A Comparative Study of Serum and Salivary Uric Acid Measurement in Pre-eclampsia and Normal Pregnancy in a Tertiary Care Hospital in Punjab: A Pilot Study.

Background Pre-eclampsia is a multisystem progressive disorder associated with significant maternal and neonatal morbidity and mortality. It is essential to identify the potential indicators of associated complications in pre-eclampsia to improve pregnancy outcomes. Serum uric acid (UA) levels are increased in pregnancies complicated by pre-eclampsia. This study was performed to validate salivary UA as an alternative non-invasive biomarker to serum UA in pre-eclampsia. Methodology A total of 150 pregnant women were enrolled in the study. They were divided equally into three groups with 50 participants in each group. Group 1 included healthy normotensive pregnant women as control, group 2 included participants with non-severe pre-eclampsia and group 3 included participants with severe pre-eclampsia. Both salivary and serum UA were estimated in all the study participants and comparative analyses were done. Results Serum UA was elevated in 33(66%) and 48(96%) of participants in groups 2 and 3 respectively while saliva uric acid in 30(60%) and 43(86%) as compared with healthy controls who had serum UA raised in 14(28%) and salivary UA in 12(24%) with a significant p-value of 0.0001. The mean values of serum and salivary UA in group 1 were 4.5 ±1.16 mg/dl and 4.11±1.74 mg/dl respectively whereas in group 2 these were 6.12±1.86mg/dl and 5.96±1.90mg/dl and in group 3 these were 8.24±2.31mg/dl and 8.17±3.31mg/dl respectively. There was a significant correlation between serum and salivary UA values in groups 1 and 2, groups 1 and 3, and groups 2 and 3 with a p-value of 0. 001. The serum and salivary UA levels showed an increasing trend from healthy controls (group 1) to non-severe pre-eclampsia (group 2) with the highest values in severe pre-eclampsia (group 3). Oligohydramnios was present in 10(20%) cases in group 1 whereas 24(48%) cases in group 3. The appearance, pulse, grimace, activity, respiration (APGAR) score at 1 and 5 minutes was abnormal in 5(1.23%) and 7(1.33%) cases in group 1, 6(1.26%) and 7(1.29%) cases in group 2 and 5(1.73%) and 6(1.53%) cases in group 3. The area under curve (AUC) in group 2 was 0.778 for serum UA and 0.779 for salivary UA. In group 3, the AUC for serum UA values was 0.938 and for salivary UA 0.882. A statistically significant correlation between serum and salivary UA values in group 2 (non-severe pre-eclampsia) was found with a p-value of 0.001 and Pearson's correlation coefficient r of 0.738. Conclusions Serum and salivary UA levels correlate with the severity of pre-eclampsia with maximum levels in severe pre-eclampsia (group 3) followed by group 2 (non-severe pre-eclampsia) with the lowest levels in group 1 (healthy controls). The authors are of the opinion that a non-invasive salivary UA test can replace the serum UA test and can be a useful supplementation for conventional pre-eclampsia prediction.

To Compare the Maternal and Fetal Outcomes of COVID-19-Affected Expectant Mothers During the First and Second COVID-19 Waves: Data From a Tertiary Care Referral Hospital in Punjab.

BACKGROUND: Coronavirus 2019 (COVID-19) infection, declared pandemic in March 2020 by the World Health Organization, paved the way for newer research in the field of medicine. The second wave, beginning in March 2021, appeared to be more devastating. The purpose of this study is to evaluate the clinical characteristics, effects of COVID-19 infection in pregnancy, and obstetric and perinatal outcomes in the first and second waves. MATERIALS AND METHODS: This study was conducted from January 2020 to August 2021 at the Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. The patients were enrolled immediately after each infected woman was identified as per the inclusion and exclusion criteria. Demographic details of the patients, associated comorbid conditions, intensive care unit (ICU) admission, and treatment details were noted. Neonatal outcomes were recorded. The testing of pregnant women was done as per the Indian Council of Medical Research (ICMR) guidelines. RESULTS: There were 3421 obstetric admissions and 2132 deliveries during this period. Group 1 had 123 COVID-19-positive admissions, while group 2 had 101 admissions. The incidence of COVID-19 infection in pregnancy was 6.54%. In both groups, the majority of patients were between the ages of 21 and 30. About 80(66%) of the admissions in group 1 and 46(46%) in group 2 were in the gestational age of 29-36 weeks. Multiparity was more common in both groups, with 58% of cases in group 1 and 79% of cases in group 2. Obstetric comorbidities were common in both groups, seen in 46% of cases in group 1 and 78% of cases in group 2. The majority of patients were asymptomatic in group 1, with an 89% incidence, whereas only 33% of patients in group 2 were without symptoms. In biological data, D-dimers, prothrombin time, and platelet count were altered in 11%, 14%, and 17% of cases, respectively, in group 2, with almost normal data in group 1. Most cases in group 2 (52%) were critical cases in the moderate and severe categories requiring intensive care unit (ICU) treatment, whereas there was only single ICU admission in group 1. The overall case fatality rate (CFR) in group 2 was found to be 19.8(20/101).  Delivery by cesarean section was done in 38.2% of cases in group 1, while in 33% of cases in group 2, with a significant p-value of 0.001. About 29% of cases in group 1 and 34% of cases in group 2 underwent vaginal delivery. The rate of abortion was almost similar in both groups. Only two cases in group 1 and nine cases in group 2 had intrauterine fetal death. Observations of neonatal outcomes suggested that five cases in group 2 and two cases in group 1 had severe birth asphyxia. Only one case in group 1 and four cases in group 2 had positive COVID-19 status. Maternal mortality was significantly higher in group 2 with 20 cases, while only one case was in group 1. Anemia and pregnancy-induced hypertension were the chief comorbidities in this group. CONCLUSION: COVID-19 infection during pregnancy may be associated with maternal mortality while having a minimal effect on neonatal morbidity and mortality. The possibility of maternal-fetal transmission cannot be ruled out completely. The severity and characteristics of COVID-19 may vary in each wave, and we need to modify treatment strategies. More studies or meta-analyses reports are required to authenticate this transmission.

Cephalometric evaluation of pharyngeal airway and tongue space following treatment with Herbst and AdvanSync appliances : A prospective randomized clinical trial.

OBJECTIVES: To evaluate and compare pharyngeal airway and tongue space changes after treatment with fixed functional appliances-Herbst and AdvanSync™ (Ormco, Orange, CA, USA) appliances-in skeletal class II patients in pre- and posttreatment lateral cephalograms. METHODS: For this randomized, controlled trial, 40 patients (21 male, 19 female) were divided into two groups-a Herbst group (mean age 12.6 ± 0.67 years) and an AdvanSync group (mean age 12.8 ± 0.66 years). Pre- and posttreatment (appliance therapy duration-8 months) lateral cephalograms were traced using a software program to evaluate pharyngeal airway and tongue space changes. RESULTS: Nasopharyngeal airway, velopharyngeal airway, glossopharyngeal airway, and hypopharyngeal airway increased in the Herbst group by 2.12 mm (p ≤ 0.001), 2.33 mm (p ≤ 0.001), 2.40 mm (p ≤ 0.01), and 1.57 mm (p ≤ 0.05), while in the AdvanSync group the increases were 1.89 mm (p ≤ 0.001), 1.21 mm (p ≤ 0.001), 1.18 mm (p ≤ 0.001), and 1.53 mm (p ≤ 0.001), respectively. In the Herbst group, tongue length and height increases were 2.04 mm (p ≤ 0.01) and 3.74 mm (p ≤ 0.001), while the values in the AdvanSync group were 2.41 mm (p ≤ 0.05) and 2.69 mm (p ≤ 0.001). The change of the tongue tip from the lower occlusal plane was 0.69 mm (p ≤ 0.001) in the Herbst group and 0.77 mm (p ≤ 0.001) in the AdvanSync group. The velopharyngeal airway dimension was correlated positively with that of the retroglossal oropharyngeal airway, which in-turn positively correlated with the laryngopharyngeal airway which correlated well with the distance of the tongue tip from the lower occlusal plane. CONCLUSIONS: The airway dimensions and tongue parameters increased significantly in both treatment groups in the present study. These changes were higher in the Herbst appliance than in the AdvanSync group, except for the distance of the tongue tip from the lower occlusal plane. A significant difference between the pharyngeal airways was found only for the retropalatal oropharyngeal airway.

Effects of anterior maxillary distraction compared to LeFort-1 osteotomy and total maxillary distraction osteogenesis for treating hypoplastic maxilla in patients with cleft lip and palate- A systematic review and meta-analysis.

OBJECTIVE: To compare the treatment outcomes and effectiveness of Anterior Maxillary Distraction (AMD) with the LeFort I Osteotomy and Total Maxillary Distraction Osteogenesis (TMDO) to treat cleft maxillary hypoplasia. METHODS: (PROSPERO CRD42020223345) Thorough electronic search of seven databases, unpublished gray literature, and a hand search of the relevant studies reference lists was done. Studies assessing mid-facial skeletal, dentoalveolar, and soft-tissue outcomes of AMD in patients >8 years of age, hypoplastic cleft maxilla, and with either TMDO/LeFort 1/ both as control groups were included. Seven included articles were assessed for the study characteristics and qualitative synthesis. Three studies were analyzed quantitatively using the RevMan 5.4 software. The quality of studies was assessed using Cochrane ROB2 and the overall certainty of evidence using GRADE. RESULTS: AMD was performed in 241 subjects, LeFort 1 in 145 subjects, and TMDO in 42 subjects. Maxillary advancement for AMD and LeFort 1 groups showed no statistically significant difference (Mean Difference, MD -0.64°) while TMDO showed statistically significant advancement than AMD (MD -1.44°). Statistically significant upward rotation of anterior maxilla was noted with AMD (MD -6.15 degrees) than Lefort 1. Upper incisor inclination improved in both AMD and TMDO groups (MD 1.5°). Improvement in the maxilla-mandibular relationship, convexity of face, lip and nose, and marked dentoalveolar changes in overjet and upper incisor position were noted in all the three groups. Discernible airway alterations were noted in LeFort 1 and TMDOs. Total relapse was the least with AMD. CONCLUSION: Distraction osteogenesis exhibited better dento-skeletal outcomes and minor skeletal relapse than LeFort 1. TMDO is a preferred modality in treating severe maxillary hypoplasia associated with CLP than AMD. Further long-term prospective comparative studies are required, possibly involving the patient-centric merits.

Challenges in physiotherapy of managing respiratory diseases in elderly population.

INTRODUCTION: Lung function is a convincing prognosticator of longevity. With advancing age, there are many irreversible functional and anatomic changes in the body, making elderly susceptible to disease processes. As people age, the respiratory system experiences a number of anatomical, physiological, and immunological changes, predisposing risk of many chronic lung diseases (CLDs). Respiratory tract infections, TB, chronic obstructive pulmonary disease (COPD), and interstitial pulmonary disease are examples of common respiratory diseases (CRDs). The risk factors are mainly smoking, exposure to air pollution both indoors and outdoors, allergies, occupational exposure, poor diet, obesity, inactivity. Between 25 and 80 years the lung function and aerobic capacity each decline by ∼40% limiting physical function and promoting multimorbidity. In elderly, skeletal muscle dysfunction causes age-related multifactorial health disorders such sarcopenia and frailty, a recognised symptom of chronic respiratory disease. METHODS: This perspective article highlights the importance of pulmonary physiotherapy in elderly with chronic lung disease and other chronic respiratory disorders. Common symptoms frequently experienced are dyspnoea, fatigue, decreased exercise tolerance, peripheral muscle dysfunction, and mental disturbances. An individual's symptoms, physical functioning, quality of life (QoL), hospitalisation, and morbidity goals are all addressed by a pulmonary rehabilitation programme (PRP). Pulmonary physiotherapy, an extensive patient-tailored intervention as exercise training, education, and life style modification is prescribed on the basis of a thorough personalised assessment. RESULT: Through pulmonary physiotherapy, the goal is to restore the quality of life of elderly with chronic respiratory diseases and to encourage their long-term adherence to health-improving behaviour. The older patients learn to accept and overcome the reality of their illness rather than sticking to its limits. CONCLUSION: Multidisciplinary approach with a customized and comprehensive program makes the difference between living a fulfilling life and living a life with pulmonary disabilities.

Three-Dimensional Evaluation of the Tongue Volume in Different Dentoskeletal Patterns - A Cone Beam Computed Tomographic Study.

AIM: The aim of this study is to evaluate tongue volume using cone-beam computed tomographic (CBCT) and its correlation to different growth patterns in patients. MATERIALS AND METHODS: Sixty preorthodontic records of CBCT scans of subjects ranging from 14 to 25 age group from retrospective data of department were selected for the study. Patients were classified into three groups based on angle FMA; Group I (n = 20) with average growth pattern (FMA 22°-28°); Group II (n = 20) vertical growth pattern (FMA >28°); Group III (n = 25) horizontal growth pattern (FMA <20°). Tongue volume evaluation was done using Myrian® Software. Dentoskeletal features and parameters related to archform such as palatal vault depth, interpremolar, and intermolar distance were evaluated in all the subjects. ANOVA test was used for intergroup comparison of tongue volume and dentoskeletal parameters in all three groups. Correlation of the tongue volume to dentoskeletal parameters was done using Pearson's correlation test. RESULTS: Mean tongue volume in Group I was 66.10 cm3, Group II, 66.04 cm3 and Group III was 66.72 cm3. There was a statistically significant correlation (P < 0.5) of tongue volume with palatal vault width, maxillary length, and mandibular interpremolar and intermolar distance among dentoskeletal parameters. CONCLUSION: Tongue volume was found equal in all groups despite the variation in growth patterns. Skeletal differences leading to different growth patterns were found to be related to mandibular morphology. The results indicate the indirect role of the tongue in causing malocclusion in orthodontic patients.

Evaluation of stress changes in the mandible with a fixed functional appliance: a finite element study.

INTRODUCTION: The aim of this study was to evaluate the effects of a fixed functional appliance (Forsus Fatigue Resistant Device; 3M Unitek, Monrovia, Calif) on the mandible with 3-dimensional finite element stress analysis. METHODS: A 3-dimensional finite element model of the mandible was constructed from the images generated by cone-beam computed tomography of a patient undergoing fixed orthodontic treatment. The changes were studied with the finite element method, in the form of highest von Mises stress and maximum principal stress regions. RESULTS: More areas of stress were seen in the model of the mandible with the Forsus compared with the model of the mandible in the resting stage. CONCLUSIONS: This fixed functional appliance studied by finite element model analysis caused increases in the maximum principal stress and the von Mises stress in both the cortical bone and the condylar region of the mandible by more than 2 times.

Three-dimensional evaluation of pharyngeal airway in complete unilateral cleft individuals and normally growing individuals using cone beam computed tomography.

AIMS: The aim of the present study was to evaluate pharyngeal airway in cleft individuals and normally growing individuals using cone beam computed tomography. MATERIALS AND METHODS: Cone beam computed tomography scans of 22 individuals were obtained from the Department of Orthodontics and divided in two groups. Group 1 includes 11 cases with complete unilateral cleft lip and palate (mean age, 12 years) and group 2 includes 11 noncleft cases (mean age, 14 years). The oropharyngeal, nasopharyngeal, and oronasal pharyngeal airway was evaluated between the two groups. RESULTS: In the cleft group, the volume of the nasopharyngeal airway was found to be 3.66 cm(3); of the oropharyngeal airway, 9.28 cm(3); and of the oronasal pharyngeal airway, 12.67 cm(3). The volume of the nasopharyngeal airway was found to be significantly reduced in the cleft palate group when compared with the noncleft group. CONCLUSION: The nasopharyngeal airway was found to be significantly smaller among the children with cleft palate than among those in the control group.

Evaluation of fluoride varnish and its comparison with pumice prophylaxis using self-etching primer in orthodontic bonding--an in vivo study.

The aim of this study was to evaluate the use of fluoride varnish as a prophylaxis method with self etching primer (SEP) and its comparison with pumice before orthodontic bonding. Thirty seven orthodontic patients participated in a prospective clinical trial. A split mouth technique was used in each patient, one quadrant was assigned to fluoride varnish and the contralateral quadrant to pumice prophylaxis. A total of 684 teeth were bonded with SEP (Transbond plus; 3M Unitek) and monitored for 6 months for bond failures. A total of 42 (6.1%) failures were recorded, 9 (2.6%) in the pumice group and 33 (9.6%) in the fluoride varnish group. Chi-square analysis was used to compare the number of bracket failures between the pumice and fluoride varnish groups and the number of patients in each group experiencing at least one bond failure. Statistically significant differences were found both in total number of bond failures (P < 0.001) and in the number of patients with bond failures (P < 0.05) between both groups. A significantly lower and clinically acceptable bond failure rate was observed with Transbond Plus self etching primer after pumice prophylaxis.