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Introduction: With declining kidney function, the prevalence of vascular calcifications increases and calcification occurs years earlier and is more severe in chronic kidney disease (CKD) patients than in general population. We did this study to find the prevalence of vascular calcification in patients on maintenance hemodialysis using simple and inexpensive radiological method and to find out the correlation of vascular calcification score with vascular disease events, cardiovascular and all-cause mortality over a follow-up period of 1 year. Materials and methods: This prospective, observational, comparative, follow-up, single-center study of maintenance hemodialysis patients was performed at a tertiary care center in Haryana. Seventy-one patients on maintenance hemodialysis for more than 3 months were included in the study. Patients who were 18 years of age or below, CKD stage 5 patients not on dialysis and those who had previous history of parathyroidectomy were excluded. Adragao score for vascular calcification was calculated by evaluating bilateral iliac, femoral and radial arteries in plain radiographic films of pelvis and hands. Statistical analyses were performed with the SPSS System 10.0. Results: Seventy-one patients were enrolled in this study out of which, 45 were male and 26 were female. Mean age of patients was 61.92 ± 10.77 years. Majority of patients were elderly (age group ?60 years). Out of 71 patients, 66 (92.9%) were hypertensive and 26 (36.6%) patients were diabetic. Twenty-two (30.9%) patients had cardiovascular disease (CVD) at baseline. Coronary artery disease (CAD) was present in 20 (28.1%) patients, cerebrovascular disease was present in 2 (2.8%) patients and peripheral artery disease (PAD) was present in only 1 patient at baseline. Average dialysis duration received by patients was 21.35 ± 21.17 months. Out of 71 patients, 16 (22.5%) received calcium-containing phosphate binder, 51 (71.8%) received noncalcium-containing phosphate binder and 4 patients received no phosphate binder. Fifty-five (77.4%) patients received therapeutic or prophylactic vitamin D3 therapy during the study period. Vascular calcification detected with plain X-ray of pelvis and both wrists was found in 56.3% of patients on maintenance hemodialysis. The prevalence and severity of vascular calcification was higher with increasing age. Diabetes was found to be significantly associated with the presence of vascular calcification (p < 0.0005). CAD at the time of enrollment was significantly associated with vascular calcification (p = 0.009). Serum levels of calcium, phosphate, vitamin D3, intact parathyroid hormone (PTH), calcium-phosphate product or use of phosphate binders or the types or vitamin D therapy did not correlate clinically with presence of vascular calcification. Hemodialysis duration did not correlate with the presence of vascular calcification (p = 0.113). Presence of vascular calcifications in hemodialysis patients predicted future vascular disease events over 1 year follow-up (p = 0.013) but did not correlate with cardiovascular and all-cause mortality. Conclusion: There is a high prevalence of vascular calcification in maintenance hemodialysis patients in our center. The risk factors of vascular calcification were higher age, diabetes and CAD. These patients should be followed-up regularly for vascular events. We also want to reiterate with this study that plain X-ray is sufficient to rule out vascular calcification in CKD patients and should be employed regularly in dialysis clinics.
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Background: Laparoscopy is the best available tool and method to manage impalpable undescended testes; management of the impalpable testis often pose a significant diagnostic and therapeutic challenge to a surgeon. The aim of this work was to elucidate and present the sensitivity and the value of laparoscopy, as a surgeon’s tool, for the diagnosis and treatment of the impalpable testis.Methods: From November 2015 to December 2018, 56 patients with 60 impalpable testes were operated upon by laparoscopic approach by a single surgeon. One-stage Fowler-Stephens laparoscopic orchidopexy was performed in 14 cases, while two-stage Fowler-Stephens laparoscopic orchidopexy was performed in 16 cases and Vessel-Intact Laparoscopic Orchidopexy (VILO) was done in 22 cases. In 2 cases vessel and vas was entering through deep ring and inguinal orchidopexy was done. Blind ending vessel/vas was noticed in 4 cases (vanishing/absent testes). Laparoscopic orchidectomy was required in 2 patients for nubin. No case of disorder of sexual dysfunction was (DSD) was found.Results: Laparoscopy was successfully completed in all the cases. 34 testicles were impalpable on right side, 18 on left side and other 4 cases (8 testicles) were bilaterally impalpable. Laparoscopic orchidopexy was carried out for 36 testes at the same. 16 needed a staged procedure. Orchidectomy was done in 2 cases/testes. In 4 cases testes was absent/vanishing. In 2 cases testes was canalicular, standard inguinal orchidopexy was done. The mean operative time was 48 minutes. Patients were allowed oral fluids 6 hours of the operation and were discharged at one day after the procedure. None of the patients had wound infection. Patients were followed up for a mean period of 12 months. At follow-up, all but one of the testes were well down in the bottom of the scrotum. In one patient, the testis was in a high scrotal position. All testes were of normal size, no atrophy was seen so far and no malignant change is suspected in any case so far. No severe morbidity or death was observed in our study.Conclusions: Laparoscopy offers surgeons a safe and reliable diagnostic and therapeutic option to patients with impalpable testes. No other imaging investigation is required, if well versed with basic laparoscopy. Intra-abdominal dissection allows more testes to be brought down to the scrotum. Even when open orchidopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilize the testicular vessels adequately. The procedure is best viewed as laparoscopy-assisted; as Orchidopexy has to be done in a conventional manner.
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The purpose of this study was to evaluate surface characteristics of Reciproc (R25) WaveOne (WO) &WaveOne Gold (WOG) files using SEM before and after use. Methods: fifteen primary files from each system were scanned for surface defects before instrumentation at 10x-1000x. Each file was planned to be used to instrument six root canals and then examined under SEM after preparing three and six canals at same magnifications. Data were scored and statistically analysed using CHI –SQ and Anova tests (p≤ 0.05). Results: Surface defects were detected in all study groups with higher values in WO & WOG group before use. Surface defects significantly increased in both WO and WOG groups after use as compared to R25. WO & WOG group showed significantly greater defects including metal strips, pitting, craters, micro-cracks and blunt edges (p≤ 0.05). Conclusions: Wave One Gold file has a different metallurgy due to its gold finish that does not enhance its resistance to surface defects during clinical use. Wave One and Wave One Gold showed significant increase in surface defects after six canal use which limits their usage in more than one teeth in single patient.
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Aim: Antibiotic loaded bone cement has been used extensively in orthopaedic surgery and in the treatment of osseous defects resulting from joint infection, osteomyelitis, osteitis. No endodontic investigation has used this type of material in the treatment of bony resorptive defects of the periapical lesions associated with failed endodontic therapy or periapical surgery. Therefore, this study was conducted with the use of gentamycin loaded bone cement, to assess healing ability of osseous defects in apical re-surgery cases after failed apical surgery. Methods: In all patients periapical lesions were surgically removed and gentamicin loaded bone cement was used as root end filling material and then carefully packed without pressure into the bony defect. Results: Long-term recall demonstrated clinical and radiographic healing and good tolerance of bone fill material by the periapical tissues. Conclusion: results from this study shows that gentamicin loaded bone cement is a biocompatible material and can be used effectively in apical resurgery cases for treating recalcitrant infectious osseous defects of periapical lesions associated with failed periapical surgery.
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Bleaching of vital teeth is a very common practice nowadays prompted by high esthetic demands of patients. But bleaching agents are known to cause some transient damage to enamel microstructure, so the need arises to determine the effect of bleaching agents on the mineral content of enamel. Aim: To evaluate mineral loss from enamel using in-office bleaching agent Hydrogen Peroxide and the effect of LED and Laser activated bleaching agent on mineral loss from enamel. Methods: Forty human premolar crowns were divided into buccal and lingual specimens and 80 blocks of 4x4x3mm each were obtained. Samples were randomly divided into four groups of twenty each depending upon the beaching treatment and activation method. Group I – Hydrogen Peroxide without additional activation, Group II – Hydrogen Peroxide with additional activation by Diode Laser, Group III – Hydrogen Peroxide with additional activation by LED Light and Group IV – Control group. Amount of calcium and Phosphate loss was calculated using atomic absorption spectrophotometry. Results: Results showed that bleaching with hydrogen peroxide leads to calcium and phosphate loss from enamel with additional activation resulting in higher amounts of mineral loss especially with Laser activation. Conclusion: Bleaching agents result in calcium and phosphate loss from enamel with significantly high loss of minerals due to additional activation by Laser and LED Light. Therefore bleaching procedures must be followed by remineralization treatments to prevent damage to enamel.
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Background: Aim: To study the outcome of single visit surgical extrusion and immediate aesthetic restoration of 15 cases of crown root fracture. Methods: Involved a conventional surgical extrusion method with elevators and stabilization with semi rigid fiber splint followed by immediate aesthetic composite buildup for restoration of aesthetics. Root canal treatment was completed after 3 weeks of Calcium hydroxide intracanal medicament. Results: Follow up examinations varying between 6 and 18 months, revealed no evident radiographic and clinical signs of root resorption, periapical disease and more important, marginal bone loss/gingival recession in any case. Conclusion: Highly favorable results of this clinical study reveal that single visit surgical extrusion with immediate aesthetics of crown root fractures may be an alternative to time consuming orthodontic extrusion which may create severe esthetic and emotional problems to patient.
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Background: Cleaning and shaping is a critical aspect of endodontic treatment as it influences the outcome of the subsequent phases of canal irrigation and filling and the success of the treatment itself. The goal of instrumentation is to produce a continuously tapered preparation that maintains the canal anatomy, without any deviation from the original canal curvature, facilitating optimal irrigation, debridement, and placement of local medicaments and permanent root filling, at the same time retaining the integrity of the radicular structures. AIM: The aim of the study was to compare the shaping ability of four different Nickel-Titanium single file systems in mesial roots of mandibular first molars. Methods: Eighty freshly extracted mandibular molars, extracted for periodontal reasons were used for the study A muffle-block was constructed as given by Aviad et al.[59] After sealing the apices with wax, the canals were mounted in the muffleblock using self-cure acrylic resin. After complete polymerization of the resin, the block was removed from the model. The blocks were sectioned horizontally at three sites (coronal, middle and apical) by a thin cutting disk (0.3-mm thick) at two levels: one 3 mm from the apex and the other 6 mm from the apex. The disk was mounted on an electric saw (CIRSAW, Confident Dental Equipments Ltd, India) for cutting the blocks. Photographs were taken of all three cross-sections of each tooth using a DSLR Camera (Nikon Digital, Tokyo, Japan) at a fixed position. The sections were reassembled in the muffle. The specimens were randomly divided into the following four groups: Group l: Prepared using Reciproc rotary files. Group 2: Prepared using WaveOne rotary files. Group 3: Prepared using OneShape rotary files. Group 4: Prepared using F6 SkyTaper rotary files. Results: The results of the present study revealed that the use of Reciproc and WaveOne instruments resulted in significantly better canal centering ability than the use of OneShape instruments and F6 SkyTaper (P < 0.05) Reciproc and WaveOne exhibited less canal transportation than OneShape and F6 SkyTape There were no significant differences in the canal transportation between Reciproc and WaveOne. And also no significant difference between OneShape and F6 SkyTaper. One Shape instruments required significantly less time to prepare the root canals followed by Reciproc, WaveOne and F6 SkyTaper (P < 0.05). Conclusion: Reciproc and WaveOne instruments respected the original canal curvature better than OneShape and F6 SkyTaper files.
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Aim: The aim of this study is to evaluate the effect of low-level laser irradiation and ibuprofen in reducing the onset and severity of postoperative pain following single visit endodontics. Materials and Methods: One hundred and twenty patients were recruited for this study. Group A (n = 30) patients were administered 400 mg of ibuprofen orally 1 h before the institution of an endodontic procedure. Group B (n = 30) patients were given irradiation of a low-level laser at 50 Hz for 3 min after the standard endodontic procedure at the periapical region on both buccal and lingual aspect. Group C (n = 30) patients were given preoperative ibuprofen followed with a low-level laser at 50 Hz for 3 min after endodontic treatment. Group D (n = 30) patients were administered no preoperative ibuprofen nor low-level laser irradiation after the endodontic procedure. The patient immediately recorded his/her pain perception on the Heft Parker pain survey after completion of the appointment and at 4, 8, 12, 24, and 48 h postoperatively. Inter group analysis was carried out using the analysis of variances with “least significant difference” post hoc test. For intra group analysis, Student's t-test was used. Chi-square test was applied for nonparametric data. Results: Pain was significantly reduced in all the treatment groups postoperatively. Ibuprofen showed significant pain reduction at 4 h and 8 h period. The combination of low-level laser and ibuprofen showed the best results in terms of postoperative pain reduction. Conclusion: This study proved that low-level laser therapy can be an effective alternative for conventional use of nonsteroidal anti-inflammatory drugs in controlling postendodontic pain thereby eliminating the adverse effects of such drugs on the patients.
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Tuberculosis is a very highly prevalent disease particularly in the developing world. In India one person dies of tuberculosis every minute. It can be a differential diagnosis of any disease ranging from infections to malignancies. But tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation is an uncommon occurrence. Among patients with pulmonary tuberculosis, those with miliary or disseminated disease or having comorbidities like acquired immunodeficiency syndrome [AIDS] are especially prone to develop acute respiratory distress syndrome [ARDS]. We present a case of a young female with no comorbidities or immuno suppression who presented with ARDS to us. We initially managed with mechanical ventilation and broad spectrum antibiotics, but there was no improvement. Only after anti tubercular therapy [ATT] and corticosteroids the patient recovered
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Humans , Female , Respiratory Distress Syndrome/diagnosis , Diagnosis, Differential , Review Literature as TopicABSTRACT
Neonatal seizures [NS] affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5[th] day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12[th] December 2006 to 25[th] September 2007 on eonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. Tonic clonic seizure was the commonest type [28%] followed by multi-focal clonic, and focal tonic seizures [25% each]. Birth asphyxia was found to be the main aetiology [46%].Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures.
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Measles outbreak was investigated in Afghan refugees camp, Haripur, NWFP where around 80 cases of measles had occurred among children of age 1-7 years during a period of two months from December 2000 to January 2001. All the 12 children who died out of the 80 measles cases were residing in a camp served by the Basic Health Unit-3 of the camp. This specific camp had high influx of refugees with low immunization coverage and high malnutrition rate