Exploring Risk Factors and Perinatal Outcomes of Preterm Birth in a Tertiary Care Hospital: A Comprehensive Analysis.

Background Preterm birth before 37 weeks of gestation is a global public health challenge, particularly in India, where the prevalence varies regionally. Understanding risk factors, such as maternal age and complications like hypertensive disorders, is vital. India's diverse healthcare landscape and regional disparities further complicate this issue. Preterm infants face increased mortality and morbidity risks like respiratory distress and intraventricular hemorrhage. This study in a tertiary care hospital aimed to analyze risk factors, assess perinatal outcomes, and contribute to the understanding of preterm birth in this complex context, providing valuable insights for maternal and child health strategies. Methods This retrospective cohort study was conducted at the Venkateshwara Institute of Medical Science, Rajabpur, over one year, extracting data from electronic health records. The study aimed to analyze risk factors associated with preterm delivery and assess perinatal outcomes. The study included diverse pregnancies, both singleton and multiple gestations, and employed sample size calculations to ensure statistical validity. Trained medical personnel collected extensive data on maternal characteristics, obstetric history, antenatal care, perinatal outcomes, and mode of delivery. Statistical analysis, utilizing SPSS (IBM, Chicago, USA), involved descriptive statistics, comparative analysis, chi-square tests, t-tests, Mann-Whitney U tests, and multivariate logistic regression models. Findings with a p-value <0.05 were considered significant. Results The study included 2042 deliveries, with a preterm birth prevalence of 14.2%. Multiparous women had higher preterm birth rates than primigravida (72.92% vs. 27.08%). Maternal age, history of preterm delivery, hypertensive disorders, inadequate antenatal care compliance, previous cesarean section, multiple gestations, antepartum hemorrhage (APH), polyhydramnios, oligohydramnios, and premature rupture of membranes (PROM) were significantly associated with preterm birth. Apgar scores at one minute and five minutes, neonatal complications, and mortality rates were notably worse among preterm births. Vaginal delivery rates were significantly lower in the preterm group (36.3%) compared to full-term deliveries (48.8%), with a higher rate of emergency cesarean sections (19.7% vs. 10.8%). Conclusion This study provides valuable insights into the risk factors and perinatal outcomes of preterm delivery at a tertiary care hospital, with precise values illustrating the extent of associations. The findings such as history of preterm delivery, hypertensive disorders, and inadequate antenatal care compliance as the most commonly associated conditions with preterm birth and management of such associated conditions may help reduce the rate of premature birth.

Utility of CT Scan in Detecting Bladder Involvement Among Patients With Cervical Carcinoma.

Background Cervical cancer is a widespread health issue in India, particularly affecting women as the second most common cancer. The burden of cervical cancer in the country necessitates accurate staging for treatment optimization. The revised International Federation of Gynecology and Obstetrics (FIGO) staging system is vital for this purpose, emphasizing the extent of parametrial and pelvic sidewall involvement. Cervical cancer's propensity to infiltrate neighboring pelvic organs, including the bladder, necessitates precise staging. In India, traditional methods like cystoscopy have been relied upon, but they have limitations. Recent advancements in medical imaging, notably the increased use of computed tomography (CT) scans, provide a non-invasive alternative for staging and evaluating bladder involvement. This study aimed to evaluate the utility and accuracy of CT scans in assessing bladder involvement. Methods This cross-sectional study examined 127 newly diagnosed cervical carcinoma cases in women over a two-year period from August 2021 to July 2023. Patients underwent CT scans (plain) and cystoscopy, and bladder involvement was determined following the revised FIGO staging. Data collected comprised patient demographics, medical history, clinical symptoms, and FIGO staging. Cystoscopy was performed using an Olympus CYF-5 flexible cystoscope, and CT scans utilized a 64-slice multidetector CT scanner. Radiological reports detailed primary tumor characteristics and proximity to the bladder. Statistical analysis encompassed descriptive statistics, and calculation of sensitivity, specificity, positive predictive value, and negative predictive value for CT scans in comparison to cystoscopy. Statistical significance was considered at p < 0.05. Results In our study, the mean participant age was 45.3 years, with 61.4% falling in the 40-60 years age group. Socioeconomic status (SES) varied, with 37.8% classified as low SES, 48.8% as middle SES, and 13.4% as high SES. Parity data showed that 76.4% had three or more pregnancies. Among presenting symptoms, abnormal vaginal bleeding (65.4%) was the most prevalent, and squamous cell carcinoma (78.7%) was the predominant histological type. The prevalence of bladder involvement was 9.4% by cystoscopy and 30.7% by CT scans. CT scan demonstrated a high sensitivity (100%) but lower specificity (76.52%), with 78.80% overall accuracy. Conclusion A combined approach, using CT scans as a screening tool and cystoscopy as a confirmatory method, could provide the most comprehensive and reliable assessment of bladder involvement in cervical carcinoma patients, ultimately contributing to improved patient care and management.

Role of Selective Serotonin Reuptake Inhibitors in Prognosis Dental Implants: A Retrospective Study.

BACKGROUND: Many recent research shows that antidepressants interfere with the osseointegration of implants. The main purpose of this study was to determine the association between selective serotonin reuptake inhibitors (SSRI) and dental implant failure. MATERIALS AND METHODOLOGY: A retrospective study consisted of 410 patients (720 dental implants). Patients' records were used to retrieve the history of SSRI use and medication. The study consists of two groups. Group I (SSRI users) consisted of 128 patients (245 dental implants) patients, whereas Group II (non-SSRI users) was formed by 282 patients (475 dental implants). The implant failure rate was evaluated and statistically examined using the Chi-square test. RESULTS: Group I had 30 implant failures with 13 (12%) males and 14 (11.8%) females, whereas Group II had 28 implant failures with 12 (6.3%) males and 16 (5.6%) females. In Group I, 26% of the implants failed in the age group >50 years, whereas it was 10.4% in Group II. However, in the age group <50 years, it was 6% and 4.2% Groups I and II, respectively. Group I shows that out of 40 implants in diabetic patients, 12 had failure, whereas in Group II, out of 32 implants placed in diabetics, 7 had failure. In smokers, 48% of the implants failed in Group I, and 29% in group II. In non-smokers the failure was seen in 7.7% cases in Group I and 2.1% cases in Group II. The difference was statistically significant (P < 0.05). CONCLUSION: The usage of SSRIs is associated with an increased rate of implant failure. It has a deleterious effect on bone remodeling and leads to excessive osteoporosis.

Evaluation of Healing of Periapical Tissue in Permanent Incisors with Open Apices after Unintentional Extrusion of Mineral Trioxide Aggregate - A Retrospective Study.

AIM: The aim of the present study was to retrospectively assess the healing of periapical lesions in permanent central incisors with open apices after unintentional extrusion of mineral trioxide aggregate (MTA). MATERIALS AND METHODS: The clinical and radiographic records of 75 maxillary permanent central teeth treated by MTA apexification were evaluated. Teeth with unintentionally extruded MTA formed the study group (Group 1, n = 28), whereas the teeth with no MTA extrusion formed the control group (Group 2, n = 47). For both the groups, the records were analyzed for a follow-up period of 3 years. RESULTS: Complete healing (CH) was observed in 25 teeth in the study group, whereas all the teeth in the control group showed CH (P > 0.05). Within the study group, 6 teeth (21%) showed CH in the 6th month in Group 1, whereas in the control group, 34 teeth (72.3%) showed CH (P < 0.001). At the 1-year follow-up appointment, 19 teeth (67.8%) showed CH in Group 1, whereas 9 teeth (19.1%) showed the same result in Group 2 (P < 0.001). At the end of the 3-year follow-up period, it was noticed that in 21 (84%) teeth, extruded MTA remained unchanged, whereas it was reduced in 4 (16%) of them (P < 0.001). CONCLUSION: Extrusion of MTA does not have a significant effect on the healing of the periapical lesion. However, it may lead to a delay in the healing of periapical healing. Patients should be informed about the complication and consequences of extruded MTA and should be kept on follow-up to observe periapical healing.

A Retrospective Study to Evaluate Biopsies of Oral and Maxillofacial Lesions.

BACKGROUND: The clinical manifestations of these lesions comprises pain, paresthesia, swelling, drainage, tooth loss, root resorption, and facial deformity. Alteration in oral and maxillofacial (OMF) tissues of the lesions may cause esthetically and functionally unfavourable effects in patients. AIMS AND OBJECTIVES: To determine the frequency of odontogenic cysts, tumors, and other lesions. MATERIALS AND METHODS: Patient's records of histopathological reports from the archives of the Department of Oral and Maxillofacial Pathology were obtained and reviewed over a period of 2 years, and therefore, the lesions were classified into four groups. In cases of recurrent lesions, only the primary diagnosis was considered. The research protocol was approved by the ethical committee of the institution. RESULTS: About 56.4% of males had ameloblastoma, 54.9% of females had cementoma. 59.4% females had giant cell granuloma, 87.5% females had pyogenic granuloma, 77.2% females had osteoma, 65.1% of the female population were belongs to the benign fibro-osseous lesions and 50.2% of females were from fibrous dysplasia in group 3. About 58.8% females had squamous cell carcinoma in group 4. CONCLUSION: To adequately determine the prevalence and incidence rate of OMF lesions, biopsies performed by other specialists such as otolaryngologists and plastic surgeons in OMF regions should also be evaluated.

Evaluation of Preoperative Salivary Cortisol Level in Patients Undergoing Major Maxillofacial Surgery.

AIM: The main purpose of the study was to compare the preoperative salivary cortisol levels 3 days before the major surgery under general anesthesia and to compare it with the patients undergoing extraction under local anesthesia. MATERIALS AND METHODS: Forty-two patients were undergoing major surgery and 42 age- and sex-matched patients undergoing dental extraction were included and their salivary cortisol levels were analyzed before and after the dental procedure. RESULTS: Results showed that there is a significant increase in the mean salivary cortisol concentration after extraction (23.7 ± 9.2) than before extraction (18.9 ± 23.7) in the study group (P = 0.015) as well as in the control group. The comparison between salivary cortisol in the study group before (18.9 ± 23.7) and after (23.7 ± 9.2) surgery was significantly higher than the control group (15.2 ± 5.5) (P = 0.013 and 0.005), respectively. CONCLUSION: We have concluded from this study that the salivary cortisol level shows a significant increase on the day of surgery.

Bacteriophage Therapy for Critical and High-Priority Antibiotic-Resistant Bacteria and Phage Cocktail-Antibiotic Formulation Perspective.

Phage therapy is revolving to address the issues mainly dealing with antibiotic resistance in the pathogenic bacteria. Among the drug-resistant microbial populations, the bacterial species have been categorized as high-priority or critical-priority bacteria. This review summarizes the efficiency and development in phage therapy used against these drug-resistant bacteria in the past few years mainly belonging to the critical- and high-priority list. Phage therapy is more than just an alternative to antibiotics as it not only kills the target microbial population directly but also leads to the chemical and physical modifications in bacterial cell structures. These phage-mediated modifications in the bacterial cell may make them antibiotic sensitive. Application of phage therapy in antibiotic-resistant foodborne bacteria and possible modulation in gut microbes has also been explored. Further, the phage cocktail antibiotic formulation, containing more than one type of phage with antibiotics, has also been discussed.

Perception and practice of placebo use among physicians in Mangalore.

BACKGROUND: Placebo use falls under two contexts: clinical care and research. In today's pharmacological era where treatment is available for almost all illnesses, there exists a lot of questions about the perceived efficacy and usage of placebos. This study focuses on assessing the knowledge, attitude, and practice of placebo use in clinical medicine. This study also aimed to pay attention to the ethical dimensions of using a placebo in clinical practice. SUBJECTS AND METHODS: A cross-sectional study was conducted among 86 physicians in five hospitals and various private clinics in Mangalore, India, using a self-administered questionnaire. RESULTS: About 72% of physicians were found to be prescribing placebos. Vitamins were the most commonly prescribed placebos. Pure placebos were prescribed by 69.4% and impure placebos by 83.9% of physicians. Pure placebos were deemed acceptable by 70.9% of physicians if used for their psychological effect, but only 46.5% said the same for impure placebos. Placebos were most commonly prescribed to conform to the patients' requests for some sort of medicine. Among our physicians, 54.8% and 62.8% of placebo prescribers felt that many or some patients would be disappointed if they were to find out that they had been treated with pure or impure placebos, respectively. CONCLUSION: Physicians agreed that placebos were acceptable in some circumstances in clinical practice. Physicians think that the information and training about placebos during their medical studies was insufficient. Perhaps, more time should be put into teaching about placebos during medical studies and proper guidelines should be laid down about placebo usage.

Determining the Neurocognitive Status and the Functional Ability of Patients to Screen for HIV-Associated Neurocognitive Disorder (HAND).

BACKGROUND AND PURPOSE: To adequately evaluate the extent of neurocognitive impairment in patient living with human immunodeficiency virus (PLHIV), a battery of neuropsychological tests is typically administered which are neither cost effective nor time efficient in the outpatient clinical setting. The aim of the study was to assess neurocognitive status and functional ability of people living with HIV and find a brief screening tool to identify those who would benefit from a full diagnostic evaluation. METHODS: The study enrolled 160 PLHIV (80 pre-antiretroviral therapy [ART] and 80 on ART) fulfilling the inclusion and exclusion criteria. Neurocognitive assessment and an assessment of Functional ability was done by using the Montreal Cognitive Assessment (MoCA) and Lawton and Brody Instrumental Activities of Daily Living Scale scale, respectively. RESULTS: The study population consisted of 75.6% males and 24.4% females with mean age of 44±10 years. The overall prevalence of HIV associated neurocognitive disorder (HAND) in the study subjects was 52.5%. Of these, 47.5% had asymptomatic neurocognitive impairment and 5% had minor neurocognitive disorder. In MoCA, the most frequently affected domains were Language (97.6%), visuospatial ability (92.9%) and memory (71.4%). CONCLUSIONS: The prevalence of HAND in both groups were similar suggesting that neurocognitive impairment starts early in HIV infection. Memory and Visuospatial function impairment had the most predictive potential for detecting the presence of HAND. HAND screening is recommended in all PLHIV at enrolment into care. Simple tools like MoCA can be used in busy outpatient settings by healthcare workers to screen for HAND.