‘N-Angle’: Clinical Indicator for Predictable Insertion of Ramal Bone Screws

Introduction: The primary concern in the placement of ramal bone screws is the blind nature of the procedure, as there is a thick, mobile layer of soft tissue over the bone; also, the ramus is not a uniplanar structure but is swerving like a propeller blade. The purpose of this study was to evaluate the possibility of establishing clinical guidelines based on visible dental and soft-tissue landmarks for safe, reliable, and accurate insertion of ramal bone screws. Aims and Objectives: Our primary objective was to evaluate the angle formed between the appropriate direction of ramal-implant placement and the line tangential to the buccal surfaces of the first and second permanent molars. Our secondary objective was to evaluate the average distance of the neurovascular bundle from the tip of the bone screw. Materials and Methods: We obtained 80 cone beam computed tomography (CBCT) samples, marked reference lines and points on selected axial and coronal sections, and evaluated the following parameters using the software’s linear- and angular-measurement device: the angle between the appropriate direction of ramal bone screw placement and the line tangential to the buccal surfaces of the first and second permanent molars; and the proximity of the bone screw to the neurovascular bundle. Results: The angle between the constructed line of insertion and the occlusal line, as evaluated from our study, was 19.04 (SD ± 6.89) degrees. The proximity of the neurovascular bundle from the screw is 7.1773 (SD ± 1.73988) mm. Conclusion: We can conclude that ramal bone screws can be placed with a comfortable margin of safety.

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Suprascapular nerve block - do it yourself

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00015 ◽

2020 ◽

Vol 8 (2_suppl) ◽

pp. 2325967120S0001

Author(s):

Pierre Laumonerie ◽

Laurent Blasco ◽

Meagan E Tibbo ◽

Panagiotis Kerezoudis ◽

Nicolas Bonnevialle ◽

...

Keyword(s):

Injection Site ◽

Average Distance ◽

Suprascapular Nerve ◽

Primary Objective ◽

Reference Points ◽

Suprascapular Notch ◽

Orthopedic Surgeon ◽

Locoregional Anesthesia ◽

Secondary Objective ◽

Do It Yourself

Background: Suprascapular nerve (SSN) block using bone reference points (BARO) is a technique that in principle is accessible to practitioners without experience in locoregional anesthesia or ultrasound guidance. The primary objective was to validate the feasibility of SSN BARO by an orthopedic surgeon. The secondary objective was to provide a description of the path of the sensory branches from the SSN to the shoulder. Methods: A BARO was performed on 15 cadaveric shoulders by an intern in orthopedic surgery. Ten ml of methylene blue and 0.75% ropivocaine were injected around the SSN. 2.5ml of a red latex solution were also injected to identify the injection site. The distribution of the sensory branches of the NSS was also described. Results: The average distance between the SSN and the injection site was 1.5cm (0-4.5cm). The most frequent injection site was the proximal third of the scapular neck. Fifteen SSNs were marked upstream of the origin of the sensory branches. The 15 SSN produced 3 sensory branches that innervate the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments. Conclusion: SSN BARO by an orthopedic surgeon is a simple, reliable, and accurate technique. Injection near the suprascapular notch is recommended to mark the SSN upstream of its three sensory branches.

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Tomographic mapping of buccal shelf area for optimum placement of bone screws: A three-dimensional cone-beam computed tomography evaluation

APOS Trends in Orthodontics ◽

10.25259/apos_20_2019 ◽

2019 ◽

Vol 9 ◽

pp. 241-245

Author(s):

Neeraj Eknath Kolge ◽

Vivek J. Patni ◽

Sheetal S. Potnis

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Bone Screws ◽

Neurovascular Bundle ◽

Cone Beam ◽

Shelf Area ◽

Bone Screw ◽

Second Molar ◽

Bone Width ◽

Mandibular Second Molar

Introduction: Buccal shelf bone screws have become increasingly popular as a preferred method of skeletal anchorage in the mandibular arch. Anatomic variations and clinical experience suggest that width and slope of the bone at buccal shelf vary in different population groups, with some individual variations. Aims and Objectives: The objective of this study was to evaluate angulation of the bone screw of mandibular buccal shelf area, total bone width, thickness of the cortical bone, and proximity to neurovascular structures. Materials and Methods: Cone-beam computed tomography scans were used to obtain measurements of the buccal shelf region of 35 patients (18 females, 17 males; mean age, 23.6 years). Measurements were taken at three locations (L1, L2, and L3) and total bone width was measured at two levels from the cementoenamel junction (CEJ, H1 and H2). Bone screws were virtually placed and their proximity evaluated from digitally traced inferior alveolar neurovascular bundle. Results: Permissible angulation for placement of buccal shelf bone screw considering the safety distance from the root and avoiding excessive buccal projection to minimize cheek irritation was found to be 74.48 (SD ± 4.26). Total bone width was maximum at the distobuccal cusp of mandibular second molar (L3H2; 6.40 ± 1.35) when measured at the level of 8 mm from the CEJ. Bone screws were well within the safety range from causing any iatrogenic damage to the inferior alveolar neurovascular bundle at all the three aforementioned locations. Conclusion: Thus, area buccal to the mandibular second molar region seems to be the most favorable site for placement of buccal shelf bone screws in Indian patients.

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The Student Room Survey: Changes in the Post Graduate Study for Cardiothoracic Surgery

Journal of Surgical Sciences ◽

10.3329/jss.v23i2.46113 ◽

2020 ◽

Vol 23 (2) ◽

pp. 71-74

Author(s):

Md Faizus Sazzad ◽

Mohammed Moniruzzaman ◽

Dewan Iftakher Raza Choudhury ◽

Arif Ahmed Mohiuddin ◽

Raafi Rahman ◽

...

Keyword(s):

Thoracic Surgery ◽

Retrospective Analysis ◽

Primary Objective ◽

Graduate Study ◽

Postgraduate Students ◽

Depth Interview ◽

Secondary Objective ◽

Cardio Vascular ◽

The University ◽

Day By Day

Background: The number of postgraduate students in Cardiac surgical discipline is increasing day by day with incremental proportion are measurably suffering from the unnecessary lingering of the present course curriculum. The primary objective of this study was to find out the last 5 years’ of results of Masters in Surgery course under the University of Dhaka from a student room survey. A secondary objective was to find out positive changes that could show us the way of a step toward up-gradation. Methods: It is a retrospective analysis of all examination results of Cardio-vascular & Thoracic Surgery published since January 2008 to January 2013 from the University of Dhaka with in depth interview of 11 participants. Results: 85.24% students failed to pass part-I of Masters in Surgery for Cardio-vascular & Thoracic Surgery course while, 82.18% in part-II and 71.28% failed to pass the final part. Average 2.51 attempts needed to complete each part of the designed course resulted into lingering of course duration for 42.18 months/student. In the thoracic surgery discipline the number of students alarmingly reduced up to 0% in the recent academic sessions. Conclusions: Masters in Surgery is resulting in unnecessary prolongation of the course. We should step forward to meet the next generation challenge. Journal of Surgical Sciences (2019) Vol. 23(2): 71-74

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Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-20-0628 ◽

2021 ◽

Vol 184 (1) ◽

pp. 19-28

Author(s):

Alexander A Leung ◽

Janice L Pasieka ◽

Martin D Hyrcza ◽

Danièle Pacaud ◽

Yuan Dong ◽

...

Keyword(s):

Cohort Study ◽

Administrative Data ◽

Laboratory Data ◽

Population Based ◽

Incidence Rates ◽

Primary Objective ◽

Administrative Databases ◽

Secondary Objective ◽

True Frequency ◽

Clinical Records

Objective Despite the significant morbidity and mortality associated with pheochromocytoma and paraganglioma, little is known about their epidemiology. The primary objective was to determine the incidence of pheochromocytoma and paraganglioma in an ethnically diverse population. A secondary objective was to develop and validate algorithms for case detection using laboratory and administrative data. Design Population-based cohort study in Alberta, Canada from 2012 to 2019. Methods Patients with pheochromocytoma or paraganglioma were identified using linked administrative databases and clinical records. Annual incidence rates per 100 000 people were calculated and stratified according to age and sex. Algorithms to identify pheochromocytoma and paraganglioma, based on laboratory and administrative data, were evaluated. Results A total of 239 patients with pheochromocytoma or paraganglioma (collectively with 251 tumors) were identified from a population of 5 196 368 people over a period of 7 years. The overall incidence of pheochromocytoma or paraganglioma was 0.66 cases per 100 000 people per year. The frequency of pheochromocytoma and paraganglioma increased with age and was highest in individuals aged 60–79 years (8.85 and 14.68 cases per 100 000 people per year for males and females, respectively). An algorithm based on laboratory data (metanephrine >two-fold or normetanephrine >three-fold higher than the upper limit of normal) closely approximated the true frequency of pheochromocytoma and paraganglioma with an estimated incidence of 0.54 cases per 100 000 people per year. Conslusion The incidence of pheochromocytoma and paraganglioma in an unselected population of western Canada was unexpectedly higher than rates reported from other areas of the world.

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Incidência da utilização de protetores bucais em diversos esportes de contato

Full Dentistry in Science ◽

10.24077/2020;1245-118122 ◽

2020 ◽

Vol 12 (45) ◽

pp. 118-122

Author(s):

Victor Paes Dias Gonçalves ◽

Hugo Leonardo Matias Nahmias ◽

Marcus Menezes Alves Azevedo

Keyword(s):

Martial Arts ◽

Rio De Janeiro ◽

Dental Trauma ◽

Primary Objective ◽

Type Ii ◽

Contact Sports ◽

The Face ◽

Secondary Objective ◽

The City

Among contact sports, the practice of martial arts offers a greater risk of causing dental trauma and fractures as contact with the face is more frequent. The primary objective of the research is to evaluate the incidence of mouthguard use, and the secondary objective is to verify which type has a greater predominance and the difficulties in its use correlating to the type of mouthguard used. A documentary study was carried out with 273 athletes of different contact sports, among them: MMA, Boxing, Muay Thai, Jiu-Jitsu, and Taekwondo of the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. It was concluded that the most commonly used mouthguard is PB Boils and Bites - Type II and its level of approval is poor, interfering with the athletes’ performance, mainly in relation to the breathing factor.

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Use of Ceftaroline in Hospitalized Patients with and without COVID-19: A Descriptive Cross-Sectional Study

Antibiotics ◽

10.3390/antibiotics10070763 ◽

2021 ◽

Vol 10 (7) ◽

pp. 763

Author(s):

Daniele Roberto Giacobbe ◽

Chiara Russo ◽

Veronica Martini ◽

Silvia Dettori ◽

Federica Briano ◽

...

Keyword(s):

Bacterial Infections ◽

Bloodstream Infections ◽

Cross Sectional Study ◽

Primary Objective ◽

Sectional Study ◽

Cross Sectional ◽

First Line Therapy ◽

Large Teaching Hospital ◽

Secondary Objective ◽

Medical Wards

A single-center cross-sectional study was conducted to describe the use of ceftaroline in a large teaching hospital in Northern Italy, during a period also including the first months of the coronavirus disease 2019 (COVID-19) pandemic. The primary objective was to describe the use of ceftaroline in terms of indications and characteristics of patients. A secondary objective was to describe the rate of favorable clinical response in patients with bloodstream infections (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA-BSI) receiving ceftaroline. Overall, 200 patients were included in the study. Most of them had COVID-19 (83%, 165/200) and were hospitalized in medical wards (78%, 155/200). Included patients with COVID-19 pneumonia were given empirical ceftaroline in the suspicion of bacterial co-infection or superinfection. Among patients with MRSA-BSI, ceftaroline was used as a first-line therapy and salvage therapy in 25% (3/12) and 75% (9/12) of cases, respectively, and as a monotherapy or in combination with daptomycin in 58% (7/12) and 42% (5/12) of patients, respectively. A favorable response was registered in 67% (8/12) of patients. Improving etiological diagnosis of bacterial infections is essential to optimize the use of ceftaroline in COVID-19 patients. The use of ceftaroline for MRSA-BSI, either as a monotherapy or in combination with other anti-MRSA agents, showed promising rates of favorable response.

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Multicenter point prevalence evaluation of the utilization and safety of drug therapies for COVID-19 at the onset of the pandemic timeline in the United States

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa426 ◽

2021 ◽

Author(s):

Nathaniel J Rhodes ◽

Atheer Dairem ◽

William J Moore ◽

Anooj Shah ◽

Michael J Postelnick ◽

...

Keyword(s):

Clinical Trials ◽

Drug Therapy ◽

Supportive Care ◽

The United States ◽

Primary Objective ◽

Point Prevalence ◽

Medical Centers ◽

Academic Medical ◽

History Of ◽

Secondary Objective

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose There are currently no FDA-approved medications for the treatment of coronavirus disease 2019 (COVID-19). At the onset of the pandemic, off-label medication use was supported by limited or no clinical data. We sought to characterize experimental COVID-19 therapies and identify safety signals during this period. Methods We conducted a non-interventional, multicenter, point prevalence study of patients hospitalized with suspected/confirmed COVID-19. Clinical and treatment characteristics within a 24-hour window were evaluated in a random sample of up to 30 patients per site. The primary objective was to describe COVID-19–targeted therapies. The secondary objective was to describe adverse drug reactions (ADRs). Results A total of 352 patients treated for COVID-19 at 15 US hospitals From April 18 to May 8, 2020, were included in the study. Most patients were treated at academic medical centers (53.4%) or community hospitals (42.6%). Sixty-seven patients (19%) were receiving drug therapy in addition to supportive care. Drug therapies used included hydroxychloroquine (69%), remdesivir (10%), and interleukin-6 antagonists (9%). Five patients (7.5%) were receiving combination therapy. The rate of use of COVID-19–directed drug therapy was higher in patients with vs patients without a history of asthma (14.9% vs 7%, P = 0.037) and in patients enrolled in clinical trials (26.9% vs 3.2%, P < 0.001). Among those receiving drug therapy, 8 patients (12%) experienced an ADR, and ADRs were recognized at a higher rate in patients enrolled in clinical trials (62.5% vs 22%; odds ratio, 5.9; P = 0.028). Conclusion While we observed high rates of supportive care for patients with COVID-19, we also found that ADRs were common among patients receiving drug therapy, including those enrolled in clinical trials. Comprehensive systems are needed to identify and mitigate ADRs associated with experimental COVID-19 treatments.

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A Pilot Study Assessing Type a Behavior in Violence-Prone Inmates

Psychological Reports ◽

10.2466/pr0.1986.59.2.371 ◽

1986 ◽

Vol 59 (2) ◽

pp. 371-382 ◽

Cited By ~ 3

Author(s):

Bernadette H. Schell ◽

Jean-Charles Cachon ◽

Ozhand Ganjavi ◽

Frank Porporino

Keyword(s):

Multivariate Analysis ◽

Type A ◽

Type A Behavior ◽

Primary Objective ◽

Prison Inmates ◽

Activity Profile ◽

Voice Analysis ◽

Assessment Techniques ◽

Secondary Objective ◽

Violent Offenses

This study compared the Type A tendencies reported on the Behavior Activity Profile questionnaire and those yielded by a taped-voice analysis of 34 male prison inmates convicted for a variety of violent offenses. The primary objective was to provide prison officials with an instrument for detecting repeated assaulters from nonassaulters. The secondary objective was to determine which of the two Type A assessment techniques was more predictive of prisoners' status as assaulters. The multivariate analysis indicated that the profile, prisoners' length of sentence, and number of convictions accounted for 88% of the variance in grouping, assaulter or nonassaulter. Implications for prison administrators and researchers were discussed.

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Abstract 3729: Delayed Hematoma Expansion Occurs After ICH: Observations from the Safety of Pioglitazone for Hematoma Resolution in INtraCerebral Hemorrhage (SHRINC) trial

Stroke ◽

10.1161/str.43.suppl_1.a3729 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Navdeep S Sangha ◽

Farhaan Vahidy ◽

Mallikarjunarao Kasam ◽

Mohammed Rahbar ◽

Bursaw Andrew ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Prospective Study ◽

Univariate Analysis ◽

Primary Objective ◽

Hematoma Expansion ◽

Hematoma Growth ◽

Secondary Objective ◽

Magnetic Resonance Imaging Mri ◽

Associated Risk Factors

Background and Purpose Early hematoma expansion (EHE) has been described in the first 48 hours. SHRINC is a phase 2 prospective safety trial whose primary objective is to assess the safety of pioglitazone (PIO) when administered to patients with spontaneous intracerebral hemorrhage (SICH) compared to standard care. A secondary objective is to characterize the changes in hematoma resolution and expansion over time. This prospective study addresses the natural history, clinical impact, and associated risk factors of late hematoma expansion (LEX) by serial magnetic resonance imaging (MRI) after SICH. Methods SHRINC aims to enroll 78 subjects between the ages of 18-80 with a SICH of ≥ 5 ml. This analysis includes the first 42 patients enrolled. Four subjects were excluded because they did not have an MRI after day 2. A baseline CTH was performed followed by an MRI within 24 hours of symptom onset. Hematoma volume (Hv) was measured on FLAIR sequences using a previously published semi-automated range of interest method. LEX was defined as an increase in Hv > 0.5 ml after the 48 hour MRI. Factors associated with LEX were evaluated with logistic regression. Longitudinal analyses were used for measurements taken over the follow up period. Results: Ten (26.3%) of 38 subjects displayed LEX. Eight subjects had LEX between day 2 to 14, and 4 between days 14 to 28. The median initial Hv was 16.1cc in LEX patients and 24.1cc in those without expansion (NEX) (p=0.23). Lower platelet counts (p=0.04) and BUN levels (p=0.03) were associated with LEX in univariate analysis. Multivariate analysis suggested that those with higher BUN levels were less likely to have LEX (OR=0.81; 95%CI 0.65-0.99). Blood pressure and EHE (13.2%) were not associated with LEX. There was no difference in neurological worsening (NIHSS increase ≥ 4), 6 month mRS or death between LEX and NEX. Conclusion: This is the first prospective study to address LEX with serial MRIs. LEX occurs between day 2 to 14 and day 14 to 28. Elevated BUN levels may decrease the likelihood of LEX. A limitation of our study is that the effect of PIO on LEX could not be evaluated because SHRINC is a blinded trial. Further studies will assess the pathophysiology of LEX and its potential implications in clinical trials evaluating hematoma growth and resolution.

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Comparative Genomics ofEscherichia coliIsolated from Skin and Soft Tissue and Other Extraintestinal Infections

mBio ◽

10.1128/mbio.01070-17 ◽

2017 ◽

Vol 8 (4) ◽

Cited By ~ 12

Author(s):

Amit Ranjan ◽

Sabiha Shaik ◽

Nishant Nandanwar ◽

Arif Hussain ◽

Sumeet K. Tiwari ◽

...

Keyword(s):

Escherichia Coli ◽

Comparative Genomics ◽

Soft Tissue ◽

Multidrug Resistant ◽

Primary Concern ◽

Beta Lactamase ◽

Soft Tissue Infections ◽

E Coli ◽

Recent Emergence ◽

Tract Infections

ABSTRACTEscherichia coli, an intestinal Gram-negative bacterium, has been shown to be associated with a variety of diseases in addition to intestinal infections, such as urinary tract infections (UTIs), meningitis in neonates, septicemia, skin and soft tissue infections (SSTIs), and colisepticemia. Thus, for nonintestinal infections, it is categorized as extraintestinal pathogenicE. coli(ExPEC). It is also an opportunistic pathogen, causing cross infections, notably as an agent of zoonotic diseases. However, comparative genomic data providing functional and genetic coordinates for ExPEC strains associated with these different types of infections have not proven conclusive. In the study reported here, ExPECE. coliisolated from SSTIs was characterized, including virulence and drug resistance profiles, and compared with isolates from patients suffering either pyelonephritis or septicemia. Results revealed that the majority of the isolates belonged to two pathogenic phylogroups, B2 and D. Approximately 67% of the isolates were multidrug resistant (MDR), with 85% producing extended-spectrum beta-lactamase (ESBL) and 6% producing metallo-beta-lactamase (MBL). TheblaCTX-M-15genotype was observed in at least 70% of theE. coliisolates in each category, conferring resistance to an extended range of beta-lactam antibiotics. Whole-genome sequencing and comparative genomics of the ExPEC isolates revealed that two of the four isolates from SSTIs, NA633 and NA643, belong to pandemic sequence type ST131, whereas functional characteristics of three of the ExPEC pathotypes revealed that they had equal capabilities to form biofilm and were resistant to human serum. Overall, the isolates from a variety of ExPEC infections demonstrated similar resistomes and virulomes and did not display any disease-specific functional or genetic coordinates.IMPORTANCEInfections caused by extraintestinal pathogenicE. coli(ExPEC) are of global concern as they result in significant costs to health care facilities management. The recent emergence of a multidrug-resistant pandemic clone,Escherichia coliST131, is of primary concern as a global threat. In developing countries, such as India, skin and soft tissue infections (SSTIs) associated withE. coliare marginally addressed. In this study, we employed both genomic analysis and phenotypic assays to determine relationships, if any, among the ExPEC pathotypes. Similarity between antibiotic resistance and virulence profiles was observed, ST131 isolates from SSTIs were reported, and genomic similarities among strains isolated from different disease conditions were detected. This study provides functional molecular infection epidemiology insight into SSTI-associatedE. colicompared with ExPEC pathotypes.

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