Enhanced recovery pathway in open and minimally invasive colorectal cancer surgery: a prospective study on feasibility, compliance, and outcomes in a high-volume resource limited tertiary cancer center.

BACKGROUND: Enhanced recovery program (ERP) has demonstrated improved postoperative outcomes with increased compliance to pathway. However, there is scarce data on feasibility and safety in resource limited setting. The objective was to assess compliance with ERP and its impact on postoperative outcomes and return to intended oncological treatment (RIOT). METHODS: A single center prospective observational audit was conducted from 2014 to 2019, in elective colorectal cancer surgery. Before implementation, multi-disciplinary team was educated regarding ERP. Compliance to ERP protocol and its elements was recorded. Impact of quantum of compliance (≥80% vs. <80%) to ERP on postoperative morbidity, mortality, readmission, stay, re-exploration, functional GI recovery, surgical-specific complications, and RIOT was evaluated for open and minimal invasive surgery (MIS). RESULTS: During study, 937 patients underwent elective colorectal cancer surgery. Overall compliance with ERP was 73.3%. More than 80% compliance was observed in 332 (35.4%) patients in the entire cohort. Patients with <80% compliance had significantly higher overall, minor and surgery-specific complications, longer postoperative stay, delayed functional GI recovery for both open and MIS procedures. RIOT was observed in 96.5% patients. Duration to RIOT was significantly shorter following open surgery with ≥80% compliance. Compliance <80% to ERP was identified as one of the independent predictors for developing postoperative complications. CONCLUSION: The study demonstrates beneficial impact of increased compliance to ERP on postoperative outcomes following open and minimally invasive surgery for colorectal cancer. Within a resource limited setting, ERP was found to feasible, safe, and effective in both open and minimally invasive colorectal cancer surgery.

Pattern of pterygomaxillary disarticulation associated with Le Fort I maxillary osteotomy.

Pterygomaxillary disarticulation (PMD) contributes to surgical complications of Le Fort 1 osteotomy and is associated with undesirable fractures of the pterygoid plates. The aim of this paper was to investigate the patterns of PMD in Le Fort I osteotomies using Rowe's disimpaction forceps, and to evaluate correlations with age and anatomical measurements. Cone-beam computed tomography (CBCT) scans of 70 consecutive orthognathic patients were retrospectively evaluated to study four patterns of PMD: Type 1 - PMD at, or anterior to, the pterygomaxillary junction (PMJ); Type 2 - PMD posterior to the PMJ; Type 3 - PMJ separation with comminuted fracture of the pterygoid plates; Type 4 - disarticulation of the maxilla involving the pterygoid plates above the level of the osteotomy line. The preoperative anteroposterior and mediolateral thicknesses of the PMJ and the length of the medial and lateral pterygoid plates were assessed. Satisfactory PMD was achieved in all cases and no severe complications were reported, including vascular, dental, mucosal, or neural damage. The most common PMD was Type 1 (54.3%), followed by Type 2 (40%). Comminuted fracture of the pterygoid plates was limited to 5.7% of cases, and no Type 4 was detected. A weak correlation was detected between PMJ thickness and PMD pattern (p = 0.04). No statistically significant correlation was detected between patients' age and type of PMD. PMD of Le Fort I maxillary osteotomy using a Smith spreader and Rowe's disimpaction forceps proved safe, with minimal damage to the pterygoid plates.

The Effects of Lavender Essential Oil and its Clinical Implications in Dentistry: A Review.

Essential oils have been known to have many medicinal properties. They have been utilized by medical practitioners since the medieval ages. Lavender essential oil is known to be rich in medicinal properties like antimicrobial activity, anxiolytic, anti-inflammatory, antinociceptive, and antioxidant properties. Utilization of herbal products like lavender essential oils will benefit the patients in many ways. Incorporation of these properties in the field of dentistry has ample advantages. The purpose of this review article is to enlist the current and prospective uses of lavender essential oils in the field of dentistry and to identify the lacunae using which research regarding this topic can be taken one step closer to clinical practice. How to cite this article: Kajjari S, Joshi RS, Hugar SM, et al. The Effects of Lavender Essential Oil and its Clinical Implications in Dentistry: A Review. Int J Clin Pediatr Dent 2022;15(3):385-388.

Evaluation of the Treatment Protocols in the Management of Pulpally Involved Young Permanent Teeth in Children: A Systematic Review and Meta-analysis.

Background: In children with young permanent teeth, dental caries and traumatic injuries are the most common problems leading to pulp necrosis. Since, root development is completed in two to three years after eruption of the tooth into the oral cavity, loss of pulp vitality in young permanent tooth creates distinctive problems. In spite of exceeding availability of treatment procedures there is a need to search for a substantial procedure to treat young permanent teeth effectively. Aim: The aim of this systematic review was to evaluate the treatment protocols in the management of pulpally involved young permanent teeth in children. Method: Systematic search was conducted on databases PubMed, Cochrane, and Google Scholar among studies published from 1st January 2010 till 31st May 2020. Studies meeting the inclusion criteria were included in the review and were then assessed for quality with the help of predetermined criteria which categorized studies into high, medium, and low. Results: Search strategy yielded 4,846 articles. After screening through titles and abstracts, 33 articles remained which were further screened for full text. At the end, 14 articles were included in systematic review. Furthermore, the included articles were statistically evaluated by meta-analysis. Conclusion: In apexogenesis and apexification procedures, newer biomimetic materials like mineral trioxide aggregate and biodentine have more success rate than conventionally used calcium hydroxide. Among regenerative endodontic procedures platelet-rich plasma and platelet- rich fibrin showed better results. Clinical significance: To amend clinician perceptions towards acceptance of the newer regenerative procedures and their effectiveness in management of young permanent tooth. How to cite this article: Saxena N, Hugar SM, Soneta SP, et al. Evaluation of the Treatment Protocols in the Management of Pulpally Involved Young Permanent Teeth in Children: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2022;15(S-1):S103-S113.

A Comparative Evaluation of Remineralizing Potential of Commonly Used Fluoridated Toothpaste, Herbal Toothpaste, Toothpaste with Zinc Hydroxyapatite, and Toothpaste with Calcium Sucrose Phosphate in Children: A Scanning Electronic Microscopic Study.

Aim: The aim of this in vitro study is to evaluate the remineralizing potential of commonly used fluoridated toothpaste, toothpaste with calcium sucrose phosphate, toothpaste with zinc hydroxyapatite, herbal toothpaste, and to compare them. Background: The process of demineralization and remineralization is balanced and occurs concurrently in the oral cavity, but even a mild disruption in this mechanism could lead to dental caries. Dental caries is a threat in the Third World countries and more common entity in childhood. The caries prevalence is reported to be 41% for children within the age of 2-11 years. Materials and method: According to previous studies and standard sample size calculating formula the sample size of 48 was calculated, the teeth were subjected to demineralization - remineralization process and were observed under scanning electron microscope. Results: The outcomes of this study suggest that the remineralizing potential of toothpaste with zinc hydroxyapatite (p = 0.0001*) was highest as compared to toothpaste with fluoride (p = 0.0087*), herbal toothpaste (p = 0.9034), and toothpaste with calcium sucrose phosphate (p = 0.0002*). Conclusion: All the four toothpastes showed an adequate amount of remineralization but the highest amount of remineralization potential was seen with toothpaste containing zinc hydroxyapatite. Clinical significance: The clinical significance of our study is to give clear and evidence-based idea to the dentist and the parents about the remineralizing toothpaste available in the market for children. Treating demineralization at an initial stage would help to remineralize the tooth structure and thereby limit further destruction of the tooth structure which will preserve the beautiful smile of the child. How to cite this article: Soneta SP, Hugar SM, Hallikerimath S, et al. A Comparative Evaluation of Remineralizing Potential of Commonly Used Fluoridated Toothpaste, Herbal Toothpaste, Toothpaste with Zinc Hydroxyapatite, and Toothpaste with Calcium Sucrose Phosphate in Children: A Scanning Electronic Microscopic Study. Int J Clin Pediatr Dent 2022;15(S-2):S158-S163.

Assessment of Knowledge, Attitude, and Practices about Dental Home among Healthcare Professionals of Belagavi City: A Cross-sectional Study.

Aim and objective: The aim and objective of the study was to assess the knowledge, attitude, and practices about dental home among healthcare professionals of Belagavi city. Materials and methods: A sample of 400 participants was divided into four groups (Ayurveda, Homeopathy, Nursing, and Medical) based on their healthcare specialty. A 20 item validated questionnaire containing four domains was distributed among the participants. The data was statistically analyzed. Results: Descriptive analysis was used followed by Chi-square for association and one-way ANOVA for comparison followed by Karl Pearson correlation coefficient for determining the correlation between knowledge, attitude, and practices of healthcare professionals. The results of the study showed that the knowledge and practices were statistically not significant among all healthcare professionals (p > 0.05). However, the results were found to be statistically highly significant when correlation was done between knowledge, attitude, and practices (p < 0.0001). Conclusion: The study concludes that there is a need to increase the level of knowledge, attitude, and practices among healthcare professionals about the concept of dental home. Clinical Significance: The clinical significance of our study is the implementation of the dental home concept in India, which can prove to be a source of coordinated care that emphasizes overall patient health and aids in rendering quality treatment. Through this initiative oral health can be incorporated as a primary healthcare entity. This can also provide an opportunity for dental professionals to take the lead in applying successful strategies to improve the provision of dental care. Moreover, treatment needs if taken care at the preliminary stages itself, can reduce a major oral healthcare burden from extensive debilitating oral pathologies in the pediatric population. How to cite this article: Saxena N, Hugar SM, Patil V, et al. Assessment of Knowledge, Attitude, and Practices about Dental Home among Healthcare Professionals of Belagavi City: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(2):164-167.

An In Vivo Evaluation of Retention and Antibacterial Efficacy of Posterior High Strength Glass Ionomer Cement and Glass Hybrid Bulk-fill Alkasite Restorative Material as Conservative Adhesive Restoration in Children with Mixed Dentition: A Comparative Study.

Aim: The aim of the study was to compare and evaluate the retention and antibacterial efficacy of posterior high strength glass ionomer cement and glass hybrid bulk-fill alkasite restorative material as a conservative adhesive restoration in children with mixed dentition. Materials and methods: A total of 60 children of age 6-12 years with mixed dentition were selected and divided into group I (control group n = 30): posterior high strength glass ionomer cement and group II (experimental group n = 30): glass hybrid bulk-fill alkasite restorative material. Restorative treatment was carried out using these two materials. Retention of the material and salivary Streptococcus mutans and Lactobacillus species count was estimated at baseline, 1, 3, and 6 months. The collected data were statistically analyzed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software (version 20.0 Chicago, Illinois, USA). Results: About 100% retention of glass hybrid bulk-fill alkasite restorative material, and 90% retention of posterior high strength glass ionomer cement was observed according to United State Public Health Criteria. The * signifies statistically significant results, i.e. p < 0.0001 reduction in salivary S. mutans colony count and Lactobacillus species colony count was seen in both groups at different time intervals. Conclusion: Both the materials showed good antibacterial properties, but glass hybrid bulk-fill alkasite restorative showed better retention, that is, 100% when compared to posterior high strength glass ionomer cement, which showed 90% retention at the end of 6 months follow-up. How to cite this article: Soneta SP, Hugar SM, Hallikerimath S, et al. An In Vivo Evaluation of Retention and Antibacterial Efficacy of Posterior High Strength Glass Ionomer Cement and Glass Hybrid Bulk-fill Alkasite Restorative Material as Conservative Adhesive Restoration in Children with Mixed Dentition: A Comparative Study. Int J Clin Pediatr Dent 2022;15(5):529-534.

Impact of enhanced recovery pathway in 408 gallbladder cancer resections.

BACKGROUND: Gallbladder cancer (GBC) is the sixth most common gastrointestinal malignancy with poor prognosis. Enhanced Recovery Pathway (ERP) is associated with improved outcomes following abdominal surgical procedures. Currently, there is no study evaluating ERP in patients undergoing GBC surgery. The objective was to assess compliance with ERP elements and evaluate its impact on postoperative outcomes. METHODS: Prospective study conducted from February 2014-2019, including elective GBC surgery. Team was educated prior to ERP implementation. Compliance with the protocol, functional gastrointestinal (GI) recovery, mobilisation, and postoperative outcomes were recorded. Impact of degree of compliance (more or less than 80%) with ERP and postoperative outcomes was evaluated. RESULTS: In 408 patients, compliance with ERP was 84.6% (53.8-100%). Compliance >80% with ERP elements was observed in 245 patients (60%). Patients with >80% compliance had lower rate of minor (18.8% vs. 27%, p = 0.050) and significantly less major (0.8% vs. 6.1%, p = 0.002) and postoperative stay (5.84 ± 4.86 vs. 7.55 ± 6.6 days, p < 0.001) and earlier functional GI recovery. Intraoperative blood loss more than 600 ml, lower compliance (<80%) with ERP and preoperative albumin independently predicted postoperative complications. CONCLUSION: This study demonstrates safety and efficacy of enhanced recovery pathway in gallbladder cancer. Higher compliance with the pathway was associated with significantly improved postoperative outcomes following gallbladder cancer surgery.

How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment.

BACKGROUND: High flow tracheostomy (HFT) is a commonly used weaning and humidification strategy for tracheostomised patients, but little is known as to how much PEEP or mechanical benefit it offers. Patient anatomy and device characteristics differentiate it from high flow nasal cannula and the physiological effects observed. OBJECTIVES: (1) To review the available literature on the effects of HFT on airway pressure and indices of gas exchange. (2) To quantify PEEP generated by a HFT circuit. METHODS: A randomised benchtop experiment was conducted, with a size 8 uncuffed Portex tracheostomy connected to an Optiflow™ with Airvo 2™ humidifier system. The tracheostomy tube was partially immersed in water to give rise to a column of water within the inner surface of the tube. An air fluid interface was generated with flows of 40 L/min, 50 L/min, and 60 L/min. The amount of potential PEEP (pPEEP) generated was determined by the distance the water column was pushed downward by the flow delivered. Findings. Overall 40 L/min, 50 L/min, and 60 L/min provided pPEEP of approximately 0.3 cmH2O, 0.5 cmH2O, and 0.9 cmH2O, respectively. There was a statistically significant change in pPEEP with change in flows from 40-60 L/min with an average change in pPEEP of 0.25-0.35 cmH2O per 10 L/min flow (p value <0.01). Interpretation. HFT can generate measurable and variable PEEP despite the open system used. The pPEEP generated with HFT is minimal despite statistically significant change with increasing flows. This pPEEP is unlikely to provide mechanical benefit in weaning patients off ventilatory support.

Cancer related nutritional and inflammatory markers as predictive parameters of immediate postoperative complications and long-term survival after hepatectomies.

BACKGROUND: The overall survival (OS), disease-free survival (DFS) and complications after liver resections is unsatisfactory. Cancer-related malnutrition and inflammation have an effect on survival but not studied/not clear on postoperative complications. METHODS: We retrospectively analyzed prospectively maintained database of 309 patients. The outcome variables included complications in terms of Clavien-Dindo (CD) Score, OS and DFS; We studied effect of preoperative albumin globulin ratio (AGR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and aspartate transaminase to platelet ratio index (APRI) and dynamic change from pre-operative to postoperative value (Delta-AGR, Delta-NLR, Delta-PLR and Delta-APRI) on complications, OS and DFS. RESULTS: Total 98 patients (31.71%) had postoperative complications. Fifty patients had CD 1 & 2 and 35 (11.33%) had CD 3 & 4, and 13 (4.12%) had mortality (CD 5). Low AGR, high NLR, high PLR and high Delta-AGR and high Delta-APRI predicted increased major complications. Preoperative high NLR predicted worse OS and low AGR predicted worse OS and DFS. Delta-APRI showed trends towards worse OS and DFS. CONCLUSION: These serum inflammatory markers can predict immediate postoperative complications. Preoperative AGR and preoperative NLR can predict survival after liver resections. High Delta-AGR, which is a new entity, is predicting more postoperative complications and needs further detailed studies.

Complications after Supramajor Gastrointestinal Surgery: Role of Enhanced Recovery after Surgery.

BACKGROUND: Enhanced recovery after surgery (ERAS) is currently the standard of care in perioperative medicine, but it is widely underutilized in our healthcare setting because of the lack of awareness of benefits exerted by ERAS and its components. ERAS is a multidisciplinary collaboration, where intensivists play an important role in the implementation of the protocol during the perioperative period. AIM: This review article aims to appraise the role of ERAS pathway on complications following supramajor gastrointestinal surgery. REVIEW: A summary and review of evidence was conducted on the role of ERAS and its elements on non-specific and surgery-specific complications. Enhanced recovery pathways (ERPs) and its elements were directly found to be associated with lower incidence of hospital-associated infections, postoperative ileus, and postoperative pulmonary complications. Although there are no specific elements of ERPs found to have beneficial effect in preventing major adverse cardiac and cerebrovascular events, and surgery-specific complications such as postoperative pancreatic fistula, delayed gastric emptying, post-pancreatectomy hemorrhage, post-hepatic liver failure, bile, and anastomotic leak, studies have demonstrated that implementation of an ERP bundle can decrease the incidence of these complications. Implementation of an ERP was associated with an increase in the incidence of acute kidney injury with minor elevations in creatinine that returned to baseline before discharge. CONCLUSION: Although there is ample evidence that ERAS is beneficial in reducing complications and hospital stay following supramajor gastrointestinal surgery, there is scope for further research to unravel the role of ERAS on patient-reported outcomes. HOW TO CITE THIS ARTICLE: Thomas M, Joshi R, Bhandare M, Agarwal V. Complications after Supramajor Gastrointestinal Surgery: Role of Enhanced Recovery after Surgery. Indian J Crit Care Med 2020;24(Suppl 4):S205-S210.

Assessment of Dentist's Perception of the Oral Health Care toward Child with Special Healthcare Needs: A Cross-sectional Study.

AIM: The study aimed to explore dentist's perception of the oral health care toward child with special healthcare needs (CSHCN). MATERIALS AND METHODS: A total sample size of 250 was calculated. A 13-item validated questionnaire containing four domains were distributed among the participants. Descriptive analysis was used followed by one-way analysis of variance for comparison. RESULTS: The results showed 51.54% confidence, 71.33% knowledge, and 66.90% perception among the participants. A statistically significant results were found between three domains (p value < 0.0001). CONCLUSION: The study concludes that there is a need to raise the level of knowledge and awareness about the oral health care of CSHCN among the dental students and professionals. HOW TO CITE THIS ARTICLE: Hugar SM, Soneta SP, Gokhale N, et al. Assessment of Dentist's Perception of the Oral Health Care toward Child with Special Healthcare Needs: A Cross-sectional Study. Int J Clin Pediatr Dent 2020;13(3):240-245.

Comparative evaluation of antibacterial efficacy of conventional glass-ionomer cement and bulk-fill alkasite material when combined with doxycycline and double antibiotic paste containing ciprofloxacin and metronidazole against Streptococcus mutans and Lactobacillus spp.: An in vitro study.

INTRODUCTION: Glass-ionomer cement (GIC) have been indispensable to pediatric dentistry. Along with these, newer materials like bulk-fill alkasite cement (Cention N) are popularizing. In spite of this, the search is still on for the "ideal" bioactive material which could provide a therapeutic edge. In light of this, incorporation of antibiotics in GIC or newer materials like bulk-fill alkasite cement (Cention N) would provide a novel alternative material to the dentists. AIM: The study was aimed at comparing the antibacterial efficacy of conventional glass-ionomer cement (CGIC) and bulk-fill alkasite cement (Cention N) with doxycycline (DOX) and double antibiotic paste (DAP) containing metronidazole and ciprofloxacin (1.5% w/w) on Streptococcus mutans and Lactobacillus. MATERIALS AND METHODS: Agar well diffusion method was followed, in which material discs of 10 mm were made and inserted into the wells. Inhibition zones were calculated after incubation for 24 h at 37°C with zone interpretation scale. RESULTS: A highly significant statistical correlation was found between antibacterial efficacy of the control groups (CGIC and bulk-fill alkasite cement [Cention N]) without antibiotics as compared to the experimental group (CGIC and bulk-fill alkasite cement [Cention N] with DOX and DAP), P = 0.0001 and P = 0.0006 for the CGIC group and P = 0.0147 and P = 0.0080 for the Cention N group (P < 0.05). CONCLUSION: Incorporation of antibiotics significantly enhanced the antibacterial efficacy of CGIC and bulk-fill alkasite cement (Cention N).

Flexed Posture in Parkinson Disease: Associations With Nonmotor Impairments and Activity Limitations.

BACKGROUND: People with Parkinson disease (PD) are twice as likely to develop flexed truncal posture as the general older population. Little is known about the mechanisms responsible beyond associations with age, axial motor impairments, and disease severity. OBJECTIVE: The objective was to explore: (1) the associations of the nonmotor impairments of PD with flexed posture, and (2) the relationships of flexed posture with activity limitations. DESIGN: This was a cross-sectional study. METHODS: Seventy people with PD participated. Posture was measured in standing as the distance between the seventh cervical vertebra and a wall. Nonmotor impairments (cognition, depression, pain, fatigue, and proprioception) and activity performance (upper limb activity, bed transfers, respiratory function, and speech volume) were variously assessed using objective measures and self-report questionnaires. Univariate and multivariate regression analyses were performed to ascertain relationships between nonmotor impairments and truncal posture, and between truncal posture and activities. RESULTS: Greater disease severity, greater axial impairment, poorer spinal proprioception, greater postural fatigue, and male sex were significantly associated with flexed truncal posture. The multivariate model containing these factors in addition to age explained 30% of the variability in flexed truncal posture, with male sex and axial motor impairment continuing to make independent contributions. A significant association was found between greater flexed truncal posture and poorer upper limb activity performance and respiratory function. LIMITATIONS: A limitation to this study was that participants had mild-to-moderate disease severity. CONCLUSIONS: Spinal proprioception and postural fatigue were the only nonmotor impairments to make significant contributions to flexed posture. Given the negative influence of flexed posture on upper limb activity and respiratory function, interventions targeting spinal proprioception and postural awareness should be considered for people with PD who might develop flexed posture.

Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway.

BACKGROUND: Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery. METHODS: Prospective study conducted from February 2014 to December 2016, following elective pancreatic cancer surgery. Team was educated prior to implementation of ERAS. Patients were followed up until 30 days postoperatively or discharge. Data was recorded regarding the compliance with the protocol, functional GI recovery, mobilisation, and postoperative morbidity and mortality. RESULTS: A total of 394 patients underwent surgery. Compliance with ER elements implemented was 84% (23-100%). Compliance > 80% with ER elements was observed in 278 patients (70.5%) and < 80% in 116 patients (29.5%). Patients with > 80% compliance have significantly lower major complications (28.7 vs. 44%, p = 0.001), mortality (2.1 vs. 6.8%, p = 0.021), and postoperative stay (11 (5-78) days vs. 15 (4-61) days, p < 0.001). CONCLUSION: ER programme is feasible and safe in resource and infrastructure limited lower middle-income country. Improved compliance was associated with reduced major complications, mortality, and shorter stay in patients undergoing pancreatic cancer surgery in high-volume centre. TRIAL REGISTRATION: CTRI/2015/01/005393 ( www.ctri.nic.in ).