Interim Fixed Space Maintainer : A New Technique.

The loss of permanent tooth in adolescent patient makes it highly desirable to perform the necessary treatment as expeditiously as possible. When a tooth is lost, space maintenance should be provided immediately after extraction to prevent tipping, tilting, or rotation of the abutment teeth or eruption of the opposing teeth. To ascertain function and esthetics, immediate treatments include interim space maintainer approaches. So this report describes a new technique for the management of the lost mandibular second premolar with a fixed functional interim space maintainer in a 12-year-old boy. The technique offers provision of conservative and cost effective fixed interim space maintainer which can restore correct, harmonious, and nondestructive occlusal relationships.

Inr In Pediatric Patients With Acute Dental Infections : A Plot Study.

Patients with congenital or acquired coagulopathies are common in the general population. Dentists should have access to the patients’ appropriate and current laboratory values to prevent bleeding complications during and after invasive dental procedures. A laboratory test called an INR(International Normalized Ratio) measures the time it takes for blood to clot and compares it to an average. Many drugs can change the INR such as aspirin, ibuprofen and Antibiotics the most common drugs used for treating acute dental infections. Aims: To determine whether there is any change in bleeding tendencies of pediatric patients with acute dental infections also to evaluate the utility of testing INR in patients who have to receive invasive dental treatments especially those with acute dental infections. Method: 10 patients, 7 boys and 3 girls, with acute dental infections were randomly selected from the patients arriving at Department of Pedodontics. Blood sample was collected through venepuncture and was immediately sent for prothrombin time tests. Using these values INR was calculated. Results: The mean INR value for the study was 1.194. The Mean INR among boys was 1.164 and Mean INR among girls was 1.29. The Mean Prothrombin Time was 14.39 sec. The Mean Prothrombin time among the boys was found to be 13.98 secs. The Mean Prothrombin time among the girls was found to be 15.33 sec. Conclusion: There was no significant change in INR in patients with acute dental infections.

Single Sitting Interim Fixed Prosthesis Using Natural Teeth Subsequent to Avulsion In 13 Year Old Child.

Facial trauma resulting in tooth avulsion results in problems of physical and emotional nature for the patient, parent and a challenge for the dentist. Avulsion accounts for 0.5–16% of traumatic injuries in the permanent dentition which can occur at any age and is most common in the young permanent dentition and in the maxillary anterior region. Re-implantation of the avulsed tooth is the preferred emergency treatment depending on the extra-alveolar period and the storage medium used. The biggest advantage of immediate re-implantation is the psychological boost to the child of retaining his/her own natural teeth. A case report of 13 year old female patient with a history of trauma to the anterior region of maxilla and avulsion of 3 anterior teeth is discussed. An interim fixed partial denture was delivered using patient’s avulsed natural teeth in a single appointment.

Impression Making For Feeding Obturator Appliance In A Cleft Palate Patient : A Case Report.

Cleft lip and palate are some of the most frequently encountered anomalies in the orofacial region. Immediate problems to be addressed in a new born with this defect would be to aid in suckling and swallowing. This article presents a case report of a neonate with cleft palate in whom a feeding obturator was delivered. In this article impression making for fabrication of obturator was discussed.

Feasibility study of stroke surveillance: Data from Bangalore, India.

Background & objectives: Stroke is a leading cause of deaths, and disabilities in India. Reliable and good quality data on epidemiological characteristics of stroke are essential to plan, implement and evaluate stroke prevention and control programmes. A feasibility study was undertaken in Bangalore to examine the possibility of establishing stroke surveillance and to develop methodology for a larger programme. Methods: The study adapted WHO STEPs-STROKE methodology to collect data on hospitalized stroke events and fatal stroke events in the city of Bangalore. In STEP I, Information was collected from 1,174 stroke patients in three large hospitals and were followed till discharge and 28 days; outcome was measured as death or disability. Stroke cases fulfilling diagnostic criteria, evaluated by neurologists and CT/MRI confirmed cases were included. Brief information on major risk factors was collected from all stroke patients / family members and from medical records by trained research officers. In STEP II, death records of Bangalore Mahanagara Palike for 2004 (n=23,312) were analyzed to identify stroke related deaths. Results: Using WHO-STEPs approach, a methodology was developed for stroke surveillance in a geographically defined population. By STEP 1 method - 7 per cent of medical and 45 per cent of neurological admissions were due to stroke with a fatality rate of 9 per cent at hospital discharge and 20 per cent at 28 days. With a mean age of 54.5 (± 17.0) yr and male preponderance, nearly half had one or more risk factors. Weakness or paresis (92%) was the commonest presentation and ischaemic stroke was most frequent (73.8%). One third of total stroke patients were dependent at both discharge and 28 day follow up. By STEP II method the proportional mortality rate for Bangalore city was observed to be 6 per cent and more than 50 per cent of total stroke deaths had occurred in 10 major hospitals. Interpretation & conclusions: The present study has shown that stroke surveillance is possible and feasible. Institution based (hospitals and vital registry data) stroke surveillance supplemented with periodical population based information can provide comprehensive information on vital aspects of stroke like mortality, risk factors, disability and outcome. There is a need to develop stroke surveillance in a phased manner along with mechanisms to apply data for prevention and control programmes.

Family burden, quality of life and disability in obsessive compulsive disorder: an Indian perspective.

BACKGROUND: Obsessive compulsive disorder (OCD) is a psychiatric disorder that often tends to run a chronic course. The lifetime prevalence of OCD is around 1-3%, which is twice as prevalent as schizophrenia and bipolar disorder. AIM: To asses the family burden, quality of life (QoL) and disability in patients suffering from at least moderately ill OCD and then to compare them with schizophrenia patients of comparable severity. SETTINGS AND DESIGN: We recruited 70 consecutive subjects (OCD=35, schizophrenia=35) who met study criteria between March 2005 and March 2006 from the psychiatric services of the National Institute of Mental Health and Neuro Sciences, Bangalore, India. MATERIALS AND METHODS: The severity of illness was rated using the Clinical Global Impression-Severity (CGI-S). Instruments used in the current study were the Family Burden Schedule, the World Health Organization (WHO) QoL (Bref) and the WHO - Disability Assessment Schedule (DAS). STATISTICAL ANALYSIS: The Fisher's exact test/chi-square test was used to compare categorical variables and the independent sample t test was used to analyze continuous variables. Analysis of covariance (ANCOVA) was used to compare the groups after controlling for potential confounding variables. Pearson's correlation was used for correlation analysis. RESULTS: Overall family burden, financial burden and disruption of family routines were significantly higher in schizophrenia patients compared to OCD although the groups did not differ with respect to other domains of family burden. On the WHO QoL, OCD patients were comparable to schizophrenia patients with respect to the psychological and social domains. On the WHO - DAS, both the groups were similar in all the domains except getting around. CONCLUSION: Severe OCD is associated with significant disability, poor QoL and high family burden, often comparable to schizophrenia. Therefore, there is an urgent need to increase the sensitivity among healthcare professionals to recognize and treat OCD.

High occurrence and low recognition of Parkinsonism (and possible PD) in old age homes in Bangalore, South India.

BACKGROUND: The elderly population in developing countries is likely to increase by 200-280%. Age related diseases like Parkinsonism are also likely to increase in ageing population. The prevalence and awareness of Parkinsonism (and possible PD) amongst them are unknown. METHODS AND MATERIAL: The objective was to know the awareness and occurrence of Parkinsonism (and possible PD) in Old Age Homes in Bangalore, South India. The study design was prospective, direct clinical evaluation, and it was old age homes in Bangalore, South India setting. There were six hundred and twelve residents of the old age homes in Bangalore. A movement disorder neurologist examined 612 elderly residents living in Old age Homes in Bangalore city, India. RESULTS: Parkinsonism was diagnosed in 109 (17.8%) of 612 residents. Possible PD was diagnosed in 9 (1.5% of 612) while in 100 (16.3% of 612) definite PD was diagnosed.94 (86.2%) had bilateral Parkinsonian signs (Stage > or = 2 of Hoehn & Yahr), only 4 (3.7%) of them or the caregivers knew they had PD. CONCLUSIONS: Knowledge about the disease was very low in the elderly residents although the occurrence of Parkinsonism was very high. Improving awareness of PD amongst the elderly and their caregivers might reduce their disability and improve their quality of life.

Road traffic deaths, injuries and disabilities in India: current scenario.

In 2005, road traffic injuries resulted in the death of an estimated 110,000 persons, 2.5 million hospitalizations, 8-9 million minor injuries and economic losses to the tune of 3% of the gross domestic product (GDP) in India. If the present trend continues, India will witness the deaths of 150,000 persons and hospitalization of 3 million people annually by 2010, increasing further to 200,000 deaths and more than 3.5 million hospitalizations annually by 2015. Nearly 10%-30% of hospital registrations are due to road traffic injuries and a majority of these people have varying levels of disabilities. A majority of victims of road traffic injuries are men in the age group of 15-44 years and belong to the poorer sections of society. Also, a vast majority of those killed and injured are pedestrians, motorcyclists and pillions riders, and bicyclists. A clearly defined road safety policy, a central coordinating agency, allocation of adequate resources, strict implementation of proven and effective interventions and reliable information systems are urgently required. Greater participation from health and other sectors based on an integrated, intersectoral and coordinated approach is essential. Health professionals can contribute in numerous ways and should take a lead role in reducing the burden of road traffic injuries in India.

Tobacco use amongst children in Karnataka.

OBJECTIVE: To estimate the prevalence, pattern and correlates of tobacco use amongst the 13-15 year olds in schools of Karnataka. METHODS: A three stage (area, school level and class level) cluster sample design was adopted and 80 schools from 12 districts of the state were selected. A total of 4,110 students participated in the study with an overall response rate of 87%. RESULTS: Point prevalence of tobacco use amongst 13-15 year old was 4.9%. Current tobacco use was predominantly a male feature and use of smokeless variety predominated (transitional Karnataka (8.2%); metropolis (6.8%); rural (3.4%). One third of current tobacco users (30.8%) purchased tobacco product in a store and one-fifth used it at home. Nearly half of the never smokers (43% to 56.7%) were exposed to tobacco smoke outside home and 83% favored a ban on smoking in public places. A male tobacco user was perceived to have more friends and was reported to make them look attractive. Print media was a predominant source of message, more so in the metropolitan region. Only one-third (31.6%) reported that the reasons of tobacco usage amongst youth was discussed in formal school settings. CONCLUSION: GYTS Karnataka has provided reliable estimates and shown the feasibility of implementing a surveillance programme. Specific challenges for Public health that emerge from the study are increasing number of users in transitional areas, continued media exposure, tobacco users being perceived to be popular and attractive, easy and relatively unrestricted access, lack of systematic support within schools and social acceptance of tobacco use at home. The need of the hour is to target and focus interventions through comprehensive programmes aimed at children, school authorities, parents and policy makers.

Epidemiology of Parkinson's disease and movement disorders in India: problems and possibilities.

Improving economy and health in developing countries like India, has increased the life span and changed the emphasis from communicable to noncommunicable diseases. This is likely to increase the prevalence of movement disorders and, age-related diseases like Parkinson's disease (PD). We review Indian epidemiological studies to describe: a) Prevalence of movement disorders, b) methodological issues and c) potential of epidemiological research in a country with multiple ethnic races and environmental risks for PD. Most Indian epidemiological studies do not specifically assess PD and figures are from studies evaluating all neurological diseases. Well-designed Indian studies on PD and essential tremors estimate prevalence rates in Parsis who are ethnically different from Indians. We compare Indian prevalence studies with other parts of the world to examine the role of ethnicity in PD. Lack of accurate epidemiological data on PD and movement disorders creates an urgent need for properly designed and conducted epidemiological studies in India. This will help find out their load, identify areas of focus, create public health policies for elderly Indians and, possibly, provide etiological clues to the pathogenesis of PD.

Epidemiological study of child & adolescent psychiatric disorders in urban & rural areas of Bangalore, India.

BACKGROUND & OBJECTIVE: There are limited data on child mental health needs in our country. Therefore, an epidemiological study to determine the prevalence rates of child and adolescent psychiatric disorders was initiated as a two-centre (Bangalore and Lucknow) study by the Indian Council of Medical Research. It also aimed to study the psychosocial correlates of the psychiatric disorders. We present here the findings of Bangalore Centre. METHODS: In Bangalore, 2064 children aged 0-16 yr, were selected by stratified random sampling from urban middle-class, urban slum and rural areas. The screening stage was followed by a detailed evaluation stage. The ICD-10 DCR criteria were used to reach a penta-axial diagnosis. RESULTS: The results indicated a prevalence rate of 12.5 per cent among children aged 0-16 yr. There were no significant differences among prevalence rates in urban middle class, slum and rural areas. The psychiatric morbidity among 0-3 yr old children was 13.8 per cent with the most common diagnoses being breath holding spells, pica, behaviour disorder NOS, expressive language disorder and mental retardation. The prevalence rate in the 4-16 yr old children was 12.0 per cent. Enuresis, specific phobia, hyperkinetic disorders, stuttering and oppositional defiant disorder were the most frequent diagnoses. When impairment associated with the disorder was assessed, significant disability was found in 5.3 per cent of the 4-16 yr group. Assessment of felt treatment needs indicated that only 37.5 per cent of the families perceived that their children had any problem. Physical abuse and parental mental disorder were significantly associated with psychiatric disorders. INTERPRETATION & CONCLUSION: Prevalence rates of psychiatric morbidity in 0-16 yr old children in India were found to be lower than Western figures. Middle class urban areas had highest and urban slum areas had lowest prevalence rates. The implications for clinical training, practice and policy initiatives are discussed.

The effect of alcohol on incidence, pattern, severity and outcome from traumatic brain injury.

Alcohol consumption is known to be a major contributing factor for the occurrence of traumatic brain injuries (TBIs) in both developed and developing countries. It also influences diagnosis, management and recovery from TBIs, subsequent to injury occurrence. The present report examines the association of alcohol in injury occurrence, and its impact on severity and outcome from TBIs. Subjects were identified from 7 major hospitals in the city of Bangalore, India with data collection undertaken by standardised methods. Alcohol users (n = 243) and non-users (n = 1310) were compared on various characteristics and injury details. Sixteen per cent of the injured patients were intoxicated at the time of hospital registration. While the incidence of road traffic injuries was similar in both the groups, falls were higher in the alcohol user group. Evening-and night-time consumption of alcohol was a major risk factor for injuries. Drivers and occupants of motorised two wheeler vehicles, and pedestrians were involved in crashes to a greater extent among alcohol users. Severity of brain injuries (based on Glasgow coma scale), duration of hospital stay, death and post-traumatic disabilities among alcohol users were significantly higher compared with non-users. With the emergence of injuries and alcohol as twin major public health problems, immediate efforts are required to reduce the burden in developing societies. Legislative and enforcement strategies along with education developed on epidemiological, clinical and public health research need to be co-ordinated, target oriented, visible and with stiffer penalties for achieving desired results.