Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis.

INTRODUCTION: Randomized controlled trials (RCTs) comparing triple therapies (inhaled corticosteroid [ICS], long-acting ß2-agonist [LABA], and long-acting muscarinic antagonist [LAMA]) for the treatment of chronic obstructive pulmonary disease (COPD) are limited. This network meta-analysis (NMA) investigated the comparative efficacy of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus any triple (ICS/LABA/LAMA) combinations and dual therapies in patients with COPD. METHODS: This NMA was conducted on the basis of a systematic literature review (SLR), which identified RCTs in adults aged at least 40 years with COPD. The RCTs compared different ICS/LABA/LAMA combinations or an ICS/LABA/LAMA combination with any dual therapy (ICS/LABA or LAMA/LABA). Outcomes of interest included forced expiratory volume in 1 s (FEV1), annualized rate of combined moderate and severe exacerbations, St George's Respiratory Questionnaire (SGRQ) total score and SGRQ responders, transition dyspnea index focal score, and rescue medication use (RMU). Analyses were conducted at 24 weeks (primary endpoint), and 12 and 52 weeks (if feasible). RESULTS: The NMA was informed by five trials reporting FEV1 at 24 weeks. FF/UMEC/VI was statistically significantly more effective at increasing trough FEV1 (based on change from baseline) than all triple comparators in the network apart from UMEC + FF/VI. The NMA was informed by 17 trials reporting moderate or severe exacerbation endpoints. FF/UMEC/VI demonstrated statistically significant improvements in annualized rate of combined moderate or severe exacerbations versus single-inhaler budesonide/glycopyrronium bromide/formoterol fumarate (BUD/GLY/FOR). At 24 weeks, the NMA was informed by five trials. FF/UMEC/VI showed statistically significant improvements in annualized rate of combined moderate or severe exacerbations versus UMEC + FF/VI and BUD/GLY/FOR. FF/UMEC/VI also demonstrated improvements in mean SGRQ score versus other triple therapy comparators at 24 weeks, and a significant reduction in RMU compared with BUD/GLY/FOR (160/18/9.6). CONCLUSION: The findings of this NMA suggest favorable efficacy with single-inhaler triple therapy comprising FF/UMEC/VI. Further analysis is required as additional evidence becomes available.

Comparative Efficacy of Umeclidinium/Vilanterol Versus Other Bronchodilators for the Treatment of Chronic Obstructive Pulmonary Disease: A Network Meta-Analysis.

INTRODUCTION: Few randomised controlled trials (RCTs) have directly compared long-acting muscarinic antagonist/long-acting ß2-agonist (LAMA/LABA) dual maintenance therapies for patients with chronic obstructive pulmonary disease (COPD). This systematic literature review and network meta-analysis (NMA) compared the efficacy of umeclidinium/vilanterol (UMEC/VI) versus other dual and mono-bronchodilator therapies in symptomatic patients with COPD. METHODS: A systematic literature review (October 2015-November 2020) was performed to identify RCTs ≥ 8 weeks long in adult patients with COPD that compared LAMA/LABA combinations against any long-acting bronchodilator-containing dual therapy or monotherapy. Data extracted on changes from baseline in trough forced expiratory volume in 1 s (FEV1), St George's Respiratory Questionnaire (SGRQ) total score, Transitional Dyspnoea Index (TDI) focal score, rescue medication use and moderate/severe exacerbation rate were analysed using an NMA in a frequentist framework. The primary comparison was at 24 weeks. Fixed effects model results are presented. RESULTS: The NMA included 69 full-length publications (including 10 GSK clinical study reports) reporting 49 studies. At 24 weeks, UMEC/VI provided statistically significant greater improvements in FEV1 versus all dual therapy and monotherapy comparators. UMEC/VI provided similar improvements in SGRQ total score compared with all other LAMA/LABAs, and significantly greater improvements versus UMEC 125 µg, glycopyrronium 50 µg, glycopyrronium 18 µg, tiotropium 18 µg and salmeterol 50 µg. UMEC/VI also provided significantly better outcomes versus some comparators for TDI focal score, rescue medication use, annualised moderate/severe exacerbation rate, and time to first moderate/severe exacerbation. CONCLUSION: UMEC/VI provided generally better outcomes compared with LAMA or LABA monotherapies, and consistent improvements in lung function (measured by change from baseline in trough FEV1 at 24 weeks) versus dual therapies. Treatment with UMEC/VI may improve outcomes for symptomatic patients with COPD compared with alternative maintenance treatments.

Bronchodilators are medicines that open the airways, allowing patients with chronic obstructive pulmonary disease (COPD) to breathe more easily. There are two different types of bronchodilators, namely long-acting muscarinic antagonists (LAMAs) and long-acting ß₂-agonists (LABAs), which can be used on their own or combined (LAMA/LABAs). Only a few clinical trials have compared different LAMA/LABA combinations with each other, so it is unclear which LAMA/LABA combination provides the greatest benefits for patients.In this study, we used network meta-analysis to compare a LAMA/LABA combination medicine called umeclidinium and vilanterol (UMEC/VI) with other LAMAs and LABAs used alone or in combination to treat patients with COPD. Network meta-analysis is a way of comparing two or more medicines by analysing data from many studies. We systematically searched for evidence from clinical trials in adult patients with COPD that were at least 8 weeks long and that compared LAMA/LABA combinations with a LAMA, a LABA, or another LAMA/LABA combination. We analysed data from 49 clinical trials that met these criteria.We found that patients treated with UMEC/VI had better lung function than patients treated with alternative LAMA/LABA combinations or bronchodilators used on their own. Patients treated with UMEC/VI had better quality of life than those receiving some other treatments, but not all. All the medicines we compared had similar side effects.Our results suggest that treating patients with COPD with UMEC/VI might improve their lung function and quality of life more than alternative bronchodilators.

Development of Dimensionless Parameters and Groups of Heat and Mass Transfer to Predict Wax Deposition in Crude Oil Pipelines.

A new methodology has been developed for analyzing heat and mass transfer to predict wax deposition in crude oil pipelines using the law of the wall dimensionless parameters. A set of physically meaningful dimensionless groups and parameters has laid a strong foundation behind the proposed methodology. The paper presents a discussion regarding the development of scale-up correlations from laboratory scale to field scale, considering the combination of both analytical groups and empirical correlations. Data from previous literature studies were employed for determining realistic values for the developed parameters and scale-up correlations. The utilization of new dimensionless scale-up parameters indicated that the wax deposition in crude oil pipelines is independent of the Reynolds number and the inner diameter of the pipeline. It further indicates that wax deposition in crude oil pipelines is mainly dependent on the heat transfer process and not on the shear reduction process. The dimensionless technique developed here can be utilized for determining the optimum pipe size and pigging frequencies to reduce and mitigate the effect of the wax deposition process.

Trends in Selection, Usage, and Techniques of Interocclusal Record Materials among Private Dental Practitioners: A Survey.

BACKGROUND: Majority of general dental practitioners provide fixed dental prosthesis in India. The aim of this study was to gather information on selection, usage, and materials and methods employed in interocclusal records and their communication with the dental laboratory for restorative procedures practised by dentists in Indore district to evaluate and to improve the quality of current practice. AIM AND OBJECTIVES: The purpose of this cross-sectional study was to understand and to evaluate dental practitioner's knowledge on interocclusal recording materials, its usage, their clinical implications, and their correlation with the laboratory in restorative procedures practiced by the dental practitioners in Indore district. MATERIALS AND METHODS: A questionnaire comprising 11 questions were framed and circulated among general dental practitioners except prosthodontists, and the results were statistically analyzed. RESULTS: Most of the practitioner's preferred wax (54.6%) as an interocclusal recording material over polyvinylsiloxane and polyether. Most of the dentists preferred full arch interocclusal record (27.8%). About 51.5% clinicians trimmed the interocclusal record before sending to the laboratory. CONCLUSION: From this survey, it has been concluded that the practitioner's attitude toward the use of interocclusal record materials is found to be deviated from well-acknowledged prosthodontic quality guidelines.

Descriptive Analysis of Mortality Predictors in H1n1 Influenza in South Indian Patients.

BACKGROUND: H1N1 (hemagglutinin-H-neuroaminidase-N) influenza infection is associated with high morbidity and mortality because of associated complications and related factors. Predictors of mortality in H1N1 patients are studied with very few without seasonal/pandemic declaration. This study was carried out to describe the clinical features, complications and different risk factors that affect the outcome in the patients with confirmed H1N1influenza infection. METHODS: A retrospective study was done in Kasturba Medical College Hospital, Manipal, India by analyzing the medical records of 141 patients admitted from January, 2011 to June, 2015. RESULTS: Of the 141 patients in the study, 51.1% of the patients were female with a mean age of 32±16.2 years. Fever with headache was observed in 92.9% patients while cough in 78.7% patients and breathlessness in 54.6% patients. On the basis of disease severity, 53.2% of the patients were put on mechanical ventilation. For all the patients, treatment for influenza management began with oseltemivir. Diuretics, antianxiety and corticosteroids were given as supportive and symptomatic care which contributed to high mortality in hospitalized patients. Mean hospitalization period was 8.5 days. During the hospitalization, patients developed different complications i.e. 31.20% patients developed respiratory tract infections, while 17.7% patients developed ARDS and 14.4% patients developed sepsis. The mortality rate of this study population was found to be 29.1 %. CONCLUSION: It was observed that low oxygen saturation during admission, high blood urea level, use of diuretics, corticosteroids, anti-anxiety drugs and complications like ARDS, sepsis influence the mortality rate of patients with H1N1 infection.

Analysis of Information, Impact and Control of HIV amongst Dental Professionals of Central India.

BACKGROUND: Dental health care providers may be exposed to a variety of microorganisms via blood, oral or respiratory secretions. Though the risk of transmission of Human Immunodeficiency Virus (HIV) in dental settings is low, the consequences of being infected are life threatening. Therefore, high standards in infection control and waste management are required in controlling occupational contagion and cross infection. AIM: To obtain comprehensive information about the HIV related information, its impact on the health care provider's attitude towards treating patients living with HIV/AIDS (PLWHA), infection control & waste disposal practices among dental professionals of Malwa region of Madhya Pradesh; situated in Central India. MATERIALS AND METHODS: A cross-sectional survey was conducted among 320 private dental practitioners. Data was collected using a pretested, self administered 40 item questionnaire and statistically analysed. RESULTS: The response rate was 81.25%. Over all 50.76% dentists were graded as having good knowledge of HIV. Unfortunately, their willingness to treat these patients remained low. In all 39.23% dentist were willing to render care to PLWHA. Junior dentists expressed less hesitation with regard to acceptance of risk patients than other dentists. Over 65% of the respondents reported adherence to universal precautions. The most alarming observation was that dentists were not following safe waste management practices. CONCLUSION: Dental professionals continue to indicate a reluctance to treat patients with HIV/AIDS or those in high- risk groups. The results suggest need to have a comprehensive motivational program and implementing ways to ensure access and availability of safe dental care for PLWHA. The desire to get training on how to handle PLWHA illustrates that receptiveness to change exists.

Evaluation of cervical marginal and internal adaptation using newer bulk fill composites: An in vitro study.

OBJECTIVE: To evaluate the cervical marginal and internal adaptation of posterior bulk fill resin composites of different viscosities, before and after thermo-cycling (TMC). MATERIALS AND METHODS: Eighty box-only class II cavities were prepared in 40 extracted human premolars with the distal proximal box beneath the enamel-cementum junction (CEJ). The teeth in the experimental groups were restored with bulk fill resin composite restorations (Gr. I- Sonic Fill, Gr. II- SDR, Gr. III- Tetric N Ceram Bulk Fill or a conventional composite designed for 2-mm increments (Gr. IV- Tetric N Flow along with Tetric N Ceram). Before and after thermal cycling, the gap-free marginal length was analyzed using SEM of epoxy resin replicas. After thermal cycling, specimens were cut longitudinally in order to investigate internal dentine adaptation by epoxy replicas under SEM (500 × magnification). RESULTS: Statistical analysis was performed using the ANOVA and Tukey Post Hoc tests (P < 0.05). In enamel, high percentages of gap-free margins were initially identified for all the groups, which declined after thermal cycling. However, no significant differences were identified among any of the groups (P > 0.05). In dentine, bulk fill groups performed at par with the incremental placement; for both marginal and internal adaptation (P < 0.05), for all materials except Tetric N Ceram Bulk Fill. CONCLUSIONS: Viscosity of the bulk fill restorative material influenced the proportion of gap-free marginal interface and the internal adaptation in dentin.

Comparative Analysis of Canal Centering Ability of Different Single File Systems Using Cone Beam Computed Tomography- An In-Vitro Study.

BACKGROUND: The ability of an endodontic instrument to remain centered in the root canal system is one of the most important characteristic influencing the clinical performance of a particular file system. Thus, it is important to assess the canal centering ability of newly introduced single file systems before they can be considered a viable replacement of full-sequence rotary file systems. AIM: The aim of the study was to compare the canal transportation, centering ability, and time taken for preparation of curved root canals after instrumentation with single file systems One Shape and Wave One, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Sixty mesiobuccal canals of mandibular molars with an angle of curvature ranging from 20(o) to 35(o) were divided into three groups of 20 samples each: ProTaper PT (group I) - full-sequence rotary control group, OneShape OS (group II)- single file continuous rotation, WaveOne WO - single file reciprocal motion (group III). Pre instrumentation and post instrumentation three-dimensional CBCT images were obtained from root cross-sections at 3mm, 6mm and 9mm from the apex. Scanned images were then accessed to determine canal transportation and centering ability. The data collected were evaluated using one-way analysis of variance (ANOVA) with Tukey's honestly significant difference test. RESULTS: It was observed that there were no differences in the magnitude of transportation between the rotary instruments (p >0.05) at both 3mm as well as 6mm from the apex. At 9 mm from the apex, Group I PT showed significantly higher mean canal transportation and lower centering ability (0.19±0.08 and 0.39±0.16), as compared to Group II OS (0.12±0.07 and 0.54±0.24) and Group III WO (0.13±0.06 and 0.55±0.18) while the differences between OS and WO were not statistically significant. CONCLUSION: It was concluded that there was minor difference between the tested groups. Single file systems demonstrated average canal transportation and centering ability comparable to full sequence Protaper system in curved root canals.

Giant cell fibroma of tongue: understanding the nature of an unusual histopathological entity.

Giant cell fibroma (GCF) is a rare case with unique histopathology. It belongs to the broad category of fibrous hyperplastic lesions of the oral cavity. It is often mistaken with fibroma and papilloma due to its clinical resemblance. Only its peculiar histopathological features help us to distinguish it from them. The origin of the giant cell is still controversial. Data available is very sparse to predict the exact behavior. Hence, we report a case of GCF of tongue in a 19-year-old male. Special emphasis is given to understand the basic process of development of the lesion, nature of giant cells, and also the need for formation of these peculiar cells. Briefly, the differential diagnosis for GCF is tabulated.

Influence of Implant Surface Topography and Loading Condition on Stress Distribution in Bone Around Implants: A Comparative 3D FEA.

A three-dimensional Finite Element Method was used to study the influence of porous coated surface topography of an implant on stress and strain distribution pattern in the cortical and cancellous bone during axial and non-axial loading. Two implants, one with porous surface topography and one with smooth surface were embedded in separate geometric models of posterior mandibular region which was generated using a CT scan data. Material properties and boundary conditions were applied. Load of 100 and 50 N were applied on to the abutment from axial and non-axial directions respectively. Porous surface topography appeared to distribute stress in a more uniform pattern around the implant with near absence of stress in the apical region of implant. Smooth surfaced implant showed high punching stress at the apex of the implant. The porous coated interface was considered to simulate the shock absorbing behavior of periodontal ligament of natural dentition. Maximum amount of stress concentration was observed in the cortical bone which plays a major role in the dissipation of the stress.