Cross infection and sterilization methods: A survey among dental practitioners in Chennai

Transmission of any infectious diseases is possible from one individual to another during dental procedures including blood-borne infections such as hepatitis B, hepatitis C and HIV. Therefore in dental clinics, the significance of sterilization and personal protection procedures is of utmost important. The aim of the present study is to evaluate the knowledge, attitude and practice of sterilization and infection control procedures among dental practitioners in Chennai. In this descriptive study, 100 dental practitioners working in private clinics in Chennai were randomly selected to evaluate the knowledge, attitude and practice of sterilization and infection control procedures using a self-administered questionnaire. 88 Dentists considered their patients as suspected of infection. 94% of the respondents are aware that sterilizing instruments at boiling temperature could not kill all type of microorganisms. 82% has answered that the time required for complete sterilization in an autoclave is 20 minutes. To sterile the instruments in the clinic, 37 dentist use autoclave. Out of 100, only 44 responded that the critical instruments (which penetrate the mucous membrane and skin) should not be sterilized by disinfectants. 66 practitioners are aware that the blood borne infections are HIV, HBV, and HCV. 86 participants are aware that the sharps should be discarded in a separate container. The attitude towards the cross infection is satisfactory nevertheless no adequate knowledge on blood-borne infections among the practitioners. Even though most of the practitioners follow proper sterilization methods, improvement in the practice of handling disinfectant solutions and methods of sterilization of hand pieces are required. We would conclude that the regular continuing education programme and short term courses about cross-infection and infection control procedures are essential

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Knowledge discovery and hypothesis generation from biomedical literature using text mining

Automated extraction of knowledge from voluminous documents is a vast research area. Text mining is a promising approach for extracting knowledge from unstructured textual documents and is the automated approach for knowledge extraction from unstructured data like text. The objective of this thesis is to mine documents pertaining to Ayurveda, which are retrieved from PubMed, and find novel transitive associations among biological objects. This thesis discusses the extraction of biological objects from the collected documents (databank) using an Automated Vocabulary Discovery (AVD) algorithm. An effective co-occurrence based text mining algorithm was designed for hypothesis generation combining AVD (Automated Vocabulary Discovery) algorithm and tf-idf (term frequency and inverse document frequency) algorithm. This algorithm was designed to extract novel binary associations and hypergraph based ternary associations (object1 – object2 – object3) among various objects (genes, chemicals, drugs etc.,) using transitive text mining. This research established relationship between objects from modern medicine and traditional Indian medicine Ayurveda. Thus generated hypotheses (novel associations) were assigned with co-occurrence based significance score and few highly significant novel associations were validated. Finally compared and analyzed thus obtained knowledge (ternary associations) with binary associations (object1 – object2) which form the superset for the ternary associations

Laminar flow past a circular cylinder at reynolds number varying from 50 to 5000

The present work aims at calculation of 2D laminar flow past a circular cylinder at Reynolds numbers varying from 50 to 5000 using an implicit pressure-based finite13; volume type Navier Stokes code for unsteady incompressible flow. The flow solution algorithm employs non-orthogonal boundary-fitted curvilinear grid with collocated variable arrangement coupled to low diffusive second order accurate schemes for discretisation of the non-linear convective fluxes and 2nd order accurate temporal discretisation schemes. The predictor-corrector type solution strategy of the SIMPLE algorithm is used with appropriate odifications for collocated variable arrangement. The computational results for mean surface pressure, skin friction, separation points,instantaneous streamlines and the temporal variation of the aerodynamic coefficients like13; lift and drag are validated against measurement and other computational data for both steady and periodic vortex shedding situations

Ciliated cyst of the maxilla following trauma: An unusual case report

Abstract Surgical ciliated cysts or post-operative maxillary cysts are benign cystic lesions usually induced after a surgical procedure in the maxillofacial area. It is a cystic lesion that develops, following a radical sinus surgery to treat maxillary sinusitis. The cyst progressively enlarges due to the osmotic diff erence causing destruction of the adjacent bone and structures. The clinical scenario may be identical to a radicular cyst if a nonvital tooth is involved. This is a case report of a healthy 17-year-old adolescent with the complaint of swelling in the right side of the face for the past 2 years