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Background: Aortic stenosis (AS) grading discrepancies exist between pre?cardiopulmonary (pre?CPB) transesophageal echocardiography (TEE) and preoperative transthoracic echocardiography (TTE). Prior studies have not systematically controlled blood pressure. Aims: We hypothesized that normalizing arterial blood pressure during pre?CPB TEE for patients undergoing valve replacement for AS would result in equivalent grading measurements when compared to TTE. Setting: Single University Hospital Design: Prospective, Interventional Methods: Thirty?five adult patients underwent procedures for valvular AS between February 2017 and December 2020 at Medical University of South Carolina. Study participants had a TTE within 90 days of their procedure that documented blood pressure, peak velocity (Vp ), mean gradient (PGm), aortic valve area (AVA), and dimensionless index (DI). During pre?CPB TEE, if a patient抯 mean arterial pressure (MAP) fell more than 20% below their baseline blood pressure obtained during TTE, measurements were recorded as 搊ut of range.� Phenylephrine was administered to restore MAP to the baseline range and repeat TEE measurements were recorded as 搃n?range.� Statistical Analysis: Differences between imaging modalities and grading parameters were examined using a series of linear mixed models. P values were Bonferroni?adjusted to account for multiple comparisons. Main Results: Significant discrepancies between TEE and TTE were observed for Vp , PGm, and DI despite blood pressure normalization across all subjects and for out?of?range measures and corrected measures. There were no statistically significant differences between TEE and TTE for AVA. Conclusions: Blood pressure normalization during pre?CPB TEE is not sufficient to avoid AS grading discrepancies with preoperative TTE.
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Abstract Dental hard tissue conditions can be of pre- or post-eruptive nature, such as enamel fluorosis and erosive tooth wear (ETW), respectively. Dental enamel fluorosis is caused by the chronic and excessive intake of fluoride during enamel development, leading to increased fluoride concentration and increased porosity. ETW has become a common clinical condition and often impairs dental function and aesthetics. This in vitro study tested the hypothesis that fluorotic enamel presents different susceptibility to dental erosion-abrasion. It consisted of a 3×3×2 factorial design, considering a) fluorosis severity: sound (TF0), mild (TF1-2), moderate (TF3-4); b) abrasive challenge: low, medium, and high; and c) erosive challenge: yes or no. A total of 144 human teeth were selected according to the three fluorosis severity levels (n=48), and subdivided into six groups (n = 8) generated by the association of the different erosive and abrasive challenges. Enamel blocks (4×4 mm) were prepared from each tooth and their natural enamel surfaces subjected to an erosion-abrasion cycling model. After cycling, the depth of the lesions in enamel was assessed by profilometry. ANOVA showed that the three-way and two-way interactions among the factors were not significant (p > 0.20). Enamel fluorosis level (p=0.638) and abrasion level (p = 0.390) had no significant effect on lesion depth. Acid exposure caused significantly more enamel surface loss than water (p < 0.001). Considering the limitations of this in vitro study, fluorosis did not affect the susceptibility of enamel to dental erosion-abrasion.
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Abstract Objective This investigation describes the effects of 5% sodium fluoride varnish and 38% silver diamine fluoride on demineralization protection of human enamel lesions of three different severities after a secondary acid challenge. Study design Specimens underwent color and enamel surface microhardness change measurements after demineralization and treatment events. Transverse microradiography was conducted following the secondary demineralization. Results After treatments, enamel surface microhardness change showed that 24-hour lesions treated with fluoride varnish had less rehardening than 24-hour lesions treated with silver diamine fluoride (p<0.05), whereas 144-hour lesions from both treatment groups showed a beneficial decrease in surface microhardness change that was markedly better in samples treated with silver diamine fluoride (p<0.05). After the secondary demineralization, 24- and 144-hour lesions treated with silver diamine fluoride showed a sustained beneficial decrease in enamel surface microhardness change when compared to fluoride varnish-treated samples of the corresponding lesion severity (p<0.05). Transverse microradiography showed no difference between fluoride varnish- and silver diamine fluoride-treated samples of any corresponding lesion severity, indicating that remineralization in both fluoride varnish- and silver diamine fluoride-treated samples was proportional to each other after a secondary acid challenge. Conclusions Using silver diamine fluoride may have comparable benefits to fluoride varnish in mineral loss prevention.
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This case series describes the ocular and retinal manifestations of rare eye diseases in systemic syndromes. This observational case series consists of five patients with varied ophthalmic manifestations and documentation of imaging in rare pediatric and adult retinopathies. Two patients had Kearns Sayre syndrome (KSS) based on the classical triad of external ophthalmoplegia, pigmentary retinopathy, and onset before 20 years of age. In one patient of KSS, the mitochondrial retinopathy was seen in an asymmetric pattern, and the second patient presented with KSS after being mis-diagnosed as myasthenia gravis elsewhere. A case of Senior Loken syndrome in pediatric age is described in this series with varied ophthalmic manifestations ranging from retinitis pigmentosa to orbital abscess. This series also enlightens features of Hallervorden Spatz syndrome presenting with bull’s eye maculopathy and a case of spino-cerebellar ataxia type 7 presenting with pigmentary retinopathy.
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Antibody tests for the novel coronavirus, SARS-CoV2, have been developed both as rapid diagnostic assays and for high-throughput formal serology platforms. Although these tests may be a useful adjunct to a diagnostic strategy, they have a number of limitations. Because of the antibody and viral dynamics of the coronavirus, their sensitivity can be variable, especially at early time points after symptom onset. Additional data are required on the performance of the tests in the South African population, especially with regard to development and persistence of antibody responses and whether antibodies are protective against reinfection. These tests may, however, be useful in guiding the public health response, providing data for research (including seroprevalence surveys and vaccine initiatives) and development of therapeutic strategies
Subject(s)
COVID-19 , Disease Outbreaks , Public Health , Severe acute respiratory syndrome-related coronavirus , Serologic Tests , South AfricaABSTRACT
Objective: The aim of this study is to characterise the clinical and microbiological profile of adult patients treated at our orthopaedic unit with septic arthritic between 2006 and 2017. Materials and Methods: A total of 70 patients who were admitted with a diagnosis of septic arthritis between 2006 and 2017 were included in the study. The patients' clinical and epidemiological characteristics were surveyed; microbiological profile and the complications relating to the patients' treatment were identified. Results: Septic arthritis was more common among males (83%). About 75% of the patients presented with a history of fever. The knee was the most commonly affected joint (71%), followed by the hip. While C-reactive protein was found to be consistently >75, total blood white blood cell (WBC) counts were found not to be reflective of the presence of infection with a mean WBC count of only 13,561/cu.mm, and Gram stain examination had a poor sensitivity of 47%. Among the co-morbidities, the most prevalent association was with diabetes mellitus. The infectious agent most frequently isolated was Staphylococcus aureus(42.85%). The antibiotic sensitivity pattern has evolved since the early years, with resistant strains becoming increasingly prevalent. Unusually, high incidence of streptococci was noted (30%), contrary to the published literature. One-third of the patients had multi-resistant organisms. Septic arthritis left 70% of the patients with a significant residual disability at 6 months follow-up and had 4.25% mortality. Conclusion: Changing sensitivity patterns of microbes in septic arthritis point to a need for reconsidering empirical antibiotic therapy. Joint damage following infection can lead to significant disability.
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Background: Prosthetic joint infection (PJI) is one of the most challenging cases that confront modern orthopaedics. Two-stage revision, which is the standard of care for PJI, is the preferred mode of treatment for these infections. Aims and Objectives: To study the microbiological profile of prosthetic joint infections (PJI) in the hip and to assess the efficacy of a two stage revision surgery for PJI. We also aimed to study the sensitivity and specificity of ESR and CRP in the diagnosis of PJI. Materials and Methods: The microbiological profile, clinical and radiological outcomes of 22 patients who had a two-stage revision for PJI of the hip between 2013 and 2017 were retrospectively analysed. PJI was defined using the criteria provided by the International Consensus Statement on PJI 2013. Results: Staphylococcus aureus was found to be the most common organism in PJI. Debridement was successful in removing the organism in 74% of PJI. At the time of re-implantation (second stage), six joints grew organisms that were different from that isolated at the index debridement - coagulase-negative staphylococci (3cases) and enterococci (3cases). Other infection parameters for these patients were negative. None of the patients who had two-stage revision surgery had clinical evidence of reinfection or radiological evidence of loosening at a mean of 2-year follow-up. An ESR cut off of >30mm/hr had a sensitivity of 75% and specificity of 88% in predicting PJI. A CRP >10mg/L had a sensitivity of 75% and specificity of 69%. The sensitivity and specificity of using both ESR and CRP cut-offs in the diagnosis of infection were 57% and 94%, respectively. The positive predictive value was 94% and negative predictive value was 56%. Conclusion: The outcomes of the study justify a two-stage revision arthroplasty for PJI of the hip. The use of ESR and CRP as screening tests for the success of debridement has value - but should be interpreted with caution.
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Background & objectives: Bacterial biofilms a multi-layered defence, comprise extracellular DNA (eDNA) and proteins, protect bacteria from harmful environment and nutrient limitation and utilize the mutual benefits within a community. Bacterial biofilms also defend bacteria from harsh environments such as antibiotic treatment. This leads to poor antibiotic penetration, slow growth, adaptive stress responses, and formation of persister cells. This study was done to determine the relation of antibiotic resistance deciphered by the biofilms in Lactobacillus plantarum, a lactic acid bacteria (LAB) with probiotic significance. Methods: The gentamicin-resistant L. plantarum isolates were allowed to form biofilms and subjected to DNase I and proteinase K treatment. The optical density (OD) values were recorded for the biofilm assay and the cell count for the number of viable cells was taken for the control and the test samples. Percentage reduction was calculated based on the difference between the initial and final OD for both the parameters. Results: The biofilm assay revealed that the native L. plantarum isolates which were phenotypically susceptible, possessed the ability to form biofilms. The OD values were significantly decreased in comparison to the biofilm-forming control culture when these were treated with DNase I and proteinase K. Interpretation & conclusions: The study revealed that the biofilms formed by L. plantarum comprised of eDNA and proteins which was evidenced by the reduction in OD values and percentage in comparison to the control upon DNase I and proteinase K treatment. This indicates that the eDNA and biofilm matrix proteins are vital constituents of biofilms and may carry significant risk when coupled with antibiotic resistance.
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Abstract Habitual toothbrushing with fluoridated toothpaste followed by rinsing with antibacterial mouthwashes is a method to maintain good oral hygiene and to diminish the occurrence and severity of dental caries and periodontal disease. However, our understanding of how antimicrobial agents in mouthwashes affect fluoride-mediated caries lesion remineralization is still poor. Objective: The objectives of this in vitro study were a) to determine the effects of the waiting period of chlorhexidine (CHX) rinsing after fluoride toothpaste use and b) to further determine the effect of the type of toothpaste surfactant [sodium dodecyl sulfate (SDS) or cocamidopropyl betaine (CAPB)] on caries lesion remineralization associated with CHX rinsing. Material and Methods: Caries lesions were formed in bovine enamel specimens and assigned to 10 treatment groups (n=18) based on Vickers surface microhardness (VHN). Lesions were then pH-cycled for 10 days with daily regimen comprised of twice daily toothpaste slurry treatments (1150 ppm fluoride, with SDS or CAPB), followed by CHX solution treatments [0, 15, 30 or 60 minutes following slurry treatment or no CHX treatment (negative control)]. VHN was measured again and the extent of lesion remineralization calculated (∆VHN). Results: ∆VHN with SDS-toothpaste was significantly lower than with CAPB-toothpaste, indicating more remineralization for the CAPB-toothpaste. ∆VHN with 0-minute waiting time was significantly lower than with 30-minute waiting time and with negative control. Conclusions: The absence of CHX as an adjunct to fluoride toothpastes led to greater remineralization of enamel lesions compared with the immediate use of CHX treatment for both SDS- and CAPB-toothpastes. CAPB-toothpastes indicated significantly greater remineralization than SDS-toothpastes, and can be suggested for patients at high risk of caries. A 30-minute waiting time for CHX treatment is recommended after brushing.
Subject(s)
Animals , Cattle , Tooth Remineralization/methods , Toothpastes/chemistry , Cariostatic Agents/chemistry , Chlorhexidine/chemistry , Dental Caries/prevention & control , Fluorides/chemistry , Mouthwashes/chemistry , Sodium Dodecyl Sulfate , Surface Properties , Time Factors , Betaine/analogs & derivatives , Reproducibility of Results , Dental Enamel/drug effects , Dental Enamel/chemistry , Hardness Tests , Hydrogen-Ion ConcentrationABSTRACT
OBJECTIVES: To determine the combined effect of fatigue cyclic loading and thermocycling (CLTC) on the shear bond strength (SBS) of a resin cement to zirconia surfaces that were previously air-abraded with aluminum oxide (Al₂O₃) particles at different pressures. MATERIALS AND METHODS: Seventy-two cuboid zirconia specimens were prepared and randomly assigned to 3 groups according to the air-abrasion pressures (1, 2, and 2.8 bar), and each group was further divided into 2 groups depending on aging parameters (n = 12). Panavia F 2.0 was placed on pre-conditioned zirconia surfaces, and SBS testing was performed either after 24 hours or 10,000 fatigue cycles (cyclic loading) and 5,000 thermocycles. Non-contact profilometry was used to measure surface roughness. Failure modes were evaluated under optical and scanning electron microscopy. The data were analyzed using 2-way analysis of variance and χ² tests (α = 0.05). RESULTS: The 2.8 bar group showed significantly higher surface roughness compared to the 1 bar group (p < 0.05). The interaction between pressure and time/cycling was not significant on SBS, and pressure did not have a significant effect either. SBS was significantly higher (p = 0.006) for 24 hours storage compared to CLTC. The 2 bar-CLTC group presented significantly higher percentage of pre-test failure during fatigue compared to the other groups. Mixed-failure mode was more frequent than adhesive failure. CONCLUSIONS: CLTC significantly decreased the SBS values regardless of the air-abrasion pressure used.
Subject(s)
Adhesives , Aging , Aluminum Oxide , Fatigue , Microscopy, Electron, Scanning , Resin CementsABSTRACT
Background: Depression, a universal problem for individuals with HIV/AIDS because the disease creates uncertainty and disruption in every aspect of their lives. Objectives: To assess the level of perceived stigma and depression among women with HIV/AIDS infection and to determine relationship between perceived stigma and depression. Methodology: A cross-sectional study was carried out in Bel – Air hospital located at Panchgani, state of Maharashtra, India during year 2013 among the women with HIV/AIDS infection. By purposive sampling technique, 50 women were enrolled and interviewed by utilizing Standardized data collection tool i.e. stigma perception scale by Sowell et al and CES-D by Radloff after institutional ethical clearance certificate. Statistics: Descriptive statistics, chi-square test and correlation coefficient was used to analyze the data. Results: The out of a total 50 HIV infected women maximum, 26(52%) were belonged to the age group of 28 – 36 years. All the women were married out of which majority were widows 28(56%). Among the study subjects, maximum, 25(50%) were having secondary education, followed by 46(92%) as housewives. 38(76%) women were aware of HIV status ranging from 1 month to 2.5 years. However, 43(86%) reported that they had acquired HIV infection from their husband. Almost all women perceived stigma at some or other time of which majority, 26(52%) perceived stigma frequently whereas 19(38%) and 5(10%) perceived stigma always and occasionally respectively. Similarly all the women have some sort of depression and majority, 37(74%) experienced depression most of the time whereas 13(26%) experienced depression occasionally. The perceived stigma and depression have a significant positive correlation as indicated by correlation coefficient. Conclusion: Moderate to severe degree of stigma and depression was perceived by women with a status of HIV/AIDS infection. A significant positive relationship is also existed between perceived stigma and depression among the women with HIV/AIDS infection.
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Background. Prescribing inhalers without imparting adequate education regarding proper technique of their usage may result in suboptimal clinical improvement and wastage of medication. Training interventions using a standard check-list may help improve faulty techniques and enhance drug efficacy. Methods. Patients using metered dose inhaler (MDI) were included in the study. Inhaler technique was first evaluated at baseline using a standard check-list of recommended steps (National Institute of Health guidelines; see Table) and scores were given for each step correctly performed. Those who could not perform all steps correctly were given training intervention. The patients were assigned to two methods of educational intervention; one group was trained by providing written material giving step-wise instructions while the other group was given an actual physical demonstration using a placebo device. The technique was re-evaluated and scored following each educational session, and continued till the patient achieved a full score, or for a maximum of 3 sessions, whichever occurred earlier. Median score was calculated after each session and was compared between the two groups. Each patient was followed up after two months and the re-evaluated the same way. Results. One hundred and seventeen subjects were enrolled in the study (59 in the written group and 57 in the practical demonstration group). At baseline, only 1 of the 117 subjects could perform all the steps of inhaler usage correctly. This patient was, therefore, not provided the inhaler technique education. The overall median (range) score of the whole group was 3 (range 1-8). This score rose to 6, 7 and 8 after each of the three subsequent educational intervention sessions. At one-month follow-up, the median score dropped to 7 and improved with a repeat educational session as previously done. A significant difference was observed in the median score improvement achieved in the practical demonstration group compared with the written instruction group (3.0 versus 2.0 respectively, p<0.001). Conclusions. Inhalation technique of patients improves after imparting systematic educational intervention. A practical demonstration of all the steps proved more effective than simple verbal/written advice. In view of increasing errors being committed over a period of time, repeated demonstration of the proper technique using a standard check-list significantly improves the errors committed during inhaler use.
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To determine the long-term follow-up of the various operations for lumbar disc herniation in a large patient population. Patients who had operations for lumbar disc herniation [microdiscectomy, endoscopic microdiscectomy and the 'classical operation', i.e. laminectomy/laminotomy with discectomy] were collected from the world literature. Patients who had follow-ups for at least 2 years were analyzed relative to the outcome. The outcome was graded by the patients themselves, and the operative groups were compared to one another. 39,048 patients collected from the world literature had had lumbar disc operations for disc herniations. The mean follow-up period was 6.1 years, and 30,809 [78.9%] patients reported good/excellent results. Microdiscectomy was performed on 3,400 [8.7%] patients. The mean follow-up was 4.1 years with 2,866 [84.3%] good/excellent results, while 1,101 [3.6%] patients had endoscopic microdiscectomy. There, the mean follow-up was 2.9 years with 845 [79.5%] good/excellent results. The classical operation was performed on 34,547 [88.5%] patients with a mean follow-up period of 6.3 years, and 27,050 [78.3%] patients had good/excellent results. These results mirror those with discectomy and the placement of prosthetic discs. The analysis of 39,048 patients with various operations for lumbar disc herniation revealed the same pattern of long-term results. Patients who had microdiscectomy, endoscopic microdiscectomy or the classical operation [laminectomy/laminotomy with discectomy] all had approximately 79% good/excellent results. None of the operative procedures gave a different outcome
Subject(s)
Humans , Lumbar Vertebrae , Follow-Up Studies , Diskectomy , LaminectomyABSTRACT
Background and Objectives: The studies on relationship between different phases of menstrual cycle and pulse rate and Sp02 changes in healthy women of Kerala are inadequate. So, this preliminary study was plan to report the same. Material and Methods: The present study was performed in twenty healthy women of Kerala, age ranging from 20-40 (mean age 27+/- 61054). Spo2 and pulse rate were recorded with pulse - oximeter in different phases of menstrual cycle and analysis of data was done by spss 20.0. Results: Variations of pulse rate and Spo2 in different phases of menstrual cycle are not statistically significant at p > 0.05. Conclusion: it was observed that there was slight increase in pulse rate in ovulatory phase and slight increase in Sp02 in secretory phase, though it is not statistically significant. It may be due to small sample size. Hence this study certainly merits continuing the work with more investigations in the field.
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Pre-clinical investigation of stem cells for repairing damaged myocardium predominantly used rodents, however large animals have cardiac circulation closely resembling the human heart. The aim of this study was to evaluate whether SPECT/CT myocardial perfusion imaging [MPI] could be used for assessing sheep myocardium following an acute myocardial infarction [MI] and response to intervention. 18 sheep enrolled in a pilot study to evaluate [[99m]Tc]-sestamibi MPI at baseline, post-MI and after therapy. Modifications to the standard MPI protocols were developed. All data was reconstructed with OSEM using CT-derived attenuation and scatter correction. Standard analyses were performed and inter-observer agreement were measured using Kappa [k]. Power determined the sample sizes needed to show statistically significant changes due to intervention. Ten sheep completed the full protocol. Data processed were performed using pre-existing hardware and software used in human MPI scanning. No improvement in perfusion was seen in the control group, however improvements of 15% - 35% were seen after intra-myocardial stem cell administration. Inter-observer agreement was excellent [k=0.89]. Using a target power of 0.9, 28 sheep were required to detect a 10-12% change in perfusion. Study demonstrates the suitability of large animal models for imaging with standard MPI protocols and it's feasibility with a manageable number of animals. These protocols could be translated into humans to study the efficacy of stem cell therapy in heart regeneration and repair
Subject(s)
Animals, Laboratory , Animals , Myocardial Reperfusion , Tomography, Emission-Computed, Single-Photon , Sheep , Mesenchymal Stem Cells , Models, AnimalABSTRACT
Aim: The aim of this in vitro study was to compare the reproducibility and accuracy of quantitative light-induced fluorescence (QLF) in relation to other technologies and conventional methods fordetecting occlusal carious lesions. Methods: Ninety-six extracted permanent molar teeth wereselected. Three examiners carried out examinations using Visual examination (VI), bitewing radiographs (RX), QLF, electrical conductance measurement (ECM), and DIAGNOdent. Twenty five percent of the teeth were re-examined for repeatability. Stereomicroscopic examination was used as the gold standard. Results: Intra- and inter-examiner agreement ranged from 0.43 to 0.89. Areas under ROC curves were 0.82, 0.54, 0.84, 0.79 and 0.88, respectively, for VI, RX,QLF, ECM and DIAGNOdent examinations, with RX significantly lower than the other methods. No significant statistical difference was found when comparing the areas under ROC curve of visual inspection and QLF. Conclusions: Although QLF and other technologies for early caries detection may offer some advantages, this study did not find significant improvement in occlusal caries detection when compared to visual examination.
Subject(s)
Dental Caries , Dental Fissures , Diagnosis , Diagnosis , Fluorescence , RadiographyABSTRACT
Mitral valve stenosis is often associated with increased pulmonary vascular resistance resulting in pulmonary hypertension, which may lead to or exacerbate right heart dysfunction. Hypocapnia is a known pulmonary vasodilator. The purpose of this study was to evaluate whether induced hypocapnia is an effective treatment for pulmonary hypertension following elective mitral valve replacement in adults. In a prospective, crossover controlled trial, 8 adult patients with mitral stenosis were studied in the intensive care unit following elective mitral valve replacement. Hypocapnia was induced by removal of previously added dead space. Normocapnic [baseline], hypocapnic and recovery hemodynamic parameters including cardiac output, pulmonary vascular resistance, pulmonary artery pressure and systemic oxygen delivery and consumption were recorded. Moderate hypocapnia [an end-tidal carbon dioxide concentration reduced to 28 +/- 5 mmHg] resulted in decreases in pulmonary vascular resistance and mean pulmonary artery pressure of 33% and 25%, respectively. Hypocapnia had no other hemodynamic or respiratory effects. The changes in pulmonary vascular resistance and mean pulmonary artery pressure were reversible. Moderate hypocapnia was effective in decreasing pulmonary vascular tone in adults following mitral valve replacement. The application of this maneuver in the immediate postoperative period may provide a bridge until pulmonary vascular tone begins to normalize following surgery