Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator.

Aim: To investigate the potential effectiveness of "medical clowns" on preoperative, intraoperative, and postoperative anxiety of children undergoing various dental treatments and also its effect on the operator's stress levels in a dental setup. Materials and methods: A total of 170 pediatric patients, aged 4-8 years, indicated for preventive therapy, extractions, restorative, and endodontics were included and divided into two groups [group I-audiovisual (A-V) aids; group II-medical clowns], group of 85 patients each after recording Modified yale preoperative scale. Both pre- and postoperatively, Frankl's behavior score was recorded for each patient. During treatment, the face, legs, activity, cry, consolability (FLACC) pain scale, and dental operator's stress level were recorded. Results: Intervention of medical clowns positively influenced children during dental treatment by increasing their pain threshold. The majority of children showed positive Frankl rating scales after dental treatment. Also, the operator's stress was significantly reduced, which led to enhanced treatment outcomes. Conclusion: Humor yields the power of healing, distracts pediatric patients, reduces their anxiety, and alleviates their pain, conferring the patients with a sense of laughter, creativity, and care.Therefore, medical clowns in pediatric dentistry can prove to be serviceable and valuable as a nonpharmacological approach to behavior management. How to cite this article: Aggarwal P, Mathur S, Chopra R. Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator. Int J Clin Pediatr Dent 2024;17(1):59-66.

Unveiling the Silent Intruder: H. pylori's Hidden Link to Ischemic Heart Disease.

Cardiovascular disease is the leading cause of death. In addition to the well-known risk factors associated with cardiovascular disease, such as age, diabetes mellitus, smoking, hypertension, and obesity, there has been a growing concern regarding cardiac complications stemming from the Gram-negative bacteria Helicobacter pylori. While H. pylori is most commonly associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric lymphoma, it has also been implicated in extra gastric manifestations, encompassing cardiac, neurologic, ocular, and dermatologic issues. Key virulent factors for coronary artery disease include the vacuolating cytotoxin gene A and the cytotoxin-associated gene A. The most likely pathogenic mechanism of the relationship between H. pylori and coronary artery disease is initiating a chronic inflammatory process associated with infection and the modifications of classic risk factors. These alterations lead to the creation of prothrombotic and procoagulant environments. Here, we review the cardiac manifestations of H. pylori and the underlying pathophysiological mechanisms.

Lab testing overload: a comprehensive analysis of overutilization in hospital-based settings.

Overuse of laboratory tests has been a growing problem in the inpatient hospital setting for years, which adds to the rising cost of care. Various factors come into play, such as clinical routines, lack of cost transparency, and the convenience of electronic health record-based ordering. The financial ramifications of the overuse are significant, as lab costs drive most medical decisions. Eliminating unnecessary testing with clinical decision support and best practices is associated with marked cost savings, improved outcomes, and decreased patient distress. The excessive use of laboratory tests highly affects patients, resulting in hospital-induced anemia, low patient satisfaction, and poor outcomes. Tackling lab overuse requires a multifaceted approach that includes education, technology, and policy changes. In the era of precision healthcare, optimizing test utilization can reduce costs, decrease waste, and improve patient care.

Pulmonary Artery Hypertension in Transfusion-Dependent Thalassemia.

OBJECTIVE: Patients with transfusion-dependent thalassemia (TDT) are at risk of developing pulmonary artery hypertension (PAH) due to chronic hemolysis, iron overload, hypercoagulability and splenectomy. The objective of the study was to assess the prevalence and predictors of PAH in patients with TDT. METHODS: Patients aged 6-18 years with TDT were included. 2D-echocardiography was done to measure the pulmonary artery systolic pressure (PASP) and left ventricular ejection fraction (LVEF). T2* MRI was done to evaluate cardiac iron overload. N-terminal-pro brain natriuretic peptide (NT-pro BNP) level was also assessed. RESULTS: Out of 61 participants, PAH was noted in 19 (31.6%). Mean (SD) age of the patients with PAH and without PAH was 12.2 (3.8) and 9.6 (3.5) years, respectively (P = 0.016). Five of 19 patients with PAH (26.3%) had undergone splenectomy as against 5 of 41 patients without PAH (12.2%) (P = 0.17). Years since splenectomy was higher in the PAH group. Mean (SD) NT-Pro BNP levels were also higher in patients with PAH [63.80 (25.89) vs 41.97 (23.95), P = 0.01]. Significantly higher number of patients with PAH had cardiac T2* value of < 10 ms (P = 0.04). Age (OR 4.11; 95% CI 1.46-8.77), years since splenectomy (OR 3.24; 95% CI 1.30-7.86), NT-Pro BNP levels (OR 4.43; 95% CI 2.14-9.61) and cardiac T2* MRI (OR 2.46; 95% CI 2.18-6.90) values were predictors of PAH in patients with TDT. CONCLUSION: PAH was observed in 31.6% of patients, with older age and years since splenectomy being important risk factors. NT-Pro BNP can be used as screening test for detecting PAH.

Age-Related Orthostatic Hypotension: A Comprehensive Analysis of Prevalence, Mechanisms, and Management in the Geriatric Population.

Geriatric patients frequently encounter orthostatic hypotension (OH), a multifaceted condition characterized by a significant drop in blood pressure upon assuming an upright position. As the elderly population is particularly susceptible to OH, our review endeavors to comprehensively explore the complex nature of this condition and various factors contributing to its development. We investigate the impact of comorbidities, polypharmacy, age-related physiological changes, and autonomic dysfunction in the pathogenesis of OH. Geriatric patients with OH are faced with an elevated risk of falls, syncope, a decline in their overall quality of life, and hence increased mortality. These implications require careful consideration, necessitating a thorough examination of therapeutic strategies. We evaluate various pharmaceutical and nonpharmacological therapies, delving into the effectiveness and safety of each approach in managing OH within geriatric populations. We explore the role of pharmacotherapy in alleviating symptoms and mitigating OH-related complications, as well as the potential benefits of volume expansion techniques to augment blood volume and stabilize blood pressure. We place particular emphasis on the significance of lifestyle changes and nonpharmacological interventions in enhancing OH management among the elderly. These interventions encompass dietary modifications, regular physical activity, and postural training, all tailored to the unique needs of the individual patient. To optimize outcomes and ensure patient safety, we underscore the importance of individualized treatment plans that take into account the geriatric patient's overall health status, existing comorbidities, and potential interactions with other medications. This review aims to improve clinical practice and patient outcomes by advocating for early detection, properly tailored management, and targeted interventions to address OH in the elderly population. By raising awareness of OH's prevalence and complexities among healthcare professionals, we hope to foster a comprehensive understanding of OH and contribute to the overall wellness and quality of life of this vulnerable demographic.

Disorders of sexual development: structured radiological reporting and practical approach.

Disorders of sexual development (DSD) comprise a complex group of conditions with varied clinical presentations, such as atypical genitalia, non-palpable testes, primary amenorrhea, or infertility. Besides being associated with other congenital anomalies, DSDs bear substantial ethical issues regarding assigning the sex of rearing to the child and future fertility options. Establishing the correct diagnosis is essential for the appropriate management of such cases. Various imaging modalities, such as ultrasonography, genitography, and MRI, when complemented with detailed clinical evaluation and karyotyping, are the key to diagnosing the condition. This article attempts to present a concise approach to various patterns of DSD, which will aid radiologists to solve these diagnostic dilemmas.

Comparison of micromorphological changes in enamel using SEM analysis after conventional and erbium, chromium:yttrium, scandium, gallium, and garnet hard-tissue laser fissurotomy: An in vitro study.

Background: Well articulated by John Knowles - "Everything has to evolve or else it perishes." With the paradigm shift of emphasis toward the prevention of dental caries, it has been proven that laser irradiation protects against both caries initiation and caries progression. Aim: The aim of the study was to evaluate and compare the micromorphology of caries-free extracted premolars using a Scanning electron microscope (SEM) after fissurotomy by conventional fissurotomy bur and erbium, chromium: yttrium, scandium, gallium, and garnet (ER, CR: YSGG) hard-tissue laser. Methodology: Sixty caries-free premolars extracted atraumatically for orthodontic treatment were included in the study. The samples were divided into two groups randomly (Group 1: fissurotomy by bur, n = 30, and Group 2: fissurotomy by hard-tissue laser, n = 30). Each sample was further divided into halves from the occlusal surface wherein one-half of the occlusal surface received fissurotomy procedure and the other half was control. Samples were analyzed by scanning electron microscopy (SEM) for micromorphological changes. Results: Profile image of control samples revealed the disorganization of enamel surface at the junction of fissures forming a heterogeneous tissue and agglomeration of enamel with deep pit and fissure. On the contrary, the image of experimented samples (with laser fissurotomy) showed smooth enamel surface and homogeneous enamel subsurface with wider pit and fissure owing to self-cleansing ability. Conclusion: On the grounds of the present study results, it could be concluded that the intervention of ER, CR: YSGG hard-tissue laser possesses self-cleansable pit and fissures for caries prevention and has the potential to irradicate the smear layer entirely for superior attachment of remineralizing agents.

Profile of Hemoglobin D (HbD) Disease in Eastern Uttar Pradesh: A Single-Center Experience.

Hemoglobin D (HbD) disease was identified in 31 samples from 15 families out of the 2560 samples (1.20%) analyzed for variant Hbs. There were five patients with HbSD disease, three with HbDß disease, and the remaining 23 were HbD trait. Patients with HbSD disease had a variable clinical presentation with a pair of siblings being transfusion dependent although the age of first blood transfusion was different in the two patients. The one with high HbF started transfusions much later. None of them had symptoms related to sickling. Patients with HbDß also had a variable presentation with only one of them being transfusion-dependent. All patients with HbSD and HbDß disease were started on hydroxyurea. Persons with HbD trait were asymptomatic with half of them having normal Hb. The remaining half had mild microcytic hypochromic anemia. All the families with HbD disease were natives of this region and not migrants from other states. Although HbD disease has not been reported from this region in previous studies, clinicians need to be aware of this entity as it can give rise to symptomatic disease in some cases if associated with beta-thalassemia or sickle cell trait.

Evaluation of biphasic hydroxapatite and ß-tricalcium phosphate as a bone graft material in the treatment of periodontal vertical bony defects - A clinical and digital radiological measurement study.

Aims and Objective: The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and ß-tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. Material and Methods: Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and ß-tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. Results: Overall, by the end of 6 months, biphasic hydroxyapatite and ß-tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow-up. In the biphasic hydroxyapatite and ß-tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. Conclusion: In the present study, biphasic hydroxyapatite and ß-tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.

Effect of Stainless-Steel Crown and Preformed Zirconia Crown on the Periodontal Health of Endodontically Treated Primary Molars Correlating with IL-1ß: An In Vivo Study.

OBJECTIVE: The purpose of this study was to evaluate the effect of different crown materials on the interleukinone beta (IL-1ß) content of the gingival crevicular fluid and to study which crown material causes the highest inflammation on the marginal gingiva on a biochemical basis in pediatric patients. STUDY DESIGN: Twenty patients in the age group of 4-8 years with endodontically treated primary molars indicated for crown placement were selected for the study which was further divided into 3 groups for sample consideration: group 1-stainless steel crown, group 2-preformed zirconia crown, and group 3- control group (primary second molar). All assay procedures were carried out and the results of the collected samples were calculated using the ELISA-AID TM technique. RESULTS: On mean comparison among the groups using ANOVA oneway test, P-value turns out to be highly significant, on mean comparison using Tukey's HSD post-hoc test, The p-value was 0.000 ,0.000 ,0.193 on comparing group 1 with group 2, group 1 with group 3, group 2 with group 3 respectively. CONCLUSION: Preformed zirconia crown can be a relative replacement of SSC in primary molars as it causes comparatively less inflammation and with an advantage of esthetics.

CT-Based Definition and Structured Reporting of Abdominal Lymph Node Stations.

Background Meticulous evaluation of abdominal lymph nodes on computed tomography (CT) is a fundamental task in radiological practice especially in oncological reporting. Although various reporting systems exist to define abdominal nodal stations for malignancies of individual abdominal organs, a complete and uniform framework for radiological reporting of abdominal lymph nodes does not exist in the literature. Purpose The goal of this review was to provide a step-wise reporting template and precise definitions of the radiological anatomy of abdominal lymph nodes and to generate a CT-based illustration of the lymph node stations of the abdomen. Conclusion This CT-based illustration and reporting template will help the radiologists to aptly describe the extent of the lymph nodal diseases and will help in comparison with posttherapy scans.

Unravelling the Biology of EhActo as the First Cofilin From Entamoeba histolytica.

Actin-depolymerising factors (ADF) are a known family of proteins that regulate actin dynamics. Actin regulation is critical for primitive eukaryotes since it drives their key cellular processes. Entamoeba histolytica, a protist human pathogen harbours eleven proteins within this family, however, with no actin depolymerising protein reported to date. We present here the NMR model of EhActo, the first Cofilin from E. histolytica that severs actin filaments and also participates in cellular events like phagocytosis and pseudopod formation. The model typically represents the ADF-homology domain compared to other cofilins. Uniquely, EhActo lacks the critical Serine3 residue present in all known actophorins mediating its phospho-regulation. The second mode of regulation that cofilin's are subjected to is via their interaction with 14-3-3 proteins through the phosphorylated Serine residue and a consensus binding motif. We found a unique interaction between EhActo and 14-3-3 without the presence of the consensus motif or the phosphorylated Serine. These interesting results present unexplored newer mechanisms functional in this pathogen to regulate actophorin. Through our structural and biochemical studies we have deciphered the mechanism of action of EhActo, implicating its role in amoebic biology.

Comparison of the effects of calcium channel blockers plus iron chelation therapy versus chelation therapy only on iron overload in children and young adults with transfusion-dependent thalassemia: A randomized double-blind placebo-controlled trial.

BACKGROUND: Myocardial iron deposition is a significant cause of morbidity and mortality in patients with transfusion-dependent thalassemia (TDT). Amlodipine, L-type calcium channel blocker with regular chelation therapy may reduce myocardial iron overload. Lack of randomized trials prompted this study to assess the effect of calcium channel blocker (amlodipine) in combination with iron chelation therapy on iron overload in patients with TDT. METHODS: Sixty-four eligible patients were randomized to receive either amlodipine and chelation (group A) or chelation alone (group B) in double-blind placebo-controlled trial. Myocardial iron concentration (MIC) using T2* magnetic resonance imaging (MRI), liver iron concentration (LIC), left ventricular ejection fraction (LVEF), and serum ferritin were measured at baseline and 12 months. RESULTS: In the amlodipine group, mean cardiac T2* value significantly increased from 18.11 ± 8.47 to 22.15 ± 7.61 (p = .002) at 12 months, whereas in control group, there was a nonsignificant increase (p = .62) in cardiac T2* value from 19.50 ± 8.84 to 20.03 ± 9.07. There was a significant decrease in MRI-derived MIC in the amlodipine group compared to control group (1.93 ± 1.61 to 1.29 ± 0.90, p = .01). Changes in the LVEF (p = .45), MRI-derived LIC (p = .09), and serum ferritin (p = .81) were not significant between the two groups. CONCLUSION: Amlodipine is safe and when combined with chelation therapy appears to be more effective in reducing cardiac iron overload than chelation only in children and young adults with TDT.

Alterations in Bone Turnover during Chemotherapy in Children with Acute Lymphoblastic Leukemia.

Background Disturbances of bone metabolism frequently occur in children with acute lymphoblastic leukemia (ALL), leading to increased risk of osteopenia and osteoporosis at diagnosis, during and after completion of chemotherapy. The present study was performed to evaluate alteration in bone mineral metabolism in children with ALL during chemotherapy. Method Fifty newly diagnosed patients with ALL in the age group of 2 to 14 years were included. Relapsed and refractory cases were excluded. Enrolled children were stratified into standard and high risk according to National Cancer Institute criteria. Quantitative analysis of bone resorptive marker carboxyl-terminal telopeptide of human type 1 collagen (ICTP) was assessed at baseline and 3 months after chemotherapy by the sandwich enzyme-linked immunosorbent assay technique. Results Of 50 patients enrolled, 21 were standard and 29 were high risk. The mean age was 7.75 ± 4.0 years and the male-to-female ratio was 3.5:1. ICTP levels were analyzed in 44 patients, of which 37 (84%) showed significantly increased levels. The mean ICTP level in patients at diagnosis and controls was 1.78 ± 1.39 and 0.96 ± 0.32 µg/L, respectively ( p = 0.001). The mean ICTP level at 3 months after chemotherapy increased to 3.55 ± 1.40 µg/L ( p = 0.000). It was significantly increased in males ( p = 0.000) and in B cell ALL group ( p = 0.000) in comparison to females and T cell group. Both standard and high risk groups were equally affected ( p = 0.000). On multivariate analysis, no single risk factor could be identified. Conclusion The marker of bone resorption (ICTP) in children with ALL was increased at diagnosis, which further increased during chemotherapy. The disease itself and the intensive chemotherapy both contributed to the increased levels.