BackgroundIndia has one of the world's largest burdens of cleft lip and palate (CLP), yet lacks a national outcomes registry or standardized system for cleft care evaluation. The Cleft Care India Study is a multicentric national initiative to assess current treatment outcomes for patients with non-syndromic unilateral CLP for 5-, 12-, and 20-year-old age groups.MethodsFourteen cleft care centers across India participated in this cross-sectional study. Standardized protocols for collecting data were formulated with input from the Study Steering Committee, validated through pilot testing, and employed for data collection. Data collected included intra-oral and extraoral photographs, study models, radiographs, surgical information, oral health assessments, speech recordings, hearing evaluations, psychosocial measures, and the intelligibility in context scale questionnaire. In this paper, we present the dentofacial outcomes. Skeletal relationships were analyzed using ANB, SNA, and SNB angles derived from cephalometric radiographs; dental arch relationships were evaluated using the 5-year or modified GOSLON indices; and nasolabial esthetics were assessed with the Asher-McDade index.ResultsData from 294 non-syndromic unilateral cleft lip and palate (UCLP) patients aged 5 (n = 72), 12 (n = 155), and 20 years (n = 67) were analyzed. Reliability testing showed strong intra and inter-rater agreement for all indices and cephalometric data (class correlation coefficient > 0.9). Nearly half of 12 year olds (46.5%) and more than half of 20 year olds (58.7%) demonstrated a Class III skeletal relationship (ANB < 0). Poor to very poor dental arch relationships (score > 3) were observed in 45%, 48%, and 43% of the 5-, 12-, and 20-year groups, respectively. Nasolabial esthetic outcomes were rated poor to very poor in 24.3% of 5 year olds, 25% of 12 year olds, and 55.4% of 20 year olds.ConclusionThis multicentric cleft outcomes audit in India demonstrated suboptimal skeletal, dental, and nasolabial outcomes when benchmarked against international standards. These findings highlight an urgent need for the centralization of cleft services, implementation of systematic national outcome monitoring, and adoption of standardized multidisciplinary care pathways to improve the quality and consistency of cleft management across India.
Abstract Background: Chronic limb-threatening ischemia (CLTI) monitoring relies on the ankle–brachial index (ABI), which is often unreliable in patients with noncompressible vessels. Pedal acceleration time (PAT) has emerged as a potential alternative, but its prognostic value requires validation. This study evaluated the accuracy of PAT in predicting limb salvage and major adverse limb events in CLTI patients undergoing infrainguinal revascularization. Methods: In this prospective single-center study, 90 CLTI patients undergoing revascularization were enrolled. PAT of the dorsalis pedis and lateral plantar arteries was recorded at baseline, postprocedure, 1 month, and 3 months. PAT was classified as: Class 1 (20–120 ms), Class 2 (121–180), Class 3 (181–224), and Class 4 (>225). The primary outcome was limb salvage; secondary outcomes included correlation with ABI and wound-healing time. Results: The cohort was predominantly male (87.8%) with a mean age of 66.3 ± 9.8 years. Preoperatively, PAT classes were: Class 1 (14.4%), Class 2 (38.9%), Class 3 (31.1%), Class 4 (15.6%). After intervention, Class 1 rose to 64.4%. The overall limb-salvage rate was 88.2%. Improvement in PAT class significantly predicted limb salvage ( P = 0.009); a 2–3 class improvement achieved 100% salvage compared with 78.3% in those without improvement. Preoperative Class 4 predicted limb loss (adjusted odds ratio 5.28, P = 0.034). PAT outperformed ABI for predicting limb salvage (area under the curve [AUC] 0.710 vs. 0.578) and wound healing (AUC 0.742 vs. 0.556). Conclusion: PAT provides more reliable prognostic information than ABI in CLTI patients undergoing infrainguinal revascularization. Its improvement strongly predicts limb salvage and wound healing, supporting its integration into routine postoperative surveillance.
AIM:Pregnancy complications such as miscarriage, preterm birth (PTB), and luteal phase defects (LPD) are significant reproductive health issues globally, with both physical and psychological implications. This review aims to examine the role of natural progesterone in pregnancy-related disorders, specifically threatened and recurrent miscarriage, PTB, and LPD. Additionally, it examines how natural progesterone's immune-modulating actions, including both direct and indirect involvement, contribute to maintaining pregnancy. METHODS:This narrative review was conducted using PubMed, Google Scholar, and reference screening to identify English-language studies examining the role of natural progesterone in miscarriage, PTB, and LPD. Emphasis was placed on progesterone's immunomodulatory actions, including cytokine regulation and the activity of the progesterone-induced blocking factor (PIBF), and their relevance to pregnancy maintenance. RESULTS:Natural progesterone demonstrates clinical benefit in managing threatened miscarriage, recurrent pregnancy loss, preterm labor, and LPD. Evidence shows that it is well-tolerated with manageable side effects, reducing miscarriage rates, preventing PTB, and improving LPD outcomes through its effects on the maternal-fetal interface. This review also highlights progesterone's dual immunomodulatory action, direct cytokine regulation, and indirect influence via PIBF, which together contribute to improved pregnancy maintenance and outcomes. CONCLUSION:Natural progesterone supports pregnancy by preventing miscarriages, preterm labor, and LPD through its direct and indirect immunomodulatory mechanisms. Clinically, it is well-tolerated with no serious or unexpected adverse events. However, gaps remain in fully understanding its effectiveness, emphasizing the need for further research.
