Anomalous origin of left coronary artery from the pulmonary artery: Our 30 years of surgical experience and outcomes.

Background: The aim of this study was to evaluate our 30 years of surgical experience and outcomes in management of anomalous origin of left coronary artery from the pulmonary artery with various age groups. Methods: Between March 1992 and August 2022, a total of 21 patients (10 males, 11 females; mean age: 16.3±15.9 years; range, 1 to 64 years) diagnosed with anomalous origin of left coronary artery from the pulmonary artery who underwent successful surgical repair were retrospectively analyzed. An initial diagnosis was made with two-dimensional echocardiography. Cardiac catheterization and angiography were performed in all our patients. Results: The median follow-up was five (range, 1 to 14) years. The mean left ventricular ejection fraction was 43.47±14.30% with associated moderate-to-severe mitral regurgitation in seven (33.33%) patients. Coronary button transfer was performed in 15 (71.42%) patients, Takeuchi repair in four (19.04%) patients, and ligation of anomalous left main coronary artery and ligation with great saphenous venous graft in one (4.76%) patient. There was no mortality. However, two (9.52%) patients had prolonged intensive care unit stay (>7 days). At the final follow-up, the mean left ventricular ejection fraction improved to 57.47±4.97%. Regression of moderate mitral regurgitation was observed in four (66.6%) patients. Conclusion: Preoperative left ventricular function is a major risk factor of perioperative mortality and morbidity. Mitral valve intervention is not warranted concomitantly in patients with moderate mitral regurgitation, if there are no structural lesions. Early diagnosis and meticulous surgical technique can yield excellent results and good long-term outcomes.

Face-Free Chest Detection Using Convolutional Neural Networks for Non-Contact Respiration Monitoring.

Non-contact methods for monitoring respiration face limitations when it comes to selecting the chest region of interest. The semi-automatic method, which requires the user to select the chest region in the first frame, is not suitable for real-time applications. The automatic method, which tracks the face first and then detects the chest region based on the face's position, can be inaccurate if the face is not visible or is rotated. Moreover, using the face region to track the chest region can under-utilize camera pixels since the face is not essential for monitoring respiration. This approach may adversely affect the quality of the respiration signal being measured. To address these issues, we propose a face-free chest detection model based on Convolutional Neural Networks. Our model enhances the measured non-contact respiration signal quality and utilizes more pixels for the chest region alone. In our quantitative study, we demonstrate that our method outperforms traditional methods that require the presence of the face. This approach offers potential benefits for real-time, non-contact respiration monitoring applicationsClinical relevance- This work enhances the performance of non-contact respiration monitoring techniques by precisely detecting the chest region without the need of face in it through a CNN-based model. The use of the CNN-based chest detection model also enhances the real-time monitoring capabilities of non-contact respiration monitoring techniques.

Bronchial epithelial gene expression and interstitial lung abnormalities.

INTRODUCTION: Interstitial lung abnormalities (ILA) often represent early fibrotic changes that can portend a progressive fibrotic phenotype. In particular, the fibrotic subtype of ILA is associated with increased mortality and rapid decline in lung function. Understanding the differential gene expression that occurs in the lungs of participants with fibrotic ILA may provide insight into development of a useful biomarker for early detection and therapeutic targets for progressive pulmonary fibrosis. METHODS: Measures of ILA and gene expression data were available in 213 participants in the Detection of Early Lung Cancer Among Military Personnel (DECAMP1 and DECAMP2) cohorts. ILA was defined using Fleischner Society guidelines and determined by sequential reading of computed tomography (CT) scans. Primary analysis focused on comparing gene expression in ILA with usual interstitial pneumonia (UIP) pattern with those with no ILA. RESULTS: ILA was present in 51 (24%) participants, of which 16 (7%) were subtyped as ILA with a UIP pattern. One gene, pro platelet basic protein (PPBP) and seventeen pathways (e.g. TNF-α signalling) were significantly differentially expressed between those with a probable or definite UIP pattern of ILA compared to those without ILA. 16 of these 17 pathways, but no individual gene, met significance when comparing those with ILA to those without ILA. CONCLUSION: Our study demonstrates that abnormal inflammatory processes are apparent in the bronchial airway gene expression profiles of smokers with and without lung cancer with ILA. Future studies with larger and more diverse populations will be needed to confirm these findings.

Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9-24 Months amidst Pandemics: A Nonrandomized Clinical Trial.

Early childhood caries (ECC) is a multifactorial disease with known etiologic factors and can be very devastating to the oral and general well-being of a child, including psychological impact on a growing child. The irony is among the different factors responsible for milk that is wholesome nutrition, if fed in a wrong pattern, can be the main factor that helps this type of rampant caries spread within no time, leading to pulp exposures and complicating proceedings. Awareness is the mainstay in prevention, and creating it becomes our sole responsibility as a pediatric dentists. A multidisciplinary approach with the involvement of mothers as a main stakeholder in this front becomes a very promising move, so this project is phase two of interprofessional collaboration involving mothers in prevention; the aim of the study is to create awareness among mothers during COVID lockdown so as to prevent ECC in this covid pandemic. Materials and methods: A total of 222 mothers with 9-24 months old children were selected and added to the e-groups. The allocated mothers were given a pretest questionnaire and collected back with a photo of their child's oral health, and anticipatory guidance and in-depth interviewing were given to them. Follow-up is done in 2, 4, and 6 months. Awareness is evaluated by pre- and posttest questionnaires. Reversal of the white spot is evaluated through indices, and progression is noted. Statistical analysis: The data was analyzed using Statistical Package for the Social Sciences 13. Result: Pretest and postquestionnaire analysis were done using the Chi-squared test. The test shows the marked raise in knowledge, attitude, and practice of mothers on their children after postintervention, which was given through motivational interviewing (MI). Conclusion: In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of early childhood caries (ECC). How to cite this article: Aravind A, Sathyaprasad S, Ilyas I. Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9-24 Months amidst Pandemics: A Nonrandomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(2):227-236.

Suspected Interstitial Lung Disease in COPDGene Study.

Rationale: Although interstitial lung abnormalities (ILA), specific patterns of incidentally-detected abnormal density on computed tomography, have been associated with abnormal lung function and increased mortality, it is unclear if a subset with incidental interstitial lung disease (ILD) accounts for these adverse consequences. Objectives: To define the prevalence and risk factors of suspected ILD and assess outcomes. Methods: Suspected ILD was evaluated in the COPDGene (Chronic Obstructive Pulmonary Disease Genetic Epidemiology) study, defined as ILA and at least one additional criterion: definite fibrosis on computed tomography, FVC less than 80% predicted, or DLCO less than 70% predicted. Multivariable linear, longitudinal, and Cox proportional hazards regression models were used to assess associations with St. George's Respiratory Questionnaire, 6-minute-walk test, supplemental oxygen use, respiratory exacerbations, and mortality. Measurements and Main Results: Of 4,361 participants with available data, 239 (5%) had evidence for suspected ILD, whereas 204 (5%) had ILA without suspected ILD. In multivariable analyses, suspected ILD was associated with increased St. George's Respiratory Questionnaire score (mean difference [MD], 3.9 points; 95% confidence interval [CI], 0.6-7.1; P = 0.02), reduced 6-minute-walk test (MD, -35 m; 95% CI, -56 m to -13 m; P = 0.002), greater supplemental oxygen use (odds ratio [OR], 2.3; 95% CI, 1.1-5.1; P = 0.03) and severe respiratory exacerbations (OR, 2.9; 95% CI, 1.1-7.5; P = 0.03), and higher mortality (hazard ratio, 2.4; 95% CI, 1.2-4.6; P = 0.01) compared with ILA without suspected ILD. Risk factors associated with suspected ILD included self-identified Black race (OR, 2.0; 95% CI, 1.1-3.3; P = 0.01) and pack-years smoking history (OR, 1.2; 95% CI, 1.1-1.3; P = 0.0005). Conclusions: Suspected ILD is present in half of those with ILA in COPDGene and is associated with exercise decrements and increased symptoms, supplemental oxygen use, severe respiratory exacerbations, and mortality.

Traction Bronchiectasis/Bronchiolectasis on CT Scans in Relationship to Clinical Outcomes and Mortality: The COPDGene Study.

Background The clinical impact of interstitial lung abnormalities (ILAs) on poor prognosis has been reported in many studies, but risk stratification in ILA will contribute to clinical practice. Purpose To investigate the association of traction bronchiectasis/bronchiolectasis index (TBI) with mortality and clinical outcomes in individuals with ILA by using the COPDGene cohort. Materials and Methods This study was a secondary analysis of prospectively collected data. Chest CT scans of participants with ILA for traction bronchiectasis/bronchiolectasis were evaluated and outcomes were compared with participants without ILA from the COPDGene study (January 2008 to June 2011). TBI was classified as follows: TBI-0, ILA without traction bronchiectasis/bronchiolectasis; TBI-1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; TBI-2, ILA with mild to moderate traction bronchiectasis; and TBI-3, ILA with severe traction bronchiectasis and/or honeycombing. Clinical outcomes and overall survival were compared among the TBI groups and the non-ILA group by using multivariable linear regression model and Cox proportional hazards model, respectively. Results Overall, 5295 participants (median age, 59 years; IQR, 52-66 years; 2779 men) were included, and 582 participants with ILA and 4713 participants without ILA were identified. TBI groups were associated with poorer clinical outcomes such as quality of life scores in the multivariable linear regression model (TBI-0: coefficient, 3.2 [95% CI: 0.6, 5.7; P = .01]; TBI-1: coefficient, 3.3 [95% CI: 1.1, 5.6; P = .003]; TBI-2: coefficient, 7.6 [95% CI: 4.0, 11; P < .001]; TBI-3: coefficient, 32 [95% CI: 17, 48; P < .001]). The multivariable Cox model demonstrated that ILA without traction bronchiectasis (TBI-0-1) and with traction bronchiectasis (TBI-2-3) were associated with shorter overall survival (TBI-0-1: hazard ratio [HR], 1.4 [95% CI: 1.0, 1.9; P = .049]; TBI-2-3: HR, 3.8 [95% CI: 2.6, 5.6; P < .001]). Conclusion Traction bronchiectasis/bronchiolectasis was associated with poorer clinical outcomes compared with the group without interstitial lung abnormalities; TBI-2 and 3 were associated with shorter survival. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Lee and Im in this issue.

Interstitial lung abnormalities are associated with decreased mean telomere length.

BACKGROUND: Interstitial lung abnormalities (ILA) share many features with idiopathic pulmonary fibrosis; however, it is not known if ILA are associated with decreased mean telomere length (MTL). METHODS: Telomere length was measured with quantitative PCR in the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) and Age Gene/Environment Susceptibility Reykjavik (AGES-Reykjavik) cohorts and Southern blot analysis was used in the Framingham Heart Study (FHS). Logistic and linear regression were used to assess the association between ILA and MTL; Cox proportional hazards models were used to assess the association between MTL and mortality. RESULTS: In all three cohorts, ILA were associated with decreased MTL. In the COPDGene and AGES-Reykjavik cohorts, after adjustment there was greater than twofold increase in the odds of ILA when comparing the shortest quartile of telomere length to the longest quartile (OR 2.2, 95% CI 1.5-3.4, p=0.0001, and OR 2.6, 95% CI 1.4-4.9, p=0.003, respectively). In the FHS, those with ILA had shorter telomeres than those without ILA (-767 bp, 95% CI 76-1584 bp, p=0.03). Although decreased MTL was associated with chronic obstructive pulmonary disease (OR 1.3, 95% CI 1.1-1.6, p=0.01) in COPDGene, the effect estimate was less than that noted with ILA. There was no consistent association between MTL and risk of death when comparing the shortest quartile of telomere length in COPDGene and AGES-Reykjavik (HR 0.82, 95% CI 0.4-1.7, p=0.6, and HR 1.2, 95% CI 0.6-2.2, p=0.5, respectively). CONCLUSION: ILA are associated with decreased MTL.

Interstitial Lung Abnormalities, Emphysema, and Spirometry in Smokers.

BACKGROUND: Most pulmonary conditions reduce FVC, but studies of patients with combined pulmonary fibrosis and emphysema demonstrate that reductions in FVC are less than expected when these two conditions coexist clinically. RESEARCH QUESTION: Do interstitial lung abnormalities (ILAs), chest CT imaging findings that may suggest an early stage of pulmonary fibrosis in individuals with undiagnosed disease, affect the association between emphysema and FVC? STUDY DESIGN AND METHODS: Measures of ILA and emphysema were available for 9,579 and 5,277 participants from phases 1 (2007-2011) and 2 (2012-2016) of the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease Study (COPDGene), respectively. ILA were defined by Fleischner Society guidelines. Adjusted linear regression models were used to assess the associations and interactions among ILA, emphysema, measures of spirometry, and lung function. RESULTS: ILA were present in 528 (6%) and 580 (11%) of participants in phases 1 and 2 of COPDGene, respectively. ILA modified the association between emphysema and FVC (P < .0001 for interaction) in both phases. In phase 1, in those without ILA, a 5% increase in emphysema was associated with a reduction in FVC (-110 mL; 95% CI, -121 to -100 mL; P < .0001); however, in those with ILA, it was not (-11 mL; 95% CI, -53 to 31; P = .59). In contrast, no interaction was found between ILA and emphysema on total lung capacity or on diffusing capacity of carbon monoxide. INTERPRETATION: The presence of ILA attenuates the reduction in FVC associated with emphysema.

Assessment of Penetration Depth and Microleakage of Different Pit and Fissure Sealants Using Dye Penetration Method: An In Vitro Study.

AIM AND OBJECTIVE: The aim of this study was to evaluate the depth of penetration as well as the microleakage of three different pit and fissure sealant materials employing the dye penetration method. MATERIALS AND METHODS: Sixty healthy human mandibular premolar teeth without dental caries that were extracted for orthodontic treatment constituted the study samples. These 60 premolar samples were subjected to an equal division (20 in every group) into three groups. Group I: self-adhering flowable composite, group II: flowable nanocomposites, group III: classical pit and fissure sealants. Every sample tooth underwent thermocycling amid 4°C ± 2°C and 60°C ± 2°C for 1,000 cycles. The samples were placed in 1% methylene blue solution for 24 hours to permit diffusion of the dye into probable gaps in between the restoration and the tooth. The teeth were sectioned and evaluated below a stereomicroscope at 10× magnification with image analysis software. RESULTS: Flowable nanocomposites (3.69 ± 0.10) exhibited a slightly greater mean depth of penetration as compared to classical pit and fissure sealants (3.58 ± 0.16) and self-adhering flowable composites (3.51 ± 0.13) in that order. This difference between the three sealants was not significant statistical. Amid the three sealant study groups, the lowest mean marginal microleakage was exhibited by the flowable nanocomposites (1.06 ± 0.03), followed by self-adhering flowable composites (1.98 ± 0.06), and classical pit and fissure sealants (2.74 ± 0.11). Analysis of variance revealed statistically significant differences among the three sealants that were studied. CONCLUSION: This study concludes that flowable nanocomposites depicted enhanced penetration and reduced marginal leakage as compared to the self-adhering flowable composites and classical pit and fissure sealants. CLINICAL SIGNIFICANCE: An efficient approach to preventing dental caries on the occlusal surfaces of teeth is the use of pit and fissure sealants. The efficiency of sealants chiefly depends on the morphological characteristics of the fissures and properties of dental materials used.

Attention to COVID-19 Pandemic among Dental Experts of Kerala State, India: A Knowledge, Attitude, and Practice Study.

BACKGROUND: Dentists are the common preys for the transmission of pandemic disease because of the airborne spread via routine dental checkups. This study which is a cross-sectional one gives the idea about awareness and alertness of dentists about COVID-19 in Kerala, India. MATERIALS AND METHODS: The survey comprised 25 closed-ended questions. The survey was separated into two sections. The initial segment of the poll was identified with the socio-segment qualities that were researched, while the subsequent part was worried about dental practitioners' perspectives toward the management of COVID-19 and the apparent danger of defilement in dental facilities. RESULTS: Coronavirus management in dental clinics differs regarding adherence to the rules. An aggregate of 750 respondents finished the form, out of which 686 (91.46%) complete reactions were incorporated. The majority of the respondents concurred on inquiries regarding the knowledge, practice, and mentality of dental specialists toward the COVID-19 pandemic. CONCLUSION: The feedback of most dental specialists with respect to the readiness and view of disease control measures against the COVID-19 pandemic was positive. Dental facilities need to adhere more to the central and state government suggestions in alertness of their facilities or by tutoring their dental specialists and staff.

Surfactant-based prophylaxis and therapy against COVID-19: A possibility.

Hand hygiene by washing with soap and water is recommended for the prevention of COVID-19 spread. Soaps and detergents are explained to act by damaging viral spike glycoproteins (peplomers) or by washing out the virus through entrapment in the micelles. Technically, soaps come under a functional category of molecules known as surfactants. Surfactants are widely used in pharmaceutical formulations as excipients. We wonder why surfactants are still not tried for prophylaxis or therapy against COVID-19? That too when many of them have proven antiviral properties. Moreover, lung surfactants have already shown benefits in respiratory viral infections. Therefore, we postulate that surfactant-based prophylaxis and therapy would be promising. We believe that our hypothesis would stimulate debate or new research exploring the possibility of surfactant-based prophylaxis and therapy against COVID-19. The success of a surfactant-based technique would save the world from any such pandemic in the future too.

Thyroid Dysfunction in Patients with Pulmonary Artery Hypertension (PAH): The Effect of Therapies Affecting the Prostanoid Pathway.

INTRODUCTION: Epoprostenol, a synthetic prostaglandin I2 (PGI2) analog, has been the mainstay of treatment for severe pulmonary arterial hypertension (PAH) for the last two decades. Treprostinil, another synthetic prostaglandin analog, and selexipag, an oral selective Inositol Phosphate (IP) prostacyclin receptor agonist, have also been approved for treatment of PAH. Prostacyclin and its analogs cause a variety of side effects in patients with PAH; however, thyroid dysfunction is rarely reported. METHODS: After treating an index case of thyroid dysfunction occurring after initiation of epoprostenol, we reviewed our databases of PAH patients treated with epoprostenol, treprostinil or selexipag to identify the occurrence of this association. RESULTS: We identified six cases of thyroid dysfunction in our cohort: five after initiation of an intravenous prostacyclin (epoprostenol) and one after initiation of an oral prostacyclin receptor agonist (selexipag). Four of the patients presented with hyperthyroidism and two with a large autoimmune goiter. Graves' disease was seen in three patients, Hashimoto's disease in two patients and thyrotoxicosis in one patient. CONCLUSION: Therapy with medications targeting the prostacyclin pathway is a potential risk factor for the development of symptomatic thyroid disease.

Prevalence of mental disorders in Punjab: Findings from National Mental Health Survey.

BACKGROUND: Knowledge of the prevalence of mental disorders is essential for setting up services and allocation of resources. Existing studies suffer from methodological problems which limit their utility and generalizability. There was a long felt need to conduct a scientifically robust study in different regions of India to have national prevalence rates. AIMS: This study aims to estimate the prevalence of mental disorders in a representative population of Punjab as a part of the National Mental Health Survey. SETTINGS AND DESIGN: Community-based survey carried out in rural and urban areas of Punjab using multistage, stratified, random cluster sampling technique and random selection was based on Probability Proportion to Size. MATERIALS AND METHODS: The survey was conducted in 60 clusters of 4 districts (Faridkot, Ludhiana, Moga, and Patiala) of Punjab. Mini-International Neuropsychiatric Interview adult version 6.0 for mental morbidity, case definition for generalized tonic-clonic seizure, an expansion of the Fagerström Nicotine Dependence Scale for tobacco use and screener for intellectual disability were used. Appropriate statistical methods were applied. RESULTS: A total of 2895 respondents aged >18 years from 719 households were interviewed. The prevalence of lifetime and current mental morbidity was 17.94% and 13.42%, respectively. Higher prevalence of mental morbidity was found among persons aged >60 years and those belonging to lower income group and rural population. CONCLUSIONS: The prevalence of mental morbidity is high in the population. The findings give a clear picture of magnitude of the problem and will help policy planners to tackle the situation which looks grave and warrants immediate intervention.

Antimicrobial Effect of Ginger, Garlic, Honey, and Lemon Extracts on Streptococcus mutans.

AIM: The aim of this study was to evaluate the effect of lemon, ginger, garlic, and honey extracts on Streptococcus mutans. MATERIALS AND METHODS: Commercially obtained honey, ginger, garlic, and lemon were included in the study to evaluate its efficacy in isolation and in combination against S. mutans. The efficacies of extracts were tested using well diffusion method, and its effect was evaluated by measuring the zone of inhibition around the well. Antimicrobial activity of the extracts was carried out individually and compared considering triplicates of all the extracts. RESULTS: When individual comparison of the extracts was made, garlic showed greatest antimicrobial activity with a mean zone of inhibition (34.9 ± 0.58 mm) and honey showed least antimicrobial activity (0.5 ± 0.6 mm). When combinations of extracts were tested against S. mutans, lemon and garlic combination showed the greatest zone of inhibition (27.6 ± 0.43 mm) compared with other combinations, and ginger + lemon combinations showed the least zone of inhibition (12.6 ± 0.43 mm). CONCLUSION: This study concluded that garlic showed a greatest antimicrobial effect against S. mutans when compared with other preparations individually and garlic and lemon showed greatest zone of inhibition in combination than other preparations. CLINICAL SIGNIFICANCE: Antibiotics and other chemical agents are mainly used to treat the common dental infections. However, due to the excessive use, it can result in antibiotic resistance. Hence, herbal medicines with medicinal values should be replaced with conventional methods.