Experimental and Emerging Free Fatty Acid Receptor Agonists for the Treatment of Type 2 Diabetes

The current management of Type 2 Diabetes Mellitus (T2DM) includes incretin-based treatments able to enhance insulin secretion and peripheral insulin sensitivity as well as improve body mass, inflammation, plasma lipids, blood pressure, and cardiovascular outcomes. Dietary Free Fatty Acids (FFA) regulate metabolic and anti-inflammatory processes through their action on incretins. Selective synthetic ligands for FFA1-4 receptors have been developed as potential treatments for T2DM. To comprehensively review the available evidence for the potential role of FFA receptor agonists in the treatment of T2DM, we performed an electronic database search assessing the association between FFAs, T2DM, inflammation, and incretins. Evidence indicates that FFA1-4 agonism increases insulin sensitivity, induces body mass loss, reduces inflammation, and has beneficial metabolic effects. There is a strong inter-relationship between FFAs and incretins. FFA receptor agonism represents a potential target for the treatment of T2DM and may provide an avenue for the management of cardiometabolic risk in susceptible individuals. Further research promises to shed more light on this emerging topic.

Vital and Nonvital Pulp Therapy in Primary Dentition: An Umbrella Review

Dental caries is the most common non-communicable disease in children with significant aesthetic, functional, and quality of life deterioration. Depending on the depth, two approaches may be considered in primary dentition: vital pulp therapy (VPT) or non-vital therapy (NPT). This umbrella review aimed to critically assess the available systematic reviews (SRs) on VPT and NPT. An electronic database search was conducted (PubMed, Embase, Scopus, Cochrane, Web of Science, and LILACS) until June 2021. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). From 272 entries, 33 SRs were included. Regarding the methodological quality, three studies were critically low, nine low, seventeen moderate, and six were rated as high quality. The quality of evidence produced by the available SRs was moderate. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of VPT and NPT.

Review of Marginal Adaptation and Fracture Resistance of Computer Aided Design/Computer Aided Manufacturer (CAD‐CAM) Fabricated Endo-crowns

Background: Zirconia-based restorations have become more popular in dentistry during the last two decades. Patients choose metal-free restorations, preferring materials with similar attributes to natural teeth and similar light scattering characteristics, resulting in a nice esthetic appearance. Restoring a root canal treated teeth is one of the hot topics today. endo crown materials can be either; feldspathic, glass-ceramic, monolithic hybrid ceramic or composite material. Considering the marginal gap of endocrown, an important cause of failure of treatment, the current study evaluated the marginal gap of CAD‐CAM concocted endo-crowns. Materials and Methods: This research is an analysis systemic review study was conducted between January 2020 and October 2021. We followed the PRISMA principles and recorded this systematic review using the PROSPERO database to find and identify published literature related to the marginal adaptation of CAD-CAM-fabricated endocrown. The search will include all relevant articles through the end of 2021. Finally, 24 papers on marginal clearance and fracture resistance in coronary arteries were reviewed. Results: The electronic database search yielded 98 studies that were relevant. After cross-referencing, further seven studies were added. After a full-text analysis and duplicate reduction, 74 of the 98 articles were eliminated. 5 clinical (prospective) studies, 19 in vitro studies were found. Conclusion: This analysis of the recent literature on the marginal seating integrity and fracture resistance of CAD/CAM made-up endo-crowns showed that the endo-crown had superior marginal seating integrity than classical full crown. CAM/CAM showed statistically significant higher mean fracture resistance than MAD/MAM.

Urtica dioica (Stinging Nettle) – Properties, Uses and Applications

Utricaceae is a family of herbs and shrubs that can be found in a variety of habitats around the world. A lot of research has been carried out till date targeted for close understanding of this medicinal plant. The botanical distribution, Ethnomedicinal applications, Traditional uses as well as Pharmacological properties of the Urtica genus, are discussed in this study. The composition such as flavonoids and array of phenolic compounds which includes alcohols, Diocanol, Diol glucosides, Terpenes diols, and sugars as well are an inclusion in the genus Urtica. A wide range of research reports have been published representing its biological and pharmacological potential against cancer, tumors, bacterial, viral or fungal infections significantly. The information about the Urtica genus has been extracted using electronic database search such as Google Scholar and Pubmed as well as a library search for peer-reviewed journal publications.

P-BN33 Should a three-port technique be the gold standard for laparoscopic cholecystectomy?

Background The four-port technique is currently considered the gold standard technique for laparoscopic cholecystectomy. A three-port technique has been described but there is no consensus over the safety profile and efficacy of this technique compared to the four-port technique. Methods A comprehensive systematic review and meta-analysis comparing the three-port technique to the standard four-port technique in laparoscopic cholecystectomy for benign diseases of the gallbladder was performed. Two authors independently conducted an electronic database search of CENTRAL, MEDLINE, EMBASE, CINAHL, WHO ICTRP and ClinicalTrials.gov. For each outcome, we calculated the risk ratio (RR), mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals. Results Eighteen trials were included which randomised 2085 participants. Length of hospital stay and postoperative analgesia requirement favoured the three-port group [(MD -0.29, 95% CI -0.43 – -0.16, p < 0.0001) and (SMD -0.68, 95% CI -1.03 – -0.33, p = 0.0001) respectively]. There were no differences in length of procedure and success rate between the two groups [(MD 0.90, 95% CI -3.78 – 5.58, p = 0.71) and (RR 0.99, 95% CI 0.97 – 1.01, p = 0.17) respectively]. There were no differences in the rate of any measured adverse events. There were no mortalities in either group. The GRADE quality of evidence was low. Conclusions The three-port technique for laparoscopic cholecystectomy can be chosen by experienced surgeons who perform it regularly. However, the decision to use three ports should not be at the expense of safe dissection.

Diagnostic Accuracy of Ultrasound in Differentiation Uterine Leiomyosarcoma from Uterine Leiomyoma: A Systematic Review

Background: Uterine leiomyosarcoma is a rare malignant pathology of smooth muscle of uterus which is mostly asymptomatic with a wide range of late onset of symptoms such as post-menopausal bleeding and severe abdominal pelvic pain and abnormal vaginal discharge. Uterine leiomyosarcoma characteristically has structural and clinical similarities with giant uterine leiomyoma because both originate from the smooth muscle cells of the uterus. The diagnosis of uterine leiomyosarcoma through ultrasound is very different difficult due to indistinguishable sonographic features of uterine leiomyoma and leiomyosarcoma but there are certain sonological features which can prove the reliability of ultrasound as the diagnostic tool for differentiating uterine leiomyosarcoma from uterine leiomyoma. Aim: To access the accuracy of ultrasound in differentiating uterine leiomyosarcoma from uterine leiomyoma. Methods: An electronic database search was performed (PubMed, Science direct, Google Scholar) with the data range from 2000 to 2021. All studies included in the research was in English language. Articles which had descriptive studies related to sonographic features of uterine leiomyosarcoma and uterine leiomyoma. Results: Total 15 articles were found regarding the prevalence, clinical manifestation and sonographic findings of uterine leiomyosarcoma and uterine leiomyoma ,10 articles were included in the introduction and technique where as 6 articles were selected for systemic review with the sample size ranging from 20-200 in all different articles and age criteria of the participant in the selected articles was above 40 years with most candidates were investigated in the post menopause period. Conclusion: We identified certain sonographic patterns that can accurately differentiate uterine leiomyoma sarcoma from uterine leiomyoma with moderate sensitivity and specificity. Keywords: Transvaginal ultrasonography, leiomyoma, leiomyosarcoma

Malignant Odontogenic Tumours: A Systematic Review of Cases Reported in Literature

Background: Malignant odontogenic tumours (MOTs) arise either de novo from the tooth forming tissues, their developmental residues or from existing odontogenic epithelial or mesenchymal neoplasms in the jaws. Their management requires extensive surgery due to their infiltrative nature and risk of metastasis. There is a need to understand the clinical and pathological features of MOTs to inform both treatment algorithms and prognostication. This is an area of diagnostic pathology which presents substantial difficulties in diagnosis, compounded by inconsistent use of terminology. Thus, this systematic review aimed to describe the clinical and pathological features of MOTs with a view to consolidating the literature and defining problematic areas in diagnosis and classification.Methods: An electronic database search was conducted in Web of Science, PubMed/Medline, and Embase. Additionally, the grey literature and reference lists of selected papers searched for completeness. Nine hundred and sixty articles were initially identified. Following removal of duplicates and application of inclusion/exclusion criteria, 312 articles were included for qualitative analysis.Results: The 312 articles encompassed a total of 507 patients with most lesions located within the mandible (74.3%). The most common first histological diagnosis was ameloblastic carcinoma (25.7% of all diagnoses), but there is considerable variation in how and when various diagnostic terms are used, and several misdiagnoses were reported. An initial benign diagnosis was made in 24.7% of patients, followed by a later malignant diagnosis and in this sub-group, the most common benign first diagnosis was ameloblastoma (42.4%). Cervical lymph nodes were the most common site of metastasis (9.3% of patients). With respect to distant metastasis (DM), the lungs were the most common organ affected (11.2% of DM patients) with metastasising ameloblastoma the most commonly reported tumour which metastasised to the lungs. Overall, 26.8% of patients developed recurrence.Conclusion: Overall, the quality of the literature on MOTs is poor. This review of the literature has highlighted variations in diagnostic terms and criteria which has resulted in areas of confusion with potential for misdiagnosis. This consolidation of primary data has identified key areas for targeted research including further discussion on the malignant potential of ameloblastoma.

Military thoracic gunshot wounds: A systematic review

A systematic review of the literature was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to investigate the frequency of military thoracic gunshot wounds (GSWs) and deaths in combat theatres since World War Two (WW2). An electronic database search of World of Science, Scopus, Science Direct, PubMed and Microsoft Academic was conducted using the keywords ‘combat, casualties, thorax, gunshot, and military’ to identify peer-reviewed journals and conference papers on the topic. Twenty-three sources relevant to this review were identified and covered multiple theatres of operation. While there is a downward trend in the frequency of thoracic GSWs and fatalities likely due to the improvement of body armour, the improvement in medical treatment and increased frequency of improvised explosive devices (IEDs), the review shows that the advancement has not removed the likelihood of thoracic GSWs, which still accounted for approximately 15% of all thoracic injuries in the most recent combat theatres. The systematic review identifies that GSWs of the thorax continue to be a risk in military theatres and therefore, medical personnel should be aware of the frequency and severity of thoracic GSWs and should be prepared to treat these life-threatening injuries, as timely intervention is essential.

Detection of Dental Caries Using Salivary Biomarkers – A Systematic Review

Background: Saliva is a mixture of organic and inorganic components that comes in constant contact with the hard and soft tissues of the oral cavity. One of the most frequent disorders is dental caries, which is a multifactorial microbial disease of the tooth. Of which saliva plays a significant role in the process of dental caries. Aim: To systematically identify and evaluate the ability of salivary biomarkers in detection of dental caries. Methods: A comprehensive search was done using electronic data bases such as PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar and direct web search. The title scan was used to find relevant articles, which were then read and appraised for inclusion. This review analyses all research that investigated the use of salivary protein biomarkers to detect dental caries. Results: Electronic database search identified 16 articles. After evaluating the title, abstract, and full text of these articles, only 4 were selected for the present systematic review. A final of 4 studies were included based on the inclusion criteria to meet the research question. All the studies analyzed the salivary biomarkers in dental caries detection. Conclusion: Salivary biomarkers are a significant indicator in detection of dental caries and can be used in determining the further treatment planning.

225 The Management of Acute Cholecystitis in a District General setting: An Audit of Practice

Aim The benefits of laparoscopic cholecystectomy during index admission with acute cholecystitis (AC) are multiple. As such, current NICE guidelines dictate that adults with AC undergo laparoscopic cholecystectomy within 1 week of diagnosis. However, significant variation exists with regards to the management of such patients. Here we present the results of an audit of practice at a UK district general hospital and suggest that this standard can be achieved regardless of hospital. Method Electronic database search at Salisbury District Hospital over a period of 12 months to identify all patients with a coded diagnosis of AC. Electronic Discharge System (EDS) was consulted to assess whether patients underwent laparoscopic cholecystectomy within 7 days of diagnosis. Notes were reviewed for all patients who failed to meet this target to ascertain reasons why. Results Of the 336 patients coded as AC 8 were excluded due to incorrect coding leaving 328. 285 patients (87%) underwent laparoscopic cholecystectomy within 7 days. Of the 43 that did not, 31 (65%) had clinically justified reasons for delay. 285/297 (96%) patients met the NICE standard. Conclusions At Salisbury District Hospital 87% patients presenting with AC underwent laparoscopic cholecystectomy within 7 days. Common reasons for failure included: Awaiting further investigation (i.e., ERCP / MRCP), unfit for operative management, patient choice. Excluding justifiable reasons 96% of patients met NICE standards. Poor documentation was the most common cause for failure. Subsequent education and re-audit showed significant improvement. This audit exemplifies that NICE standards for the management of AC can be achieved in a district general setting.