Virtual yoga may significantly reduce chronic low back pain intensity and improve back-related function: JAMA

A new study published in JAMA suggests that virtual yoga may significantly reduce chronic low back pain intensity and improve back-related function.

Chronic low back pain (CLBP) is a common condition with substantial impact on patients, in the form of physical and emotional suffering; health care costs; productivity; and health care professional burden. Although clinical guidelines recommend use of nonpharmacologic treatments first, such as yoga, there is a gap between guidelines and implementation in clinical practice. A study was done to compare the effects of virtual yoga classes vs a wait-list control on CLBP intensity, back-related function, sleep quality, and pain medication use. Single-blinded, 24-week, 2-arm, randomized clinical trial conducted from May 3, 2022, through May 23, 2023, comparing live streamed yoga classes (the yoga now group) with a wait-list control (the yoga later group, in which participants were offered the virtual intervention after the study but without assessments) among adults with CLBP. Adults 18 to 64 years of age with CLBP were recruited from the Cleveland Clinic Employee Health Plan, a large health system self-insured health plan. Inclusion criteria included a mean LBP intensity score of at least 4 on an 11-point numerical rating scale (scores ranged from 0 to 10, with higher scores indicating worse pain) and daily back pain interference about half or more of the days. Coprimary outcomes were mean pain intensity in the previous week on the 11-point numerical rating scale and back-related function as assessed using the 23-point modified Roland Morris Disability Questionnaire ([RMDQ], with higher scores reflecting poorer function) at 12 weeks. Secondary and exploratory outcomes included these measures at 24 weeks, pain medication use, and PROMIS sleep quality assessed using the Sleep Disturbance Short Form 8a, item 1 (scores ranged from 0 to 4, with higher scores reflecting better sleep quality). Analyses followed the intention-to-treat principle. Results Among 140 participants enrolled (yoga now = 71; yoga later = 69), the mean (SD) age was 47.8 (11.7) years and most were female (113 [80.7%]) and college-educated (103 [73.5%]). Mean (SD) baseline pain intensity (5.7 [1.5]) and RMDQ ([12.1 [4.4]) scores reflected moderate back pain and impairment. At week 12, yoga now compared with yoga later had greater reductions in mean pain intensity (−1.5 [95% CI, −2.2 to −0.7] points; P < .001) and mean RMDQ (−2.8 [95% CI, −4.3 to −1.3] points; P < .001) scores. At 24 weeks, the improvements in pain (mean change, −2.3 [95% CI, −3.1 to −1.6] points; P < .001) and RMDQ (mean change, −4.6 [95% CI, −6.1 to −3.1] points; P < .001) scores were sustained. At 12 weeks, yoga now participants reported 21.4 (95% CI, 5.2-37.6) absolute percentage points less use of any analgesic medication during the past week than yoga later participants and at 24 weeks, 21.2 absolute percentage points (95% CI, 5.2%-37.3%). Improvements in sleep quality were greater for participants in yoga now than among participants in yoga later at 12 weeks (mean change, 0.4 [95% CI, 0.1-0.7] points; P = .008) and 24 weeks (mean change, 0.4 [95% CI, 0.1-0.7] points; P = .005). Results of this randomized clinical trial of 140 adults with CLBP who were members of a large health system self-insured health plan suggest that virtual yoga classes may be a feasible, safe, and effective treatment option.

Reference:

Tankha H, Gaskins D, Shallcross A, et al. Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(11):e2442339. doi:10.1001/jamanetworkopen.2024.42339

Keywords:

Virtual, yoga, significantly, reduce, chronic low back pain, intensity, improve, back-related, function, JAMA , Tankha H, Gaskins D, Shallcross A

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Cold snare resection safe in patients on continuous clopidogrel and aspirin, suggests study

A new study published in the journal of Gastrointestinal Endoscopy found the safety of cold snare resection in individuals treated with continuous clopidogrel and aspirin. 2 well-established methods for removing colorectal lesions include underwater resection (polypectomy) and conventional endoscopic mucosal resection (EMR).

Despite being a more recent technique, underwater resection is safe and efficient, and it has benefits over traditional EMR, such as quicker resection and lower resource use. One technique that has a significant risk of bleeding is polypectomy. While it is advised to stop taking clopidogrel 5 to 7 days before polypectomy and the guidelines advise continuing to take aspirin throughout the procedure. The cold snare resection technique, with or without submucosal injection, is thought to be safer when compared to traditional polypectomy with electrocoagulation for post-polypectomy bleeding. Thus, Tae-Geun Gweon and colleagues carried out this investigation to compare the bleeding problems linked to cold snare resection between users of aspirin and clopidogrel.

Users of aspirin and clopidogrel who had polypectomy were included in this multicenter, prospective cohort research, which was carried out at 5 university hospitals in Korea. Antiplatelet agents were used continuously, with continuous usage defined as ≤ 3 days of interruption. In contrast to acute bleeding, which required hemostasis 2 minutes after polypectomy, delayed bleeding was the main goal and was defined as bleeding that occurred many hours after polypectomy. For every polyp, risk factors for rapid bleeding were examined.

A total of 263 of the 509 individuals (n = 129 on clopidogrel and n = 134 on aspirin) had polypectomies. Noninferiority was met by the rates of delayed bleeding per patient in the clopidogrel and aspirin groups, which were 0.8% and 0.7%, respectively (rate difference 0.03% [95% CI: –2.07% to 2.13%]). 100 patients (19.8%) who had polypectomy attained hemostasis. Female sex, end-stage renal illness, submucosal injection prior to resection, and polyp size > 5 mm were all risk factors for immediate hemorrhage.

Overall, the safety of cold snare resection methods for removing small colon polyps in people taking aspirin and clopidogrel continuously was confirmed by a recent study. The noninferiority of this study was supported by similar rates of delayed bleeding, which was 0.8% for clopidogrel users and 0.7% for aspirin users. Female sex, end-stage renal illness, submucosal injection, and polyp size > 5 mm were risk factors for rapid hemorrhage.

Source:

Gweon, T.-G., Kim, H. G., Jung, Y., Jeon, S. R., Na, S.-Y., Lee, Y. J., & Kim, T. H. (2024). Safety of cold snare resection techniques for removal of small colon polyps in patients with clopidogrel and aspirin: A Korean Association for the Study of Intestinal Diseases prospective, multicenter study. In Gastrointestinal Endoscopy. Elsevier BV. https://doi.org/10.1016/j.gie.2024.10.014

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Chronic rhinosinusitis with and without nasal polyps closely correlated with asthma, reveals study

A study published in Frontiers in Medicine reveals that chronic rhinosinusitis with and without nasal polyps is closely correlated with asthma.

A study was done to investigate the correlation between chronic rhinosinusitis (CRS) and bronchial asthma, focusing on the CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP), as well as their impact on lung function. A total of 141 patients diagnosed with chronic nasal-sinus inflammation were included in this study. Clinical data, including medical histories, nasal endoscopy scores, CT scores, symptom scores, and quality of life assessments, were collected. Results: Among the patients with CRSsNP, 23.8% had concomitant bronchial asthma. The incidence of asthma was significantly associated with the severity of sinus involvement in CRSsNP patients (p = 0.049). Pulmonary function impairment was correlated with the severity of sinus inflammation in CRSsNP patients (p = 0.019). Quality of life was significantly affected in patients with concomitant asthma and CRSsNP or CRSwNP. Chronic rhinosinusitis, both with and without nasal polyps, is closely correlated with bronchial asthma. Pulmonary function impairment is associated with the extent of inflammatory lesions in CRSsNP. Although CRSwNP does not significantly affect pulmonary function, the treatment of sinus diseases can contribute to the control of asthma.

Reference:

Kang, Jing, et al. “A Clinical Study On the Relationship Between Chronic Rhinosinusitis and Bronchial Asthma.” Frontiers in Medicine, vol. 11, 2024, p. 1388585.

Keywords:

Chronic, rhinosinusitis, without, nasal polyps, closely, correlated, asthma, reveals, study, Kang, Jing, Frontiers in Medicine

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History of concussion linked to higher risk of severe mental illness after childbirth, suggests study

People with a history of concussion face a 25% higher risk of having severe mental health issues after childbirth, according to a new study from ICES and the University of Toronto.

The research underscores the importance of identifying individuals with past concussions early in their prenatal care and highlights the need for long-term, trauma-informed support to safeguard their mental health.

“We found that individuals with a history of concussion were significantly more likely to experience serious mental health challenges, such as psychiatric emergency department visits or self-harm, in the years following childbirth,” says lead author Samantha Krueger, a registered midwife and PhD candidate in Health Research Methodology at McMaster University. The study was completed as part of Krueger’s MSc at the University of Toronto’s Institute of Health Policy, Management and Evaluation.

“This association was especially strong for people with no prior mental health history, meaning that concussion may be an important but overlooked risk factor during pregnancy and postpartum care,” adds Krueger.

The study followed more than 750,000 birthing people across Ontario between 2007 and 2017, tracking mental health outcomes for up to 14 years after delivery. Researchers found that among those with a history of concussion, 11% experienced severe maternal mental illness, compared to 7% for those without prior concussions. Even after adjusting for various factors like age, income, and history of interpersonal violence, concussion was associated with a 25% higher risk of severe mental illness.

The study’s findings were particularly striking among participants without a pre-existing mental health diagnosis. For these individuals, a prior concussion increased the risk of developing severe maternal mental illness by 33%, compared to those with no concussion history.

Senior author Dr. Hilary Brown notes that the physical and emotional demands of parenting may exacerbate concussion-related challenges. “Sleep is critical to recovery after a head injury, but sleep deprivation is a reality for many new parents,” says Brown, who is an Adjunct Scientist at ICES and Associate Professor in the Department of Health and Society at the University of Toronto Scarborough.

“Cognitive impairments, sensitivities to light and noise, and the stress of caring for a newborn can all intensify concussion symptoms, which in turn may raise the risk of mental health issues over time,” says Brown.

Given the biological links between brain injury and mental illness, the researchers advocate for routine antenatal screening for concussion history, provision of mental health resources, and the use of trauma-informed care during the postpartum period. “Our study points to a critical need for healthcare providers to take concussion history into account when supporting new parents,” adds Krueger. “Early identification and long-term support could make a real difference in preventing serious psychiatric outcomes.”

The study contributes to growing evidence that reproductive care should incorporate neurological and mental health factors to address the full spectrum of risks faced by birthing people. The researchers hope their findings will encourage healthcare providers and policymakers to prioritize concussion prevention in people of reproductive age and ensure adequate mental health resources for new parents with concussion histories. 

Reference:

Samantha Krueger, Simone N. Vigod, FRCPC; Vincy Chan, Tatyana Mollayeva, History of Concussion and Risk of Severe Maternal Mental Illness: A Population-Based Cohort Study,Journal of Clinical Psychiatry, DOI:10.4088/JCP.24m15373.

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T-VASI and F-VASI may Track Meaningful improvement in nonsegmental Vitiligo, confirms Study

France: A recent mixed-methods study has shed light on the psychometric properties and meaningful change thresholds of the Vitiligo Area Scoring Index (VASI), specifically the total VASI (T-VASI) and the facial VASI (F-VASI). The research, published in JAMA Dermatology, is particularly significant for patients with nonsegmental vitiligo, a chronic skin condition characterized by loss of pigment.

According to the study, the T-VASI and F-VASI have proven reliable and valid assessment tools that distinguish between different clinical groups and effectively track changes in patients with nonsegmental vitiligo.

“Notably, the study found that the thresholds for meaningful change are lower than those typically established in clinical trials. This indicates that T-VASI 50 and F-VASI 75 serve as conservative benchmarks, capturing improvements that are genuinely significant for patients managing nonsegmental vitiligo,” the researchers wrote.

Establishing meaningful improvement through the T-VASI and the F-VASI enhances the interpretation of results from clinical trials assessing vitiligo treatments. However, definitive and clinically significant thresholds for these measures have yet to be established. To address this knowledge gap, Khaled Ezzedine, Department of Dermatology, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil, France, and colleagues aimed to evaluate the concept validity and measurement effectiveness of the T-VASI and F-VASI in patients with nonsegmental vitiligo, while also identifying thresholds for meaningful change.

For this purpose, the researchers conducted a mixed-methods study that analyzed data from a phase 2 multicenter, double-blind trial involving adult patients with nonsegmental vitiligo across 35 sites in Canada, France, Japan, and the US. Participants were randomized to receive 6-, 11-, or 22-mg/day upadacitinib or placebo for 24 weeks.

The study assessed the psychometric performance of the Total Vitiligo Area Scoring Index and Facial VASI, along with thresholds for meaningful change, using clinician- and patient-reported data. Qualitative interviews evaluated content validity and patient perceptions of meaningful repigmentation. Data analyses were conducted between March and July 2023.

The study led to the following findings:

  • The psychometric analysis involved 164 participants, averaging 46 years old (63% female), while the qualitative analysis included 14 participants with an average age of 48.8 years (64% female, 36% male).
  • Intraclass correlation coefficients indicated strong test-retest reliability: 0.98 for T-VASI and 0.99 for F-VASI between baseline and week 4.
  • At baseline and week 24, correlations were moderate to strong: T-VASI with PhGVA-T (r = 0.63-0.65) and F-VASI with PhGVA-F (r = 0.65-0.71).
  • Average VASI scores decreased with repigmentation, and least-square mean scores increased with greater improvement as measured by PhGIC-V.
  • A 30% improvement in T-VASI and a 50% improvement in F-VASI scores were identified as meaningful changes from baseline to week 24.

The study validates the measurement properties of the Total Vitiligo Area Scoring Index (T-VASI) and Facial VASI (F-VASI) and highlights the clinical significance of the concepts they encompass. The randomized controlled trial data indicate that improvements of as little as 30% in T-VASI and 50% in F-VASI can be viewed as meaningful changes for patients.

“Consequently, the established thresholds of 50% improvement for T-VASI and 75% for F-VASI, as suggested by Kitchen et al., are effective for capturing patients’ perceptions of meaningful change in vitiligo treatment trials. Thus, both T-VASI and F-VASI are suitable tools for use in clinical trials focusing on patients with nonsegmental vitiligo,” the researchers concluded.

Reference:

Ezzedine K, Soliman AM, Camp HS, et al. Psychometric Properties and Meaningful Change Thresholds of the Vitiligo Area Scoring Index. JAMA Dermatol. Published online October 30, 2024. doi:10.1001/jamadermatol.2024.4534

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Abdominal sacrocolpopexy and sacrohysteropexy with synthetic mesh safe for vault /prolapse repair: Study

Pelvic organ Prolapse (POP) is relatively a common condition
among parous women. Uterine prolapse is defined as downward displacement of the
uterus from its normal anatomical position usually associated with prolapse of
the vaginal wall. Post-hysterectomy, vaginal vault slips down from anatomical
position into or beyond vaginal introitus called vault prolapse. Uterine
prolapse not associated with vaginal wall prolapse usually seen in nulliparous
women is called nulliparous prolapse.

With increasing life span of women, POP incidence increases
and it adversely affects the quality of life of the women. The most important
cause of vault prolapse is failure to identify and repair an enterocele during
hysterectomy. The management of vault prolapse depends upon age, parity,
associated comorbidities, duration of anesthesia; desire to preserve sexual
function and expertise of the surgeon. Conservative managements like vaginal
ring pessary, pelvic floor exercise have limited role in management of vault
prolapse. Many surgical procedures both vaginal and abdominal have been
described over the years however abdominal sacrocolpopexy has better anatomical
outcome. It has been shown to be a reliable and durable procedure with a
success rate of 78-100%. In this procedure, the vaginal apex is fixed to the
anterior ligament of the sacrum with a synthetic mesh. It restores the vaginal
apex close to the normal anatomical position.

There are many retrospective studies on sacrocolpopexy and
sacrohysteropexy where objective anatomical and surgical outcomes have been
dealt with. The functional components (vaginal symptoms, sexual life) of the
procedure have been neglected. In the present study short term (12 months)
anatomical and subjective (vaginal symptoms, sexual well-being and impact on
quality of life of the patients) outcomes has been studied.

Aim of the present study was to determine the effectiveness
of the abdominal sacrocolpopexy / sacrohysteropexy with synthetic mesh for
repair of vault prolapse and nulliparous prolapse respectively. The primary
objectives were to describe the outcomes in the form of anatomical correction,
symptomatic improvement and women’s satisfaction and the secondary objective
was to describe the complications of the procedure in peri-operative and in follow-up
period.

This prospective observational study was carried out in the
department of Obstetric and Gynaecology, at a tertiary care center. The present
study included 22 women with vault prolapse (n=18) and nulliparous prolapse
(n=4), underwent abdominal sacrocolpopexy /sacrohysteropexy respectively for 2
years from 1st February 2021 to 31st January 2023 and follow up for 12 months.

Most of the women had preoperative apical prolapse in
stages-3 (59%), mean age in abdominal sacrocolpopexy/ sacrohysteropexy group
was 53.6 years and 26.5 years respectively. Perioperative complications were
bladder injury (n=1), paralytic ileus (n=1), wound dehiscence (n=1) and UTI
(n=1). In post-operative reassessment of pelvic organ prolapse, vault/uterus
was well supported (100%), 100% symptomatic relief. During follow up
dyspareunia (n=1), lower backache (n=1) were present, no mesh erosion and no
recurrence of Pelvic organ prolapse observed.

Abdominal sacrocolpopexy for vault prolapse and
sacrohysteropexy for nulliparous uterine prolapse have high and consistent
success rate with minimal perioperative complications. Along with this, these
procedures are highly significant for patients satisfaction for vaginal
symptoms and overall impact on their quality of life.

Source: Kumari et al. / Indian Journal of
Obstetrics and Gynecology Research 2024;11(2):270–275

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Adenoidectomy combied with tympanostomy tube insertion may significantly reduce repeat procedures and oral antibiotic use in kids: JAMA

Adenoidectomy combined with tympanostomy tube insertion may significantly reduce repeat procedures and oral antibiotic use in kids suggests a study published in the JAMA.

The benefit of adenoidectomy on otologic outcomes after tympanostomy tube (TT) insertion is unclear. Results from prior work are challenging to interpret due to small sample sizes, heterogeneous study designs, and varying outcome measures. A study was done to evaluate the association between adenoidectomy and otologic outcomes using a US population-level sample of children who received TTs, producing generalizable results for widespread clinical application. A matched cohort study was conducted using claims data from the Merative MarketScan Research Databases. The study included 601 848 children who received TTs between January 1, 2007, and December 31, 2021. Children who received adenoidectomy and TTs simultaneously (Ad+TT) were identified irrespective of the number of prior TTs. Control participants who received TTs without adenoidectomy were matched based on sex, age at the time of the procedure, and the number of prior TT procedures. The primary outcomes were repeat TT insertion and subsequent oral antibiotic prescriptions after TT insertions. Multivariable logistic regression was used to quantify the effects of adenoidectomy and covariates on each outcome. Stratified analyses were performed in children younger than 4 years and 4 years or older. Results Overall, 601 848 children (median [IQR] age, 2 [1-4] years; range, 0-11 years; 351 078 [58.3%] male) who received TTs were identified. The Ad+TT cohort included 201 932 children, with an equal number in the matched cohort. In children younger than 4 years, Ad+TT was common and was associated with lower odds of subsequent oral antibiotics (odds ratio [OR], 0.59; 95% CI, 0.58-0.60) but higher odds of repeat TT insertions (OR, 1.24; 95% CI, 1.22-1.27). In children 4 years or older, Ad+TT was associated with lower odds of repeat TT insertions (OR, 0.78; 95% CI, 0.75-0.81) and subsequent oral antibiotics (OR, 0.63; 95% CI, 0.62-0.65). This study found that in children younger than 4 years, Ad+TT was commonly performed and may have had a secondary benefit of reducing subsequent oral antibiotic courses; however, it was not associated with a reduction in the risks of repeat TT insertions. In children 4 years or older, Ad+TT was associated with a reduction in the risk of repeat TT insertions and subsequent oral antibiotics. Given these findings, Ad+TT may be offered in children 4 years or older to improve otologic outcomes.

Reference:

Qian ZJ, Truong MT, Alyono JC, Valdez T, Chang K. Tympanostomy Tube Insertion With and Without Adenoidectomy. JAMA Otolaryngol Head Neck Surg. Published online October 17, 2024. doi:10.1001/jamaoto.2024.3584

Keywords:

Adenoidectomy, combined, tympanostomy, tube, insertion, may, significantly, reduce, repeat, procedures, oral, antibiotic, use, kids, JAMA, Qian ZJ, Truong MT, Alyono JC, Valdez T, Chang K

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Preventive use of landiolol beneficial for patients undergoing bimaxillary surgery, suggests study

The difficulty in bimaxillary surgery is the considerable bleeding during the surgery, leading to the exploration of different methods to reduce blood loss. Recent study aimed to assess the risks and benefits of using hypotensive anesthesia and piezosurgical instruments in bimaxillary surgery, particularly regarding their impact on intraoperative bleeding and cardiac function. The research found that the combined use of hypotensive anesthesia and piezosurgical instruments significantly reduced intraoperative bleeding, but was associated with a higher incidence of tachycardia, especially when using nicardipine. The combination also significantly lengthened the duration of the surgery and may have increased the burden on cardiac function. The study suggested that proactive preparation and preventive small-dose administration of landiolol could be beneficial in managing the potential occurrence of tachycardia when employing hypotensive anesthesia.

Reducing Blood Loss in Bimaxillary Surgery

Bimaxillary surgery, which combines mandibular and maxillary osteotomies, involves significant intraoperative bleeding and the need for transfusion, making it crucial to explore alternative measures with minimal adverse effects to reduce blood loss. Hypotensive anesthesia, a technique in which blood pressure is intentionally lowered during surgery to reduce bleeding, has been recognized for its potential in reducing intraoperative bleeding, but concerns regarding vital organ hypoperfusion during hypotensive anesthesia have been raised in other studies. The use of piezosurgical instruments in bimaxillary surgery provides an alternative strategy for bleeding management, albeit with potential challenges such as prolonged surgical duration. The study collected and analyzed data from the medical records of 30 patients who underwent bimaxillary surgery between 2015 and 2023. The results indicated that the combination of hypotensive anesthesia and piezosurgical instruments effectively reduced blood loss. However, it was observed that tachycardia may occur during hypotensive anesthesia, especially when nicardipine is used, which may lead to a strain on cardiac function. The study demonstrated the effectiveness of landiolol in managing tachycardia and suggested that the preparation and preventive use of landiolol may be beneficial for patients undergoing bimaxillary surgery.

Challenges and Limitations of Combined Approach

The study also highlighted the challenges and limitations involved in the combined use of hypotensive anesthesia and piezosurgical instruments, including the inability to discern the individual impacts of each method and the potential confounding variables associated with variations in anesthesia methods and hypotensive techniques. Additionally, the study indicated the need for further research and larger scale studies in this area to better understand the risks and benefits of the combined approach in bimaxillary surgery.

Key Points

– The study assessed the risks and benefits of using hypotensive anesthesia and piezosurgical instruments in bimaxillary surgery, aiming to reduce intraoperative bleeding and strain on cardiac function. – The combined use of hypotensive anesthesia and piezosurgical instruments was found to significantly reduce intraoperative bleeding, but it was associated with a higher incidence of tachycardia, particularly when using nicardipine. The combination also led to a significant lengthening of the surgical duration and potential increased burden on cardiac function.

– The study suggested that proactive preparation and preventive small-dose administration of landiolol could be beneficial in managing the potential occurrence of tachycardia when employing hypotensive anesthesia.

– Bimaxillary surgery involves significant intraoperative bleeding and the need for transfusion, making it crucial to explore alternative measures with minimal adverse effects to reduce blood loss. The combination of hypotensive anesthesia and piezosurgical instruments effectively reduced blood loss, but concerns regarding tachycardia during hypotensive anesthesia, especially when nicardipine is used, highlight the need for careful management of cardiac function.

– The study demonstrated the effectiveness of landiolol in managing tachycardia and suggested that proactive preparation and preventive use of landiolol may be beneficial for patients undergoing bimaxillary surgery.

– The study also highlighted the challenges and limitations involved in the combined use of hypotensive anesthesia and piezosurgical instruments, including the inability to discern the individual impacts of each method and the need for further research and larger scale studies in this area to better understand the risks and benefits of the combined approach in bimaxillary surgery.

Reference –

Yamamura K, Murakami K, Hirata Y, et al. (August 21, 2024) Assessing the Risks and Benefits of Hypotensive Anesthesia and Piezosurgical Instruments in Bimaxillary Surgery. Cureus 16(8): e67394. DOI 10.7759/cureus.67394

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Cone-beam computed tomography superior to periapical radiography for detection of vertical root fractures: Study

A new study published in the journal BMC Medical Imaging showed that Cone-beam computed tomography (CBCT) had a greater sensitivity than periapical radiography (PA) in diagnosing vertical root fractures (VRF). An entire or partial root surface may be affected by a vertical root fracture, which is characterized as a longitudinal fracture in the root that starts in the root canal and continues towards the apical periodontium. Tooth extraction is sometimes the only treatment option for fractured teeth, which has a poor or disastrous prognosis.

Accurate VRF identification is crucial to avoid incorrect diagnosis and the extraction of a tooth that might be treated and kept. The most common diagnostic techniques for identifying VRFs include radiography, clinical examination, and invasive procedures like exploratory surgery. It is controversial to use two-dimensional radiography techniques to detect VRFs. In contrast to PA radiography, CBCT is three-dimensional. Recent research has shown that improved understanding of VRF detection, together with the introduction of more sophisticated CBCT scanners and software, has increased diagnostic accuracy. In order to compile the existing data comparing the diagnostic accuracy of PA and CBCT for the diagnosis of vertical root fractures, Abbas Shokri and team carried out this study to do a systematic review and meta-analysis.

A search for published literature about all kinds of human teeth was done using PubMed, Scopus, and Web of Science. The Comprehensive Meta-Analysis statistical software V3 was used to examine the data. The heterogeneity of the studies were examined using the I2 statistic. The requirements for inclusion in the systematic review and meta-analysis were fulfilled by 23 and 16 papers, respectively. For PA radiography, the sensitivity and specificity for VRF detection were determined to be 0.51 and 0.87, respectively, whereas for CBCT, they were 0.70 and 0.84, respectively.

Although CBCT offers benefits like high-resolution 3D images and avoids the drawbacks of traditional radiography modalities like superimposing anatomical structures, it should be remembered that CBCT still carries a higher radiation dose and should not be used as a first radiography technique until after a thorough clinical examination to look for any signs of a fracture line. According to the current findings, CBCT generally had a much greater overall sensitivity than PA radiography for the identification of VRFs; however, there was no discernible difference in the two methods’ specificity.

Source:

Shokri, A., Salemi, F., Taherpour, T., Karkehabadi, H., Ramezani, K., Zahedi, F., & Farhadian, M. (2024). Is cone-beam computed tomography more accurate than periapical radiography for detection of vertical root fractures? A systematic review and meta-analysis. In BMC Medical Imaging (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12880-024-01472-5

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Nano nano-hydroxyapatite effective conservative alternative to fluoride for remineralizing White spot lesions, suggests study

Nano nano-hydroxyapatite effective conservative alternative to fluoride for remineralizing White spot lesions suggests a study published in the Journal of Dentistry.

A study was done to assess the effect of nano-hydroxyapatite (nano-HAP) either with or without fluoride on white spot lesions (WSLs) in terms of remineralisation and colour change. An electronic search was carried out in MEDLINE via PubMed, Scopus, Web of Science, LILACS, Embase, Cochrane Library, Google Scholar, Grey literature, and hand search. There were no limitations in terms of language and date (till August 2024) and all studies meeting the inclusion criteria were included. The outcome variables were enamel surface microhardness, enamel remineralisation rate, mineral content, and colour change. Different risk of bias tools were employed according to the study design. The level of evidence was graded using the GRADE profiler. A total of 14 out of 422 studies met the inclusion criteria. Three out of 14 studies were in vivo, one was in situ, while ten of them were in vitro. All 14 studies investigated the nano-HAP effects on WSLs. Following the full-text reviews and statistical analysis, 12 out of 14 studies were only included in the meta-analysis, since the remaining two studies lacked comparable data (mean±SD). Results: Different forms of delivery for nano-HAP were reported in the included studies. Pure nano-HAP showed promising effects on enamel surface microhardness (MD = 9.29, 95 % CI [7.74, 10.84], p < 0.00001), and mineral gain (MD = 0.09, 95 % CI [0.05, 0.13], P < 0.0001) when compared to fluoride alone. In addition, nano-HAP and fluoride demonstrated similar remineralisation abilities based on the DIAGNOdent™ readings (MD=0.09, 95 % CI [0.05, 0.13], p < 0.0001) There were no colour improvements within the WSLs following the application of nano-HAP (MD = -2.76, 95 % CI [-6.79, 1.27], p = 0.18). The intervention containing pure nano-HAP showed a promising remineralisation effect on WSLs in comparison to fluoride alone. However, there were no colour changes within WSLs following the use of nano-HAP. Limited number of clinical studies, high risk of bias, quality of the available studies, and relatively short follow-up periods failed to result in concrete evidence. The intervention containing pure nano-HAP showed a promising remineralisation effect in comparison to fluoride alone. Therefore, it might be an effective alternative to fluoride-containing agents.

Reference:

S Alajlan, Baysan A. The effect of nano-hydroxyapatite on white spot lesions: A systematic review and meta-analysis, Journal of Dentistry, Volume 151, 2024, 105402, ISSN 0300-5712. https://doi.org/10.1016/j.jdent.2024.105402.

(https://www.sciencedirect.com/science/article/pii/S0300571224005724)

Keywords:

Nano, nano-hydroxyapatite, effective, conservative, alternative, fluoride, remineralising, White spot lesions, study, Journal of Dentistry, S Alajlan, Baysan A

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