Treatment outcomes in maxillofacial rehabilitation: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to assess the treatment outcomes following maxillofacial rehabilitation and to identify the tools used to evaluate those outcomes. INTRODUCTION: Maxillofacial defects caused due to tumor, trauma, or any pathology affects the patient physically, mentally, and psychologically. Various methodologies and strategies are used for jaw reconstruction and oral rehabilitation to help the patient regain the functions and quality of life that were lost due to the defect. The evaluation of these treatment outcomes is imperative to assess the success of rehabilitation. INCLUSION CRITERIA: The review will include patients with any maxillofacial defect caused by a developmental anomaly, trauma, or tumor. The patients must have undergone any type of reconstruction and/or rehabilitation and can be from any age group. All treatment outcomes of maxillofacial rehabilitation will be considered. Information from primary and secondary sources and from diverse geographical settings will be included. METHODS: This review will follow the JBI methodology for scoping reviews. Databases to be searched will include PubMed (Ovid), Scopus, PsycINFO (EBSCOhost), CINAHL(EBSCO), Web of Science, Cochrane CENTRAL, ProQuest Dissertations and Theses, and Google Scholar (first 10 pages of the search). Two independent reviewers will screen the titles and abstracts and extract data from selected studies. Data will be presented in tabular format, accompanied by a narrative summary. DETAILS OF THE REVIEW CAN BE FOUND IN OPEN SCIENCE FRAMEWORK: https://doi.org/10.17605/OSF.IO/DP8WC.

Improving medication adherence among persons with cardiovascular disease through m-health and community health worker-led interventions in Kerala; protocol for a type II effectiveness-implementation research-(SHRADDHA-ENDIRA).

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication. METHODS: The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4-5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. DISCUSSION: The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. TRIAL REGISTRATION: The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.

Profile of 10,935 elderly patients attending the geriatrics department of a medical college: A retrospective study from South India.

Introduction: Globally, the elderly population is growing at a rate of 2.6% per year. Understanding the health profile and healthcare needs of the elderly is important. The elderly is the most vulnerable and high-risk groups in terms of health status. Their healthcare-seeking behaviour is crucial in any society. There is a need to generate awareness among the public, politicians, and policymakers regarding multiple issues related to the ageing population in the country. Objective: To know the health profile and health-related problems of geriatric patients visiting the department of geriatrics at a medical college. Methodology: A five-year retrospective analysis of medical records of patients visiting the department of geriatrics from 4 September 2016 to 4 September 2021 was done using Microsoft Excel software and IBM SPSS Statistics. All records in that duration were reviewed and included. Results: Descriptive statistics of medical and dental problems of geriatric patients were recorded. The association of medical and dental problems with gender was assessed. Conclusion: A majority of geriatricians are unaware of oral health problems. Medical-dental collaboration is inadequate and should be improved in geriatrics.

Hypocholesterolaemia as a prognostic factor in venomous snakebite: a retrospective study from a single centre in Kerala, India.

BACKGROUND: Studies have suggested a association between serum cholesterol values and severity of envenoming. The objective of the study was to correlate the serum cholesterol levels with severity of envenoming in victims of snakebite, across snake species in our patient population. METHODS: Retrospective secondary data analysis of health records of a cohort of snakebite victims treated at Little Flower Hospital, Angamaly, Kerala during June 2006-January 2008 was performed. The cholesterol values were assessed in 205 consecutive patients admitted with snakebite envenoming, within 24 h of admission and 10 h of overnight fasting. Lipid fractions were estimated from fasting serum through the standard CHOD-PAP method on a Hitachi analyzer. The cholesterol level was compared between victims with mild and serious envenoming to assess the proportion among each category with a low cholesterol (defined as ≤150 mg/dl as per institutional criteria). In addition, low cholesterol as a marker of severity was compared with other laboratory parameters suggesting severe envenoming such as low fibrinogen, low platelet count, neutrophilia, elevated creatinine, d-dimer, hepatic transaminases and albuminuria. RESULTS: Of the 146 victims with serious degree of snakebite envenoming 116 (79%) had low cholesterol values ≤150 mg%, while 30 (21%) had values >150 mg%. Of the patients with low cholesterol, 116 (78%) had serious envenoming, while 22% had mild envenoming. By contrast, 30 patients (21%) had values >150 mg%. The risk of moderate-severe envenoming with low cholesterol was 2.7 times (170%) that of victims with normal or high cholesterol on admission. CONCLUSIONS: A low cholesterol on admission in victims of snake envenoming suggested a more severe degree of envenoming and likelihood of complications.

A comparison of clinical outcomes between vaccinated and vaccine-naive patients of COVID-19, in four tertiary care hospitals of Kerala, South India.

THE PROBLEM CONSIDERED: This multi-centric study analyzed data of COVID-19 patients and compared differences in symptomatology, management, and outcomes between vaccinated and vaccine-naive patients. METHODS: All COVID-19 positive individuals treated as an in-or out-patient from the 1stMarch to 15th May 2021 in four selected study sites were considered for the study. Treatment details, symptoms, and clinical course were obtained from hospital records. Chi-square was used to test the association of socio-demographic and treatment variables with the vaccination status and binary logistic regression were used to obtain the odds ratio with a 95% confidence interval. RESULTS: The analysis was of 1446 patients after exclusion of 156 with missing data of which males were 57.3% and females 42.7%. 346 were vaccinated; 189 received one dose and 157 both doses. Hospitalization was more in vaccinated (38.2% vs 27.4%); ICU admissions were less in vaccinated (3.5% vs 7.1%). More vaccinated were symptomatic (OR = 1.5); half less likely to be on non-invasive ventilation (OR = 0.5) while vaccine naive patients had 4.21 times the risk of death. CONCLUSION: Severe infection, duration of hospital stays, need for ventilation and death were significantly less among vaccinated when compared with vaccine naive patients.

Oral health status and related quality of life among elderly tribes in India.

INTRODUCTION: Oral health reflects overall well-being for the elderly population. In elderly people, oral health contributes significantly towards quality of life (QOL). Good health is essential for older people to remain independent and to play a part in family and community life. Epidemiological data on health and its related issues are very important in order to plan for future health care provision. OBJECTIVES: To assess the oral health status,treatment needs and oral health related quality of life using GOHAI indexin elderly patients in Kalpetta. METHODOLOGY: A cross sectional study was conducted in the elderly patients reporting to the OPD of Amritakripa Hospital, Kalpetta. Oral Health status was assessed by structured proforma and WHO oral health assessment form 2013 which included DMFT score, Periodontal status, Oral Mucosal lesions, Treatment needs etc. Oral health related quality of life was assessed by Geriatric oral health assessment index. Data analysis was done using SPSS version 20 and descriptive status were obtained. RESULTS: The sample consisted of 214 females and 66 males.70.7% of of participants were illiterate. 96.4% of the population(270)were having daily wage <500. 59.3% of population were unaware about oral health problems. Emergency treatment was need in 41.4% of population. On assessing oral health related quality of life, Male population found to have GOHAI score of 26.44 and that for the female population, it was 19.72.GOHAI score was compared for prosthetic status and age also. Considering the psychological parameters, suggest that this group of elderly in Kerala does not regard poor oral health as barriers to social interactions. CONCLUSION: The oral disease burden is very high in tribes. The prevalence of the tobacco habits is of concern. Education and motivation of these laity is needed to improve their oral health.

Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review.

Trismus refers to a person's inability to normally open his or her mouth. Trismus can occur as a symptom due to tumor ingrowth or it can occur postsurgical following the treatment for head and neck cancer. Radiation-induced trismus is also a relatively common oral complication. This review aimed at reviewing the etiopathogenesis of trismus in patients with head and neck cancer. Of the 16 publications included after final screening, of which one was a nonrandomized control trial, one a randomized control trial, 6 prospective cohort studies, and 8 retrospective cohort studies. Among them, 6 articles addressed the possible mechanism for trismus related to tumor ingrowth, 8 articles suggested the likely reason for trismus in patients who had undergone radiation therapy and 2 articles addressed the postsurgical cause for trismus. This review highlights the possible involvement of infratemporal fossa as a predetermining factor for developing trismus related to tumor extension. The molecular mechanism of radiation-induced fibrosis is well studied in the literature.

Influence of the previous dental visit experience in seeking dental care among young adults.

INTRODUCTION: Dental fear is one of the highly prevalent types of fear which deters patients from seeking dental cares. AIM: This study aims to assess the influence of a previous dental visit experience for seeking dental care among adults. METHODOLOGY: Young adults (n = 150, 15-26 years) with previous dental visit for care were selected randomly among outpatients' visit in tertiary dental teaching hospital. To assess the influence of previous experience of dental visit in seeking care, we self-administered a Post-traumatic Check List-Civilian Version [posttraumatic stress disorder (PTSD)], an Autobiographical Memory Questionnaire (AMQ), and a Dental Fear Survey (DFS). The relationship of negative and positive experience of previous dental treatment, dental fear, and symptoms of PTSD was assessed using Pearson's correlations. Spearman's rho was used to find out the correlation between the DFS and PCL-C and history of dental treatment undergone. RESULTS: The mean score of the DFS and PCL-C was found to be 69.57 and 40.17, respectively. The characteristics of the most negative experience including physical reactions (P = 0.936), emotional intensity (P = 0.935), sight (P = 0.941), smell (P = 0.917), and sound (P = 0.911) of dental treatment showed a significant relationship with dental fear, whereas the characteristics of the most positive memory of dental treatment showed only a few statistically significant associations with dental fear. Most of the symptoms of PTSD also show significant associations (P < 0.05) with characteristics of the most negative memory. Spearman's correlation between the DFS and the PCL-C was also statistically significant, r (150) =0.365, indicating that dental fear is indeed associated with symptoms of PTSD. CONCLUSION: There is a significant association between the characteristics of the most negative experiences of dental treatment and increased dental fear in young adults, while positive experiences did not show the inverse relationship with dental fear.