Akilesh Ramasamy

Background: Patients undergoing long-term glucocorticoid therapy are administered additional glucocorticoids before minor dental procedures, although this is not supported by evidence. The authors designed this study to validate the hypothesis that routine blanket glucocorticoid supplementation is unnecessary during minor oral surgical procedures under local anesthesia. Methods: The authors recruited 270 patients into 3 groups (1:1:1 allocation) from the dental outpatient department. Primary outcomes were changes in hemodynamic parameters and frequency of adverse events among the 3 groups. The secondary outcome was the association of preprocedural stress and procedural pain with periprocedural adverse events in the long-term glucocorticoid therapy group (groups I and II). Results: No clinically relevant changes in hemodynamic parameters among the 3 groups were found. The authors also found low periprocedural adverse events in all 3 groups combined (n = 1), so they did not explore the secondary outcomes further. Conclusions: Among patients undergoing long-term glucocorticoid therapy for indications other than primary adrenal insufficiency, elective minor oral surgical procedures can be performed safely with only their daily dose of glucocorticoid when their medical conditions are optimized. Routine additional glucocorticoid supplementation appears unnecessary. The results of the study also revealed opportunities for value addition by means of integrating oral health care with medical follow-up for patients with multiple co-occurring medical conditions. Practical Implications: Routine blanket glucocorticoid supplementation among patients taking a long-term glucocorticoid for indications other than primary adrenal insufficiency appears unnecessary before minor oral surgical procedures under local anesthesia. This clinical trial was registered at Clinical Trial Registry-India. The registration number is CTRI/2017/02/007779. The final version is more revised and concise. But this pre-print version has the supplemental files for additional references. Further errors were corrected before final version was published. May request for the final version if not accessible.

Temporomandibular joint disorders are common in individuals with intellectual disability and yet our current knowledge in this specific population is less. Current methods of assessment have limitations in being used for these individuals and have not been validated in such settings, highlighting need for such efforts to standardize and validate, innovate assessment of Temporomandibular disorders among individuals with intellectual disability. (Abstract not part of the original article)

The perspective contains the challenges in assessing pain and practical considerations when using visual analogue scale, numerical rating scale and similar scales in subjective reporting by patient. The article highlights the importance of patient-specific considerations which can affect the accuracy. In addition, the article also highlights the limitations to be considered when using such scales in research and patient-specific decision making.

Guidelines and practices in trauma care constantly evolve based on evidence available, and every healthcare provider who treats trauma should be up-to-date in trauma-care concepts. The Eleventh Edition of Advanced Trauma Life Support, released in 2025, contains a complete revamp of the foundational principles of care, as well as content design, delivery, and training, based on medical and educational evidence. In this edition, a significant update is the emphasis on control of exsanguinating/major haemorrhage (ABCDE to x-ABCDE where x stands for control of exsanguinating haemorrhage in trauma resuscitation. In addition to damage control resuscitation, some of the significant changes include recommendations for permissive hypotension, limiting crystalloids, early transfusion, neuroprotective focus, and modifications in operational principles in spine motion restriction. Some of these conceptual changes with their rationale are briefly described in this review as an update for any healthcare provider involved in trauma resuscitation.

We aim to evaluate the prevalence of reporting and the extent of statistical heterogeneity of systematic reviews with meta-analyses (SRMAs) of exercise training for hypertension and to provide practical recommendations for dealing with statistical heterogeneity. We systematically searched on four databases (from 2002 to September of 2023) for SRMAs comparing exercise interventions vs. a non-exercise control on blood pressure (BP) control in adults with hypertension. Fifty-nine SRMAs, with a median of 14 studies, were analysed. Cochran's Q (41%), I² (24%), forest plots (44%), and particularly τ² (54%) and prediction intervals (96.6%) frequently were not reported for the hypertension subgroup. The recalculated prediction intervals were discrepant (i.e., crossed the null effect) of significant 95% confidence intervals of most meta-analyses (systolic BP: 65%; diastolic BP: 92%). This suggests substantial heterogeneity across studies, which was often not acknowledged by authors' conclusions (78%). Consequently, downgrading the certainty of the available evidence may be justified alone due to heterogeneity across studies. Finally, we illustrate areas for improving I² interpretation and provide practical recommendations on how to address statistical heterogeneity across all stages of a SRMA.