Immediate autotransplantation of a mandibular premolar with complete roots to a fractured tooth site, using platelet-rich fibrin in an orthodontic patient, report of a case.

Transplantation of one tooth to another site in the same individual can be considered an attractive alternative to dental implants or fixed prostheses. This study reports the treatment results of a 16-year-old female with severe crowding in upper and lower arches and a fractured mandibular premolar with a poor prognosis. The crowding of the lower left quadrant was relieved by the extraction of the first premolar. This extracted tooth with a complete root was transplanted to the right quadrant with the fractured tooth. Platelet-rich fibrin can stimulate and accelerate periodontal healing. The platelet concentrate of this patient was prepared and applied to the socket wall at the time of surgery. The acceptable occlusion and the excellent 4-year prognosis of the transplanted tooth are presented.

Diagnostic value of an increase in central venous pressure during SBT for prediction of weaning failure in mechanically ventilated patients: A cross-sectional study.

Background: Timely and successful extubation is an essential step forward in clinical practice to minimize complications of mechanical ventilation and unsuccessful weaning processes. Thus, research into predictive factors of weaning outcome to optimize spontaneous breathing trial (SBT) precision before extubation is critical in intensive care practices. In this study, we aimed to investigate the predictive factors of the weaning outcome before and during SBT in mechanically ventilated patients. Methods: In this cross-sectional study, 159 mechanically ventilated patients who were eligible for SBT were enrolled. Of these patients, 140 had successful extubation, whereas the remainder failed. Each patient's PaCO2 and PaO2 levels, respiratory rate (RR), SpO2, mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) values at the start of SBT, 3 min later, and at the end of SBT were measured. These values, along with the patients' clinical characteristics, were then investigated to determine if there was any correlation between these variables and the weaning outcome. Results: Our analysis revealed that increase in CVP, independent of hemoglobin (Hb) concentration, PaO2, SpO2, duration of mechanical ventilation (MV), length of intensive care unit (ICU) stay, and SBT process, as well as underlying disease, was positively correlated with extubation/weaning failure. While age, gender, vital signs (MAP, RR, and HR), sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation (APACHE) scores had no significant correlation with patients' extubation outcomes. Conclusion: According to our findings, integrating CVP assessment into SBT besides routine indices measurement and monitoring can be considered for the prediction of weaning outcome in critically ill mechanically ventilated patients.

Therapeutic and anti-inflammatory effects of baricitinib on mortality, ICU transfer, clinical improvement, and CRS-related laboratory parameters of hospitalized patients with moderate to severe COVID-19 pneumonia: a systematic review and meta-analysis.

BACKGROUND: Due to the high incidence and mortality of the worldwide COVID-19 pandemic, beneficial effects of effective antiviral and anti-inflammatory drugs used in other diseases, especially rheumatic diseases, were observed in the treatment of COVID-19. METHODS: Clinical and laboratory parameters of eight included cohort studies and five Randomized Control Trials between the baricitinib group and the control group were analyzed on the first day of admission and days 7, 14, and 28 during hospitalization. RESULTS: According to the meta-analysis result of eight included cohort studies with 2088 patients, the Pooled Risk Ratios were 0.46 (P < 0.001) for mortality, 6.14 (P < 0.001) for hospital discharge, and the mean differences of 76.78 (P < 0.001) for PaO2/FiO2 ratio was -47.32 (P = 0.02) for CRP, in the baricitinib group vs. control group on the seventh or fourteenth day of the treatment compared to the first day. Based on the meta-analysis of five RCT studies with 11,825 patients, the pooled RR was 0.84 (P = 0.001) for mortality and 1.07 (P = 0.014) for patients' recovery. The mean differences were -0.80 (P < 0.001) for hospitalization days, -0.51(P = 0.33) for time to recovery in the baricitinib group vs. control group. CONCLUSIONS: Baricitinib prescription is strongly recommended in moderate to severe COVID-19.

Design and Production An Effective Bispecific Tandem Chimeric Antigen Receptor on T Cells against CD123 and Folate Receptor ß towards B-Acute Myeloid Leukaemia Blasts.

OBJECTIVE: The clinical studies of acute myeloid leukaemia (AML) revealed that antigen escaping variants cause cancer recurrence even after treatment with chimeric antigen receptor (CAR)-T cells that target a single tumour antigen. Due to the heterogeneous expression of antigens on leukaemia blasts, we hypothesized that a novel bispecific CAR, directed to the folate receptor beta (FRß)-binding single-chain variable fragment (scFv) and an IL3α-binding receptor (CD123) that has more expression in AML blasts, can decrease CAR-T cell exhaustion and increase the efficacy of CAR-T cells to prevent antigen escaping and consequent recurrence of AML. MATERIALS AND METHODS: In this experimental study, the survival, proliferation, and cytolysis of CAR-T cells remains suboptimal even with a costimulatory endodomain. Hence, we designed and constructed a tandem CAR that joins an FRß and CD123 in the second generation retroviral vector to generate a bispecific tandem CAR (TanCAR-T cell). RESULTS: TanCAR FRß-CD123 T cells showed distinct binding to FRß or CD123 expressing cells. They could lyse the leukaemia cell lines (66.1 ± 11%) comparable to the single CAR-T cells against these determinants. TanCAR FRß- CD123 T cells simultaneously engaged FRß and CD123, which promoted T cell activation in targeting and lysis of the examined leukaemia cell lines. TanCAR-T cell significantly induced interferon gamma (IFNγ) and interleukin 2 (IL-2) production more than single CAR-T cells, which produced a synergistic enhancement of TanCAR FRß-CD123 T cell function when dual antigens faced simultaneously. CONCLUSION: Dual-specific TanCAR FRß-CD123 T cells showed therapeutic potential to improve AML control by coengaging FRß and CD123 molecules in a robust, divalent immune system. This strategy may be a useful therapeutic approach in patients with relapsed B-cell malignancies.

Management of Critically Ill Patients with COVID-19: What We Learned and What We Do.

There are many unknown questions and puzzle pieces that should describe the clinical course of COVID-19 and its complications, especially ARDS. We provide the initial immediate surge response to allow every patient in need of an ICU bed to receive one. Till our knowledge is improved, the most important intervention in the treatment of critically ill patients with COVID-19 seems to be the level of standard care and appropriate and early diagnosis and treatment. It seems that each center should have its protocol on the management of critically ill COVID-19 patients regarding prevention, diagnosis, and treatment. This treatment should now be performed regardless of the reason which lies behind the pathophysiology of this disease, which is yet unknown. In this report, we share our experience in the management of critically ill COVID-19 patients during the 2 months in our intensive care unit.

Red Cell Distribution Width as a Novel Prognostic Marker in Multiple Clinical Studies.

Red cell distribution width (RDW), which is a quantitative method applied for the measurement of anisocytosis, is the most reliable and inexpensive method for differentiation of iron deficiency anemia and thalassemia trait. An increase in its rate reflects a great heterogeneity in the size of red blood cells (RBCs). Recent studies have shown a significant relationship between RDW and the risk of morbidity and mortality in patients with multiple diseases. A strong association is established between changes in RDW and the risk of adverse outcome in patients with heart failure in multiple studies. In this review, we try to focus on the association and correlation between the increase in RDW and different outcomes of common diseases that may be related to RDW and based on the results of various studies, we are trying to introduce RDW as a diagnostic indicator for these diseases. HOW TO CITE THIS ARTICLE: Yousefi B, Sanaie S, Ghamari AA, Soleimanpour H, Karimian A, Mahmoodpoor A. Red Cell Distribution Width as a Novel Prognostic Marker in Multiple Clinical Studies. Indian J Crit Care Med 2020;24(1):49-54.

Comparing the effect of preparation of the implant sites with piezosurgery and conventional drilling on the stability of implants at 5-months follow-up.

The objective of this study was to compare the effects of preparing for implant site osteotomy with conventional drilling or piezosurgery on the stability of oral implants after a 5 month follow-up period. Thirty patients participated in this randomized clinical trial and received two implants in posterior mandible in bone of the same quality. All surgical procedures were performed by the same surgeon. Implant stability amounts were measured by resonance frequency analysis using the Osstell Mentor device and are reported in the format of implant stability quotient (ISQ) values at baseline and 90 and 150 days after surgery. All implants were well osseointegrated. Differences in ISQ levels were statistically significant in the piezosurgery group at all time intervals, whereas those in the conventional drill group were not significant as analyzed by analysis of variance. The significance of differences between the two groups in each time interval was assessed with Student's t test. In the second interval (90 days), there were statistically significant differences in ISQ levels between the two groups at the buccal, lingual side of implants and mean of two measurements, but at baseline and 150 days, there were no significant differences between these techniques. The early increase of ISQ values in piezoelectric sites shows that piezosurgery is a less traumatic bone osteotomy method with a shorter inflammatory phase and little resorption compared with sites prepared by conventional drilling. ISQ values of up to 60-65 at the time of insertion of the implant predict a good prognosis for immediate implant loading. In this study, the ISQ values were almost always higher than this, offering the safe condition for immediate or early loading protocols after the piezoelectric method of implant site osteotomy. These results may increase predictability of immediate-loading procedure in oral implantology.

Flow Cytometry of CD64, HLA-DR, CD25, and TLRs for Diagnosis and Prognosis of Sepsis in Critically Ill Patients Admitted to the Intensive Care Unit: A Review Article.

Sepsis is an important health problem with a high burden on health systems. Finding new aspects of immune system function in sepsis showed a new role for flow cytometry in the diagnosis of sepsis. We made a review on the role of CD64, HLA-DR, CD25, and TLRs as more useful flow cytometric tools in diagnosing sepsis, both in adults, and neonates. According to our results, we concluded that for diagnosis and treatment of the septic, flow cytometry can play an important role so that it can be used as a novel method in individualized treatment of septic patients based on their immune system situation.

Efficacy of Application of Platelet-Rich Fibrin for Improvement of Implant Stability: A Clinical Trial.

Use of platelet concentrates to increase implant stability, due to their regenerative potential, has recently attracted the attention of researchers. This study aimed to assess the effect of platelet-rich fibrin (PRF) on dental implant stability. This clinical trial evaluated 10 patients who received 50 dental implants. Each patient received at least two implants. Half of the implants were placed in the sockets along with PRF while the remaining half were inserted conventionally without PRF. Implant stability was measured by resonance frequency analysis on the day of surgery (T1), at one week (T2), and at one month (T3). At the end of the first week (T2), the mean implant stability quotient (ISQ) was 59.85 ± 5.32 in the PRF group and 55.99 ± 3.39 in the non-PRF group. Compared to baseline, the ISQ increased in the PRF group by 0.12 ± 0.47 (P = 1.000) and decreased in the non-PRF group by 2.42 ± 0.36 (P < 0.001). At one month postoperatively, ISQ significantly increased by 6.89 ± 0.96 in the PRF group and by 4.82 ± 0.92 in the non-PRF group compared to baseline (P < 0.001). Application of PRF in the implant osteotomy site can prevent or minimize primary reductions in implant stability and seems to enhance the process of osseointegration.

Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture.

BACKGROUND: Outpatient management is appropriate for chronic pilonidal sinuses. Even though there are different surgical treatments for pilonidal sinuses, the outcome may not be uniformly satisfactory. The aim of this paper was to examine the ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. METHODS: We present our experience with outpatient management of asymptomatic chronic pilonidal disease. We prospectively studied patients presenting with pilonidal disease from Mar. 20, 2005, to Mar. 20, 2008. All were managed as outpatients. We reviewed presentation, treatment, healing, time off work and recurrences. RESULTS: In all, 150 patients (131 men and 19 women) with chronic pilonidal sinuses underwent ambulatory plain lateral excision and primary repair during the study period. The mean age of patients was 22.1 years. The mean duration of surgery was 18.4 minutes. No general complications occurred. Local complications consisted of 3 wound infections and 4 wound hematomas. No sinus recurrence occurred. The healing rate was fast in all patients. CONCLUSION: Advantages of ambulatory plain lateral excision and primary repair include immediate treatment, minimal pain and a quick return to normal activities. This method is a simple and effective procedure in the treatment of uncomplicated pilonidal sinuses.