Techniques of Maxillary Sinus Floor Elevation

Posterior maxillary region is often limited for standard implant placement because of reduced residual vertical bone height. An elevation of the maxillary sinus floor is one option in solving this problem. This article describes the various surgical techniques that can be used to enter the sinus cavity, elevating the sinus membrane and placing the bone grafts for placement of dental implants in the resorbed posterior maxillary region.

A Review of Intubation Techniques in Anaesthetic Management of Temporomandibular Joint Ankylosis

Intubation of a patient with temporomandibular joint ankylosis is a challenge for every anaesthesiologist. Dependable anaesthetic technique is most desired by all anaesthesiologists. The purpose of the present article is to have a brief overview of temporomandibular joint ankylosis, its clinical features, management and to review literature demonstrating various intubation techniques available to an anaesthesiologist while managing patients with temporomandibular joint ankylosis.

Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity

Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.

Prevalence of specific developmental disorder of scholastic skill in school students in Chandigarh, India.

Background & objectives: Several studies have been conducted in India to determine the prevalence of learning disabilities in school children which has been reported to be 3-10 per cent among students population. The present study was conducted to find out prevalence of specific developmental disorder of scholastic skills in students of classes VII to XII and to find out feasibility of screening tool in Chandigarh, India. Methods: A cross-sectional study on school students was carried out in two phases. The students were drawn from classes VII to XII from 10 schools of Chandigarh, India. Details of academic performance of all the students was taken, subjectively from class teachers and objectively from the marks obtained in the last academic session. In phase I, 2402 students were assessed. In phase II, 108 students were randomly selected for evaluation for assessing sensitivity and specificity of screening proforma for teachers. A total of 124 students from phase I and all students in phase II were assessed in detail. Tests of intelligence (Malin’s Intelligence Scale for Indian Children and Standard Progressive Matrices), and NIMHANS Index for specific learning disability (SLD) battery were administered. Results: A total of 38 students were found to be having specific developmental disorder of scholastic skills in phase I, that gave a prevalence of 1.58 per cent. Majority had mixed type of errors on SLD battery. There were more boys diagnosed with specific learning disability. Teacher’s screening instrument had high sensitivity (90.385) and specificity (94.68). Interpretation & conclusions: The findings of our study conducted in community, showed that specific learning disability was not identified even till later age. The screening instrument thus could be used by teachers to suspect students with specific learning disability.

How benign is benign tertian malaria.

Objective: This retrospective study was conducted to determine the incidence of various complications of Plasmodium vivax malaria based on review of case records. Methods: The case records of all confirmed cases of malaria over the period of one year (September 2005–August 2006) were studied. Complete blood count, peripheral blood findings, liver and kidney functions were reviewed. The results of rapid diagnostic test for malaria (OptiMAL test, Diamed AG, Switzerland) were correlated with the peripheral blood smear findings in the patients in whom it was requested. All abnormal results like a positive direct Coomb’s test were noted. Findings were clinically correlated. Results: There were 265 confirmed cases by peripheral blood examination. Of these 221 were due to Plasmodium vivax and 41 due to P. falciparum. Two cases had mixed infection and in one case the species could not be identified as it showed only malarial pigment. The peak incidence of malaria was seen in September 2005 and August 2006. The complications in P. vivax were thrombocytopenia, biochemical evidence of hepatic dysfunction, renal damage, positive DCT and death due to ARDS. Thrombocytopenia was seen in 213 patients with counts < 20 x 103/μl in 13 patients. Nine (4%) patients had serum bilirubin >3 mg/dl with normal liver enzymes. Liver enzymes were elevated in 60 patients with seven patients showing liver enzymes level, three times the normal. Renal dysfunction was seen in 17 patients with serum creatinine ranging from 1.3–10.65 mg/dl. One patient went into acute renal failure following quinine therapy and showed red cell fragments in the peripheral blood. In two children DCT was positive with the peripheral smear showing RBC agglutinates around the parasitised RBC. There were three maternal deaths at about 32 weeks gestation due to ARDS. The peripheral blood smear in these patients showed WBC agglutinates. Conclusion: This paper is presented to highlight that P. vivax malaria though considered to be a benign entity can also have a severe and complicated course which is usually associated with P. falciparum malaria

Megaloblastic anaemia: prevalence and causative factors.

BACKGROUND: Megaloblastic anaemia is not uncommon in India, but data are insufficient regarding its prevalence, and causative and precipitating factors. We did a prospective study to document such data for patients of megaloblastic anaemia. METHODS: All patients presenting to our hospital over a period of 6 months with a haemoglobin < 10 g/dl and/or mean corpuscular volume > 95 fL and blood film findings consistent with megaloblastosis were included in the study. Demographic data, diet, drug intake, previous blood transfusion and presenting symptoms were recorded. Clinical findings were obtained from medical records of patients. Complete blood counts, blood film examination, reticulocyte count and cobalamin and folate assays were done. Results of liver function tests and bone marrow slides were available for review. RESULTS: Megaloblastic anaemia was diagnosed in 175 patients with anaemia. Assays were done on 120 patients (55 were lost to follow up) and results showed cobalamin deficiency in 78 patients (65%), combined cobalamin and folate deficiency in 20 patients (12%) and pure folate deficiency in 8 patients (6%). Fifteen per cent of patients had normal or high values of both vitamins, having received blood or haematinics before the diagnosis was established. The peak incidence of megaloblastic anaemia was in the age group of 10-30 years (48%), with female preponderance (71%). The predominant symptoms were fatigue, anorexia and gastritis, low grade fever, shortness of breath, palpitations and mild jaundice. Twenty-five per cent of patients were on acid-suppressing medication and 15% had previous transfusion for anaemia. Eighty-seven per cent of patients with cobalamin deficiency and 75% with folate deficiency were lactovegetarians. In the combined deficiency cohort, 71% were vegetarians and 29% were occasional non-vegetarians. Physical findings were pallor (85%), glossitis (29%), mild icterus (25%) and hyperpigmentation (18%). Abnormal haematological findings were mean corpuscular volume 77-123 fL (9 patients had iron deficiency), red cell distribution width 16%-44%, pancytopenia in 62% of patients, reticulocyte count > 2% in 42% of patients and typical megaloblastic blood films in all patients. Bone marrow smears available in 22 patients showed moderate-to-severe megaloblastosis. Thirty-two per cent of patients in whom liver function tests were done showed indirect bilirubinaemia with normal enzymes. CONCLUSION: Megaloblastic anaemia was diagnosed from complete blood counts, red cell indices, blood film examination and assays of the two vitamins. Bone marrow examination was not essential for diagnosis. Cobalamin deficiency was the major cause of megaloblastosis. Aetiological factors were a diet poor in cobalamin or folate, increased requirements during the growth period and pregnancy, and the use of acid-suppressing medication. Physicians managing these patients need to be aware of the timing of blood sampling for assays, that haematinics and transfusions provide only short term benefits, and that long term follow up and diet counselling is crucial.

Occult cobalamin and folate deficiency in Indians.

BACKGROUND: Our aim was to assess cobalamin and folate levels in normal Indian subjects before undertaking a prospective study of megaloblastic anaemia. METHODS: We took samples from 25 men and 25 women to establish the normal range. The exclusion criteria for subjects were age below 18 years and above 65 years, haemoglobin < 12 g/dl, and those who were pregnant, lactating or on any medication including vitamin supplements. A complete blood count and blood film examination for hypersegmented neutrophils were done. Serum cobalamin and folate assays were performed by a competitive immunoassay. The reference range supplied with the kits for serum cobalamin was 100-700 pg/ml and for serum folate it was 3-22 ng/ml. RESULTS: Since many 'normal' subjects in the sample showed values below the normal reference range, the numbers sampled were increased to 46 men and 50 women. Of all the subjects tested, 46.9% had subnormal values of one of the two vitamins. The normal ranges for serum cobalamin established in this study were--men 100-388 pg/ml and women 105.3-434 pg/ml. Of the 46 men tested, 17 (36.9%) had low cobalamin levels and of the 50 women tested, 23 (46%) had low cobalamin levels. Levels < 50 pg/ml were seen in 46.9% of these subjects. The normal ranges for serum folate in the study were--men 3.1 to > 22 ng/ml, women 3-12.26 ng/ml. In the study group, 8 men (17.3%) and 6 women (12%) had folate deficiency. Eight subjects (17%) had combined deficiency of the two vitamins. The mean corpuscular volume was not informative and was elevated in only 1 subject. Hypersegmentation of neutrophils was present in 75% of deficient subjects. CONCLUSION: We established normal levels for serum cobalamin and folate in our study group. Of the subjects studied, 46.9% had subnormal levels of serum cobalamin or serum folate, cobalamin deficiency being five times more common than folate. Hypersegmentation of neutrophils was a better indicator of occult megaloblastosis than the mean corpuscular volume.