SUN-136 Clinico-Pathological Features, Treatment Modalities and Survival of Patients with Malignant Insulinoma: A Multicenter Study

Abstract Introduction: management of malignant insulinoma is challenging due to the need to control both hypoglycemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study: to analyze clinical-pathological characteristics, treatment modalities and prognosis of patients with malignant insulinoma. Materials and methods: Multicenter retrospective study on 31 patients (M 61.3%) diagnosed between 1988 and 2017. Results: The mean age at diagnosis was 48 ± 15 years. In 5 cases (16.1%) the hypoglycemic syndrome occurred after 46 ± 35 months from the diagnosis of NET, in 26 (83.9%) cases it led to the diagnosis of NET, of which 11 cases (42.3%) with mean diagnostic delay of 32.7 ± 39.8 months. The majority of the NET were G2 (70.8 %) and in the pancreatic body-tail (78.6%). The mean NET diameter was 41 ± 31 mm. Metastases were widespread in 40.7%, only hepatic in 37%, only lymph nodal in 18.5%..Surgical treatment was performed in 21/31 (67.7%) with hypoglycemic control in 42.9%. Except for 2 patients with curative surgery, the others underwent further different lines of therapies including somatostatin analogues (SA), Peptide Receptor Radionuclide Therapy (PRRT), everolimus, chemotherapy, TAE/TACE/RFA, radiotherapy. PRRT was performed in 14/31 (45.1%) with complete (42.9 %) or partial (50%) syndrome control. The median follow-up was 60 months. The 5-year survival rate was 62%. The median overall survival (OS) was 40 months. No significant difference in OS was observed according to the site of primary tumour and its dimension. A trend towards increased survival was found according to grading (5-year OS 100% for G1, 77% for G2, 33% for G3). Patients with Ki-67 ≤ 10% had a significant higher survival rate compared to patient with Ki-67 >10% (5-year OS rate 87% vs 43%, p: 0.03). As regards the type of treatment, patients who underwent surgery had a higher survival rate than those who did not (5-year OS 76% vs 31.7%, p= 0.006). Moreover, patients receiving PRRT as II line treatment had a better prognosis than those who underwent it in further lines, although the 5-year OS was not significantly different (80% vs 25% respectively, p=0.057). Conclusions: Our study includes the largest series of patients with malignant insulinomas up to now reported. The hypoglycemic syndrome may occur after years in initially non-functioning NETs, or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 <10% are prognostic factors associated with better survival. PPRT seems to be promising in the control of hypoglycemic syndrome.

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Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Acta Endocrinologica ◽

10.1530/eje-19-0989 ◽

2020 ◽

Vol 182 (4) ◽

pp. 439-446 ◽

Cited By ~ 3

Author(s):

A Veltroni ◽

E Cosaro ◽

F Spada ◽

N Fazio ◽

A Faggiano ◽

...

Keyword(s):

Surgical Treatment ◽

Diagnostic Delay ◽

Delayed Diagnosis ◽

Peptide Receptor Radionuclide Therapy ◽

Insulin Level ◽

Ki 67 ◽

Factors Associated ◽

Malignant Insulinoma ◽

Small Series ◽

The Mean

Introduction Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma. Materials and methods Multicenter retrospective study on 31 patients (male: 61.3%) diagnosed between 1988 and 2017. Results The mean age at diagnosis was 48 years. The mean NET diameter was 41 ± 31 mm, and 70.8% of NETs were G2. Metastases were widespread in 38.7%, hepatic in 41.9% and only lymph nodal in 19.4%. In 16.1% of the cases, the hypoglycaemic syndrome occurred after 46 ± 35 months from the diagnosis of originally non-functioning NET, whereas in 83.9% of the cases it led to the diagnosis of NET, of which 42.3% with a mean diagnostic delay of 32.7 ± 39.8 months. Surgical treatment was performed in 67.7% of the cases. The 5-year survival rate was 62%. Overall survival was significantly higher in patients with Ki-67 ≤10% (P = 0.03), insulin level <60 µU/mL (P = 0.015) and in patients who underwent surgery (P = 0.006). Peptide Receptor Radionuclide Therapy (PRRT) was performed in 45.1%, with syndrome control in 93% of patients. Conclusions Our study includes the largest series of patients with malignant insulinoma reported to date. The hypoglycaemic syndrome may occur after years in initially non-functioning NETs or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 ≤10% are prognostic factors associated with better survival. PPRT proved to be effective in the control of hypoglycaemia in majority of cases.

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Hemicraniectomy with dural augmentation in medically uncontrollable hemispheric infarction

Neurosurgical FOCUS ◽

10.3171/foc.1997.2.5.7 ◽

1997 ◽

Vol 2 (5) ◽

pp. E7 ◽

Cited By ~ 45

Author(s):

Christian Rainer Wirtz ◽

Thorsten Steiner ◽

Alfred Aschoff ◽

Stefan Schwab ◽

Holger Schnippering ◽

...

Keyword(s):

Survival Rate ◽

Surgical Intervention ◽

Vegetative State ◽

Surgical Decompression ◽

Middle Fossa ◽

The Past ◽

Small Series ◽

Significant Difference ◽

The Mean ◽

Hemispheric Infarction

Surgical decompression to alleviate raised intracranial pressure has been reported repeatedly in the past decades in small series of patients. Only recently have there been indications from larger trials that surgical decompression may be beneficial in treating space-occupying hemispheric infarction. However, surgical requirements for the procedure to be effective have not yet been defined. Based on theoretical criteria, the authors operated on 43 patients with medically uncontrollable hemispheric infarctions. The craniectomies were planned to be as large as possible and performed in combination with a subtemporal decompression. Postoperative computerized tomography scans were evaluated for these criteria. The mean survival rate for the group of 43 patients was 72.1% and no surviving patient ended up in a vegetative state. The mean area of craniectomy was found to be 84.3 ± 16.5 cm2 and the mean distance of the inferior craniectomy margin to the middle fossa was 1.8 ± 1.3 cm. Comparison of survivors and nonsurvivors failed to show a significant difference in the size of craniectomy or the distance to the floor of the middle fossa. Compared with the reported 80% fatality rate for medically treated stroke patients, in this subgroup the outcome (72.1% survival rate) is remarkably good. The authors conclude that decompressive craniectomy is an effective treatment, able to reduce mortality, and to improve neurological outcome in patients with space-occupying cerebral infarction if the size of craniectomy is large enough. Nevertheless, there is a need for further investigation to identify patients who will benefit from surgery and predictors to optimize the timing of surgical intervention.

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AB0664 DIAGNOSIS DELAY IN ANKYLOSING SPONDYLITIS PATIENTS IN EGYPT: FACTORS, SOCIOECONOMIC AND CLINICAL OUTCOME

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5003 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1627.2-1627

Author(s):

F. I. Abdelrahman ◽

M. Mortada

Keyword(s):

Ankylosing Spondylitis ◽

Social Life ◽

Activity Index ◽

Diagnostic Delay ◽

Disease Activity Index ◽

Diagnosis Delay ◽

Functional Index ◽

Delay In Diagnosis ◽

Significant Difference ◽

The Mean

Background:Ankylosing spondylitis (AS) is a destructive inflammatory disease which was reported to have the longest diagnostic delay among the inflammatory rheumatic disease. This lag period have a great impact on the clinical outcome and socioeconomic state of the patients. With the advent of tumor necrosis factor-α (TNF-α) inhibitors, early diagnosis in AS has become important(1).Objectives:to evaluate the period from symptom onset to diagnosis of AS in Egyptian patients and to examine possible reasons for delayed diagnosis and its impact on the economic and social life of the patients.Methods:The study included 87 AS patients diagnosed according to the Assessment of Spondyloarthritis international Society (ASAS) criteria (2). A face-to-face interview was applied to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first AS symptom and correct diagnosis of AS. Clinical and functional assessment of axial SpA measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI). The direct medical cost during years of delay (including costs of medical consultations, medications, investigations, physiotherapy and surgical treatment) had been estimated by Egyptian pound.Results:The study included 87 AS patients with mean age (30.03±8.3), 70 male (80.5%) and 17 female (19.5%).Mean delay in diagnosis was(5.7 ±4.9) years. Mean of diagnostic delay for patient diagnosed before 2010 is (14±4.4) and that of patients diagnosed after 2010 is (3.5±1.8) with significant difference between both (p value<0.0001). The main cause of delay was incorrect diagnosis as follow degenerative disc disease (43/87, 49.4%), non-specific back pain (31/87, 35.6%), rheumatoid arthritis (10/87,11.5%), rheumatic fever (2/87, 2.3%) and tuberculosis of spine (1/87, 1.1%). The mean of the medical visits was (6±5.4). Most incorrect initial diagnoses were made by orthopedicians (57.9%), followed by neurologists (22.2%) followed by rheumatologist (10%) and general phyisicians (9.9%). Absence of extra-articular manifestations, negative family history and juvenile age are significantly associated with diagnostic delay. Delay in diagnosis is significantly associated with higher disease activity index(BASDAI), functional index (BASFI), and damage index(BASMI). The mean of the costs during years of delay is (15671.3±546.1) with the mean of cost per each year delay (660.9±6.6) with high significant association between the cost and longer delay in diagnosis (<0.0001). Regarding work ability, we found that(32.2%) are fit for work, unfit (29.9%), partially fit (37.9%) with high significant difference between ability of work and shorter delay. Regarding social effect, 40.2 % of patients developed negative effect on social life with significant association to diagnostic delay (0.004).Conclusion:Our study confirmed the importance of early diagnosis of AS due to its impact on patient’s health outcome and socioeconomic state.We recommend to increase the awareness about the disease among healthcare professionals in our region.References:[1]Sykes M. et al: Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis; Ann Rheum Dis.2015;74:e44.[2]Rudwaleit M. et al: The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis; Ann Rheum Dis, 68 (2009), pp.777-783.Disclosure of Interests:None declared

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The Percutaneous Surgical Approach for Repairing Acute Achilles Tendon Rupture

Journal of the American Podiatric Medical Association ◽

10.7547/1000270 ◽

2010 ◽

Vol 100 (4) ◽

pp. 270-275 ◽

Cited By ~ 7

Author(s):

Shay Tenenbaum ◽

Niv Dreiangel ◽

Ayal Segal ◽

Amir Herman ◽

Amnon Israeli ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Demographic Data ◽

Achilles Tendon Rupture ◽

Treatment Modalities ◽

Main Concern ◽

Complication Rates ◽

Percutaneous Surgery ◽

Significant Difference ◽

The Mean

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. Methods: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24–58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results: All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90°/sec for plantarflexion power between the injured and healthy legs but no difference at 30° and 240°/sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. Conclusions: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments. (J Am Podiatr Med Assoc 100(4): 270–275, 2010)

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Impact of muscle mass on blood glucose level

Journal of Basic and Clinical Physiology and Pharmacology ◽

10.1515/jbcpp-2021-0316 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Murtada Taha ◽

Yaser A. AlNaam ◽

Thekra Al Maqati ◽

Lenah Almusallam ◽

Gharam Altalib ◽

...

Keyword(s):

Blood Glucose ◽

Blood Glucose Level ◽

Muscle Mass ◽

Glucose Level ◽

Glucose Utilization ◽

Treatment Modalities ◽

Healthy Population ◽

Inverse Association ◽

Significant Difference ◽

The Mean

Abstract Objectives At present, diabetes is one of the leading causes of mortality across the world. It was hypothesized that muscle mass could have a significant influence on blood glucose level and this corelation if established successfully could pave way for novel treatment modalities for type 2 diabetes mellitus (T2DM). In the present study, the association between muscle mass and blood glucose level was examined in a healthy population who was not having T2DM at baseline and was undergoing a regular course of exercise. Methods The clinical study was performed involving 53 healthy male populations between 10 and 60 years of age. The participants were sampled in accordance with the quantitative experimental study design, using nonprobability sampling techniques. The independent variable measured among the subjects included muscle mass and blood glucose level, using bioelectrical impedance and a simple glucometer respectively. Subgroup analysis amongst different substantial parameters including body mass index (BMI), myostatin inhibitor usage, and age factor that could affect the muscle mass and glucose level correlation were also studied simultaneously. Results The study findings demonstrated a negative correlation between muscle mass and glucose utilization levels. There was a significant difference in the mean muscle mass of the participants which was 36.2453, and the mean glucose utilization level which was 15.1493%. Pearson correlation between the muscle mass and percentage of glucose utilization of the participants indicated a significant difference (since p-value <0.05) between these two studied parameters. Conclusions The study finding suggests an inverse association of the skeletal muscle mass with blood glucose level which encourages the implication of muscle-building exercises as the preventive measure for T2DM.

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Consumer Prices for Surgical Management of End-Stage Hallux Rigidus

Foot & Ankle Specialist ◽

10.1177/1938640019846966 ◽

2019 ◽

Vol 13 (4) ◽

pp. 276-280

Author(s):

Niall A. Smyth ◽

Vaishnavi Krishnan ◽

Johnathon R. McCormick ◽

Jonathan R. Kaplan ◽

Amiethab A. Aiyer

Keyword(s):

Health Care ◽

Hallux Rigidus ◽

Treatment Modalities ◽

Potential Cost ◽

First Metatarsophalangeal Joint ◽

Consumer Prices ◽

Wide Range ◽

Significant Difference ◽

The Mean ◽

End Stage

Background. Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis; however, the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, health care consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods. Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to 3 times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results. Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21 767 (range $8417 to $39 265). The mean bundled price for synthetic cartilage implantation was $21 546 (range $4903 to $74 145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusions. There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, thus impeding health care consumers’ decision making. There was a wide range of quotes for both procedures, indicating potential cost savings. Levels of Evidence: IV, basic science

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The Effect of Pterygium Surgery on Corneal Topography

QJM ◽

10.1093/qjmed/hcaa058.026 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

N M Welson ◽

M M M Samy ◽

A A Gaafar ◽

T A Badran

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Corneal Topography ◽

Surgical Removal ◽

Significant Difference ◽

Uncorrected Visual Acuity ◽

Pterygium Surgery ◽

The Mean ◽

Pterygium Excision ◽

Topographic Astigmatism

Abstract Objective To evaluate the effect of pterygium surgery on corneal topography by comparing wave front analysis before and one month after the surgical treatment. Methodology Fifty eyes of forty-one patients were included in this study. Twenty five male and sixteen female patients seeking pterygium surgery were recruited from the Ophthalmology Department Outpatient Clinic in Sohag Teaching Hospital during the period from July 2017 to May 2018. All eyes underwent pterygium excision with conjunctival autograft. Results In this study we found a highly statistically significant improvement in the mean uncorrected visual acuity from 0.44±0.21SD preoperatively to 0.62±0.18SD postoperatively (p < 0.001) and a highly statistically significant difference in the mean logMAR visual acuity as it was decreased from 0.43±0.28 SD preoperatively to 0.34±0.23 SD postoperatively (p < 0.001). Also, there was a highly statistically significant improvement in mean of manifest refractive astigmatism from -4.08±3.28 SD preoperatively to -1.46±1.40 SD postoperatively (p < 0.001). We also found a highly statistically significant improvement in the mean cycloplegic astigmatism from -4.00±3.01 SD preoperatively to -1.39±1.33 SD postoperatively (p < 0.001) and also there was a highly statistically significant improvement in the mean topographic astigmatism from -5.17±4.08 SD preoperatively to -2.20±2.31 SD postoperatively (p < 0.001). We also found a highly statistically significant improvement in the mean of ISV (Index of Surface Variance) from 76.22±36.86 SD preoperatively to 33.56±15.02 SD post operatively (p < 0.001) and also there was a highly statistically significant improvement in the mean IHD (Index of Height Decentration) from 0.042±0.027SD pre-operatively to 0.023±0.036 SD post operatively. Conclusion There was a highly statistically significant difference in the mean logMAR visual acuity and a highly statistically significant improvement in the mean uncorrected visual acuity. A highly statistically significant improvement in both refractive and topographic astigmatism after one month of the surgery was noted also. Here were also a highly statistically significant improvement in ISV and IHD that indicate improvement after pterygium removal. Recommendations Patient with pterygium that inducing astigmatism will benefit from surgical removal of the pterygium.

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Surgical Treatment of Spinal Extradural Arachnoid Cysts in the Thoracolumbar Spine

Neurosurgery ◽

10.1227/neu.0b013e318257bf74 ◽

2012 ◽

Vol 71 (2) ◽

pp. 278-284 ◽

Cited By ~ 31

Author(s):

Haruki Funao ◽

Masaya Nakamura ◽

Naobumi Hosogane ◽

Kota Watanabe ◽

Takashi Tsuji ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Procedure ◽

Thoracolumbar Spine ◽

Neurological Recovery ◽

Dural Defect ◽

Total Resection ◽

Duration Of Symptoms ◽

Significant Difference ◽

The Mean ◽

Poor Outcomes

Abstract BACKGROUND: Because an idiopathic spinal extradural arachnoid cyst (SEAC) is rare, its optimal surgical treatment remains controversial. OBJECTIVE: To evaluate the results of surgical treatments for SEACs and to clarify features of the disease associated with poor outcomes. METHODS: Twelve patients with SEACs who underwent surgery at our hospital between 1988 and 2008 were examined retrospectively. The mean follow-up period was 4.7 years. Total resection of the cyst was performed in 7 patients and closure of the dural defect without cyst resection in 5 patients. Surgical outcomes were evaluated with regard to the duration of symptoms, the size of the cyst, and the surgical procedure used. RESULTS: Neurological recovery was observed in all patients, and there was no recurrence. Poor outcomes were observed in patients with a long duration of symptoms (>1 year, P < .01) and large cyst size (>5 vertebrae, P < .05). The surgical procedure had no significant association with the postoperative neurological recovery. However, there was a significant difference in the degree of the mean postoperative kyphotic angle between the patients treated by total resection of the cyst (9.7 degrees) and those treated by closure of the dural defect without cyst resection through selective laminectomy (2.2 degrees) (P < .01). CONCLUSION: There was no significant difference in postoperative neurological recovery between the 2 surgical procedures. However, closure of the dural defect without cyst resection was less invasive, preventing postoperative kyphotic deformity of the thoracolumbar spine.

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Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment

Journal of Neurosurgery Spine ◽

10.3171/2011.8.spine11395 ◽

2012 ◽

Vol 16 (1) ◽

pp. 8-14 ◽

Cited By ~ 36

Author(s):

Masatoshi Sumi ◽

Hiroshi Miyamoto ◽

Teppei Suzuki ◽

Shuichi Kaneyama ◽

Takako Kanatani ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Mr Imaging ◽

Cervical Spondylotic Myelopathy ◽

Japanese Orthopaedic Association ◽

Rank Test ◽

Imaging Findings ◽

Significant Difference ◽

The Mean

Object Because the main pathology of cervical spondylotic myelopathy (CSM) is spinal cord damage due to compression, surgical treatment is usually recommended to improve patient symptoms and prevent exacerbation. However, lack of clarity of prognosis in cases that present with insignificant symptoms, particularly those of mild CSM, lead one to question the veracity of this course of action. The purpose of this study was to elucidate the prognosis of mild CSM without surgical intervention by evaluation of clinical symptoms and MR imaging findings. Methods Sixty cases of mild CSM (42 males and 18 females, average age 57.2 years) presenting with scores of 13 or higher on the Japanese Orthopaedic Association (JOA) scale were treated initially by in-bed Good Samaritan cervical traction without surgery. These patients were enrolled between 1995 and 2003 and followed up periodically until the date of myelopathy deterioration or until the end of March 2009. The deterioration of myelopathy was defined as a decline in JOA score to less than 13 with a decrease of at least 2 points. As a prognostic factor, the authors used their classification of spinal cord shapes at their lateral sides on axial T1-weighted MR imaging. “Ovoid deformity” was classified as a situation in which both sides were round and convex, and “angular-edged deformity” where one or both sides exhibited an acute-angled lateral corner. The duration of follow-up was assessed as the tolerance rate of mild CSM using Kaplan-Meier survival analysis and compared between 2 groups classified by MR imaging findings. Furthermore, differences between groups were analyzed by various applications of the log-rank test. Results Of the initial 60 cases, follow-up records existed for 55, giving a follow-up rate of 91.7% (38 males and 17 females, average age 56.1 years). The mean JOA score at end point was 14.1, which was not statistically different from the mean of 14.5 at the initial visit. Deterioration in myelopathy was observed in 14 (25.5%) of 55 cases, whereas 41 (74.5%) of 55 cases maintained mild extent myelopathy without deterioration through the follow-up period (mean 94.3 months). The total tolerance rate of mild CSM was 70%. However, there was a significant difference in the tolerance rate between the cases with angular-edged deformity (58%) and cases with ovoid deformity (95%; p = 0.049). Conclusions The tolerance rate of mild CSM was 70% in this study, which proved that the prognosis of mild CSM without surgical treatment was relatively good. However, the tolerance rate of the cases with angular-edged deformity was 58%. Therefore, surgical treatment should be considered when mild CSM cases show angular-edged deformity on axial MR imaging, even if patients lack significant symptoms.

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Randomized controlled trial on the effectiveness of silver diamine fluoride in arresting caries in Lagos, Nigeria

Brazilian Journal of Oral Sciences ◽

10.20396/bjos.v21i00.8666341 ◽

2021 ◽

Vol 21 ◽

pp. e226341

Author(s):

Moses Okechukwu Azouru ◽

Modupe Olufunmilayo Ashiwaju ◽

Augustine Edomwonyi ◽

Afolabi Oyapero ◽

Bola Obisesan ◽

...

Keyword(s):

Controlled Trial ◽

Phase Iii ◽

Treatment Modalities ◽

Control Group ◽

Chi Square ◽

Silver Diamine Fluoride ◽

Randomized Controlled ◽

Significant Difference ◽

Chi Square Test ◽

The Mean

Treatment of dental caries in children still remains challenging due to lack of cooperation with conventional treatment modalities. Recently, the use of Silver Diamine Fluoride (SDF) has proved useful in addressing this challenge. Aim: This clinical trial aimed to evaluate the effectiveness of Silver Diamine Fluoride (SDF) in arresting caries in children in Lagos, Nigeria. Methods: This was a phase III balanced randomized controlled school based interventional study on 240 children. The study group was treated with SDF while GIC was used in the control group. Follow up visits in 2 weeks, 1 month, and 3 months were carried out to assess the treatment outcome. Inferential statistics with the use of Pearson Chi-square test and Independent Student t-test were used at 5% level of significance. Results: There was significant relationship between SDF and caries arrest in 2 weeks, 1 month and 3 months’ assessment period (p = 0.001). The control group showed continuous decline (71.7%, 54.3% and 50.9%) in restorative success from 2 weeks to 3 months respectively. The mean ± SD and Confidence Interval (CI) of arrested caries in the SDF group were 113± 1.24 and 113.1 – 113.5 respectively. In the control group the mean ± SD and CI of restorative success were 69.3±11.8 and 67.2 – 71.4. The effect size was 5.24. Conclusion: The result of the study showed that SDF was effective in arresting caries in children without any harm and there was statistically significant difference in the use of 38% SDF in arresting caries in children.

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