Full mouth rehabilitation with fixed and removal prosthesis using extracoronal attachments: A clinical report.

Full mouth rehabilitation always claims careful attention and meticulous treatment planning. It becomes more challenging with the partial edentulism where bilateral segment is found missing. Successful restoration can be done with plenty of contemporary and conventional treatment planning. Attachment retained partial dentures are one such kind of treatment modality in prosthodontics. Studies have also demonstrated that precision-attachment partials last longer, wear less, need less adjustments, look better, work better, less destructive, protect abutment teeth, and are easier to clean. In this case report patient’s functional and aesthetic expectations were met by doing full mouth rehabilitation using combination of Porcelain fused to metal (PFM) restorations and semiprecision attachments.

Fasting plasma homocysteine levels are increased in young patients with acute myocardial infarction from Western India.

BACKGROUND: Fasting hyperhomocysteinemia is positively associated with atherothrombosis and acute myocardial infarction in several prospective and retrospective studies. In India folic acid deficiency is not uncommon, and subclinical folic acid deficiency is known to cause hyperhomocysteinemia without thrombocytopenia. OBJECTIVE: To observe the prevalence of plasma hyperhomocysteinemia in a cohort of patients with acute myocardial infarction after 2 weeks of oral folic acid therapy. MATERIAL AND METHODS: A cohort of 120 consecutive patients with acute myocardial infarction below the age of 40 years was tested for fasting hyperhomocysteinemia 8-10 weeks after AMI. Five hundred age and sex matched unrelated controls and 50 family controls were also studied for two mutations, MTHFR C677T and cystathionine Beta synthase (CBS) T833C mutations Parents of the AMI patients were also tested to see hyperhomocysteinemia in the family. The patients were given two weeks of oral folic acid therapy (folviteR - 5mg once daily) and fasting plasma homocysteine levels were measured again and the pattern of response was noted. Patients who responded partially or not responded at all to oral folic acid therapy received intramuscular injection of 1 mg of cyanoco-balamin ( NeurobionR,) and their level of plasma homocysteine were noted 1 week later. RESULTS: Sixty three out of 120 patients showed hyperhomocysteinemia compared to 9% of the age and sex matched controls. Fifty seven therapy percent of hyperhomocysteinemia patients responded completely to oral folvite. Subsequent vitamin B12 & B6 therapy normalized homocysteine levels in only 2/12 partial responders with less than 50 microg/l of plasma homocysteine levels, but none of the folate non responders and partial responders having plasma homocysteine levels above 50 microgm/l responded to the therapy. CONCLUSION: Hyperhomocysteinemia is common amongst young acute myocardial infarction patients from western India. The major cause of hyperhomocysteinemia in young myocardial infarction cases is folic acid deficiency. However a fair number of patients who did not respond to folic acid, also did not respond to vitamin B12 and B6 parenterally suggesting existence of defect in other pathways of homocysteine metabolism in a subset of our patients.

Combination of thrombophilia markers in acute myocardial infarction of the young.

BACKGROUND: The pathogenesis of arterial thrombotic disease involves multiple genetic and environmental factors related to atherosclerosis and thrombosis. But, there have been very few studies in India which have investigated some of the thrombophilia markers. AIM: To look for combined thrombophilia in MI patients. SETTINGS AND DESIGN: One hundred twenty patients of myocardial infarction (age below 40 yrs.) were recruited 8-10 weeks after stabilization. Hundred age and sex-matched healthy controls were also recruited in the present study. METHODS AND MATERIAL: Following thrombophilia markers were screened in these patients--plasma fibrinogen, protein C, protein S, antithrombin III, factor V Leiden, PT G20210A polymorphism, MTHFR C677T, homocysteine, fibrinogen b448 Arg/Lys polymorphism and CBS T833C mutation. STATISTICAL ANALYSIS: Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 10.0, SPSS Inc., Chicago, USA. RESULTS AND CONCLUSION: Elevated fibrinogen levels, homocysteine (p< 0.001 and homocysteine with odds ratio 6.26) and factor V Leiden (p=0.038) were independently associated with MI in our patients. A total of 37 patients (42.5%) had the presence of more than one thrombophilia markers in combination. Out of these, 10 had the presence of three markers in combination and 1 had five thrombophilia markers in combination. Only 2 controls had prothrombotic markers in combination. Combined prothrombotic risk factors were significant in cases in comparison to controls (p< 0.001). Further larger studies on a nationwide basis recruiting a large number of young MI patients should be done to substantiate these findings.