ABSTRACT
Background@#Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. @*Methods@#This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. @*Results@#The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. @*Conclusion@#Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.
ABSTRACT
Background@#Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. @*Methods@#This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. @*Results@#The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. @*Conclusion@#Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.
ABSTRACT
Objectives: Dhat syndrome is a cultural bound syndrome in which affected individuals have morbid pre-occupation with semen loss in their urine and its impact on the body. Previous studies have explored the symptomatology and perception regarding seminal discharge of such patients while there is lacked of literature on the assessment by quacks and practitioner of alternative and complementary practitioners (ACMP). Therefore, in addition to objectives of previous studies, this study explores the reprehensibility of such practitioners as they may not be giving correct advice to such patients. Methods: For duration of three months, this mixed method study was conducted in Rohilkhand Medical College campus; individuals were approached both in and outside the Psychiatric Outpatient Department using purposive sampling procedure. ICD-10 diagnostic criterion was used to include affected individual in the study sample. Subsequently, a semi-structured questionnaire to document their socio-demographic data and symptomatology was used. Further, previous consultation to quack, ACMPs and allopathic practitioners other than psychiatrist and advice given to the patient by them was obtained via in-depth interview. The quantitative data was analyzed through proportions whereas qualitative data via thematic analysis. Results: There were 38 out of 110 with Dhat syndrome. Invariably, they complained of undue concern regarding debilitating effects of seminal discharge and harmful for the body. A total 21.1% had prior consultation to ACMPs and attributing it to masturbation and hot weather. Surprisingly, allopathic practitioners consulted gave incorrect advices. Conclusion: Dhat syndrome affects individuals irrespective of their social and education background. Sex education among the masses and emphasis for awareness of this syndrome among ACMPs and allopathic practitioners other than psychiatrist is necessary to reduce this cultural bound syndrome.
ABSTRACT
Coeliac autoimmunity [CA] has a known association with type 1 diabetes mellitus [T1DM] for which screening is routinely recommended but less frequently followed. The impact of CA in T1DM has been variably reported. The aims of this study are as follows: [1] to study the prevalence of CA in patients with T1DM and [2] to study the impact of CA not only on nutritional parameters but also on glycaemic control, endocrine axes and bone health. Patients and Eighty-six consecutive patients with T1DM were screened for CA using immunoglobulin A [IgA] tissue transglutaminase as a marker [TTG; IgG anti-gliadin in IgA-deficient case]. CA positive [CA+] cases were compared with age-matched and sex-matched CA negative [CA-] T1DM cases for anthropometry, glycaemic control [assessed by glycated haemoglobin [HbA1c] and hypoglycaemic/ hyperglycaemic episodes], endocrine [thyroid function, cortisol, growth hormone [GH] axis, gonadal axes], haematological [haemoglobin, iron profile and vitamin B12 status] and calcium metabolism parameters and bone densitometry [by dual-energy X-ray absorptiometry [DXA]]. Consenting patients with CA also underwent upper gastrointestinal [GI] endoscopy with duodenal biopsy. Out of 86 patients, 11 [12.75%] screened positive for CA [seven patients underwent duodenal biopsies which were suggestive of Marsh grade III[2], II[3] and I[2] disease]. The CA+ T1DM patients were comparable with CA- T1DM in terms of anthropometry. CA+ patients had higher HbA1c [10.7 +/- 1.8 vs. 8.4 +/- 1.0 [93 +/- 19 vs. 68 +/- 11 mmol/mol]; p < 0.01], more hypoglycaemic episodes [five vs. two; p < 0.05], higher prevalence of iron and vitamin B12 deficiency, lower insulin-like growth factor-1 [IGF- 1] levels and lower bone mineral density [BMD] z-score at total body [-1.91 +/- 1.05 vs. -0.63 +/- 0.73; p < 0.05] and lumbar spine [-1.69 +/- 0.92 vs. 0.36 +/- 0.93; p < 0.05]. The incidence of fractures in the past 3 years was also more in CA+ patients than in CA- patients [four vs. one; p < 0.05]. CA has an important autoimmune association with T1DM. The concomitant presence of CA adversely affects stature, bone health, glycaemic control and iron and B[12] levels in T1DM. IgA sufficiency should be ensured before using an IgA-based screening test for CA
ABSTRACT
Biotinidase deficiency is an autosomal recessive genetic disorder which is not uncommon in the Saudi population. Biotinidase is responsible for biotin recycling and biotin is an essential cofactor for activation of the carboxylase enzymes. Absence of biotinidase leads to infantile or early childhood encephalopathy, seizure disorder, dermatitis, alopecia, neural deafness and optic atrophy. The disease can be diagnosed by simple fluorometric enzyme assay. Treatment with biotin is both cheap and simple, resulting in rewarding clinical recovery and normalization of the biochemical, neuroradiological and neurophysiological parameters. If neglected, however, a patient may die of acute metabolic acidosis or may suffer from permanent neural deafness and optic atrophy, with mental and motor handicap. We describe the detection and treatment of 20 cases of biotinidase deficiency in our hospital and recommend the introduction of a neonatal screening programme for this disorder