Background: The COVID-19 pandemic continues to escalate. There is urgent need to stratify patients. Understanding risk of deterioration will assist in admission and discharge decisions, and help selection for clinical studies to indicate where risk of therapy-related complications is justified. Methods: An observational cohort of patients acutely admitted to two London hospitals with COVID-19 and positive SARS-CoV-2 swab results was assessed. Demographic details, clinical data, comorbidities, blood parameters and chest radiograph severity scores were collected from electronic health records. Endpoints assessed were critical care admission and death. A risk score was developed to predict outcomes. Findings: Analyses included 1,157 patients. Older age, male sex, comorbidities, respiratory rate, oxygenation, radiographic severity, higher neutrophils, higher CRP and lower albumin at presentation predicted critical care admission and mortality. Non-white ethnicity predicted critical care admission but not death. Social deprivation was not predictive of outcome. A risk score was developed incorporating twelve characteristics: age > 40, male, non-white ethnicity, oxygen saturations < 93%, radiological severity score > 3, neutrophil count > 8.0 x10 9 /L, CRP > 40 mg/L, albumin < 34 g/L, creatinine > 100 μmol/L, diabetes mellitus, hypertension and chronic lung disease. Risk scores of 4 or higher corresponded to a 28-day cumulative incidence of critical care admission or death of 40.7% (95% CI: 37.1 to 44.4), versus 12.4% (95% CI: 8.2 to 16.7) for scores less than 4. Interpretation: Our study identified predictors of critical care admission and death in people admitted to hospital with COVID-19. These predictors were incorporated into a risk score that will inform clinical care and stratify patients for clinical trials.

The observers' shade matching performance was significantly better with the computer method compared with the conventional one. There was a large variation in the observers' matching ability. The digital camera can be used as a means of colour measurements in the dental clinic.

It has been observed that teeth become lighter when they are dried. The present study was designed to quantify these changes and the time taken for tooth colour to return to normal. The colour of an upper central incisor in each of seven subjects was measured using a reflectance spectrophotometer before and after application of a rubber dam and, in another seven subjects before and after taking a polyvinylsiloxane impression. There were statistically significant changes in the L*, a* and b* values following rubber dam application and in the L* value following impression taking. The results demonstrate that teeth become brighter and less colour saturated after rubber dam application and brighter after impression taking. The original values were regained after 30 min.

No abstract

NICE has accredited the process used by BSR to create its clinical guidelines. The term began on 27 February 2012 and the current renewed accreditation is valid until 31 December 2023. More information on accreditation can be viewed at www.nice.org.uk/accreditation.

Osteoarthritis (OA) is the most prevalent arthritis worldwide and is characterized by chronic pain and impaired physical function. We hypothesized that heightened pain in hand OA could be reduced with duloxetine or pregabalin. In this prospective, randomized clinical study, we recruited 65 participants, aged 40–75 years, with a Numerical Rating Scale (NRS) for pain of at least 5. Participants were randomized to one of the following three groups: duloxetine, pregabalin, and placebo. The primary endpoint was the NRS pain score, and the secondary endpoints included the Australian and Canadian Hand Osteoarthritis Index (AUSCAN) pain, stiffness, and function scores and quantitative sensory testing by pain pressure algometry. After 13 weeks, compared to placebo, ANOVA found significant differences between the three groups (P=0.0078). In the intention-to-treat analysis, the pregabalin group showed improvement for NRS pain (P=0.023), AUSCAN pain (P=0.008), and AUSCAN function (P=0.009), but no difference between duloxetine and placebo (P>0.05) was observed. In the per protocol analysis, NRS pain was reduced for pregabalin (P<0.0001) and duloxetine (P=0.029) compared to placebo. We conclude that centrally acting analgesics improve pain outcomes in people with hand arthritis, offering new treatment paradigms for OA pain.

Radiovisiography (RVG) is a commercially available, dental radiographic digital imaging system which is claimed to rival conventional techniques in terms of decreased radiation dose and the production of instantaneous images. The aim of this study was to compare in vitro the sensitivities and specificities derived from three examiners using conventional bitewing radiographic film (D and E speed) with those achieved by the same examiners using basic mode RVG bitewing videoprints of occlusal and approximal caries. Videoprints were used in this study, as they are the principal method of archiving radiovisiographic images, unless a separate compatible personal computer is used. The histological appearance of the subsequently sectioned teeth was used as the validating criterion. The in vitro results of basic mode RVG suggest that for occlusal caries, overall the sensitivity and specificity of RVG videoprints are similar to those of bitewing radiography. For approximal caries, the specificity of RVG videoprints was similar to that of bitewing radiography, but the sensitivity was slightly lower. Further work using the different modes available and electronically modified images is indicated.

Objectives : Multiple RCTs of interkeukin-6 (IL-6) inhibitors in COVID-19 have been published, with conflicting conclusions. We performed a meta-analysis to assess the impact of IL-6 inhibition on mortality from COVID-19, utilising meta-regression to explore differences in study results. Methods : Systematic database searches were performed to identify RCTs comparing IL-6 inhibitors (tocilizumab and sarilumab) to placebo or standard of care in adults with COVID-19. Meta-analysis was used to estimate the relative risk of mortality at 28 days between arms, expressed as a risk ratio. Within-study mortality rates were compared, and meta-regression was used to investigate treatment effect modification. Results : Data from nine RCTs were included. The combined mortality rate across studies was 19% (95% CI: 18, 20%), ranging from 2% to 31%. The overall risk ratio for 28-day mortality was 0.90 (95% CI: 0.81, 0.99), in favour of benefit for IL-6 inhibition over placebo or standard of care, with low treatment effect heterogeneity: I 2 0% (95% CI: 0, 53%). Meta-regression showed no evidence of treatment effect modification by patient characteristics. Trial-specific mortality rates were explained by known patient-level predictors of COVID-19 outcome (male sex, CRP, hypertension), and country-level COVID-19 incidence. Conclusions : IL-6 inhibition is associated with clinically meaningful improvements in outcomes for patients admitted with COVID-19. Long-term benefits of IL-6 inhibition, its effectiveness across healthcare systems, and implications for differing standards of care are currently unknown.