Journal of Chemical Health Risks (Islamic Azad University, Iran)
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Computer Aided Evaluation of Bite Force in Complete Dentures – An in Vivo Study.
Get PDFIntroduction: Achieving balanced occlusion in complete denture therapy is critical for comfort, function, and patient satisfaction. Conventional clinical remount procedures are effective but time-consuming and often impractical for elderly patients. This study evaluated the effectiveness of selective grinding guided by digital occlusal analysis using the digital system in improving bite force distribution in complete denture wearers.
Objectives: To evaluate and compare occlusal force percentage in complete dentures.
Methods: A clinical observational study was conducted on 10 completely edentulous patients aged over 40 years, rehabilitated with conventional complete dentures. Following laboratory remounting, occlusal force distribution was recorded using the OccluSense system. High-pressure contact points were identified digitally and clinically and adjusted through selective grinding. Bite force distribution was recorded before and after the adjustment. Statistical analysis included the Statistical analysis used: paired t-test, Mann-Whitney U test, and Kruskal-Wallis test.
Results: The mean bite force on the left side increased from 46.10 ± 2.96 to 48.30 ± 1.95, while on the right side it decreased from 53.90 ± 2.96 to 51.70 ± 1.95. The changes were statistically significant (p < 0.005), indicating effective redistribution of occlusal forces. No significant differences were observed across gender or age groups.
Conclusions: Selective grinding based on digital occlusion analysis with OccluSense significantly improved occlusal force distribution in complete denture wearers. This approach provides a practical, efficient, and patient-friendly alternative to conventional clinical remounting. However, larger sample sizes and long-term follow-up are recommended to validate these findings
Comparative Analysis of Buccal Fat Pad vs Buccal Advancement Flap in Cases of Oro-Antral Communication – A Retrospective Study
Get PDFIntroduction: Oroantral communication (OAC) is a common complication following maxillary posterior tooth extractions and surgical interventions involving the maxillary sinus. If untreated, it may progress to oroantral fistula (OAF) and chronic sinusitis. Among several surgical options, buccal fat pad (BFP) and buccal advancement flap (BAF) are the most widely used. This study retrospectively compared their clinical outcomes in OAC management.
Materials and Methods: A retrospective review of 40 patients treated for OAC over one year was performed. Patients were divided into two groups: BFP (n=20) and BAF (n=20). Parameters assessed included, complete closure rate, mean healing time(days), dehiscence (flap opening), recurrence. Statistical analysis was done using chi-square and Student’s t-test, with p<0.05 considered significant.
Results: Both techniques achieved high closure rates. The BFP group showed fewer cases of wound dehiscence, faster mucosal epithelialization, and no recurrence, with an overall success rate of 95%. The BAF group achieved 90% closure but was associated with more postoperative discomfort and reduction in vestibular depth. No major complications were reported in either group.
Conclusion: Both BFP and BAF are effective for OAC closure. BFP is preferable for larger defects, while BAF remains suitable for smaller ones. A tailored, case-specific approach ensures optimal outcomes
The Advancements in the Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD)
Get PDFNon-alcoholic fatty liver disease (NAFLD) is a series of diseases, involving excessive lipid deposition in the liver and is often accompanied by obesity, diabetes, dyslipidemia, abnormal blood pressure, and other metabolic disorders. In order to more accurately reflect its pathogenesis, an international consensus renamed NAFLD in 2020 as metabolic (dysfunction) associated with fatty liver disease (MAFLD). The changes in diet and lifestyle are recognized the non-drug treatment strategies; however, due to the complex pathogenesis of NAFLD, the current drug therapies are mainly focused on its pathogenic factors, key links of pathogenesis, and related metabolic disorders as targets. There is still a lack of specific drugs. In clinical studies, the common NAFLD treatments include the regulation of glucose and lipid metabolism to protect the liver and anti-inflammation. The NAFLD treatments based on the enterohepatic axis, targeting gut microbiota, are gradually emerging, and various new metabolism-regulating drugs are also under clinical development. Therefore, this review article has comprehensively discussed the research advancements in NAFLD treatment in recent years
Completion Thyroidectomy - Predicting Bilateral Disease
Get PDFBackground: It is not uncommon for patients with indeterminate thyroid nodules to undergo diagnostic hemithyroidectomy. When the final pathology determines that the nodule is in fact malignant, patients require counselling as to the whether a completion thyroidectomy is necessary.
Objectives: 1. Determine the incidence of well differentiated thyroid cancer (WDTC) in the contralateral thyroid lobe in patients undergoing completion thyroidectomy. 2. Identify features of the malignant tumor in the initial resection that increase the likelihood of malignancy in the contralateral lobe.
Methods: Retrospective chart review of 97 patients who underwent hemithyroidectomy and completion thyroidectomy in a university’s teaching hospital network between 2016 and 2022. Pathology reports from both surgeries as well as patient and thyroid nodule characteristics were reviewed.
Results: Of the 97 patients, 47 (48 %) had a malignancy in the contralateral lobe. In the contralateral lobe, 42/47 (89 %) of malignancies were papillary microcarcinomas (PMC) and 15/42 (36 %) of the PMC were multifocal. Multifocal malignancies in the initial specimen had a 60 % rate of contralateral malignancy and were found to be a predictor of bilateral disease (p = 0.04) with OR = 2.74 (95 % CI: 1.11–6.79; p = 0.003) in WDTC and OR = 3.59 (95 % CI:1.35 9.48; p = 0.01) in papillary cancer specifically. There was no statistical significant correlation established for the following variables: presence of positive cervical nodes, extrathyroidal extension, positive resection margins, size and angio-lymphatic invasion. Moreover, there was no statistical correlation between any of the variants of papillary thyroid cancer and bilateral disease, even though most aggressive subtypes were found to be bilateral.
Conclusion: In this study, the rate of malignancy in the contralateral lobe was 48 %. Multifocality and presence of an aggressive subtype of papillary thyroid cancer in the initial specimen were found to be more important variables to consider in decision-making regarding completion thyroidectomy than size of the initial tumor alone
Operative Management of Thyroid Disease in Older Adults
Get PDFBackground: As the population ages, both domestically and globally, clinicians will increasingly find themselves navigating treatment decisions for thyroid disease in older adults. When considering surgical treatment, individualizing risk assessment is particularly important, as older patients can present with very different health profiles. While fit, independent individuals may benefit from thyroidectomy with minimal risk, those with multiple comorbidities and poor functional status are at higher risk of perioperative complications, which can have adverse health effects and detract from long-term quality of life. In order to optimize surgical outcomes for older adults, strategies for accurate risk assessment and mitigation are being explored. Surgical decision-making also should consider the characteristics of the thyroid disease being treated, given many benign thyroid disorders and some well-differentiated thyroid cancers can be appropriately managed nonoperatively without compromising longevity. Shared decision-making becomes increasingly important to respect the health priorities and optimize outcomes for older adults with thyroid disease. This review summarizes the current knowledge of thyroid surgery in older adults to help inform decision-making among patients and their physicians.
Abbreviations: ACS NSQIP, American College of Surgeons National Surgical Quality Improvement Program; ATC, anaplastic thyroid cancer; DTC, differentiated thyroid cancer; GD, Graves’ disease; MNG, multinodulargoiter; MTC, medullary thyroid cancer; RFA, radiofrequency ablation; RLN, recurrent laryngeal nerve; SEER, Surveillance, Epidemiology, and End Results
Surgical Management of Early Stage Invasive Breast Cancer - A Practice Guideline
Get PDFBackground: Objectives: To assess the available evidence on sentinel lymph-node biopsy, and to examine the long term follow-up data from large randomized phase III trials comparing breast-conserving therapy with mastectomy in order to make recommendations on the surgical management of early invasive breast cancer (stages I and II), including the optimum management of the axillary nodes: for the breast - modified radical mastectomy or breast-conserving therapy; for the axilla - complete axillary node dissection, axillary dissection of levels I and II lymph nodes, sentinel lymph-node biopsy or no axillary node surgery.
Outcomes: Overall survival, disease-free survival, local recurrence, distant recurrence and quality of life.
Evidence: MEDLINE, EMBASE, the Cochrane Library databases and relevant conference proceedings were searched to identify randomized trials and meta-analyses. Two members of the Practice Guidelines Initiative, Breast Cancer Disease Site Group (BCDSG) selected and reviewed studies that met the inclusion criteria. The systematic literature review was combined with a consensus process for interpretation of the evidence to develop evidence-based recommendations. This practice guideline has been reviewed and approved by the BCDSG, comprising surgeons, medical oncologists, radiation oncologists, pathologists, a medical sociologist, a nurse representative and a community representative.
Benefits, harms and costs: Breast-conserving therapy (lumpectomy with levels I and II axillary node dissection, plus radiotherapy) provides comparable overall and disease-free survival to modified radical mastectomy. Levels I and II axillary dissection accurately stages the axilla and minimizes the morbidity of axillary recurrence but is associated with lymphedema in approximately 20% of patients and arm pain in approximately 33%. Currently, there is insufficient data regarding locoregional recurrence and long term morbidity associated with sentinel-node biopsy to advocate it as the standard of care. Breast conserving therapy may offer an advantage over mastectomy in terms of body image, psychological and social adjustment but appears equivalent with regard to marital adjustment, global adjustment and fear of recurrence.
Recommendations: Women who are eligible for breast-conserving surgery should be offered the choice of either breast-conserving therapy with axillary dissection or modified radical mastectomy.
Removal and pathological examination of levels I and II axillary lymph nodes should be the standard practice in most cases of stages I and II breast carcinoma. There is promising but limited evidence to support recommendations regarding sentinel lymph-node biopsy alone. Patients should be encouraged to participate in clinical trials investigating this procedure.
Validation: A draft version of this practice guideline and a 21-item feedback questionnaire was circulated to 201 practitioners in Ontario. Of the 131 practitioners who returned the questionnaire, 98 (75%) completed the survey and indicated that the report was relevant to their clinical practice. Eighty (82%) of these practitioners agreed that the draft document should be approved as a practice guideline
Hemodynamic Changes, Analgesic Duration, And Maternal–Fetal Outcomes with Intrathecal Bupivacaine and Fentanyl in Lscs: A Randomized Clinical Study
Get PDFBackground: Spinal anesthesia using bupivacaine is standard for lower segment cesarean section (LSCS). The addition of intrathecal fentanyl may enhance analgesia quality and duration without compromising hemodynamic stability or fetal outcomes.
Objective: To compare hemodynamic changes, analgesic duration, and maternal-fetal outcomes in patients receiving intrathecal 0.5% hyperbaric bupivacaine alone versus combined with fentanyl (12.5 µg) during elective LSCS.
Methods: Ninety ASA Grade II parturients scheduled for elective LSCS were randomized into two groups: Group 1 received 10 mg of 0.5% hyperbaric bupivacaine alone (n=45); Group 2 received the same dose of bupivacaine with 12.5 µg fentanyl (n=45). Parameters recorded included onset and duration of sensory and motor block, hemodynamic variables (heart rate, systolic, diastolic, and mean arterial pressures), side effects, and neonatal APGAR scores.
Results: Group 2 showed significantly faster onset of sensory analgesia (mean 2.17 ± 0.68 min vs 4.83 ± 0.62 min, p<0.001) and prolonged duration of effective analgesia (234.4 ± 43.4 min vs 144.2 ± 25.9 min, p<0.001). Hemodynamic parameters were more stable with a lower incidence of hypotension (6.7% vs 22.2%, p=0.036), nausea, and shivering. Motor block characteristics and neonatal APGAR scores were comparable between groups, indicating no adverse fetal effects. Minor transient pruritus occurred only in the fentanyl group (4.4%).
Conclusion: The addition of 12.5 µg fentanyl to intrathecal bupivacaine in LSCS provides superior analgesia and improved hemodynamic stability without compromising maternal or neonatal safety. This combination is recommended for enhancing spinal anesthesia quality in cesarean deliveries
Correlation between Ultrasonography and Mri in Evaluating Fatty Liver
Get PDFIntroduction:
Non-alcoholic fatty liver disease (NAFLD) is a growing global health concern associated with obesity and metabolic syndrome. While magnetic resonance imaging–proton density fat fraction (MRI-PDFF) is considered the gold standard for hepatic fat quantification, ultrasonography (USG) remains a widely used screening tool due to its accessibility and cost-effectiveness. This study is aimed to evaluate the role USG and MRI in assessing fatty liver severity and to correlate between their diagnostic accuracy.
METHODS:
A retrospective observational study was conducted at Meenakshi Medical College Hospital from January 2024 to March 2025. Fifty patients who underwent USG for suspected fatty liver were included. MRI upper abdomen screening was performed for all the patients who underwent USG. USG grading was based on liver echogenicity and MRI grading based on MRI-PDFF quantified hepatic fat fraction using the mDIXON-Quant sequence. The agreement and correlation between modalities were assessed using chi-square analysis and Kendall’s Taub.
Results:
USG and MRI demonstrated substantial agreement, especially for grade 0 (80%) and grade I (70.8%) steatosis. A strong positive correlation was observed (Kendall’s Tau-b = 0.776, p < 0.001). MRI-PDFF showed excellent diagnostic performance with 97.5% sensitivity and 100% specificity (AUC = 1.00), while USG demonstrated 92.31% sensitivity and 72.73% specificity (AUC = 0.906). Also MRI showed superior diagnostic efficacy especially in identifying early or subtle steatotic changes.
Conclusion:
Though USG remains a valuable initial screening tool, MRI is a superior modality for accurately quantifying hepatic steatosis and should be considered the reference standard, particularly for early-stage disease
Interferon Gamma as a Biomarker in Tuberculosis Diagnosis in a Tertiary Care Centre
Get PDFIntroduction: Tuberculosis (TB) is a major global health concern, with India accounting for a significant proportion of cases. Interferon-gamma (IFN-γ), a Th1 cytokine, is a potential biomarker for TB diagnosis. Currently, Interferon-gamma for Tuberculosis diagnosis is primarily used for research purposes only and is not commercially available for routine clinical use. The role of interferon gamma in TB patients has been evaluated in previous studies, however due to inconclusive results, this current study has been undertaken to compare blood IFN-γ levels in Tuberculosis patients versus healthy controls to evaluate its utility as a diagnostic biomarker for TB.
Objectives: To compareblood IFN-γ levels between Tuberculosis patients and healthy controls at a tertiary care centre to assess the utility of IFN-γ as a biomarker for TB diagnosis.
Methods: A cross-sectional study was conducted over a period of four months from November 2024 to February 2025 at the Department of Respiratory Medicine, Karpaga Vinayaga Institute of Medical Sciences, Chengalpattu. 60 participants were enrolled, including 30 newly diagnosed patients with TB (sputum-positive pulmonary TB, smear-negative pulmonary TB, and extrapulmonary TB) versus 30 healthy controls. Demographic and clinical data were also recorded. Venous blood (5 ml) was analysed for IFN-γ using a quantitative sandwich enzyme immunoassay.
Results: The mean age was 44.00±14.00 years in the TB group and 42.27±10.22 years in the control group (p = 0.586). The mean BMI was identical at 24.57±1.92 in both groups (p = 1.000). Females comprised 50% of TB patients and 60% of Healthy individuals (p = 0.436). Smoking was reported in 16.7% of TB patients and 6.7% of Healthy individuals (p = 0.228), whereas alcohol use was observed in 30% of TB patients and 16.7% of Healthy individuals (p = 0.222). Median IFN-γ was significantly higher in TB patients (203.0 pg/ml; IQR:18.7–485.0) compared to Healthy individuals (11.9 pg/ml; IQR:8.2–16.0) (p < 0.0001). At a cut-off of 17.1 pg/ml, IFN-γ yielded an AUC of 0.995, with sensitivity, specificity, PPV, NPV, and accuracy all at 96.67%.
Conclusions: Serum IFN-γ levels were significantly higher in active TB patients than in healthy controls. These results support IFN-γ as a reliable biomarker for TB diagnosis, especially in high-burden settings
Identification of FKS 1 and FKS 2 Gene Encoding Antifungal Resistance in Clinical Isolates of Candida Auris
Get PDFBackground:
Candida auris was first isolated in Japan in 2009 from the external auditory canal of a patient. It has shown strong resistance to azole antifungal drugs and has caused severe nosocomial outbreaks and complicates the treatment of infectious diseases.
Material and Methods
:12 isolates of C.auris were identified from various clinical samples using morphological features on culture medium. Further identification and antifungal susceptibility testing was done using VITEK 2 compact system. Susceptibility was determined using an AST-YS09card which tests MIC of 6 antifungals, FLU, 5-FC, VRC, AMB, CAS and MFG. Isolates showing multi drug resistance were subjected to conventional PCR for the identification of FKS 1 and FKS 2 gene which is responsible for its multidrug resistance feature.
Result:
Of the 12 Candida auris isolates 8(67%) isolates showed multidrug resistance.6(75%)isolates were found to contain FKS1 gene and 5(41%) isolates contained FKS 2 gene that contributes in its antifungal resistance feature.
Conclusion:
The emergence of multidrug-resistant C. auris is a multifactorial phenomenon that raises many serious public health concerns. Our study documented 67% of resistance against C.auriswhich emphasizesthe rapid & accurate identification of C.auris for controlling its outbreaksand better treatment. The findings of this study also underline the importance of better routine diagnostic workflows for fungal infections particularly in regions where C. auris prevalence is increasing. A thorough understanding of the molecular insights into this organism is crucial for improved management which includes conductingC. auris surveillance and antifungal therapy in high-risk patients