A retrospective analysis of 1000 consecutively placed implants in private practice

Background:  There have been numerous reports evaluating clinical outcomes of implants placed in institutional settings, but there are few studies relating to implants placed in private practice. The aim of this retrospective study was to analyse the clinical outcomes of 1000 consecutively placed Straumann implants in private specialist periodontal practice.
Methods:  A hand-search of patient records was undertaken to identify 1000 consecutively placed implants. Data extracted included patient demographics, details of implants placed, implant sites, timing of placement after extraction, hard and soft tissue augmentation procedures, loading protocols, type of prostheses and treatment outcomes (implant survival, implant success and complications).
Results:  The majority of implants (71.5 per cent) placed in patients aged 40 to 69, and the majority of patients (88.6 per cent) received 1 or 2 implants. During the period of the study, 9 implants were lost and 45 presented with complications requiring chairside intervention. A life table analysis showed 5 and 10-year cumulative survival rates of 99.2 per cent and 98.4 per cent respectively, and 5 and 10-year cumulative success rates of 93.1 per cent and 90.9 per cent respectively.
Conclusions:  With careful treatment planning and adherence to recommended surgical and prosthetic protocols, high implant survival and success rates can be achieved in a private practice setting.     

Uncontrolled hypertension in older patients: markers and associated factors to masked and white-coat effect

Background Hypertension is the main risk factor for cardiovascular diseases, affecting more than half the elderly population. It is essential to know if they have proper control of hypertension. The aim of this study was to identify the associated factors to masked uncontrolled hypertension and false uncontrolled hypertension in older patients. Methods Two-hundred seventy-three individuals (70.1 ± 6.7 years-old) had blood pressure (BP) measured at the office and by ambulatory BP monitoring (ABPM), with the definition of controlled group (C), individuals with high office BP and adequate ABPM, called white-coat effect group (WCE), uncontrolled (UC), and subjects with appropriate office BP and elevated ABPM denominated masked effect group (ME). Age, body mass index, diabetes, pulse pressure (PP) and BP dipping during sleep were evaluated (Kruskal-Wallis test and logistic regression models). Results Age was higher in UC than in C and ME (P < 0.01), and 24-h ABPM PP was lower in C (48 ± 7 mmHg) and WCE (51 ± 6 mmHg) than in UC (67 ± 12 mmHg) and ME (59 ± 8 mmHg) (P < 0.01). Sleep systolic BP dipping was lower in ME than in C (P = 0.03). Female gender was associated with a greater chance of being of ME group, which showed a higher PP and lower BP dipping during sleep. Conclusions In older individuals, office BP measurements did not allow the detection of associated factors that would permit to differentiate WCE from UC group and C from ME group. ABPM favored the identification of a higher PP and a lower BP dipping during sleep in the masked effect and uncontrolled groups.     

Corneal volume measures for monitoring contact lens induced corneal swelling: a pilot study

Background: This study investigated the use of corneal volume to monitor the corneal swelling response induced by wearing high plus power contact lenses. Methods: Twelve young non‐contact lens wearers were recruited with one eye fitted with a soft contact lens (Polymacon material, 38.6 per cent water, Dk of 9 and 0.27 mm centre thickness) and the fellow eye served as control. The treated eye was patched for two hours leaving the control eye uncovered. Central corneal thickness (CCT) was measured with non‐contact specular microscopy and corneal volumes (at three, five and 10 mm zones) were measured with a corneal topographer (Pentacam, Oculus Inc, Germany), before eye patching as well as immediately after and every 20 minutes for 100 minutes. Results: Subjects had similar CCT and corneal volumes between the two eyes before treatment. The treatment eyes showed a mean corneal swelling of 8.1 per cent immediately after lens removal. Corneal volume was significantly increased at the three (mean swelling of 5.9 per cent), five (5.6 per cent) and 10 millimetre (3.3 per cent) zones. It took 20 minutes for the corneal volume at the 10 mm zone to return to baseline but required 60 minutes for the three and five millimetre zones to return to the baseline level. The central corneal thickness was still significantly thicker 80 minutes after patching. Conclusion: Corneal volume could be a useful parameter to monitor corneal change when an event affects the entire cornea. Corneal volume combined with central corneal thickness could give more comprehensive information to monitor central corneal swelling.     

The Association of Childhood Pneumonia with Household Air Pollution in Nepal: Evidence from Nepal Demographic Health Surveys

Introduction

Childhood pneumonia is a major cause of mortality worldwide while household air pollution (HAP) is a major contributor to childhood pneumonia in low and middle-income countries. This paper presents the prevalence trend of childhood pneumonia in Nepal and assesses its association with household air pollution.

Methods

The study analysed data from the 2006, 2011 and 2016 Nepal Demographic Health Surveys (NDHS). It calculated the prevalence of childhood pneumonia and the factors that cause household air pollution. The association of childhood pneumonia and HAP was assessed using univariate and multi-variate analysis. The population attributable fraction (PAF) of indoor pollution for causing pneumonia was calculated using 2016 NDHS data to assess the burden of pneumonia attributable to HAP factors.

Results

The prevalence of childhood pneumonia decreased in Nepal between 2006 and 2016 and was higher among households using polluting cooking fuels. There was a higher risk of childhood pneumonia among children who lived in households with no separate kitchens in 2011 [Adjusted risk ratio (ARR) 1.40, 95% CI 1.01–1.97] and in 2016 (ARR 1.93, 95% CI 1.14–3.28). In 2016, the risk of children contracting pneumonia in households using polluting fuels was double (ARR 1.98, 95% CI 1.01–3.92) that of children from households using clean fuels. Based on the 2016 data, the PAF for pneumonia was calculated as 30.9% for not having a separate kitchen room and 39.8% for using polluting cooking fuel.

Discussion for Practice

Although the occurrence of childhood pneumonia in Nepal has decreased, the level of its association with HAP remained high.

     

Xenotransplantation: A historical–ethical account of viewpoints

Formal clinical trials of pig-to-human organ transplant—known asxenotransplantation—may begin this decade, with the first trials likely to consist of either adult renal transplants or pediatric cardiac transplant patients. Xenotransplantation as a systematic scientific study only reaches back to the latter half of the 20th century, with episodic xenotransplantation events occurring prior to that. As the science of xenotransplantation has progressed in the 20th and 21st centuries, the public's knowledge of the potential therapy has also increased. With this, there have been shifting ethical stances toward xenotransplantation in key areas, such as religious and public viewpoints towards xenotransplantation, animal rights, and public health concerns. This review provides a historical–ethical account of xenotransplantation and details if or how viewpoints have shifted over time.     

Improved obstetric management after implementation of a scaled-up quality improvement intervention: A nested before-after study in three public hospitals in Nepal

Background

We assessed the change in obstetric management after implementation of a quality improvement intervention, the Nepal Perinatal Quality Improvement Package (NePeriQIP).

Methods

The Nepal Perinatal Quality Improvement Package was a stepped-wedge cluster-randomized controlled trial conducted in 12 public hospitals in Nepal between April 2017 and October 2018. In this study, three hospitals allocated at different time points to the intervention were selected for a nested before–after analysis. We used bivariate and multivariate analyses to compare obstetric management in the control vs intervention group.

Results

There were 25 977 deliveries in the three hospitals during the study period: 10 207 (39%) in the control and 15 770 (61%) in the intervention group. After adjusting for maternal age, ethnicity, education, gestational age, stage of labor at admission, complications during labor, and birthweight, the intervention group had a higher proportion of fetal heart rate monitoring performed as per protocol (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12–1.27), shorter time intervals between each fetal heart rate monitoring (aOR 2.09, 95% CI 1.96–2.23), a higher likelihood of abnormal fetal heart rate being detected (aOR 1.53, 95% CI 1.25–1.68), progress of labor more often being recorded immediately after per vaginal examination (aOR 2.73, 95% CI 2.55–2.93), and partograph filled as per standards (aOR 3.18, 95% CI 2.98–3.50). The cesarean birth rate was 2.5% in the control group and 8.2% in the intervention group (aOR 3.12, 95% CI 2.64–3.68).

Conclusions

The NePeriQIP intervention has potential to improve obstetric care, especially intrapartum fetal surveillance, in similar low-resource settings.     

Management of COVID-19 and vaccination in Nepal: A qualitative study

Objective

The aim of this research is to investigate the perspective of citizens of Nepal on the management COVID-19, the roll-out of the vaccine, and to gain an understanding of attitudes towards the governments' handling of the COVID-19 pandemic.

Method

A qualitative methodology was used. In-depth interviews were conducted with 18 males and 23 females aged between 20 and 86 years old from one remote and one urban district of Nepal. Interviews were conducted in November and December 2021. A thematic approach was used to analyse the data, utilising NVivo 12 data management software.

Result

Three major themes were identified: (1) Peoples' perspective on the management of COVID-19, (2) people's perception of the management of COVID-19 vaccination and (3) management and dissemination of information. It was found that most participants had heard of COVID-19 and its mitigation measures, however, the majority had limited understanding and knowledge about the disease. Most participants expressed their disappointment concerning poor testing, quarantine, vaccination campaigns and poor accountability from the government towards the management of COVID-19. Misinformation and stigma were reported as the major factors contributing to the spread of COVID-19. People's knowledge and understanding were mainly shaped by the quality of the information they received from various sources of communication and social media. This heavily influenced their response to the pandemic, the preventive measures they followed and their attitude towards vaccination.

Conclusion

Our study concludes that the study participants' perception was that testing, quarantine centres and vaccination campaigns were poorly managed in both urban and rural settings in Nepal. Since people's knowledge and understanding of COVID-19 are heavily influenced by the quality of information they receive, we suggest providing contextualised correct information through a trusted channel regarding the pandemic, its preventive measures and vaccination. This study recommends that the government proactively involve grassroots-level volunteers like Female Community Health Volunteers to effectively prepare for future pandemics.

Patient and Public Contribution

This study was based on in-depth interviews with 41 people from diverse socioeconomic backgrounds. This study would not have been possible without their participation.