Archive for month: June, 2024

In the randomized clinical trial (RCT) of maternal progesterone therapy, the overall effect was not statistically different from 0. Subgroup analyses indicate heterogeneity of the response to progesterone among congenital heart defect diagnosis and fetal sex.

Congenital heart defects, affecting approximately 1% of newborns globally, pose significant medical challenges, often requiring complex interventions and lifelong management. Beyond the cardiac implications, these defects have been associated with neurodevelopmental delays and disorders, raising concerns about cognitive and behavioral outcomes in affected children.

Neurodevelopmental outcomes for children with CHD have improved minimally over the past 20 years. J. William Gaynor, University of Pennsylvania, Philadelphia, and colleagues aimed to assess the tolerability and feasibility of maternal progesterone therapy and the magnitude of the effect on neurodevelopment for fetuses with CHD.

For this purpose, the researchers conducted a double-blinded individually randomized parallel-group clinical trial of vaginal natural progesterone therapy vs placebo in participants carrying fetuses with CHD between 2014 and 2021 at a quaternary care children’s hospital.

Participants included maternal-fetal dyads with CHD identification before the fetus’ 28 weeks of gestational age and were likely to require surgery with cardiopulmonary bypass in the neonatal period. Exclusion criteria included an extracardiac anomaly or major genetic than 22q11 deletion syndrome and known contraindication to progesterone.

Participants were block-randomized in a 1:1 ratio to vaginal progesterone or placebo by diagnosis: transposition of the great arteries (TGA), hypoplastic left heart syndrome (HLHS), and other CHD diagnoses. Twice daily treatment was administered between 28 and up to 39 weeks gestational age.

The primary outcome was the motor score of the Bayley Scales of Infant and Toddler Development-III; secondary outcomes were language and cognitive scales. Exploratory prespecified subgroups included fetal sex, cardiac diagnosis, maternal-fetal environment, and genetic profile.

The study led to the following findings:

• The 102 enrolled fetuses primarily had HLHS (50.9%) and TGA (37.3%), were more frequently male (65.7%), and without genetic anomalies (59.8%).
• The mean motor score differed by 2.5 units for progesterone compared with placebo, a value not statistically different from 0.
• Exploratory subgroup analyses suggested treatment heterogeneity for the motor score for cardiac diagnosis and fetal sex but not genetic profile or maternal-fetal environment.

“We recommend continued study into possible benefits of progesterone for a targeted subset of patients with congenital heart defects,” the researchers concluded.

Reference:

Gaynor JW, Moldenhauer JS, Zullo EE, et al. Progesterone for Neurodevelopment in Fetuses With Congenital Heart Defects: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(5):e2412291. doi:10.1001/jamanetworkopen.2024.12291

The latest study stated, “With endocrowns made of the mentioned ceramics showing a high durability and success rate in the short term, they can be considered a safe choice for endodontically restoring treated teeth.” The researchers noted that caries were the most common reason for the failure of the restorations, and type of restoration or tooth type had no role to play in restoration failure. 89.36% of restorations were identified as clinically excellent or good.

Endocrowns are an essential restorative option for extensively damaged teeth, offering functional and aesthetic benefits. However, the choice of material for these restorations can significantly impact their clinical performance and longevity. Faezeh Atri, associate professor, Tehran University of Medical Sciences, Tehran, Iran, and colleagues aimed to demonstrate the clinical efficacy of endocrowns made of zirconia lithium silicate, feldspathic, and lithium disilicate ceramics using a chairside CAD/CAM system.

For this purpose, the researchers compared the clinical outcomes of 141 endocrown restorations in the posterior teeth of 85 patients in a two-year follow-up. Restorations’ efficacy was evaluated in three aspects: biological response, esthetics, and function, with the aid of the FDI guideline, and presented as descriptive analyses.

Based on the study, the researchers reported the following findings:

• The type of restorations (zirconia lithium silicate, feldspathic, and lithium disilicate) and underlying teeth (molars and premolars) play no part in restorations’ failure.
• Recurrence of caries is primarily responsible for the failure of the endocrowns.
• Secondary caries and radiolucency were observed in four teeth (2.83%).
• The clinical efficacy of 89.36% of restorations fell into the category of “clinically excellent” and “clinically good.”
• 7.09% of restorations were classified as “clinically sufficient/satisfactory,” and only 3.54% of restorations needed replacement due to having “clinically unsatisfactory” and “clinically poor” quality.

“Endocrowns made of several ceramics have been proven reliable restorations for endodontically treated premolars and molars,” the researchers wrote.

With further research and advancements in material science, restorative dentistry continues to evolve, offering patients increasingly sophisticated treatment options tailored to their specific needs and preferences.

The study represents a significant contribution to the dental community, providing valuable insights that will inform clinical decision-making and enhance the quality of patient care in the realm of endocrown restorations.

Reference:

Jalali, S., Asgari, N., Pirooz, P., Younespour, S., & Atri, F. (2024). Comparison of Clinical Efficacy of CAD/CAM Endocrowns Made of Feldspathic, Zirconia Lithium Silicate, and Lithium Disilicate: A Two-year Mixed Cohort Study. Journal of Dentistry, 105019. https://doi.org/10.1016/j.jdent.2024.105019

The case has highlighted serious allegations of
corruption and complicity in promoting gender bias. The clerk’s actions are
being scrutinized as they undermine the efforts to prevent gender-based
discrimination and ensure the effective implementation of the PNDT Act, which
aims to curb sex-selective practices and uphold gender equality.  

The case revolves around allegations that a clerk
demanded a bribe from a doctor to settle a notice related to the PNDT Act. A
doctor who was running an Imaging and Diagnostic Centre at
Barsat Road, Panipat complained that in the year 2023, a Nodal Officer PNDT and a
dealing clerk of the Civil Hospital, Panipat had checked F-Forms (patient forms) in
their centre and they issued him notice by deliberately creating errors with
the intention for taking bribe.

When the complainant met the doctor and the clerk, they
demanded Rs. 3,00,000/- bribe money and threatened the complainant that if the bribe amount was not paid, then they would falsely implicate him (complainant) in
PC & PNDT cases. However, the complainant approached the police and set a
trap to catch the offenders who agreed to settle the matter with Rs 2,00,00 red-handed. The prosecution presented substantial evidence,
including recorded conversations, that implicated the clerk in the bribery scheme.
Additionally, the recovery of the bribe money further corroborated the charges
against him.

Upon reviewing the evidence and the serious nature
of the allegations, the Court concluded that the clerk’s involvement in the
bribery scandal justified the denial of anticipatory bail. The Bench emphasized
his extensive communication with Dr Kumar and the recovery of the bribe
as strong evidence supporting the accusations. The court also stated
that the
petitioner’s job was to keep an eye on the clinics that had licenses to conduct
ultrasound, and such machines were under the provisions of the PNDT Act.

While denying bail to the complainant, the bench
comprising Justice Anoop Chitkara stated, “Those who, for
their small monetary gains misuse such sensitive positions, not only betray the
trust the system has reposed in them, being on such responsible and powerful
positions but also fail the society, making their conduct highly unethical,
immoral and reducing them to the status of lowest kinds of human beings.

Furthermore, the Court underscored the broader
societal impact of gender bias, highlighting statistics on the
declining female-to-male ratio in India and Haryana. The Bench noted the
prevalence of son preference and its harmful effects on gender equality, urging
vigorous efforts to combat gender bias and promote social justice.

“The Nodal Agencies under
the PNDT are supposed to work with the highest standards of morality, with a
strong and unshakeable sense of responsibility, and have to be bold enough to
work towards curbing female foeticide, which has led to falling female-gender
ratio in the North Indian population. When officials at such responsible,
sensitive, powerful positions, instead of proudly shouldering their
responsibilities, pawn off their morals, their honour, their duties; for
illegal financial gains, the society needs to get alarmed. Protecting the life
of our future generation is not only one of the most fundamental duties of the
legal system but also of the world at large and such a pivotal constitutional
duty cannot be callously brushed away, as it is our dignity itself, which is at
stake,” stated the order. 

The court has expressed genuine concern over such incidences where offenders blackmail these unethical
people and doctors and further extract and extort massive amounts of money. Instead of
checking and putting an end to such practices and unethical practitioners
and such gangs, who are extorting money from those doctors who agree to disclose
gender and pregnancy status under pressure or because of the greed for money,
certain corrupt employees at such highly sensitive and noble posts, very
lightly, shrug off their principal duties.

To view the order, click the link below: