Search

Background: Seasonal influenza continues to present a significant annual burden as the vaccination rate in the United States is 51.8%. Emergency Department (ED) based influenza programs have been successfully implemented and improve vaccine uptake, reduce incidence and costs, and improve outcomes. Objective: To develop a predictive model to assess preventable influenza cases, hospitalizations, fatalities, and incremental cost avoidance based on the unvaccinated population. Methods: A retrospective cohort of ED encounters limited to Medicare and Medicaid populations was performed across 14 tertiary care hospital EDs and six freestanding EDs for 2020. The total number of unvaccinated individuals was identified to determine the potential impact of an ED vaccination campaign. The average cost and loss per inpatient stay was identified from prior industry Medicare benchmark data and was utilized to extrapolate Medicaid losses. Results from published cost-effectiveness studies identified the vaccination thresholds to prevent one additional case of influenza, one additional hospitalization, and one additional fatality. Results: A total of 39,463 unvaccinated individuals were identified, with 14,064 classified as Medicare, and 25,379 classified as Medicaid. Assuming a 95% target outreach, 90% medical eligibility, and 70% acceptance rate, 414 influenza cases would be prevented (266 Medicaid, 148 Medicare), 28 hospitalizations would be prevented (18 Medicaid, 10 Medicare), and eight deaths would be prevented (5 Medicaid, 3 Medicare). Accordingly, a reduction in admissions would prevent $409,360 in total inpatient medical costs and $36,232 in losses to healthcare systems. Conclusion: An ED-based influenza vaccination program would have a measurable impact on patient influenza disease burden and associated medical expenditures.

Objectives To assess the pattern and determinants of healthcare service utilisation among adults with coronary artery disease (CAD) in a rural setting in Kerala, India.Design A community-based cross-sectional analysis conducted within a study cohort.Setting The study was conducted from January 2022 to March 2022 within the ENDIRA Cohort (Epidemiology of Non-communicable Diseases In Rural Areas) in the rural part of Aluva municipality of Ernakulam district, Kerala, India, which comprises five adjacent panchayats with a population of approximately 100, 000 individuals.Participants Patients with CAD aged 35–80 years from the ENDIRA cohort with a history of at least one event of myocardial infarction in the past decade.Outcome measures The main outcome measured was the inadequacy of healthcare service utilisation among patients with CAD. The factors evaluated included age, gender, socioeconomic status, insurance, out of pocket expenses, choice of health care facility for follow up, distance from health centre as well as reported alcohol use, tobacco use and healthcare satisfactionResults The study encompassed 623 participants with a mean age of 65.12 (±8.55) years, of whom 71% were males. The prevalence of inadequate utilisation of health services was 58.7%. The independent predictors of underutilisation included reported alcohol consumption (adjusted OR (AOR) 2.36; 95% CI 1.41 to 3.95), living more than 20 km from healthcare facilities (AOR 1.96; 95% CI 1.14 to 3.37) as well as the preferences for specific doctors and adequate services at healthcare facilities (AOR 3.43; 95% CI 1.46 to 8.04). The patients with monthly CAD medication expenses exceeding Rs4000 had 0.26 times lesser odds to underuse healthcare services (AOR 0.26; 95% CI 0.10 to 0.65).Conclusion The study reveals a suboptimal pattern of healthcare service utilisation among patients with CAD. Ensuring community access to standardised, high-quality follow-up care is crucial for enhancing healthcare utilisation following CAD.

Aim: This study aimed to estimate and correlate the serum and gingival crevicular fluid (GCF) levels of caspase-3 and milk fat globule–epidermal growth factor 8 (MFG-E8) in healthy, gingivitis and generalised chronic periodontitis subjects. Materials and Methods: A total of 24 subjects were selected and divided into three groups. After recording the periodontal parameters (plaque index (PI), modified gingival index (MGI), probing depth (PD) and clinical attachment level (CAL)), the serum and GCF samples were collected and the levels of caspase-3 and MFG-E8 were estimated using enzyme-linked immunoassay (ELISA). Results: The mean values of PI, MGI, PD and CALs were significantly higher in group III when compared to group II and group I. The mean value of serum and GCF caspase-3 increased with increasing disease severity, whereas the mean serum and GCF values of MFG-E8 decreased with increasing severity of disease. Spearman’s correlation showed a strong positive correlation between the serum and GCF levels of caspase-3 and periodontal parameters, whereas serum and GCF levels of MFG-E8 showed a strong negative correlation with the periodontal parameters. Conclusion: The findings of this study are suggestive that the serum and GCF levels of caspase-3 and MFG-E8 could serve as a potential biomarker for the role of apoptosis in periodontal disease. However, further studies are required to explore the mechanism and understand the relationship between these apoptotic markers and periodontitis.

Introduction: Malocclusion is multifactorial in origin, caused by the interaction of various general and local factors. The consequences of malocclusion include dental caries, periodontitis, impaction of teeth, and compromised chewing abilities. Thus, if left untreated, malocclusion can not only lead to oral health problems like periodontal problems and dental caries but also psychological problems, causing a loss of self-esteem and confidence in the individual. Aim: To assess the potential relationship between malocclusion with orthodontic treatment needs and dental caries, periodontal diseases, dental traumatic injuries, oral hygiene, and Oral Health-related Quality of Life (OHRQoL). Materials and Methods: A cross-sectional study was conducted among 1800 school-going and college students at their respective Institutions in Chennai, Tamil Nadu, India from December 2021 to June 2022 with and without orthodontic treatment needs, to identify malocclusion and various oral conditions/diseases associated with it, in addition to the effect of malocclusion on OHRQoL. Oral health status was assessed using the World Health Organisation (WHO) Basic Oral Health Survey (2013); malocclusion was assessed using the Index of Orthodontic Treatment Needs (IOTN) index, and OHRQoL was measured using OHIP-14. Data were analysed using Statistical Packages for Social Sciences (SPSS) version 23.0 software, and statistical significance was assessed using Pearson’s Chi-square test and Mann-Whitney U Test. Results: The study was conducted among 1800 subjects aged between 14 and 21 years (mean 17.47±1.58 years) from various schools and colleges in Chennai. Among the study subjects, 1066 (59.2%) were males, and 734 (40.8%) were females. About 46.7% of the study subjects had malocclusion. The binomial logistic regression analysis suggested that study subjects with orthodontic treatment needs had greater odds of experiencing dental caries, gingival bleeding, and traumatic dental injuries compared to study subjects without orthodontic treatment needs. Conclusion: There is a definite relationship between malocclusion, orthodontic treatment needs, dental caries, periodontal diseases, dental traumatic injuries, oral hygiene, and OHRQoL.

Summary: Background: Patients with atrial fibrillation (AF) frequently experience multimorbidity. Cluster analysis, a machine learning method for classifying patients with similar phenotypes, has not yet been used in South Asian AF patients. Methods: The Kerala Atrial Fibrillation Registry is a prospective multicentre cohort study in Kerala, India, and the largest prospective AF registry in South Asia. Hierarchical clustering was used to identify different phenotypic clusters. Outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and composite bleeding events within one-year follow-up. Findings: 3348 patients were included (median age 65.0 [56.0–74.0] years; 48.8% male; median CHA2DS2-VASc 3.0 [2.0–4.0]). Five clusters were identified. Cluster 1: patients aged ≤65 years with rheumatic conditions; Cluster 2: patients aged >65 years with multi-comorbidities, suggestive of cardiovascular-kidney-metabolic syndrome; Cluster 3: patients aged ≤65 years with fewer comorbidities; Cluster 4: heart failure patients with multiple comorbidities; Cluster 5: male patients with lifestyle-related risk factors. Cluster 1, 2 and 4 had significantly higher MACE risk compared to Cluster 3 (Cluster 1: OR 1.36, 95% CI 1.08–1.71; Cluster 2: OR 1.79, 95% CI 1.42–2.25; Cluster 4: OR 1.76, 95% CI 1.31–2.36). The results for other outcomes were similar. Atrial fibrillation Better Care (ABC) pathway in the whole cohort was low (10.1%), especially in Cluster 4 (1.9%). Overall adherence to the ABC pathway was associated with reduced all-cause mortality (OR 0.26, 95% CI 0.15–0.46) and MACE (OR 0.45, 95% CI 0.31–0.46), similar trends were evident in different clusters. Interpretation: Cluster analysis identified distinct phenotypes with implications for outcomes. There was poor ABC pathway adherence overall, but adherence to such integrated care was associated with improved outcomes. Funding: Kerala Chapter of Cardiological Society of India.

Objectives: Ever since the emergence of COVID-19, health and the economy worldwide have witnessed a severe disruption, with infection spreading rapidly, covering 231 countries as of May 07, 2023. Policymakers and Governments have been working to offer tailored interventions to the most vulnerable cohorts. Given this background, the paper involves description towards developing a Web-based Calculator to compute various estimates that quantify health economic impacts as these are much helpful than just mortality and simpler measures. Methods: The computations required to determine the estimates and the variables involved have been picked based on the observations and literature. The manuscript presents the significance of the estimates, a description of the Calculator developed, followed by validation. The values estimated using Calculator were validated against those computed using formulas for the state of West Bengal, India. Results: The results indicated that the Calculator is able to produce near accurate results with the highest error percentage witnessed for Cost of Productivity Lost due to Absenteeism as 0.946%. Error percentages for Disability-Adjusted Life Years was 0.175, and less than 0.1 for all other estimates. Conclusions: This could prove to be an effective tool for the policymakers and practitioners to identify the long-term impacts and the most vulnerable cohorts and devise targeted interventions. Additionally, these tools will allow the policymakers and governments to save time in compute these estimates in the future.

Autologous platelet rich fibrin (PRF), is currently being widely used and investigated across the globe by clinicians and periodontal research. The technical aspect required for the procurement of PRF includes revolution per minute (RPM), relative centrifugal force (RCF) or G-force, rotor radius, rotor angle, stability or vibration in the centrifugal machine and material of test-tube, besides the systemic health of the individual may influence the final outcome. Present technical note intends to compile these aspects for better understanding and appropriate outcome while preparing PRF in varying clinical scenarios.

Introduction: Surgical sutures play an important role in wound healing at surgical sites, which are susceptible to microbial infections. These sutures need to prevent bacterial adhesion and proliferation, particularly in areas exposed to oral fluids, to avoid contamination inside the wound. Antibiotic-coated sutures have shown effective antibacterial properties, and silver has emerged as a promising antimicrobial agent. Additionally, Aloe vera, a natural source of bioactive compounds, has been extensively studied for its antibacterial, antiviral, anti-tumour, and anti-inflammatory activities. Aim: To analyse the morphological, mechanical, and antibacterial properties of plain silk sutures compared to silk sutures coated with silver nanoparticles (AgNPs) and silk sutures coated with AgNPs and aloe vera extract. Materials and Methods: This in-vitro study was conducted in the White Lab of Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, over a one-month period from September 2022 to October 2022. The study included three groups, with three samples in each group. Group A consisted of plain silk sutures, Group B consisted of silk sutures coated with AgNPs, and Group C consisted of silk sutures coated with AgNPs and Aloe vera extract. Morphological and microanalytical characterisation was performed using Scanning Electron Microscopy (SEM) images and Energy-Dispersive X-ray Spectroscopy (EDS). Tensile strength was determined using straight-pull and knotpull tests, following the Instron® method, and knot efficiency. Antibacterial efficacy was evaluated using antimicrobial culture tests for the three groups. Statistical analysis was performed using the Shapiro-Wilk test to assess normality of continuous variables, followed by parametric tests of significance including paired t-tests and Analysis of Variance (ANOVA). Results: The tensile strength, as determined by the straight-pull test, knot-pull test, and knot efficiency, was highest in Group C, followed by Group B and Group A (statistically significant, p-value

ABSTRACT: Objectives: The presence of red-complex bacteria (RCB) has been associated with the occurrence of not only periodontal disease but also other systemic diseases, thereby potentiating an oral–systemic relationship. This study aimed to explore the levels of periodontal RCB in pregnant preeclamptic women with periodontal disease, potentiating the pathophysiology of a bacterial association in both periodontitis and preeclampsia. Methods: Six hundred pregnant women (aged 20 to 35 years) in their third trimester were selected and divided into 3 groups comprising a control group (systemically and periodontally healthy pregnant women), group A (preeclamptic women with chronic periodontitis), and group B (preeclamptic women without chronic periodontitis). Demographic variables and periodontal parameters were recorded. Other variables such as systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the urine protein content were also estimated. RCB, namely Porphyromonas gingivalis (Pg), Treponema denticola (Td), and Tenerella forsythia (Tf), were assessed in both subgingival plaque samples and placental samples of all the pregnant participants in the study. Results: The mean weight, mean body mass index, mean SBP, mean DBP, and mean urine protein content were significantly elevated in group A and group B when compared to the control group. Preeclamptic women with chronic periodontitis (group A) had higher levels of plaque index, probing pocket depth, bleeding on probing, and clinical attachment level as compared with the other groups. The numbers of the RCB were found to be elevated in group A, out of which Pg was found to be more prevalent. Conclusions: Our findings indicate that the periodontal indices, blood pressure, and urine protein content were found to be higher in preeclamptic women with periodontitis. Hence, reducing the periodontal bacterial load in pregnant women via good oral hygiene maintenance would further reduce the putative risk of adverse pregnancy outcomes including preeclampsia in these women.

Introduction: Hypertension is the leading risk factor for global disease burden. Inequalities in health among urban poor and non-poor is a matter of concern. The current study was done to estimate the prevalence of hypertension and to describe the health seeking and risk factor profile of people with hypertension in the urban slums of Kochi, Kerala, India. Methods: Blood pressure of 5980 adults from 20 randomly selected slums were measured by door to door survey by trained nurses as a part of baseline assessment for a cluster randomised controlled trial. Results: Prevalence of hypertension was found to be 34.8% (95% CI 33.5–34.9). Among those with hypertension, 66.9% were aware of their hypertensive status, of which 75.8% were initiated on treatment for hypertension. Proportion of hypertensive in the population who had their blood pressure under control was 24.5%. Among hypertensive, 53% were obese, 25.1% had diabetes mellitus, 14% had history of hospitalisation for high blood pressure. Of them, 60.3% had a per capita salt consumption above 8 g/day and 47.5% of them reported sitting for more than 8 h on a usual day. Mean monthly out of pocket expenditure for treatment of hypertension was $9(Median $8, IQR $16). Conclusion: One in three adults in urban slums of Kochi had hypertension. High rates of obesity, salt intake, physical inactivity prevails among the people with hypertension. Awareness, treatment initiation and control rate of hypertension are lower in urban slums as compared to non-slum urban areas. Slums require additional attention to ensure equitable and universal access to hypertension control.

Objectives. Various researches have shown periodontitis to share common pathophysiological pathways with systemic diseases such as diabetes, cardiovascular diseases, and osteoporosis and recently neurological disorders. This article provides a narrative review summarizing the various linking mechanisms and the nature of association between two multifactorial diseases—periodontitis and migraine. Materials and Methods. A literature search was performed for articles related to periodontitis and migraine up till the year 2023 which yielded totally 14 articles. There were only three randomized controlled clinical trials; therefore, we were unable to conduct a systematic review and focused on a narrative review. The keywords searched were “migraine”, “periodontitis” and “biomarkers” in PubMed/Medline, Web of Science, and Embase databases. Any article related to the association of periodontitis and migraine and the dental management of subjects with headache disorders were included and studies with migraine and other dental diseases were excluded. Results. It is found that the occurrence of periodontitis and migraine are associated with each other. There is reasonable evidence to believe that periodontitis and migraine are linked by direct and indirect mechanisms which can eventually lead to chronic inflammatory conditions like periodontitis worsening neurovascular conditions such as migraine. However, upon detailed analysis it was found that the strength of association is weak owing to the presences of various common confounding and risk factors. Conclusions. The association between periodontitis and migraine cannot be denied, however, not all the criteria are fulfilled while examining the nature of association and future long-term studies are required to prove the same. Clinical Relevance. Various studies have reported poor periodontal health in patients with migraine. The risk of exacerbation of migraine also increases in subject undergoing dental therapy if the triggering factors are manipulated. Hence, knowing the precise pathophysiologic mechanisms linking both the diseases would be favorable in planning treatment protocols for subjects with migraine.

Periodontal regeneration involves the composite action of cell, scaffolds and signaling molecules. There are numerous autologous sources of regenerative cells which are present close to the vicinity of the periodontally debilitated site, the primary one being the periodontal ligament stem cell, which is believed to have a key role in regeneration. Various methods can be harnessed to optimize and enhance the regenerative potential of PDLSCs such as the application of LASERs. In the last few years there have been various studies which have evaluated the effect of different types of LASERs on PDLSCs and the present review summarizes the photo-biomodulative activity of LASERs in general and its beneficial role in the stimulation of PDLSC specifically.

Plastid behaviour often occurs in tandem with endoplasmic reticulum (ER) dynamics. In order to understand the underlying basis for such linked behaviour we have used time-lapse imaging-based analysis of plastid movement and pleomorphy, including the extension and retraction of stromules. Stable transgenic plants that simultaneously express fluorescent fusion proteins targeted to the plastid stroma, and the ER along with BnCLIP1-eGFP, an independent plastid envelope localized membrane contact site (MCS) marker were utilized. Our experiments strongly suggest that transient MCS formed between the plastid envelope and the ER are responsible for their concomitant behaviour.

Objectives The state of West Bengal witnessed a significant surge of COVID-19 in all three waves. However, there is a gap in understanding the economic loss associated with COVID-19. This study estimates future non-health gross domestic product (NHGDP) losses associated with COVID-19 deaths in West Bengal, India.Setting Various open domains were used to gather data on COVID-19 deaths in West Bengal and the aforementioned estimates.Primary and secondary outcome measures The NHGDP losses were evaluated using the cost-of-illness approach. Future NHGDP losses were discounted at 3%. Excess death estimates by the WHO and Global Burden of Disease (GBD) were used. Sensitivity analysis was carried out by varying discount rates and average age of death (AAD).Results 21 532 deaths in West Bengal from 17 March 2020 to 31 December 2022 decreased the future NHGDP by $0.92 billion. Nearly 90% of loss was due to deaths occurring in the age group of 30 years and above. Majority of the NHGDP loss was borne by the 46–60 years age group. NHGDP loss/death was $55,171; however, the average loss/death declined with rise in age. Based on the GBD and WHO excess death estimates, the NHGDP loss increased to $9.38 billion and $9.42 billion, respectively. When the lower age interval is considered as AAD, the NHGDP loss increased to $1.3 billion. At 5% and 10% discount rates, the losses reduced to $0.767 billion and $0.549 billion, respectively.Conclusions Results from the study suggest that COVID-19 contributed to a major economic loss in West Bengal. The mortality and morbidity caused by COVID-19, the substantial economic costs at individual and population levels in West Bengal, and probably across India and other countries, is another economic argument for better infection control strategies across the globe to minimise the impact of COVID-19.

Objectives: Pentraxin 3 (PTX3) is a biomarker, associated with the pathogenesis of Periodontitis and coronary artery disease (CAD) individually, but their role in patients with both diseases remains unclear. The current study aims to evaluate the association of PTX in patients with concomitant periodontitis and CAD. Materials and Methods: In a case–control study, 240 participants were selected and divided into four groups. Nonperiodontitis + noncardiac = 60 patients, periodontitis + noncardiac (P + NC) = 60 patients, nonperiodontitis + cardiac (NP + C) = 60 patients, periodontitis + cardiac (P + C) = 60 patients. Demographic variables, cardiac and periodontal parameters were recorded. PTX was evaluated in the subgingival plaque and atheromatous plaque samples using real-time quantitative polymerase chain reaction and compared between the groups. The results were statistically analyzed. Results: Among the demographic variables, age showed a significant difference between the groups. Systolic and diastolic blood pressure, low-density lipoprotein, and random blood sugar were significantly higher in NP + C and P + C groups (P ≤ 0.05). The plaque index, probing pocket depth, and clinical attachment loss were significantly higher in P + NC and P + C groups (P ≤ 0.05). PTX was significantly elevated in P + C group (P = 0.000). Pearson's correlation revealed a significant correlation between the periodontal parameters and PTX in both the cardiac and oral samples. Conclusion: PTX3 levels were elevated in CAD patients with periodontitis suggesting the influence of periodontal inflammation in the progression of CAD. PTX3 may serve as a diagnostic and prognostic tool for both periodontitis and CAD. This study could provide an understanding and awareness about the potential role of PTX3 in both periodontitis and CAD.

Aim: To evaluate correlation of PRF and HAS with glycemic control (HbA1c) and other systemic parameters amongst the chronic periodontitis patients. Materials and Methods: Twenty-seven non-smoker, non-tobacco users, non-alcoholic moderate chronic periodontitis volunteers (Stage II, Grade A or B), aging between 40 and 50 years of both genders with type 2 diabetes mellitus (T2DM, HbA1c >6.5%) or without T2DM (HbA1c

This lecture on “Sex Selection – Cultural and Ethical Issues” delves into the complex and controversial topic of sex selection, exploring its technological, cultural, and ethical implications. While there is an argument of parent autonomy and their rights to choose and have the option to control and design their family structure, the topic of designing one’s own family is still considered highly contentious as well as controversial. At first glance, such a practice seems quite justifiable as the technology enables parents to avoid having disabled children and serious genetic disorders and maintain balance in the family structure. Yet, on the slippery slope and fine line drawn between what is justifiable and acceptable and what is a definite strong NO, people have become increasingly misguided and ill steered into a rather dark and mischievous side of the practice of sex selection. The lecture begins by discussing the cultural aspects of sex selection, examining how different societies view gender preferences and how these preferences impact reproductive choices. It explores historical perspectives and cultural norms that influence the desire for a specific sex, highlighting variations across regions and communities. The existing patriarchal traditions in most of the Asian countries, masculine hegemony, female seclusion, social and cultural norms with regards to gender roles all contribute to a male biased sex selection. As the Chinese say, “With one son you have a descendant, with ten daughters you have nothing”, and Amartya Sen has rightly stated the concept of ‘missing girls’, the social norms of preference for a son has led to a situation of ‘floating men’ or ‘bare branches’ or ‘surplus males’. These skewed sex ratios are a threat to the society in ways that may not be realised at the moment. Women-trafficking, expansion of prostitution, young surplus males failing to find partners will be prone to pursue satisfaction through vice and violence, which may intensify socially disruptive behaviour, low self-esteem, rape, anti-social behaviour, threatening regional and international security. While at the national level, all south Asian countries have taken a paternalistic approach by making strict regulations regarding the abortion and female feticide (sex selective abortion SSA), what remains to be addressed is the society’s mind-set towards ending discrimination at the womb. Couples in such societies are under constant coercive forces in their family and outside, for sex selection, and may perhaps be stigmatized by their society for not having a male child. So, is it even up-to the parents at all to decide their family structure? The evidence shows that banning SSA is not enough to control SSA; banning SSA resembles treating a disease but not the cause of the disease. Women’s devaluation in many Asian societies is embedded in religious beliefs and traditional cultural practices, and uprooting this culture may not be easy and immediate. A good stewardship approach is what is the need of the hour, wherein, the countries develop and implement policies, legislations, and programs within a holistic context, addressing women’s education deficit, rights, socioeconomic disadvantage, health, and nutrition, living conditions, so that they are not perceived as ‘Paraya Dhan’, meaning someone else’s property, but seen as independent, empowered members of the society.

Introduction: Gingival recession was treated with gum drop technique (GDT) along with pericardial membrane, advanced platelet rich fibrin (A-PRF) and injectable platelet rich fibrin (i-PRF) in the defect sites for regeneration of soft tissue. Patient Concerns: Several 3-4 mm of recession sites in the maxillary right and left canine and premolar region. These sites were selected and divided into two groups: A and B based on the application with A-PRF and pericardium, respectively. Probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), recession width (RW) and keratinized tissue width (KTW) were assessed. The keratinized tissue width (KTW) was measured as the distance between the marginal gingiva and the mucogingival junction. Treatment: The defects were treated with the GDT following irrigation with i-PRF and followed up for 6 months. Both groups achieved significant root coverage which was stable even after 6 months post operatively. Keratinized tissue showed a 1 mm gain with pericardial membrane.