The Nasal Microarchitecture: How Does Tracheostomy Affect it?

This study aims to evaluate the histological changes in the nasal mucosa post Tracheostomy. A prospective observational study was done on 30 patients undergoing Tracheostomy after obtaining written informed consent from patients/legally accepted representatives. Prior to Tracheostomy, anterior rhinoscopy was done, and findings were noted; nasal mucosal biopsy was obtained from the inferior turbinate. The patients enrolled were followed up for four weeks, and in the patients still having Tracheostomy, repeat inferior turbinate biopsies were taken and compared. Statistically significant atrophy of lining epithelium was seen in 80% of the subjects, i.e., pseudostratified lining epithelium at Baseline with multilayered appearance changed to a single layer of flattened cells at follow-up. There was also a marked reduction in the number of seromucinous glands in the stroma at follow-up in 80% of the subjects. Additionally, fibrosis in the stroma was noted in 43.3% of subjects at follow-up. The results from this study indicate that Tracheostomy, likely as a result of nasal airflow deprivation, brings about significant changes in the microanatomy of the nasal airway. The extent of this causation and its implication in nasal pathology must be studied in larger populations with extended follow-up periods.

Study protocol for a randomised cross-over trial of Neurally adjusted ventilatory Assist for Neonates with Congenital diaphragmatic hernias: the NAN-C study.

BACKGROUND: Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers oxygen pressures in proportion to electrical signals of the diaphragm. The proportional assistance can be adjusted by the clinician to reduce the patient's work of breathing. Several case series of infants with congenital diaphragmatic hernias (CDH) have shown that NAVA may reduce oxygenation index and mean airway pressures. To date, no clinical trial has compared NAVA to standard methods of mechanical ventilation for babies with CDH. METHODS: The aim of this dual-centre randomised cross-over trial is to compare post-operative NAVA with assist control ventilation (ACV) for infants with CDH. If eligible, infants will be enrolled for a ventilatory support tolerance trial (VSTT) to assess their suitability for randomisation. If clinically stable during the VSTT, infants will be randomised to receive either NAVA or ACV first in a 1:1 ratio for a 4-h period. The oxygenation index, respiratory severity score and cumulative sedative medication use will be measured. DISCUSSION: Retrospective studies comparing NAVA to ACV in neonates with congenital diaphragmatic hernia have shown the ventilatory mode may improve respiratory parameters and benefit neonates. To our knowledge, this is the first prospective cross-over trial comparing NAVA to ACV. TRIAL REGISTRATION: NAN-C was prospectively registered on ClinicalTrials.gov NCT05839340  Registered on May 2023.

Comparing the Efficiency of Infrazygomatic Crest (IZC) Screws and Conventional Method for Anterior Retraction in Patients Undergoing Fixed Orthodontic Treatment for Class 2 Malocclusion: A Prospective Clinical Study.

Introduction In orthodontic treatment for class 2 malocclusion, conventional approaches involve extracting the upper first premolars and using methods like en masse retraction and extra-oral or intra-oral distalization. However, these often result in unintended forces and adverse effects. Contemporary techniques, such as maxillary arch distalization with mini-implants like infrazygomatic crest (IZC) implants, offer superior outcomes. IZC implants provide a safe, flexible, and effective site for implant placement, achieving a remarkable 93.7% success rate. Power arms enable precise control, allowing orthodontists to apply controlled forces for optimal tooth movement. This study aims to compare cephalometric parameters pre and post treatment using IZC/buccal shelf (BS) screws and conventional retraction, assessing the efficiency of IZC screws in maintaining arch length during teeth retraction. Methods In a split-mouth study at Yenepoya Dental College, 40 orthodontic patients aged 18-35 were divided into control (premolar extraction, anterior retraction) and study (third molar removal, IZC screw distalization) groups. The control group used a nitinol spring/E chain for retraction, while the study group employed IZC screw-assisted en masse distalization. Regular reviews and adjustments occurred, with radiographs and study models assessed after six months for cephalometric parameters and arch length. Results A significant difference was found in U1-SN (degree), L1-Apog (in mm), L1-NB (degree), and L1-NB (in mm) of pretreatment records, whereas all other measurements showed statistically similar values between conventional and IZC groups. Improvement was higher with the conventional group when compared with IZC groups in these measurements due to the extraction of the first premolars rather than third molar extraction and distalization. However, the IZC group also showed statistically significant improvement in cephalometric parameters such as U1-SN (degree), L1-Apog (in mm), L1-NB (degree), and L1-NB (in mm). Conclusion  The statistical analysis of radiographic and cast measurements in both the maxilla and mandible demonstrated a significant efficiency of IZC screws in teeth retraction while preserving arch length compared to conventional methods. Nevertheless, to strengthen the findings of our study, additional clinical investigations on IZC screws are warranted.

Sildenafil in Pulmonary Hypertension Associated with Bronchopulmonary Dysplasia: Friend or Foe?

INTRODUCTION: Sildenafil is a phosphodiesterase-5 inhibitor used to treat pulmonary hypertension, although its efficiency remains disputed in the neonatal population. We aimed to assess the clinical use of this drug in extremely premature infants diagnosed with pulmonary hypertension associated to bronchopulmonary dysplasia. STUDY DESIGN: This is a retrospective study of 18 patients born at ≤ 32 weeks gestational age with pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia, which was diagnosed on echocardiography at 36 weeks corrected gestational age. Median corrected gestational age at starting sildenafil was 48 weeks (range 32-60). In 4 cases there was a period of > 2 weeks between the evidence of moderate-severe pulmonary hypertension and starting sildenafil. In all other cases it was started as soon as the diagnosis was suspected or confirmed. RESULTS: All infants tolerated the use of sildenafil. However, 5 babies (26.31%) died despite ongoing intensive care, and 5 babies (26.31%) died after having care redirected due to severe chronic lung disease (1 due to co-existing neurological abnormality), with on overall mortality of this study of 52.62%. Eight babies (42.1%) survived: 5 continued on sildenafil until hospital discharge, 1 continued on transfer to the paediatric intensive care unit and 2 stopped while inpatients. Upon follow up to 2 years of age, out of the 5 patients who continued upon hospital discharge, 4 stopped at 6, 7, 12 and 18 months respectively, with 1 child being lost to follow up. Two patients (10.52%) restarted sildenafil use later in childhood. Echocardiographic evidence of improvement was noted in 58% (11 cases), with no improvement in 6 cases (32%) and incorrect original diagnosis in 1 case (5%). One infant died less than a week from the initiation of treatment. CONCLUSION: sildenafil use showed no clinical improvement of pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia in extremely premature infants.