetics and dye release followed Higuchi kinetics. In vitro cell studies showed no toxic effects of the polymers. Osteogenesis studies revealed that the polymers can be remarkably efficient because more than twice the amount of minerals were deposited on the polymer surfaces than on the tissue culture polystyrene surfaces. Thus, a family of novel poly(ester amide)s has been synthesized, characterized for controlled release and tissue engineering applications wherein the physical, degradation, and release kinetics can be tuned by varying the monomers and their molar ratios.

Schizophrenia and periodontal disease: An oro-neural connection? A cross-sectional epidemiological study.

BACKGROUND: Schizophrenia is a psychosis characterized by delusions and hallucinations occurring in clear consciousness. Studies have shown that the cytokines may modulate dopaminergic metabolism and schizophrenic symptomatology in schizophrenia. Cytokine involvement in periodontal disease is also well documented. To date, however, there has been relatively little research assessing periodontal status of patients with schizophrenia. The present study was therefore mainly intended to understand the exact link, if any, between periodontal disease and schizophrenia. MATERIALS AND METHODS: A total of 250 schizophrenic patients (140 males and 110 females), between 25 and 55 years of age, were selected from the out patient department of National Institute of Mental Health and Neural Sciences, Bangalore and their periodontal status was assessed as part of this cross-sectional epidemiological survey. RESULTS: ANOVA showed that there was increased evidence of poor periodontal condition, as evidenced by gingival index and plaque index in patients who had been schizophrenic for a longer duration of time (P < 0.001). So also, higher probing pocket depths were found in schizophrenics suffering from a longer period of time than others (P < 0.001). CONCLUSIONS: Although oral neglect might be a cause of poor periodontal health in schizophrenics, the possible link between periodontal diseases giving rise to schizophrenia cannot be overlooked due to the presence of cytokine activity which is present both in schizophrenia and periodontal disease.

Comparison of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with mitomycin or carboplatin for diffuse malignant peritoneal mesothelioma.

Diffuse malignant peritoneal mesothelioma is a rare, aggressive disease. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved outcomes where systemic chemotherapy has not succeeded. In this study, we compare outcomes of patients treated with mitomycin or carboplatin as perfusate. In this retrospective study, 47 procedures (CRS + HIPEC) were conducted on 44 patients between March 2003 and August 2010 with either mitomycin or carboplatin. χ(2) and Student's t test were used for comparison of clinicopathological variables and Kaplan-Meier curves and log rank test were used to compare overall survival. Median survival of the mitomycin group was 18 months with 1- and 5-year survivals of 72.3 and 27.3 per cent, respectively. Median survival of the carboplatin group was not reached and 1- and 5-year survivals were 89.7 and 62.5 per cent, respectively (P = 0.014). Mean hospital and intensive care unit length of stay was 18.9 and 8.7 days in the mitomycin group and 12.5 and 2.3 days in the carboplatin group (P = 0.0069). Mean number of packed red blood cell units transfused was higher in the mitomycin group compared with the carboplatin group (3.54 vs 0.83, P < 0.05). There was no postoperative mortality. HIPEC with carboplatin in diffuse malignant peritoneal mesothelioma is associated with improved overall survival and shorter hospital stay compared with HIPEC with mitomycin.

A clinico-biochemical evaluation of the role of a herbal (Ayurvedic) immunomodulator in chronic periodontal disease: a pilot study.

BACKGROUND: Host modulation is fast gaining popularity as a preferred therapeutic modality for periodontal disease. Recent research in the medical field into herbal immunomodulators such as Septilin® has spurred an interest in evaluating its efficacy in periodontitis for the first time. AIM: The aim of the study was to assess the immunomodulatory effects of the herbal immunomodulator Septilin® (Himalaya Drug Company, Bangalore, India) when used as an adjunct to scaling and root planing in chronic periodontal disease. METHODS: Forty systemically healthy patients aged between 25 and 55 years of age and with chronic periodontitis were randomly divided into two groups. The test group was administered Septilin® tablets for two weeks following scaling and root planing whereas the control group was treated by scaling and root planing alone. Changes in gingival index (GI), gingival bleeding index (GBI), serum C-reactive protein (CRP) levels and salivary tumour necrosis factor-alpha (TNF-α) levels were assessed at day 0, at two weeks, and at three and six months. RESULTS: The GI and GBI showed a statistically significant reduction at two weeks, three months and six months (P<0.001) in both groups. Salivary TNF-α level reduction was significant in the test group only (P<0.001). No significant change was found in serum CRP levels in both groups (P>0.05). CONCLUSION: In this pilot evaluation, Septilin® was found to be a safe and effective immunomodulator as an adjunct to routine periodontal therapy. Further long-term studies to test Septilin® on larger sections of the population are recommended.

Proposed classification of pseudomyxoma peritonei: influence of signet ring cells on survival.

The nomenclature and classification of pseudomyxoma peritonei (PMP) is confusing and controversial. Numerous classification systems have been proposed, none of which are easily reproducible or a useful guide for treatment. Patients with PMP of appendiceal origin were identified from our institution's database. Kaplan-Meier analyses were performed based on a proposed new PMP classification, a three-tiered grading system designated PMP1, PMP2, and PMP3. These results were compared with the established schemes by Ronnett and Bradley et al. There were 211 patients included in the analysis with a mean age of 51 ± 12 years at diagnosis. For PMP1, 86 patients (40.8%) included cases with abundant extracellular mucin and columnar nonstratified epithelium without dysplasia or atypia. For PMP3, 50 patients (23.7%) consisted of PMP with any percentage of signet ring cells (SRCs), For PMP2, 75 patients (35.5%) included all other patients. The mean age (± standard deviation) for PMP 1, 2, and 3 were 51 ± 12, 51 ± 12, and 51 ± 10 years, respectively (P = 0.90). The three groups had similar sex distribution (P = 0.24) and resection status (P = 0.47). Kaplan-Meier analyses showed median survivals of 120, 88, and 40 months and 5-year survival rates of 85.7, 63.05, and 32.2 per cent (P < 0.0001) for PMP 1, 2, and 3, respectively. Three distinct categories, PMP1, 2, and 3, were identified, which provide better stratification in terms of overall survival and represent differences in tumor biology that may impact treatment recommendations.

Postoperative respiratory failure after thyroid and parathyroid surgery: analysis of national surgical quality improvement program.

BACKGROUND: The risk-benefit analysis of any operation is influenced by its perioperative complications. Our objective was to examine the relationship between preoperative clinical characteristics and postoperative respiratory failure (PRF: mechanical ventilation for >48 hours after surgery or reintubation) within 30 days of thyroid and parathyroid surgeries. METHODS: American College of Surgeons' multicenter, prospective, National Surgical Quality Improvement Program (NSQIP) datasets (2007/2008) were used. Multivariable logistic regression was performed. RESULTS: Eighty-three of 20,778 (0.4%) patients developed PRF. Comparing patients who developed PRF to those who did not, 30-day mortality was seen in 13 of 83 versus 11 of 20,695 patients (p < .0001); and mean length of stay (LOS) was 9.1 (±9.5) days versus 1.1 (±1.6) days (p < .0001). Multivariable analysis demonstrated preoperative pneumonia, dependent functional status, dyspnea, dialysis dependence, hypertension, advanced age, and combined thyroid and parathyroid surgery as risk factors for PRF. CONCLUSION: PRF after thyroid and parathyroid surgeries is uncommon, but associated with significantly increased 30-day morbidity and mortality.

Gingival blood glucose estimation with reagent test strips: a method to detect diabetes in a periodontal population.

BACKGROUND: Periodontal disease is considered the sixth complication of diabetes. Therefore, as a foremost responsibility of the periodontist, the present study was carried out to screen an unsuspecting periodontal population for the presence of diabetes with the help of gingival blood glucose and reagent test strips. METHODS: A total of 356 patients with no known medical history of diabetes visiting the outpatient Department of Periodontics, at the Government Dental College and Hospital, Nagpur, Maharashtra, India, were divided into 3 groups: group 1 included patients with a healthy periodontium; group 2, patients with gingivitis; and group 3, patients with periodontitis. Gingival blood, formed by puncturing the interdental papilla of the upper anterior teeth with a lancet, was allowed to fall onto a test reagent strip, where the color change was noted, and corresponding glucose values recorded. Patients with glucose values >120 gm% (per manufacturer provided chart) were sent for glucose tolerance tests to confirm their glycemic status. Patients with abnormal glucose tolerance values were further referred to a physician for the confirmation of diabetes. RESULTS: Diabetes was detected in 19.1% of the survey population, of which 3.9% of patients belonged to group 1, 7.8% of patients belonged to group 2, and 7.3% of patients belonged to group 3. Diabetes was detected in 40.8% of patients with hyperglycemia, of which 8.4% of patients belonged to group 1, 16.8% of patients belonged to group 2, and 15.6% of patients belonged to group 3. A total of 10.11% of the survey population who tested positive for diabetes were females and 8.99% were males. CONCLUSIONS: The use of reagent strips for the estimation of gingival blood glucose seemed to be a suitable option for the screening of an unsuspecting periodontal population for the presence of diabetes; however, additional studies in a larger population are needed to confirm their suitability.

Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: a cross-sectional study.

BACKGROUND: Non-smokers exposed to environmental tobacco smoke (ETS) absorb nicotine and other compounds just as smokers do, and as the exposure to ETS increases, the level of these harmful compounds in the body also increases. The ill effects of ETS range from gingival pigmentation to lung cancer and death. The exposure to ETS is difficult to quantitatively measure and has been approximated by self-reported estimates, primarily of the smoking history of spouses. However, the documentation of gingival pigmentation in non-smokers is meager and has remained contentious. We aimed to assess the effects of ETS from smoker parents on gingival pigmentation in children and young adults and assess the urine cotinine levels in these individuals. METHODS: A total of 153 non-smoking participants with ≥1 smoker parent were randomly selected from the outpatient Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate Research Center, Bangalore, India. These participants were divided into three groups based on age, and the smoking history of parents was established by an interview with participants and parents. The degree of gingival pigmentation of participants was assessed by using the gingival pigmentation index and a standardized digital oral photograph. A urine analysis was conducted to assess levels of cotinine. The κ statistic was performed for interexaminer agreement, and χ(2) and Fisher exact tests were used for statistical analyses. RESULTS: The prevalence of gingival pigmentation in passive smokers was statistically significant (P <0.05). Increased levels of urinary cotinine were observed in all three groups with the highest levels in group 3 (19 to 24 years old). CONCLUSION: This study depicts the effects of ETS on gingival melanin pigmentation.