ABSTRACT
Objective Information available on acid–base imbalance in ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous intervention is limited and no data were present on intracoronary blood analysis, extracted from obstructed artery. Methods This was a prospective study conducted over 12 months in which STEMI patients presenting in emergency and undergoing primary percutaneous coronary intervention were included. Blood gas analysis of intracoronary arterial blood from obstructed vessel and peripheral arterial blood was performed. Patients in whom adequate intracoronary sample could not be obtained were excluded. Intracoronary and peripheral arterial blood gas measurements were correlated and relationship of intracoronary parameters were compared with clinical parameters, investigational markers and short-term outcome. Results The mean age of study population was 54.8 years and average symptom onset to door time was 162 min. On comparing intracoronary blood with peripheral blood arterial obtained, pH (95% confidence interval [CI] −0.01 to 0.02;p = 0.44), lactate (95% CI 0.03–0.1;p = 0.28), bicarbonate (95% CI 0.6–1.5;p = 0.64), pCO2 (95% CI 1.1–2.4;p = 0.79) and pO2 (95% CI 3.2–47.5; p = 0.06) were all found to be statistically insignificant. Intracoronary hyperlactatemia was present in patients presenting with higher symptom onset to door time (p = 0.025). Systolic blood pressure (SBP) (p = 0.03) was also significantly lower in patients who had high intracoronary lactate levels. Conclusion The evaluation of intracoronary blood provides no additional information regarding the prognosis and short-term (30-day) outcome of the patients when compared with peripheral blood. However, there was a significant intracoronary hyperlactatemia in patients presenting late after symptom onset. SBP was also significantly less in patients with high intracoronary lactate, which signifies that predominant cause of hyperlactatemia was systemic hypoperfusion rather than local increase in lactate levels.
ABSTRACT
The force of orthodontic treatment, is basically categorized as controlled trauma,[1] that can damage the pulp because of the absence of collateral blood supply in the pulp tissues makes pulp as the most sensitive tissues of the whole body. The problem is not the accumulations, but there is a likelihood of conversion of the supra gingival plaque accumulations into sub gingival plaque while tipping or intrusion tooth movements that favors the change of gingivitis into periodontitis. The present study was conducted with the aim to determine the periodontal response to orthodontic tooth movement. Methods: The present prospective observational study was conducted in the department for a period of 1 year. Before the start of treatment, clinical attachment and probing depth was measured. These parameters were also measured after active tooth movement and tooth retention. Difference in clinical attachment was noted before and at the end of the treatment. All the data was arranged in a tabulated form and analyzed using SPSS software. The data was expressed as mean +/- standard deviation. Results: The mean age of the subjects was 28.75+/-3.64 years. There were 66.7% (n=20) males and 33.3% (n=10) females. The baseline probing depth amongst control teeth was 4.4+/-0.5 and after tooth movement was 3.7+/-0.5 and after retention was 3.6+/-0.05. The mean difference in clinical attachment loss after tooth movement on mesial and distal side was -0.5+/-1.7 and - 0.6+/-0.9 respectively. The mean difference in clinical attachment loss after tooth retention on mesial and distal side was -0.7+/-1.4 and -0.8+/-1.1 respectively. Conclusion: Orthodontic movement of teeth may be detrimental for the periodontal health when realignment of the teeth have been considered.
ABSTRACT
Background: The trial was done to evaluate the efficacy and tolerability of hydroxychloroquine when added to stable insulin therapy in combination with metformin and glimepiride in patients with type 2 diabetes (T2DM) compare to sitagliptin.Methods: After two weeks run in period, eligible patients inadequately controlled on long acting, intermediate acting or premixed insulin (HbA1c ?7.5% and ?10%), in combination with metformin and glimepiride were randomised 1:1 to the addition of once daily hydroxychloroquine 400mg or sitagliptin 100mg over 24weeks study period. The primary endpoint was HbA1c change from baseline at week 24. Home based glucometer was used to determine finger stick glucose value to detect hypo or hyperglycemia periodically.Results: At 24 weeks, the addition of hydroxychloroquine significantly (p <0.001) reduced HbA1c by 1.3% compared with Sitagliptin which was 0.9%. A greater proportion of patients achieved an HbA1c level <7% while randomised to Hydroxychloroquine as compared with sitagliptin (31 vs. 18% respectively; p <0.001). The addition of hydroxychloroquine significantly (p<0.001) reduced fasting plasma glucose by 31.0mg/dl (vs 23.2mg/dl with sitagliptin) and post prandial plasma glucose by 52.1mg/dl (vs 41mg/dl with sitagliptin) relative to sitagliptin. The difference in mean value of total daily insulin dose showed a highly significant decrease (P <0.0001) from baseline to end of the treatment with hydroxychloroquine i.e. from 41±10.2 to 31.87±16.49 IU as compare to sitagliptin i.e. from 41±10.6 to 37.91±11.71 IU. And also highly significant (P <0.0001) decrease in mean weight was observed at the end of trial with hydroxychloroquine.Conclusions: Hydroxychloroquine decreases HbA1c in patients whose type 2 diabetes is poorly controlled with stable-dose insulin therapy with metformin and glimepiride.