Dental fear and anxiety management in children is considered one of the biggest challenges in pediatric dentistry.Intranasal sedation is a promising technique for managing unco-operative pediatric patients with rapid onset, ease of administration, and minimal invasiveness. We aimed to review the efficacy, onset time, duration, and behavioral success of intranasal sedation agents in pediatric dental procedures and identify the most effective regimens for clinical practice.This systematic review followed the PRISMA 2020 guidelines and included randomized controlled trials (RCTs) assessing intranasal sedation in children undergoing dental procedures. Primary outcomes were onset time, duration of sedation, and sedation success rates. The inclusion criteria were applied through search in six databases.Risk of bias was evaluated using the Cochrane RoB 2 tool. Meta-analyses were carried out using RevMan software, where pooled odds ratios and weighted mean differences were calculated on efficacy outcomes.Eighteen RCTs fulfilled the inclusion criteria, where intranasal agents such as midazolam, ketamine, dexmedetomidine, and their combinations were used. Meta analyses demonstrated intranasal sedation generally has a faster onset (moderate heterogeneity, I² = 40%) and is associated with greater success rates for achieving sedation than other methods. A combination of midazolam with ketamine or dexmedetomidine provided better results for both onset and behavioral success. The duration of sedation appears equivalent to oral or intravenous routes. Overall risk of bias was moderate due to blinding and selective reporting concerns.Midazolam, especially when combined with ketamine or dexmedetomidine, yielded promising results in relation to rapid onset and success of sedation. However, further large-scale RCTs are necessary to standardize dosing protocols and ensure that these findings are validated and optimized for clinical applications.

Dental fear and anxiety management in children is considered one of the biggest challenges in pediatric dentistry.Intranasal sedation is a promising technique for managing unco-operative pediatric patients with rapid onset, ease of administration, and minimal invasiveness. We aimed to review the efficacy, onset time, duration, and behavioral success of intranasal sedation agents in pediatric dental procedures and identify the most effective regimens for clinical practice.This systematic review followed the PRISMA 2020 guidelines and included randomized controlled trials (RCTs) assessing intranasal sedation in children undergoing dental procedures. Primary outcomes were onset time, duration of sedation, and sedation success rates. The inclusion criteria were applied through search in six databases.Risk of bias was evaluated using the Cochrane RoB 2 tool. Meta-analyses were carried out using RevMan software, where pooled odds ratios and weighted mean differences were calculated on efficacy outcomes.Eighteen RCTs fulfilled the inclusion criteria, where intranasal agents such as midazolam, ketamine, dexmedetomidine, and their combinations were used. Meta analyses demonstrated intranasal sedation generally has a faster onset (moderate heterogeneity, I² = 40%) and is associated with greater success rates for achieving sedation than other methods. A combination of midazolam with ketamine or dexmedetomidine provided better results for both onset and behavioral success. The duration of sedation appears equivalent to oral or intravenous routes. Overall risk of bias was moderate due to blinding and selective reporting concerns.Midazolam, especially when combined with ketamine or dexmedetomidine, yielded promising results in relation to rapid onset and success of sedation. However, further large-scale RCTs are necessary to standardize dosing protocols and ensure that these findings are validated and optimized for clinical applications.

Dental fear and anxiety management in children is considered one of the biggest challenges in pediatric dentistry.Intranasal sedation is a promising technique for managing unco-operative pediatric patients with rapid onset, ease of administration, and minimal invasiveness. We aimed to review the efficacy, onset time, duration, and behavioral success of intranasal sedation agents in pediatric dental procedures and identify the most effective regimens for clinical practice.This systematic review followed the PRISMA 2020 guidelines and included randomized controlled trials (RCTs) assessing intranasal sedation in children undergoing dental procedures. Primary outcomes were onset time, duration of sedation, and sedation success rates. The inclusion criteria were applied through search in six databases.Risk of bias was evaluated using the Cochrane RoB 2 tool. Meta-analyses were carried out using RevMan software, where pooled odds ratios and weighted mean differences were calculated on efficacy outcomes.Eighteen RCTs fulfilled the inclusion criteria, where intranasal agents such as midazolam, ketamine, dexmedetomidine, and their combinations were used. Meta analyses demonstrated intranasal sedation generally has a faster onset (moderate heterogeneity, I² = 40%) and is associated with greater success rates for achieving sedation than other methods. A combination of midazolam with ketamine or dexmedetomidine provided better results for both onset and behavioral success. The duration of sedation appears equivalent to oral or intravenous routes. Overall risk of bias was moderate due to blinding and selective reporting concerns.Midazolam, especially when combined with ketamine or dexmedetomidine, yielded promising results in relation to rapid onset and success of sedation. However, further large-scale RCTs are necessary to standardize dosing protocols and ensure that these findings are validated and optimized for clinical applications.

Hospitals worldwide recognise the importance of data and digital transformation in healthcare. We traced a smart hospital's data-driven journey to build an artificial intelligence and digital ecosystem (AIDE) to achieve healthcare excellence. We measured the impact of data and digital transformation on patient care and hospital operations, identifying key success factors, challenges, and opportunities. The use of data analytics and data science, robotic process automation, AI, cloud computing, Medical Internet of Things and robotics were stand-out areas for a hospital's data-driven journey. In the future, the adoption of a robust AI governance framework, enterprise risk management system, AI assurance and AI literacy are critical for success. Hospitals must adopt a digital-ready, digital-first strategy to build a thriving healthcare system and innovate care for tomorrow.
Artificial Intelligence ; Humans ; Delivery of Health Care ; Hospitals ; Cloud Computing ; Robotics ; Internet of Things ; Data Science

Mandibular prognathism is a well-known skeletal discrepancy with varying prevalence rates demographically. Patients with severe prognathism may experience difficulties speaking and chewing food as well as problems with psychosocial adjustment, indicating the need for surgical correction. In cases of single-stage larger mandibular setbacks, complications such as reduction in the pharyngeal airway and instability can be encountered. Therefore, two-stage orthognathic surgery could be recommended. Two patients (17-year-old female and 16-year-old female) reported with large mandibular antero-posterior discrepancies. Surgical correction was performed in two stages. In the first stage, a mandibular setback was performed with an anterior mandibular body osteotomy using Dingman’s technique with a modified step osteotomy, as it provides an increased surface area of contact between the osteotomized segments to achieve better stability. Osteofixation was done using locking titanium miniplates. A year after orthodontic decompensation at the second stage, maxillary advancement using Le Fort I osteotomy and bilateral sagittal split osteotomy for mandibular setback were performed and fixed with unsintered hydroxyapatite/poly-L-lactic acid plates and screws. The post-operative course was followed by post-surgical orthodontics. It can be concluded that a harmonized facial profile with good outcome in terms of skeletal stability, airway dimensions and occlusion were achieved with patient satisfaction.

Background: and Purpose In-hospital onset stroke (IHOS) accounts for a significant proportion of large vessel occlusion acute ischemic strokes, leading to worse outcomes due to delays in evaluation and treatment. Limited data is available on the effectiveness of mechanical thrombectomy in IHOS patients. This study aims to assess the safety and efficacy of mechanical thrombectomy for patients with IHOS and compare the outcomes with those of community-onset strokes (COS). Methods: We conducted a systematic review and meta-analysis following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to April 11, 2023. Eligible studies reporting outcomes of interest were included, and relevant data was extracted and analyzed using Stata software version 17.0. Results: In a meta-analysis of nine studies, comprising 540 cases of IHOS and 5,744 cases of COS, IHOS cases had a significantly lower rate of good functional outcomes on follow-up (35.46% vs. 40.74%, P<0.01) and a higher follow-up mortality rate (26.29% vs. 18.08%, P<0.01) compared to COS patients. Both groups had comparable successful recanalization rates (IHOS: 79.32% vs. COS: 81.44%, P=0.11), incidence rates of periprocedural complications (IHOS: 15.10%, COS: 12.96%, P=0.78), and symptomatic intracranial hemorrhage (IHOS: 6.24%, COS: 6.88%, P=0.67). It is worth noting that much of the observed effect size for mortality and good functional outcomes on follow-up was derived from only one and two studies, respectively. Conclusion While the current literature suggests that mechanical thrombectomy is a safe and effective treatment for IHOS, further research is necessary to comprehensively evaluate its impact, particularly during follow-up.

Introduction: Alcohol, when used frequently, accelerates the ageing process, causes brain damage, and results in a reduced volume of grey and white matter, leading to frontal lobe abnormalities. The neurotoxicity resulting from alcohol overuse affects the higher functions of the brain. This study aimed to evaluate the effect of alcohol dependence on the executive functioning of the brain. Methods: This study was carried out as a case-control study among 60 patients with alcohol dependence and 60 controls. Assessment of executive function was carried out using the Comprehensive trail-making test (CTMT) and the Wisconsin card sorting test (WCST). Comparison between the alcohol dependence group and normal healthy controls were calculated using the Mann-Whitney U test as data followed a non-parametric distribution. Results: The mean age of the participants among the cases and controls was 38.3±5.5 years and 37.8±5.4 years, respectively. The results showed a significant difference in both WCST and CTMT between cases and controls (p<0.05). Conclusion: This study concludes that there was an impaired performance in executive functions in alcohol- dependence patients in early abstinence compared to normal controls showing frontal lobe impairment in alcohol-dependence patients.

Bimaxillary transverse width discrepancies are commonly encountered among patients with dentofacial deformities. Skeletal discrepancies should be diagnosed and managed appropriately with possible surgical corrections. Transverse width deficiencies can present in varieties of combinations involving the maxilla and mandible. We observed that in a significant proportion of cases, the maxilla is normal, and the mandible showed deficiency in the transverse dimension after pre-surgical orthodontics. We designed novel osteotomy techniques to enhance mandibular transverse width correction, as well as simultaneous genioplasty. Chin repositioning along any plane is applicable concomitant with mandibular midline arch widening. When there is a requirement for larger widening, gonial angle reduction may be necessary. This technical note focuses on key points in management of patients with transversely deficient mandible and the factors affecting the outcome and stability. Further research on the maximum amount of stable widening will be conducted. We believe that developing evidence-based additional modifications to existing conventional surgical procedures can aid precise correction of complex dentofacial deformities.

Blood Coagulation Disorders/etiology* ; Goals ; Humans ; Motivation ; Resuscitation ; Wounds and Injuries/complications*

INTRODUCTION: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC. METHODS: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. RESULTS: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, CONCLUSION Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Adult ; Airway Extubation ; Cannula ; Critical Care ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Respiratory Insufficiency/therapy* ; Singapore/epidemiology*