Background: and Purpose Antiplatelets are often used before direct oral anticoagulant (DOACs) initiation after an acute ischemic stroke related to atrial fibrillation (AF), but the evidence is weak. Here, we explored the risks and benefits of this approach. Methods: A post-hoc analysis of ELAN (Early versus Late Initiation of Direct Oral Anticoagulants in Post-ischemic Stroke Patients with Atrial Fibrillation) trial data (NCT03148457) was conducted to compare the risk of recurrent ischemic stroke, systemic embolism, major bleeding (extracranial or intracranial hemorrhage [ICH]), and vascular death within 30 days (as a composite and as individual outcomes) in participants treated with and without antiplatelets before DOAC initiation after an AF-associated ischemic stroke. We used both logistic and cause-specific Cox proportional hazards regression in inverse probability of treatment weighted models to account for confounding. We calculated the net benefit of antiplatelet use by subtracting the weighted rate of excess bleeding events attributable to antiplatelets from the rate of excess ischemic events possibly prevented by antiplatelets. Results: Among 2,013 participants (median age 77 years, 45.5% female), 1,090 (54.1%) used antiplatelets, and 70 (3.5%) experienced the composite outcome. Antiplatelet use was not associated with the composite outcome (inverse probability of treatment weighted odds ratio [ORweighted] 1.06, 95% confidence interval [CI] 0.66–1.72; inverse probability of treatment weighted hazard ratio [HRweighted] 1.06, 95% CI 0.65–1.72), but showed a lower risk of ischemic stroke recurrence (ORweighted 0.58 [0.30–1.08], HRweighted 0.57 [0.30–1.10]), and a higher risk of major bleeding (ORweighted 1.76 [0.56–6.63], HRweighted 1.88 [0.56–6.39]). Its net benefit was +0.57 (95% CI -1.25 to +2.34) to +0.30 (-1.82 to +2.27) weighted events/100 person-months for ICH weights 1.5 to 3.1. Conclusion Following an AF-associated ischemic stroke, we found a lower risk of recurrence and no signs of net harm with antiplatelet use before DOAC initiation, despite an increased risk of bleeding.

Objectives: Geriatric maxillofacial trauma (GMT) is not an uncommon entity in maxillofacial surgery practice. The aim of the study was to document the experience with GMT cases in a single private dental college and hospital in an effort to uncover the etiology, prevalence, fracture sites, and various types of treatment in GMT. Materials and Methods: This was a retrospective study conducted at Saveetha Dental College and Hospital in Chennai. Data from patients diag-nosed with maxillofacial trauma between January 2019 and December 2023 were retrieved from hospital records, and those aged ≥60 years wereincluded in the study. Patients’ basic demographic details and the prevalence, etiology, fracture sites, and various treatments of GMT were recorded and analyzed. The collected data were entered into a structured database and analyzed using IBM SPSS Statistics ver. 23.0 (IBM). Results: A total of 867 cases were screened, and 37 (4.04%) GMT patients were finally included in the study. The mean age of the study population was 65±5 years, and there were six females and 31 males. A ground-level fall was the common etiology (n=17), and the most common site of fracture was the mandible (n=15). Open reduction and internal fixation (ORIF) was the most common treatment modality (n=24) among included cases. Conclusion Although the prevalence of GMT was low, ground-level falls were a common reason for trauma; hence, geriatric patients require comprehensive care in home and outdoor settings. Enhanced anesthetic and surgical techniques have made ORIF a suitable treatment approach in the present era.

Background: and Purpose Antiplatelets are often used before direct oral anticoagulant (DOACs) initiation after an acute ischemic stroke related to atrial fibrillation (AF), but the evidence is weak. Here, we explored the risks and benefits of this approach. Methods: A post-hoc analysis of ELAN (Early versus Late Initiation of Direct Oral Anticoagulants in Post-ischemic Stroke Patients with Atrial Fibrillation) trial data (NCT03148457) was conducted to compare the risk of recurrent ischemic stroke, systemic embolism, major bleeding (extracranial or intracranial hemorrhage [ICH]), and vascular death within 30 days (as a composite and as individual outcomes) in participants treated with and without antiplatelets before DOAC initiation after an AF-associated ischemic stroke. We used both logistic and cause-specific Cox proportional hazards regression in inverse probability of treatment weighted models to account for confounding. We calculated the net benefit of antiplatelet use by subtracting the weighted rate of excess bleeding events attributable to antiplatelets from the rate of excess ischemic events possibly prevented by antiplatelets. Results: Among 2,013 participants (median age 77 years, 45.5% female), 1,090 (54.1%) used antiplatelets, and 70 (3.5%) experienced the composite outcome. Antiplatelet use was not associated with the composite outcome (inverse probability of treatment weighted odds ratio [ORweighted] 1.06, 95% confidence interval [CI] 0.66–1.72; inverse probability of treatment weighted hazard ratio [HRweighted] 1.06, 95% CI 0.65–1.72), but showed a lower risk of ischemic stroke recurrence (ORweighted 0.58 [0.30–1.08], HRweighted 0.57 [0.30–1.10]), and a higher risk of major bleeding (ORweighted 1.76 [0.56–6.63], HRweighted 1.88 [0.56–6.39]). Its net benefit was +0.57 (95% CI -1.25 to +2.34) to +0.30 (-1.82 to +2.27) weighted events/100 person-months for ICH weights 1.5 to 3.1. Conclusion Following an AF-associated ischemic stroke, we found a lower risk of recurrence and no signs of net harm with antiplatelet use before DOAC initiation, despite an increased risk of bleeding.

Objectives: Geriatric maxillofacial trauma (GMT) is not an uncommon entity in maxillofacial surgery practice. The aim of the study was to document the experience with GMT cases in a single private dental college and hospital in an effort to uncover the etiology, prevalence, fracture sites, and various types of treatment in GMT. Materials and Methods: This was a retrospective study conducted at Saveetha Dental College and Hospital in Chennai. Data from patients diag-nosed with maxillofacial trauma between January 2019 and December 2023 were retrieved from hospital records, and those aged ≥60 years wereincluded in the study. Patients’ basic demographic details and the prevalence, etiology, fracture sites, and various treatments of GMT were recorded and analyzed. The collected data were entered into a structured database and analyzed using IBM SPSS Statistics ver. 23.0 (IBM). Results: A total of 867 cases were screened, and 37 (4.04%) GMT patients were finally included in the study. The mean age of the study population was 65±5 years, and there were six females and 31 males. A ground-level fall was the common etiology (n=17), and the most common site of fracture was the mandible (n=15). Open reduction and internal fixation (ORIF) was the most common treatment modality (n=24) among included cases. Conclusion Although the prevalence of GMT was low, ground-level falls were a common reason for trauma; hence, geriatric patients require comprehensive care in home and outdoor settings. Enhanced anesthetic and surgical techniques have made ORIF a suitable treatment approach in the present era.

Background: and Purpose Antiplatelets are often used before direct oral anticoagulant (DOACs) initiation after an acute ischemic stroke related to atrial fibrillation (AF), but the evidence is weak. Here, we explored the risks and benefits of this approach. Methods: A post-hoc analysis of ELAN (Early versus Late Initiation of Direct Oral Anticoagulants in Post-ischemic Stroke Patients with Atrial Fibrillation) trial data (NCT03148457) was conducted to compare the risk of recurrent ischemic stroke, systemic embolism, major bleeding (extracranial or intracranial hemorrhage [ICH]), and vascular death within 30 days (as a composite and as individual outcomes) in participants treated with and without antiplatelets before DOAC initiation after an AF-associated ischemic stroke. We used both logistic and cause-specific Cox proportional hazards regression in inverse probability of treatment weighted models to account for confounding. We calculated the net benefit of antiplatelet use by subtracting the weighted rate of excess bleeding events attributable to antiplatelets from the rate of excess ischemic events possibly prevented by antiplatelets. Results: Among 2,013 participants (median age 77 years, 45.5% female), 1,090 (54.1%) used antiplatelets, and 70 (3.5%) experienced the composite outcome. Antiplatelet use was not associated with the composite outcome (inverse probability of treatment weighted odds ratio [ORweighted] 1.06, 95% confidence interval [CI] 0.66–1.72; inverse probability of treatment weighted hazard ratio [HRweighted] 1.06, 95% CI 0.65–1.72), but showed a lower risk of ischemic stroke recurrence (ORweighted 0.58 [0.30–1.08], HRweighted 0.57 [0.30–1.10]), and a higher risk of major bleeding (ORweighted 1.76 [0.56–6.63], HRweighted 1.88 [0.56–6.39]). Its net benefit was +0.57 (95% CI -1.25 to +2.34) to +0.30 (-1.82 to +2.27) weighted events/100 person-months for ICH weights 1.5 to 3.1. Conclusion Following an AF-associated ischemic stroke, we found a lower risk of recurrence and no signs of net harm with antiplatelet use before DOAC initiation, despite an increased risk of bleeding.

Objectives: Geriatric maxillofacial trauma (GMT) is not an uncommon entity in maxillofacial surgery practice. The aim of the study was to document the experience with GMT cases in a single private dental college and hospital in an effort to uncover the etiology, prevalence, fracture sites, and various types of treatment in GMT. Materials and Methods: This was a retrospective study conducted at Saveetha Dental College and Hospital in Chennai. Data from patients diag-nosed with maxillofacial trauma between January 2019 and December 2023 were retrieved from hospital records, and those aged ≥60 years wereincluded in the study. Patients’ basic demographic details and the prevalence, etiology, fracture sites, and various treatments of GMT were recorded and analyzed. The collected data were entered into a structured database and analyzed using IBM SPSS Statistics ver. 23.0 (IBM). Results: A total of 867 cases were screened, and 37 (4.04%) GMT patients were finally included in the study. The mean age of the study population was 65±5 years, and there were six females and 31 males. A ground-level fall was the common etiology (n=17), and the most common site of fracture was the mandible (n=15). Open reduction and internal fixation (ORIF) was the most common treatment modality (n=24) among included cases. Conclusion Although the prevalence of GMT was low, ground-level falls were a common reason for trauma; hence, geriatric patients require comprehensive care in home and outdoor settings. Enhanced anesthetic and surgical techniques have made ORIF a suitable treatment approach in the present era.

Background: Primary malignancies of the thyroid gland are less frequent in the first two decades of life and accounts for only 0.5-3% of all malignant neoplasms in children and adolescents. Methods: A retrospective analysis was undertaken on children less than 18 years of age who were diagnosed with thyroid malignancy from 1st June 2018 to 31st May 2022. The electronic health records were reviewed to determine patient demographics, pathological characteristics, interventions (surgery and radioactive iodine therapy [RAI]) and follow up. Results: Eighteen patients were less than 18 years of age at the time of diagnosis.Mean age at diagnosis was 14.7 years (6-18 years). Majority were females and in post pubertal age group. Among our cohort 83.4% had stage 1 disease, whereas 16.6% had stage II disease. Lung involvement was noted in 16.6%. Risk stratification revealed that 44.6% of the children were in the high-risk group and 38.8% in the intermediate-risk group. Fifteen patients (83.3%) underwent I-131 therapy. Follow up period ranged from 2-51.7 months with a median follow up period of 22.15 months.Complete remission was noted in 15 patients (83.3%). Out of the children with metastatic lung disease, 1 had progressive disease, 2 had stable disease. Overall survival was 100%. Conclusion Majority of our children in our retrospective data presented with nodal and distant metastasis. With the current advances in the treatment of thyroid malignancies, a good survival was noted even in children with pulmonary metastasis.