Inclusion in the World Health Organization model list of essential medicines of non-vitamin K anticoagulants for treatment of non-valvular atrial fibrillation: a step towards reducing the burden of cardiovascular morbidity and mortality

Non-vitamin K antagonist oral anticoagulants (NOACs) represent a paradigm shift in the treatment of non-valvular atrial fibrillation (AF) with major practice guidelines around the world recommending NOACs over vitamin K antagonist oral anticoagulants for initial treatment of AF for stroke prevention. Here we describe the evidence collated and the process followed for the successful inclusion of NOACs into the 21st WHO Model List of Essential Medicines (EML). Individual NOACs have been reported to be non-inferior or superior to warfarin in preventing stroke and systemic embolism in eligible AF patients with a reduction in the risk of stroke and systemic embolism and a lower risk of major bleeding in patients with non-valvular AF compared with warfarin in both RCTs and real-world data. The successful inclusion of NOACs in the WHO EML is an important step forward in the global fight against cardiovascular morbidity and mortality, especially in low- and middle-income countries, where the burden of disease is high and limited access to diagnosis and treatment translates into a higher burden of morbidity, mortality, and economic costs

Metastatic seminoma with isolated gastric metastases:a case report

Gastric metastases are a rare occurrence in patients with malignancy. In case reports of these arising from germ cell tumours, the majority were non-seminomatous germ cell tumours and had evidence of retroperitoneal involvement. We present a unique case of a 67-year-old man with metastatic testicular pure seminoma. He presented with dyspepsia and investigation found isolated metastases to the gastric mucosa and sub-mucosa from a right testicular primary. No lymph node involvement was identified. The patient was managed with curative intent with total gastrectomy and inguinal orchidectomy. To date, there is no evidence of disease recurrence

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study

Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions

INFLUENCE OF BEVERAGES ON THE DENTOALVEOLAR SYSTEM (EXPERIMENTAL STUDY)

The aim of the study was to determine the influence of various drinking liquids on an the dentoalveolar system in rats. The study was carried out on 25 white male rats from the nursery of Krolinfo branch of the Moscow region which were kept in standard vivarium conditions. Age of rats-3-6 months, weight - 150-200 grams. The study was carried out in accordance with the ethical principles of humane treatment of animals, in accordance with the current legislation of the Russian Federation. To assess the effect of consumed fluids, groups of 5 animals of the same sex (males, females) were used. The animals were randomly assigned to groups. Observation of animals was carried out for 6 months, during this period the animals were in conditions of free access to food and as drink received the studied liquids ad libitum. Experimental groups within 3 months received the following types of drink: I (control group) - tap water; The II group - Coca-Cola; The III group - honey water; The IV group - the distilled water; The V group - light water. The results obtained by the authors and the data provided in literature confirm that among the factors that affect the teeth condition, in particular the characteristics of the hardness of enamel and dentin, the use of various sugar-containing drinks, as well as the duration, quantity, and frequency of their use, can play a significant role. These factors remain largely unexplored at present. It is obvious that in order to stop caries, it is necessary to develop and carry out a set of preventive measures, including limiting the consumption of sweets and beverages containing sugar, along with regular dental care and a balanced diet

The Effect of Intravenous Deep Sedation on Behaviour of Non Cooperative Children in the Dental Office-An Interventional Study

Introduction: Recently, there has been an increasing need for sedation techniques to reduce anxiety in children undergoing painful diagnostic and therapeutic procedures. Therefore, multiple tactics (oral sedation, Intravenous (IV) sedation) were devised to help practitioners manage such cases. Aim: To determine the efficiency and effects of propofol on the behaviour of anxious children during dental treatment. Materials and Methods: This interventional study was conducted at Damascus University, Damascus, Syria, from August 2018 to September 2020. Total 23 aged 3 to 6 who were physically healthy (American Society of Anesthesiologists I (ASA I) and uncooperative (negative or definitely negative according to Frankel's behaviour scale) were included to determine the effects of intravenous propofol on their behaviour during treatment. Behaviour during treatment was evaluated using the Ohio State University Behavioural Rating Scale (OSUBRS). Also, the sedation level was evaluated using the University of Michigan Sedation Scale (UMSS). Mann-Whitney test was used to compare the levels of behaviour and degrees of sedation between males and females. The significance level was set at p-value<0.05. Results: Behaviour according to OSUBRS and degree of sedation according to UMSS during treatment were favourable, and treatment was completed for all participants. The Mann-Whitney test showed no statistically significant difference between males and females regarding the level of behaviour (p-value=0.605) or the degree of sedation (p-value=0.376). A strong positive relationship between treatment time and awakening time was found using the Pearson's correlation coefficient (0.813, p-value<0.001). Conclusion: In the presence of an anaesthesiologist, intravenous propofol deep sedation was considered effective in managing anxious and uncooperative children during dental treatment

Comparative efficacy of Botox and surgical lip repositioning in the correction of gummy smile [Sravnitel'naya effektivnost' vvedeniya botoksa i khirurgicheskoi operatsii dlya korrektsii polozheniya gub pri desnevoi ulybke]

BACKGROUND: A smile plays an important role in determining a person's initial impression. OBJECTIVE: This study aims to evaluate the effectiveness of both injection botulinum toxin type A (botox) and surgical lip repositioning in the correction of the gummy smile due to hyperactive upper lip according to the resulting smile and the patients' satisfaction. MATERIAL AND METHODS: The study consisted of 24 patients: 12 received the BTX-A (botulinum toxin type-A) injection and the remaining 12 underwent the surgical procedure (lip repositioning). The patients rated their satisfaction according to their gingival display that was defined as the difference between the lower margin of the upper lip and the superior margin of the right incisor, and patients were followed at 2 weeks, 2 months, and 6 months. Post injection and post-surgery with changes documented by photographs. Both groups answered a questionnaire addressing the overall appearance and they were asked to rate the improvement of their smile according to a 5-point aesthetic scale. RESULTS: The patients rated the effects of BTX-A as highly favorable if we take into consideration that BTX-A had a temporary effect while the surgical procedure (lip repositioning) had a relapse likelihood of more than 80% because the lip reverted back to its original position with almost complete relapse after 6 months and not to mention the risks affiliated with the surgical procedures. CONCLUSION: BTX-A injection exhibits better results than those of surgery and had given safer and more satisfactory results and achieved the required cosmetic patient requirement than lip repositioning.ОБОСНОВАНИЕ: Улыбка играет важную роль в формировании первоначального впечатления о человеке, поэтому многие пациенты прибегают к коррекции линии улыбки по психологическим и социальным причинам. ЦЕЛЬ ИССЛЕДОВАНИЯ: Оценка эффективности инъекции ботулинического токсина типа А (ботокс; BTX-A) и хирургической коррекции десневой улыбки, возникающей из-за гиперактивности верхней губы, на основании удовлетворенности пациента результатами вмешательства. МАТЕРИАЛ И МЕТОДЫ: В исследование были включены 24 пациента: 12 из них была проведена инъекция BTX-A, а остальные 12 перенесли хирургическую операцию коррекции верхней губы. Пациенты оценивали свое состояние в соответствии с изменением степени обнажения десны, которое определялось как расстояние между нижним краем верхней губы и верхним краем правого резца. Повторные осмотры пациентов проводились через 2 нед, 2 и 6 мес, как после введения ботулотоксина, так и после проведения хирургической операции; все изменения, происходившие с пациентами после вмешательства, были задокументированы клиническими и фотоматериалами. Обе группы испытуемых заполнили анкету, касающуюся удовлетворенности своим внешним видом, в которой их попросили оценить результат вмешательства по 5-балльной эстетической шкале. РЕЗУЛЬТАТЫ: Пациенты оценили эффект от введения BTX-A как очень благоприятный, если принять во внимание, что введение BTX-A давало непродолжительный эффект, в то время как хирургическая операция репозиции верхней губы в 80% случаев требовала повторных корригирующих операций в связи с тем, что верхняя губа вернулась в исходное положение с почти полным рецидивом через 6 мес. При этом возникали риски, связанные с выполнением любых хирургических вмешательств. ЗАКЛЮЧЕНИЕ: Результаты введения BTX-A лучше, чем при хирургическом вмешательстве; данная процедура безопаснее и легче переносится пациентами

Pain assessment following endodontic treatment using two automated systems compared to manual treatment in primary molars

Background. Root canal treatment in primary teeth is quite difficult and time-consuming, especially canal preparation. Pain is the most common negative outcome following root canal treatment, occurring hours or days after treatment. It is an unpleasant experience for both the patient and the dentist. Objectives. The objective of this study was to assess the severity and duration of pain following the endo-dontic treatment of primary molars with the use of rotary and reciprocating preparation systems compared to the traditional manual method. Material and methods. The research sample consisted of 157 asymptomatic primary lower second molars with non-vital pulp that were indicated for root canal treatment. The patients were randomly divided into 3 groups: in the 1st group, the molars (n = 52) were prepared using the manual method; in the 2nd group (n = 53), a reciprocating automated preparation system (WaveOne®) was used; and in the 3rd group (n = 52), a rotary preparation system (ProTaper Next®) was used. Pain assessment was carried out after 6, 12, 24, 48, and 72 h, and after 1 week, using a four-face facial pain scale. Results. The manual method provided a higher pain score through 6, 12 and 24 h (p &lt; 0.05) as compared to the 2 automated preparation systems. The intensity of pain did not vary between the 2 machine preparation systems after 6, 12, 24, and 48 h (p &gt; 0.05). There were no differences between the 3 methods after 72 h and after 1 week (p &gt; 0.05). Conclusions. The manual method caused more pain than the other 2 preparation systems, but there was no difference between the 2 automated methods. Automated root canal preparation systems could be used to reduce the intensity of postoperative pain after the endodontic treatment of primary teeth. © 2021 by Wroclaw Medical University

Evaluation of the effect of sodium hypochlorite gel on composite bonding strength to enamel of primary teeth after salivary contamination: in vitro study [Primenenie gelya gipokhlorita natriya dlya uluchsheniya stsepleniya kompozitnogo materiala s emal'yu vremennykh zubov pri slyunnoi kontaminatsii]

OBJECTIVE: The study investigated the effect of 2%s odium hypochlorite gel application after post-etching salivary contamination on composite bonding strength to primary teeth enamel. MATERIAL AND METHODS: The sample consisted of 79 primary human teeth that were extracted no more than one month ago. The sample was randomly divided into four groups: (1) the control group (A) comprised 10 primary teeth, and composites were applied in the traditional manner without any salivary contamination; (2) the second group (B) consisted of 23 primary teeth in which salivary contamination was conducted after etching followed by re-etching and follow-up; (3) the third group (C) comprised 23 primary teeth in which saliva contamination was done after etching followed by washing, drying, and follow-up; and (4) the fourth group (D) comprised 23 primary teeth, in which salivary contamination was conducted after etching followed by application of sodium hypochlorite gel and follow-up. The samples were tested using the Testometric Tensile Strength Device (Testometric M350-10 kN, Testometric Ltd., UK) to measure the composite bonding strength to enamel of primary teeth. RESULTS: The arithmetic mean strength values in the research sample were ordered as followed: (A=13.39 MPa) > (D=11.82 MPa) > (C=8.07 MPa) > (B=6.15 MPa). The application of sodium hypochlorite gel after salivary contamination significantly improved the composite bonding strength to primary teeth enamel when compared with re-etching or only washing and drying. CONCLUSION: 15 s exposition of sodium hypochlorite gel with subsequent rinse and drying is recommended in case of saliva contamination of etched primary tooth enamel surface.ЦЕЛЬ ИССЛЕДОВАНИЯ: Изучение воздействия геля, содержащего 2% гипохлорита натрия, на последующее сцепление композитного материала и эмали после попадания слюны на поверхность эмали, которая была обработана 37% ортофосфорной кислотой TetricN-Etch (Ivoclar Vivadent). МАТЕРИАЛ И МЕТОДЫ: Исследованы 79 временных зубов, которые были удалены не более 1 мес назад. Данные зубы были поделены случайным образом на 4 группы: группа A включала 10 временных зубов, эмаль которых была обработана классическим методом без нанесения слюны, группа B — 23 временных зуба, эмаль которых была протравлена с последующим нанесением слюны и повторным протравлением, группа C — 23 временных зуба, эмаль которых была протравлена, после чего на нее нанесли слюну, рабочее поле промыли водой и высушили, а затем выполнили композитную реставрацию, группа D — 23 временных зуба, эмаль которых была обработана слюной после протравливания, затем был использован гель гипохлорита натрия, и работа была продолжена. Исследование проводилось на аппарате для определения прочности при разрыве (Testometric M350-10 kN, «Testometric Ltd.», Великобритания). РЕЗУЛЬТАТЫ: Среднеарифметические значения сцепления композита и эмали зубов распределились следующим образом: (A=13,39 МПа) > (D=11,82 МПа) > (C=8,07 МПа) > (B=6,15 МПа). Исследования показали, что использование гипохлорита натрия в виде геля после попадания слюны на поверхность обработанной эмали укрепляет сцепление композита с эмалью временных зубов статистически значимо больше, чем повторное протравливание или промывание водой с высушиванием. ЗАКЛЮЧЕНИЕ: Во время работы с композитными материалами при попадании слюны после стадии протравливания на рабочее поле эмали временного зуба авторы рекомендуют наносить гель гипохлорита натрия в течение 15 с с последующим промыванием и высушиванием