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Dextrocardia with situs inversus is a rare heart condition with a genetic predisposition. Although most individuals lead a normal healthy life and usually, it is an incidental finding. Due to their unique anatomical variations and associated congenital variations, they may pose challenges to attending clinicians. We are hereby reporting a successful anesthetic management of the case of a 2.5-year-old child who presented for emergency laparotomy and on investigations, was found to have dextrocardia along with situs solitus.
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Mucormycosis has emerged as an important fungal infection with high associated mortality rates. Mucormycosis causes devastating angio-invasive fungal infections, primarily in patients with underlying risk factors. The prevalence of mortality associated with invasive Mucormycosis is high (>30-50%), with 90% mortality contributed by disseminated disease. Sudden rise in Mucormycosis cases during the COVID-19 pandemic came as a surprise to all. Lowered immunity due to COVID and associated conditions like diabetes, made the population susceptible to this dreaded disease. This disease led to both increase in morbidity and mortality among the general population. Aim of the Study : To interpret in detail the causes of mortality of patients presenting with COVID Associated Mucormycosis (CAM-19) at AIIMS Patna between May-November, 2021. Materials and Methods : An observational study of all patients who were treated for mucormycosis during the period of May 2021-Nov 2021 in ENT Department, AIIMS, Patna. During the period of study, 219 patients of RhinoOrbital-Cerebral Mucormycosis (ROCM) were admitted for treatment. Five patients had gone on Leave Against Medical Advice (LAMA). So, 214 patients were included in the study. Results : Among the 214 patients, 165 patients were treated surgically through both endoscopic and open approaches along with antifungal therapy management. 41 patients died during the hospital course of the treatment. The mortality rate of ROCM stood at 19.15% in our series. Pulmonary Mucormycosis had high mortality (100%). Diabetes is the most common risk factor. Multiple co-morbidities and extensive intracranial involvement had a strong association with mortality. Conclusion : The advanced stage of ROCM was associated with more deaths. Our series mortality rate of 19.15% is lower than most of the other documented mortality rates. Our results support that early aggressive surgical approach, antifungal therapy and multidisciplinary approach has reduced the mortality
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COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, efforts were initiated to develop safe and effective vaccines. Till date, 11 vaccines have been included in the WHO’s emergency use list. The emergence and spread of variant strains of SARS-CoV-2 has altered the disease transmission dynamics, thus creating a need for continuously monitoring the real-world effectiveness of various vaccines and assessing their overall impact on disease control. To achieve this goal, the Indian Council of Medical Research (ICMR) along with the Ministry of Health and Family Welfare, Government of India, took the lead to develop the India COVID-19 Vaccination Tracker by synergizing three different public health databases: National COVID-19 testing database, CoWIN vaccination database and the COVID-19 India portal. A Vaccine Data Analytics Committee (VDAC) was constituted to advise on various modalities of the proposed tracker. The VDAC reviewed the data related to COVID-19 testing, vaccination and patient outcomes available in the three databases and selected relevant data points for inclusion in the tracker, following which databases were integrated, using common identifiers, wherever feasible. Multiple data filters were applied to retrieve information of all individuals ?18 yr who died after the acquisition of COVID-19 infection with or without vaccination, irrespective of the time between vaccination and test positivity. Vaccine effectiveness (VE) against the reduction of mortality and hospitalizations was initially assessed. As compared to the hospitalization data, mortality reporting was found to be much better in terms of correctness and completeness. Therefore, hospitalization data were not considered for analysis and presentation in the vaccine tracker. The vaccine tracker thus depicts VE against mortality, calculated by a cohort approach using person-time analysis. Incidence of COVID-19 deaths among one- and two-dose vaccine recipients was compared with that among unvaccinated groups, to estimate the rate ratios (RRs). VE was estimated as 96.6 and 97.5 per cent, with one and two doses of the vaccines, respectively, during the period of reporting. The India COVID-19 Vaccination Tracker was officially launched on September 9, 2021. The high VE against mortality, as demonstrated by the tracker, has helped aid in allaying vaccine hesitancy, augmenting and maintaining the momentum of India’s COVID-19 vaccination drive
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BACKGROUND Hand sanitizer (HS) has been increasingly used during the Covid-19 pandemic. We compared the telephonic calls received by the National Poisons Information Centre (NPIC), New Delhi, India, related to its unsafe exposure and inappropriate use during the lockdown and prelockdown periods. METHODS We analysed and compared telephonic call records of 3 months of pre-lockdown and 3 months of the lockdown and HS-related calls in different age groups and zones during these periods. RESULTS The centre received 4000 calls; of these 1583 (40%) were related to household products of which only 63 (4%) were related to HS. There was an 8-fold increase in the number of calls received at the NPIC during the lockdown compared to the pre-lockdown period seeking medical attention following unsafe exposure or inappropriate use of HS. More calls were received from the south and north zones and, in the majority of these cases, HS was ingested accidentally. In some cases, HS was ingested intentionally for suicide during the lockdown. CONCLUSIONS Our study shows that unsafe exposure of HS is common under conditions of stress as seen during the lockdown period of the Covid-19 pandemic. It should be kept out of reach of small children. Further, providing psychological help and counselling to older age groups under conditions of stress are important issues of concern.
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Background: UTI constitute a major public health problem in India accounting 2nd most common infection next to respiratory tract infection. They are responsible for increasing treatment cost and significant morbidity.Aim:-To determine the incidence of UTI, evaluation of pathogens responsible and their antimicrobial susceptibility pattern in the population.Methods:Urine samples were collected from 300 patients attending the OPD Patna medical college, Patna during the period of 18 months (January 2017 to June 2018) Antimicrobial sensitivity testing was done for the bacterial isolates present in the sample by Kirby- Bauer disc diffusion method. Only those samples were taken into consideration which develops count equal to or greater than 1*105CFU/ml as indicated by Kass.Results:Out of 300 samples collected 146 (48.66%)) yielded bacterial growth. Out of 146 culture isolates E.Coli was the most common pathogen followed by klebsiella, CoNS and staphylococcus. Antibiotic sensitivity was performed on all the isolates. It was observed that highest sensitivity was 49.31% to amikacin, gentamycin (45.89%), nitrofurantoin (38.35%) meropenem (27.39%).Conclusions:It was observed that high grade of resistance to ampicillin, cotrimoxazole, ciprofloxacin, cefuroxime, chloramphenicol, cefotaxime, cefazolin, amoxicillin + clavulanic acid and gentamycin is present as a result of misuse or improper use of antibiotic in the community. Hence urine culture is necessary for the diagnostic screening of UTI before the treatment.
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Docosanol is the only US Food and Drug Administration(FDA)approved over-the-counter topical product for treating recurrent oral-facial herpes simplex labialis.Validated analytical methods for docosanol are required to demonstrate the bioequivalence of docosanol topical products.A gas chromatography/selected ion monitoring mode mass spectrometry(GC/SIM-MS)method was developed and validated for docosanol determination in biological samples.Docosanol and isopropyl palmitate(internal standard)were separated on a high-polarity GC capillary column with(88％cyanopropy)aryl-polysiloxane employed as the stationary phase.The ions of m/z 83 and 256 were selected to monitor docosanol and isopropyl palmitate,respectively;the total run time was 20 min.The GC/SIM-MS method was validated in accordance with US FDA guidelines,and the results met the US FDA acceptance criteria.The docosanol calibration standards were linear in the 100-10000 ng/mL concentration range(R2＞0.994).The recoveries for docosanol from the receptor fluid and skin homogenates were＞93.2％and＞95.8％,respectively.The validated method was successfully applied to analyze ex vivo human cadaver skin permeation samples.On applying Abreva?cream tube and Abreva?cream pump,the amount of doco-sanol that penetrated human cadaver skin at 48 h was 21.5±7.01 and 24.0±6.95 ng/mg,respectively.Accordingly,we concluded that the validated GC/SIM-MS was sensitive,specific,and suitable for quantifying docosanol as a quality control tool.This method can be used for routine analysis as a cost-effective alternative to other techniques.
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Abstract Introduction Individual variability in the language outcomes of children with cochlear implantation (CI) is a major concern. In CI rehabilitation, there is lack of a protocol regarding uniform post-CI language assessment interval duration, which can ensure better understanding of the trajectory of language growth as well as optimize language outcomes by providing feedback in fine tuning the language intervention program. Objective To evaluate the receptive and expressive language in Hindi speaking children with up to 2 years of CI experience using revised receptive-expressive emergent language test-3ed. (REELT-3) at 6 months intervals and to compare it with that of children with normal hearing (NH). Methods The present study included 192 children divided in 2 groups, 96 children with CI (15.8 ± 6.7 months), and 96 age-matched children with NH (22.3 ± 7.9 months). A cross-sectional, prospective study design was used to measure the language ability score (LAS) at an interval of 6 months from the time of implantation (TIA), which is 0 to 6 months, 7 to 12 months, 13 to 18 months, and 19 to 24 months of CI usage. Results The two-way analysis of variance revealed that the LAS after 18 months of CI usage was similar to (F (3, 92) = 8.63, p= 0.19, ηp2 = 0.028) that of the children with NH. However, other demographic factors, for instance, gender (F (3, 92) = 1.73, p= 0.505, ηp2 = 0.002), parent's education, (F (3, 92) = 2.05, p= 0.937, ηp2 = 0.031), and financial background (F (3, 92) = 2.49, p= 0.351, ηp2 = 0.076) had no major impact on language. Conclusion Eighteen months of CI usage duration can potentially stimulate receptive and expressive language up to age-matched children with NH. A protocol of periodic assessment of language, at least of 6 months, may be developed to optimize language outcomes.
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Background: Peak expiratory flow rate (PEFR) is a measure of the maximum speed of exhalation after a deep inspiration. The peak expiratory flow is measured by a device named peak flow meter. This study concentrates on the correlation of the PEFR with the pectoral muscle length.Methods: It is a cross sectional study of 30 convenient samples based on gender distribution where the PEFR and pectoralis muscle length were measured in the subjects.Results: Statistical analysis shows that there is a significant correlation between right pectoralis major general muscle length and PEFR (p=0.030), left pectoralis major general muscle length and PEFR (p=0.014), right pectoralis major clavicular end muscle length with PEFR (p=0.010).Conclusions: There is a significant correlation between peak expiratory flow and pectoralis muscle length.
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Background and Objective: Glossopharyngeal nerve block (GNB) technique has been used as alternative of treatment of cancer and noncancer pain of the oral cavity. The objective of the study is to compare the two approaches (extraoral and intraoral) of GNB in patients of carcinoma of the tongue in terms of efficacy, duration, and complications. Materials and Methods: This was a prospective comparative randomized study over a period of 1 year. Fifty patients of either sex of ASA physical status and 2, between 21 and 70 years of age, suffering from carcinoma of the tongue, were selected. The patients were randomly divided into two groups. Group I received 4 mL of 0.5% bupivacaine combined with 40 mg, of triamcinolonacetonide by extraoral approach of GNB, and Group II received the same amount of drug by intraoral approach of GNB. Hemodynamic parameters, degree of pain relief using visual analog scale (VAS), number of attempts, effect on quality of life (QOL), and complication were noted during the performance of GNB. Results: Demographic profile in both groups was comparable. Rate of complication and number of attempts to complete intervention were higher in Group I, which was found to be statistically significant. However, mean VAS scores in Group I were significantly higher as compared to those in Group II during most of the study period starting from the 1st follow-up at 30 min to the 2nd month postintervention (P < 0.05). No statistically significant difference in mean QOL scores of two groups was observed for the entire study period except at 1 week when mean scores in Group I were higher as compared to those in Group II (P = 0.011). Conclusion: The intraoral approach of GNB was better with respect to pain control and improvement in QOL whereas the rate of complication and number of attempts was lower in extraoral approach of GNB
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Background: Hypertension is one of the most important non-communicable diseases. Although high blood pressure is a recognized risk factor for cardiovascular disease, the prevalence of hypertension still remains unclear for most populations. The objectives of the study were to estimate the prevalence of hypertension in rural area of Faizabad and to identify the associated risk factors for hypertension.Methods: This community-based cross sectional study was carried out among 300 adults from a randomly selected village in rural health training centre, Safdarganj who were aged 18 years and above over a period of 3 months from March 2019 to May 2019. Participants were interviewed and examined for the assessment of socio-demographic detail, behavioral and lifestyle risk factors of hypertension. Template generated in MS excel sheet and analysis was done on SPSS software.Results: Among 300 study participants, 45.3% were male and 54.7% were female. The prevalence of hypertension was observed to be 10.33%. It was found to be more common in males. Prevalence increased as the age increased. The prevalence of hypertension was high among obese and those consuming more than 2 spoons of salt every day.Conclusions: Prevalence of hypertension is different in different parts of the country. Higher age, male sex, tobacco use, obesity, less physical activity and high salt intake are significantly associated with hypertension.
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Background:After the decades of Dichlorodiphenyltrichloroethane (DDT) use, Phlebotomus argentipesreportedly developed resistance against it affecting every aspect of vector control at grass-root level. Although DDT based Indoor Residual Spray (IRS) has been replaced with Alphacypermethrine-a Synthetic Pyrethroid (SP) based insecticide, since 2016 butits successful implementation at the Visceral Leishmaniasis (VL) endemic regime of Bihar doesn’t cause much effect upon VL vector density. Furthermore, the outcomes of existing operational research works, it Original ResearchArticle had been observed that VL vectors are continuously changing its behavior under the pressure of insecticides. Methods: For validating the hypothesis, present study has been carried out at Vaishali and Patna being highly and semi-endemic sites respectively for quantifying the oriental behavior among VL vectors persuaded by the IRS and enforce them to remain alive and get trapped in light trap even after changed chemical composition of IRS i.e., SP-IRS from routine DDT-IRS. Results:Following results, a significant reduction in sand fly density (i.e., 33.09% and 29.16%) was observed for outdoor and indoor caught sand flies, collected with light trap and aspirator respectively. Significant higher no. of sand fly collection in terms of per light traps per night was recorded from the outdoor sites than thosefrom indoor habitat for each village of Vaishali and Saran district of Bihar. Higher no. of male sand flies than to that of female ones were collected from outdoor sites and only unfed female sand flies (i.e., 100%) were caught following SP-IRS from each study villages of Vaishali and Saran districts of Bihar.Conclusions:The results of higher no. of sand flies collection from the outdoor sites as compared with the indoor habitat validate the hypothesis of gradual shifting of habitat of VL vectors from endophilic to exophilic which is undoubtedly followed due to the fact of developed resistance among them against chemical constituent of IRS. Results provide very useful information about the sand fly dynamics under the impact of IRS and accordingly, advocates the combined approach of IRS along with insecticidal fogging together at a same time that could be an effective dividend for maximum VL vector control along for negotiating VL cases at par for longer duration during the maintenance phase at the VL foci.
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Hemophagocytic Lymphohistiocytosis (HLH) is a fatal hyperinflammatory syndrome characterized by histiocytic proliferation along with hemophagocytosis. HLH can be primary (inherited) or secondary, to any severe infection, malignancy or rheumatological disease. HLH, though rare, has also been noted in association with scrub typhus which is an acute febrile illness resulting from the bite of infected larval form of mite (also known as chigger). We hereby describe two cases of HLH associated with rickettsial infection (Oriental tsutsugamushi) in a 36-year-old male and in a 10-year-old male child. The former presented with high-grade fever and pruritic macular rash over abdomen. While the latter was presented with fever and decreased urinary output at the time of admission
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Background: The relationship between thyroid abnormalities and rheumatoid arthritis is a debatable subject. Studies show a higher prevalence of thyroid abnormalities in patients with RA. It is widely observed that disorders with an autoimmune pathogenesis occur with increased frequency in patients with a history of another disease. RA is a systemic disorder that can affect any organ in the body, it could be speculated that abnormal thyroid functions are due to thyroid activity of the autoantibodies produced in this disease. Objectives:-Present study was doneto study the prevalence and correlation between Rheumatoid Arthritis and thyroid dysfunction; hypo as well as hyperthyroidism and to find whether thyroid disorders are found with increased frequency in Rheumatoid Arthritis patients as compared to general population. Methods: A cross sectional observational study was conducted on 50 patients of RA (diagnosed according to 2010 ACR/EULAR criteria) attending outdoor or admitted in wards at Rajindra hospital Patiala. Age and sex matched 50 persons from general population were taken as control group. These patients were evaluated for thyroid abnormalities using thyroid function test T3, T4, TSH. Results: Thyroid abnormalities were found among 28% cases of RA as compared to 8% among controls. Percentage of clinical hypothyroidism, subclinical hypothyroidism, and clinical hyperthyroidism in cases was 10%, 16%, 2% respectively. In controls percentage of clinical and subclinical hypothyroidism observed was 2% and 6% respectively. Females with RA had two fold enhances prevalence of thyroid abnormalities as compared to males with RA (31.6% females and 16.7% males with RA had thyroid abnormalities). Conclusion: The asymptomatic or mildly symptomatic clinical course of thyroid diseases in RA patients may be masked by underlying disease, posing hazards of late diagnosis and treatment. So higher prevalence of thyroid abnormalities in RA patients in comparison to controls indicate the need for screening by thyroid function tests.
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Background: Pregnancy induced hypertension (PIH) occur in women with pre-existing primary or secondary chronic hypertension, and in women who develop new-onset hypertension in the second half of pregnancy. Preeclampsia is one of the maternal diseases that cause complications to mother and fetus both. Methods: An observational cross sectional study was done in ANMMCH, a tertiary care hospital in Gaya, Bihar. All PIH patients were included in the study period of one year. Investigative workup was done after due clinical check up. The maternal outcomes were further divided into normal outcome, Eclampsia and other complications Perinatal outcome measures that was studied include live births, fetal growth restriction (IGUR), still births, neonatal complications and deaths. Results: A total of 75 patients of PIH were selected for the study. Maximum (57.3%) were in age group of 25-35 year. 45.3% were from urban area while 22.7% were working. 60% were primigravida. 50.7% were delivered vaginaly. Most common presenting symptom was labour pain, followed by edema and headache. Most common complication was CNS symptom including seizure (Eclampsia) in 16% patients followed by vaginal bleeding in 9.3%. Other complications were pulmonary edema in 8% and HELLP syndrome in 2.2% patients. 5 patients died. Most common neonatal outcome was low birth weight. Renal failure was present in 6.7% patients Visible jaundice was present in 4% patients. Conclusion: Preeclampsia is associated with multiple maternal and neonatal complications. Early diagnosis and treatment through regular antenatal check-up is a key factor to prevent hypertensive disorders of pregnancy and its complications. So, complete clinical and biochemical workup is necessary for appropriate management of PIH patients.
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Background: Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinological disorders with a broad spectrum of clinical manifestations affecting women of reproductive years. It is a common diagnosis in women presenting with infertility. All the dimensions of PCOS have not been completely explored. Many studies have tried to characterize the exact presentation of the disease. The main objective of this study was to find out the clinical and biochemical profile of patients with polycystic ovary syndrome (PCOS) in patient population attending the tertiary care hospital in Gaya, Bihar. Methods: A cross sectional study was done among 300 PCOS patients in a span of one year. Pregnant patients, patients with symptomatic disease and those of age less than 15 years and more than 35 years were excluded. PCOS patients were diagnosed using Rotterdam’s criteria. A detailed history and examination was obtained. Transvaginal USG was undertaken to detect PCOS. Anthropometric measurements were also done. Biochemical and hormonal test were done by standard methods. Results: The mean age group of patients was 28.11± 4.9 SD with mean BMI 26.12± 5.12. Maximum (42.7%) number of patients was in the age group 26-30 years. Out of 245 fertile patients, 68.6% were nulliparous. Among them, 82.7% had primary infertility. According to duration of infertility, maximum (45.2%) were of 6-10 years duration. About 93.7% were detected to have PCOS in ultrasonography. Androgenic features like acne was present in 22.3% of the patients, acanthosis nigricans in 18% of the patients and androgenic alopecia was present in 7.7%. The prevalence of metabolic syndrome was 21.7% while 20.3% had hypothyroidism. Elevated total testosterone was elevated in 41.3% of the patients. Conclusion: Early diagnosis and intervention will reduce the long term health complications associated with PCOS. A complete clinical, biochemical and radiological workup is necessary for appropriate management.
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Aroma and flavour are the important part of food that increase the organoleptic properties of a food and makes the food more acceptable among consumers. Flavour and aromatic compounds are the most essential components in food, feed, cosmetics, pharmaceutics, and toiletries products. Commercial production of flavour and aroma compounds from the microbial source in the industry is a modern approach but the concept behind it is in human practices since time immemorial. However, the health-promoting benefits of microbial bioprocesses products are numerous ranging, from antibiotics to fermented functional foods are among the most appreciable one. This review includes the verity of flavour production from various types of microorganisms and its application in the food industry, and a brief discussion about its health benefits among the consumers.
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Background: Diabetic wound is a major socioeconomic debilitating problem in this society. Various treatment options are available but still it requires better treatment option. In diabetes mellitus the oxygenation to the tissues is reduced. In this study effects of low level laser therapy were compared with topical application of Streptococcus thermophilus on diabetic wounds that induces formation of new blood vessel and free radical scavenging system, a comparative study to get better treatment option for diabetic wounds.Methods: 18 male rats were selected and divided randomly into three groups. Diabetes was induced in all the rats by using the Alloxan monohydrate at a dose of 120mg/kg of the body weight. Group A was treated with normal saline, group B was treated with low level laser therapy and group C was treated with Streptococcus thermophilus topically. Skin tissues were collected on day three and seven, slides were prepared for microscopic examination to observe the new blood vessels formation.Results: Mean number of new blood vessel formation was observed in group B compared with group A and C. Significant vasculogenesis was seen in group B when treated with Low level laser therapy.Conclusions: In the group of low level laser therapy new blood vessel formation was seen with better wound healing. It means LLLT provides better oxygenation to the tissues by generation of new blood vessels compared with Streptococcus thermophilus and normal saline.
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Introduction: Bipolar I disorder typically characterized bycycles of depression and mania. Onset after the age of 75 yearsis very rare and the reported incidence of mania is 2/100000,which most often occur due to secondary organic aetiology.Here we are presenting a review and an interesting case oflate-onset first episode mania while evaluating and excludingall other secondary causes of mania.Case Report: 79-year-old male presented with 2 weeks’duration of illness and symptoms was suggestive of a manicepisode. The patient was thoroughly assessed with laboratoryinvestigations and non-contrast computerised tomography(NCCT) brain to find any secondary causes of mania butnothing was significant. Finally, as per tenth revision of theInternational Statistical Classification of Diseases (ICD-10)diagnosis of first episode Mania without psychotic symptoms(F30.1) was made. He was started on Valproate which wasgradually increased up to 750 mg/day and olanzapine 5mg.After 6 weeks, the YMRS score decreased from 32 to 8 and heachieved his premorbid functioning level.Conclusion: This case highlights that primary psychiatryillness can occur at any age but in the geriatric populationbefore finalizing the diagnosis all other secondary causesshould be ruled out. There is a high need for systematicresearch in this area to formulate effective managementguidelines in the geriatric population.
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BACKGROUND: Epithelial ovarian cancer is the second most common gynecological cancer. Human Epididymis Protein 4 is a novel biomarker for ovarian cancer. This study aims to explore the role of HE4 in monitoring recurrence and prognostication of ovarian cancer by predicting overall survival (OS) and progression-free survival (PFS). MATERIALS AND METHODS: In total, 149 patients with ovarian carcinoma were enrolled in the study. Baseline and post-treatment 3 monthly biomarker levels were recorded. For analysis, patients were divided into primary debulking surgery (PDS) and interval debulking surgery (IDS) groups. Statistical analysis was done using SPSS 24. RESULTS: Median age of patients at diagnosis was 45 (19–75) years. Recurrence was seen in 68.5% (n = 102) patients. The sensitivity of serum HE4 in detecting recurrence was 85.3% (95%CI: 76.95%–91.5%) and specificity was 91.5% (95%CI: 89.5%–98.2%). A >80% decline in HE4 levels during treatment indicated a better PFS, which was statistically significant in both groups (P = 0.04 in PDS and P = <0.001 in IDS group). Multivariate analysis suggested that OS was influenced by optimal cytoreduction in both groups of patients and stage in the IDS group. On the contrary, PFS was influenced by stage and response in HE4 levels in both groups. CONCLUSION: HE4 levels have similar sensitivity but more specificity when compared with CA125 in diagnosing recurrent ovarian cancer. A >80% decline in HE4 levels during treatment predicts better PFS and can help in prognostication
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Abstract Antibiotic resistance is a growing public health concern. Antibiotics continue to be prescribed by some clinicians to resolve dental pain even though research indicates that antibiotics are not effective for treating conditions such as irreversible pulpitis. The objective of this study was to determine the extent to which current research and evidence around irreversible pulpitis has been translated into dental practice and the gaps in dentists' knowledge. An on-line clinical vignette format survey questionnaire about treatment of irreversible pulpitis was distributed to the members of the Academy of Operative Dentistry and Academy of General Dentistry (US based international dental bodies). Their responses were recorded and evaluated. A total of 403 dentists participated in the survey. Over a third (39.3%) indicated they would prescribe antibiotics for symptomatic irreversible pulpitis in a permanent tooth occurring without any signs of systemic infection. The rest indicated they would not prescribe antibiotics; most of them would prescribe an analgesic combined with pulpectomy. Those who had undertaken advanced education training achieved a significantly higher mean knowledge score compared to those with just a primary dental degree (p=0.011). Similarly, full or part time academicians had a higher mean knowledge score than the clinicians who work only in private practice (p=0.014). Some dentists continue to prescribe antibiotics inappropriately for alleviating pain due to irreversible pulpitis. Antibiotic prescribing practices of dentists with advanced education or academic engagement were better as compared to the other participants. There is clear evidence of antibiotic over-prescribing for irreversible pulpitis which needs to be addressed urgently.
Resumo A resistência aos antibióticos é uma preocupação crescente para a saúde pública. Os antibióticos continuam a ser prescritos por alguns dentistas para resolver a dor dentária, embora pesquisas indiquem que os antibióticos não são eficazes no tratamento de condições como a pulpite irreversível. O objetivo deste estudo foi determinar em que medida as pesquisas atuais e as evidências em torno da pulpite irreversível foram traduzidas em prática odontológica e as lacunas existentes no conhecimento dos dentistas. Um questionário de pesquisa em formato de vinheta clínica on-line sobre o tratamento da pulpite irreversível foi distribuído para os membros da Academia de Odontologia Operatória e da Academia de Odontologia Geral (órgãos dentários internacionais dos EUA). Suas respostas foram registradas e avaliadas. Um total de 403 dentistas participou da pesquisa. Mais de um terço (39,3%) indicaram que prescreveriam antibióticos para pulpite irreversível sintomática em um dente permanente sem qualquer sinal de infecção sistêmica. O restante respondeu que eles não prescreveriam antibióticos; a maioria deles prescreveria um analgésico combinado com pulpectomia. Aqueles que realizaram o treinamento de educação avançada obtiveram uma pontuação de conhecimento médio significativamente maior em comparação com aqueles com apenas um grau primário de conhecimento odontológico (p=0,011). Da mesma forma, acadêmicos em tempo integral ou parcial tiveram uma pontuação média de conhecimento maior do que os clínicos que trabalham apenas em consultório particular (p=0,014). Alguns dentistas continuam a prescrever antibióticos inadequadamente para aliviar a dor decorrente de pulpite irreversível. Práticas de prescrição de antibióticos por dentistas com educação avançada ou envolvimento acadêmico foram melhores em comparação com os outros participantes. Há evidências claras de excesso de prescrição de antibiótico para pulpite irreversível que precisa ser tratada com urgência.