COVID-19 Pandemic in ASEAN Region and Implication in Dentistry

The coronavirus disease (COVID-19) has spread globally and has influenced every aspect of life worldwide. In the ASEAN region, at present, many nations are still locked the academic organizations, shopping malls, events, and activities, and banks and airports are shut down to prevent the spread of the COVID-19 infection. COVID-19 has affected dental practice, and, in many countries, dentists are affected by COVID-19, leading to deaths. The dental treatments should be done with high standards of care and infection control by following proper recommendations. Personal protective equipment, patient screening, hand hygiene practices, mouth rinsing, disposable instruments, and use of rubber dam, reducing ultrasonic instruments use, treating suspected or confirmed COVID-19 patients in separate rooms, and disinfection of the inanimate surfaces helps in protecting clinicians and patients.

Cost-Effective Approach to the Laparoscopic Appendectomy

Background Surgeons can help reduce health care spending by selecting affordable and efficient instruments. The laparoscopic appendectomy (LA) is commonly performed and can serve as a model for improving health care cost. Methods We retrospectively reviewed all adult patients who underwent LA for non-perforated appendicitis from March 2015 to November 2017. Our objective was to determine which combination of disposable instruments afforded the lowest total operative cost without compromising postoperative outcomes. Results In total, 1857 consecutive patients were reviewed from 2 hospitals. After determining the 8 most commonly utilized combinations of disposable instruments, 846 patients were ultimately analyzed. The combination of a LigaSure, Endoloop, and an EndoBag (LEB) had the shortest median operative time (25 minutes, P < .001) and lowest median total operative cost ($1893, P < .001). Conclusions The LEB instrument combination rendered the shortest operative time, lowest total operative cost, and can be used to maximize surgical value during LA.

Comparison of the Clinical Efficacy of Draining Autovalve Limbosclerectomy and Trabeculectomy in the Treatment of Primary Open-Angle Glaucoma with Long-Term Follow-Up

Purpose: to evaluate the immediate and long-term hypotensive efficacy, the number of complications, and the clinical benefits of a draining autovalve limbosclerectomy (DALS) performed using a kit of disposable instruments in patients with POAG of various stages in comparison with trabeculectomy (TE).Patients and Methods. The study is based on the analysis of the clinical and functional condition of 127 eyes of 127 patients with primary open-angle glaucoma (stage I POAG was detected in 2 eyes, stage II in 30 eyes, stage III in 88 eyes and stage IV in 7 eyes). Patients were divided into groups: the main group—76 people who underwent DALS using a set of disposable instruments, and the control group—51 people who underwent TE. The average age of patients is 68.9 ± 10.3 years. Before and within 24 months after surgery, all patients underwent standard diagnostic examinations. The initial level of IOP against the background of the maximum antihypertensive mode varied from 24 to 50 mm. Hg. According to gonioscopy, the angle of the anterior chamber was open in all cases (III–IV degree). Patient exclusion criteria: history of laser or surgical treatment of glaucoma, cataract treatment.Results. After 24 months of follow-up after DALS, the level of IOP in patients with stage I–II of POAG was 14.19 ± 1.83 mm Hg and with III–IV stage of POAG 14.95 ± 2.15 mm Hg, compensation was achieved in 88.2 % of patients without the use of antihypertensive drops. After TE, compensation was received in 72.6 % of patients, the IOP level was 16.9 ± 2.21 and 17.78 ± 2.31 mm Hg. respectively (p < 0.01). After DALS surgery, a decrease in the number of complications was revealed in comparison with TE: a decrease in сiliochoroidal detachment by 9.1 %, hyphema by 2.5 %, ophthalmic hypertension in the early p/o period by 3.2 %, cystic changes in the filtering bleb by 7.1 %.Conclusion. The standardized DALS operation using a disposable tool kit is a new highly effective and safe method for the surgical treatment of glaucoma. DALS may be the operation of choice in the treatment of POAG of all stages.

Surgical Management of Intraocular Silicone Oil Microdroplet

Purpose Intraocular silicone oil microdroplets have been described after intravitreal injection of anti-VEGF agents packaged at a compound pharmacy. We present a case with the presence of an intraocular silicone oil microdroplet after a vitreoretinal operation using disposable instruments, and the surgical technique for its removal. Methods A 59-year-old patient who had been operated on for vitreous opacities using a disposable 27-g vitrectomy kit complained of a small round structure floating in the eye. It appeared a few days after surgery. The bubble was not present at all times and it disappeared for days on end. Clinical examination of the vitreous and retina during these uneventful periods was normal. The bubble reappeared intermittently without a link to any specific movement for some time but was again absent once the patient was examined. The physical properties of the mobile round lesion could be identified as lighter than aqueous humor, as it was described as being in the center of the visual field if the head was tilted forward. Results As the patient was very bothered by this bubble, a 23-g vitrectomy was performed. During deep indentation of the pars plana over 360 degrees, a tiny bubble of silicone oil could be found buried in the peripheral vitreous base, and controlled aspiration under deep indentation was performed. The patient has been without symptoms since the removal of the droplet and made an uneventful clinical recovery. Conclusion Microdroplets of silicone oil may be present in disposable vitreoretinal instruments and stay in the eye after surgery, causing a visual disturbance. The origin of these droplets may be linked to the plastic tubing of the instruments.

STERILIZATION & CROSS INFECTION IN DENTISTRY

Objectives: This study aims to assess the knowledge, perception and attitudeof patients towards sterilization and cross Infection and to assess the effects of education onperception and behavior towards sterilization and cross infection. Cross infection control ismost important in dentistry as it is considered one of the main reasons of rapid spread ofinfectious diseases now a days. Setting: Major public sector hospital of Punjab Pakistan, PunjabDental Hospital Lahore. Material & Method: We surveyed patients in OPDs of Punjab DentalHospital Lahore. Survey questions covered demographics as well as 15 questions related tosterilization and cross infection in dentistry. Questionnaires were given to educated peopleand interviews were taken from uneducated or less educated people. Data was collected andanalyzed. Results: patients have some knowledge about sterilization and cross infection buttheir concepts need a lot of improvement. Patients know that microbial contamination occursbut they are unaware of the diseases that are transmitted. Similarly on other perspective thereis discrepancy in knowledge and practice, as they do not take it seriously or they are unawareof the consequences of cross infection or long term effects of HIV, Hepatitis B & C. Disposableinstruments are very important for controlling cross infection. Only 60% people said they wouldprefer disposable instruments over reusable instruments when option is given to them. Mostpeople are reluctant to be treated with disposable instruments due to extra cost on treatment.92% were well aware of significance of hand washing of dentist before and after dental checkup,but when they go through dental examination they are either careless or hesitant to ask dentistto wash hands. Conclusion: Besides the knowledge there are other factors like patientsattitude and concerns also play vital role in preventing infection transmission in them. We haveto educate them about infectious diseases and their root of transmission and their long termeffects on health.

Reducing the Cost of Laparoscopy: Reusable versus Disposable Laparoscopic Instruments

Cost-effectiveness in health care management is critical. The situation in debt-stricken Greece is further aggravated by the financial crisis and constant National Health System expense cut-downs. In an effort to minimize the cost of laparoscopy, our department introduced reusable laparoscopic instruments in December 2011. The aim of this study was to assess potential cost reduction of laparoscopic operations in the field of general surgery. Hospital records, invoice lists, and operative notes between January 2012 and December 2013, were retrospectively reviewed and data were collected on laparoscopic procedures, instrument failures, and replacement needs. Initial acquisition cost of 5 basic instrument sets was €21,422. Over the following 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, projected cost with disposable instruments would amount to €305,270, creating savings of €272,361 over the two-year period under study. Despite the seemingly high purchase price, each set amortized its acquisition cost after only 9 procedures and instrument cost depreciated to less than €55 per case. Disposable instruments cost 9 times more than reusable ones, and their high price would almost equal the total hospital reimbursement by social security funds for many common laparoscopic procedures.