Aesthetic Dentistry - What You Decided and What I Want: Shade Selection

ABSTRACT Objective: To assess the relationship between patients' and dentists' perceptions of shade selection and its impact on satisfaction with the prosthesis. Material and Methods: A single group pre-post study was conducted at the Prosthodontics department of a teaching hospital in India. One hundred ten participants were selected through a systematic random sampling technique with inclusion and exclusion criteria. Patients' attitudes regarding the aesthetics of their maxillary anterior teeth were recorded using a validated questionnaire. Shades for the intended prosthetic crown selected by the dentist and chosen by the patient were recorded separately, and patient satisfaction with the appearance of the final prosthesis was recorded. We used descriptive statistics followed by Pearson's Chi-square test and a binomial logistic regression model for inferential statistics. Results: 109 participant's data were available for final analysis. Patients choose lighter shades than the dentist's selection, which is statistically significant (p=0.000). 73.4% were satisfied with the final prosthesis, and the binomial logistic regression model identified using patient-selected shade for the final prosthesis was significantly associated with patients' satisfaction with the final prosthesis (OR=3.3, p=0.001). Conclusion: The patient's preference should be considered with the dentist's option when selecting a shade to create good esthetics.

Phenotyping of clinically significant blood group antigens among the South Indian donor population

ABSTRACT Introduction: Data on the prevalence of clinically significant antigens (Rh, Kell, Kidd, Duffy, MNSs, Lewis, P and Lutheran) among the Indian donor population is sparse. Objective: This prospective study was aimed at determining the prevalence of 21 clinically significant antigens for the first time in the South Indian donor population. Method: A total of 672 regular O group blood donors were enrolled for Rh (C, c, E, e) and Kell (K) antigens typing. Of these, 188 donors were typed for other clinically significant antigens (k, Kpa, Kpb, Jka, Jkb, Fya, Fyb, M, N, S, s, P1, Lea, Leb, Lua and Lub). Results: Antigen frequencies were expressed in percentages. In our study, R1R1 and rr were the most common phenotypes among D+ and D− donors, respectively. Among the Rh antigens, the e antigen was expressed by 97.5% and 100% of D+ and D− donors, respectively. The K antigen was found in only 0.15% of donors. In the Duffy and Kidd blood group system, Fy (a+b+) and Jk (a+b+) were the most frequent phenotypes, respectively. In the MNSs blood group system, M+N+ and S−s+ were the most common phenotypes reported. The Le (a−b+) was found to be the phenotype with the highest prevalence in the Lewis blood group system. The Lu (a−b+) was the only phenotype found in the Lutheran blood group system. Conclusion: Knowledge regarding the prevalence of antigens in a given population is essential in developing cost-effective in-house panels and a rare donor registry comprising donors typed negative for a high-frequency antigen or a combination of common multiple antigens.

Rectus muscle pseudo-adherence syndrome

Purpose: To describe a clinical entity called “rectus muscle pseudo?adherence syndrome” following buckling surgery. Methods: A retrospective data review was undertaken to analyze the clinical profile of strabismus patients who had developed it following buckling surgery. Between 2017 and 2021, a total of 14 patients were identified. The demography, surgical details, and intraoperative challenges were reviewed. Results: The average age of the 14 patients was 21.71 ± 5.23 years. The mean pre?op deviation was 42.35 ± 14.35 prism diopters (PD) of exotropia, and the mean post?op deviation was 8.25 ± 4.88 PD of residual exotropia at 26.16 ± 19.53 months follow?up. Intraoperatively, in the absence of a buckle, the thinned?out rectus adhered to the underlying sclera with much denser adhesions along its margins. When there was a buckle, the rectus muscle adhered to the outer surface of the buckle again, but less densely, with marginal union into the surrounding tenons. In both scenarios, due to the absence of protective muscle coverings, the rectus muscles were naturally adsorbed onto the immediately available surface in the presence of active healing by the tenons. Conclusion: While correcting ocular deviations following buckling surgery, a false sense of an absent, slipped, or thinned?out rectus muscle is very much possible. This is due to active healing of the muscle with the surrounding sclera or the buckle in a single layer of tenons. This is the rectus muscle pseudo?adherence syndrome, where the culprit is the healing process and not the muscle

Serological characteristics of Lewis antibodies and their clinical significance - A case series

Abstract Introduction Lewis antibodies have been thought to play a small role in clinical transfusion practice, but recent reports suggest that they have gained more importance in the context of transfusion and transplantation. Data regarding the prevalence of Lewis antibodies and their clinical significance in the Indian context is very limited. Hence, this study was aimed at analyzing the serological characteristics and clinical significance of Lewis antibodies encountered in our patient and donor populations. Methods The retrospective data analyzed the records of red cell antibody screening results and the additional serological evaluation performed on the donor and patient samples included in the study. Results A total of 26 study subjects were noted to have Lewis antibodies (including 6 healthy donors and 20 patients). Of them, 13 individuals had anti-Leb, 10 had anti-Lea and the remaining three had an anti-Lea/Leb mixture. IgG Lewis antibodies were detected in 7 individuals. All cases of IgM Lewis antibodies detected were reacting at 37°C. Two patients were suspected of having hemolytic transfusion reactions due to Lewis antibodies. Antigen-negative cross-match compatible units were provided for transfusion in the recipients. Conclusion Lewis antibodies of the IgM class reacting at 37°C should be regarded as clinically important. The present study findings urge that the lab personnel look for the thermal amplitude of Lewis antibodies, irrespective of the fact that the antibody class and antigen-negative crossmatch compatible units should be provided to avoid hemolytic transfusion reactions.

The effect of different thickness scleral lens on corneal parameters in eyes with keratoconus

Purpose: To investigate the impact of different?thickness scleral lenses (SLs) on corneal thickness, curvature, and fluid reservoir thickness in keratoconic eyes. Methods: Schiempflug imaging and AS?OCT was captured before and immediately following 6 h of SL wear. Different?thickness lenses were used while keeping the other parameters the same. The timing of the measurement for day 1 and day 2 was matched to allow for the control of the confounding influence of diurnal variation. Results: Immediately after 6 h of lens wear, no statistically significant difference (P > 0.05) was noted in corneal edema in any region and quadrants between thin? and thick?lens wearers. The calculated percentage of corneal edema was also within the range of overnight closed eye physiological swelling. Pentacam measured higher central corneal thickness compared to AS?OCT in both baselines and after 6 h of lens wear. The current investigation reported minimal but not statistically significant (P > 0.05) flattening in anterior and steepening in posterior curvature parameters in both thin and thick SLs. The mean reduction in the fluid reservoir thickness was 80.00 ± 3.99 and 79.36 ± 3.84 microns after 6 h of thin? and thick?lens wear, respectively, which was not statistically significant (P > 0.05). A statistically significant positive correlation (r = 0.67, P = 0.02) was found between lens thickness and change in anterior steep k with thick?lens wear. Conclusion: Central lens thickness of 200–400 ?m did not cause any significant change in corneal curvature and fluid reservoir thickness and did not induce clinically significant corneal edema after short?term SL wear.

Group B Streptococcal Colonization among Pregnant Women and Neonates in a Tertiary Care Hospital in South India

Objectives To assess the prevalence of maternal and neonatal group B Streptococcal colonization, incidence of neonatal systemic illness, and antibiotic sensitivity of isolates. Methods This prospective cohort study was conducted in a South Indian tertiary care hospital. Rectovaginal swabs from pregnant mothers at 360/7–376/7 wk gestation and throat and rectal swabs from their neonates at 48 h of age were collected. Presence of group B Streptococcus (GBS) was identifed by broth enrichment step, and traditional microbiologic methods and antibiotic sensitivity of isolates was noted. All mothers received intrapartum antibiotic prophylaxis (IAP). Culture-positive sepsis, clinical sepsis, pneumonia, meningitis, and urinary tract infection were defned as neonatal systemic illness. Neonates of colonized mothers were followed at 3 mo for late-onset sepsis. Results Of the 310 mothers, 40 were GBS colonized (prevalence: 12.9%; 95% CI 9.2%, 17.6%). None of the neonates were colonized. Maternal GBS colonization was signifcantly associated with premature rupture of membrane (RR - 2.93, 95% CI - 1.66–5.16) and neonatal systemic illness (RR - 2.78, 95% CI - 1.39–5.54). Positive correlation was noted between duration of IAP?4 h and neonatal illness and between maternal GBS colonization and Apgar at 1 min?4. Clindamycin resistance was noted in 20%. All neonates remained well at 3 mo follow-up. Conclusion High maternal colonization alerts the need for GBS screening in India. Clindamycin resistance among GBS isolates questions its efectiveness as alternative therapy in penicillin allergy.

A Case of Eosinophilic Granulomatosis with Polyangiitis Mimicking Cutaneous Tuberculosis and Tuberculous Lymphadenitis

Summary@#Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg-Strauss Syndrome (CSS) is a rare granulomatous necrotizing vasculitic disease characterized by the presence of asthma, sinusitis, and hypereosinophilia. We describe a patient who was initially diagnosed with tuberculous lymphadenitis and later diagnosed with EGPA.

The moderating effect of employment status on the relationship between lifetime major depressive disorder and positive mental health

INTRODUCTION@#This paper aims to examine the (1) level of positive mental health (PMH), (2) identify the socio-demographic correlates of the PMH domains in the general population, and (3) establish if employment status moderates the relationship between major depressive disorder (MDD) and PMH among those with a lifetime prevalence of MDD.@*METHODS@#The Singapore Mental Health Study conducted between 2016 and 2018 included Singapore residents aged ≥18 years. The World Health Organization Composite International Diagnostic Interview version 3.0 was utilised to establish lifetime prevalence of MDD. Moderation analysis was conducted using SPSS PROCESS macro (Hayes, 2017) to assess if employment status moderated the relationship between MDD and PMH.@*RESULTS@#Significantly lower PMH total and domain scores were reported by respondents (n=2,270) who endorsed lifetime MDD compared to those who did not. Moderation analysis demonstrated that the effect of MDD on PMH total and domain scores varied considerably across employment status. Based on the interaction plots, the effect of MDD on both PMH total and domain scores was minimal among those employed than unemployed.@*CONCLUSION@#Healthcare professionals should support the employment needs of those who report lifetime MDD to provide care for an individual's mental well-being in a holistic manner. Acquiring or remaining in employment would be a priority depending on the PMH of the individual. Reducing barriers to employment for those with health issues or creating employment opportunities for this group are concerns that need to be addressed at a societal level.

Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study

INTRODUCTION@#Nutritional psychiatry is an emerging field of study that investigates the role of diet and nutrition in mental health. Studies conducted in the general population have linked depressive symptoms with poor dietary patterns. The aim of this study was to characterise the dietary intake and analyse the dietary pattern using the Dietary Approach to Stop Hypertension (DASH) in a sample of psychiatric patients in a multiethnic Asian nation.@*METHODS@#Participants were recruited from an outpatient clinic and an inpatient unit at the Institute of Mental Health in Singapore. Self-reported dietary habits of a sample of psychiatric patients (N=380) were analysed using DASH. To examine the variables associated with DASH scores, a linear regression was conducted with the full sample and sociodemographic variables.@*RESULTS@#Persons with depressive disorders had a mean DASH score of 21.3 (±4.2), while persons with psychotic disorders had a mean DASH score of 21.2 (±4.9). Respondents who were older (B=1.94, 95% confidence interval [CI] 0.91-2.96, @*CONCLUSION@#Dietary patterns of persons with mental disorders were characterised. A host of sociodemographic factors, and not diagnosis of mental disorders, influenced the dietary quality of people with depressive and psychotic disorders. Clinicians treating psychiatric patients need to be aware of the nuanced reasons behind poor dietary choices and provide targeted psychoeducation to specific subgroups within the patient population.

Accuracy of self-reported height, weight and BMI in a multiethnic Asian population

INTRODUCTION@#The study assessed whether self-reported height, weight and derived body mass index (BMI) can provide an accurate measure of anthropometric data in a multiethnic adult population in Singapore.@*METHODS@#Standardised anthropometric measurements were compared against the self-reported values from 5,132 adult residents in a cross-sectional, epidemiological survey. Discrepancies in self-reports from measurements were examined by comparing overall mean differences. Intraclass correlations, Cohen's kappa and Bland-Altman plots with limits of agreement, and sub-analysis by sex and ethnicity were also explored.@*RESULTS@#Data were obtained from 5,132 respondents. The mean age of respondents was 43.9 years. Overall, the height was overestimated (0.2cm), while there was an underestimation of weight (0.8kg) and derived BMI (0.4kg/m2). Women had a larger discrepancy in height (0.35cm, 95% confidence interval [CI] 0.22 to 0.49), weight (-0.95kg, 95% CI -1.11 to -0.79) and BMI (-0.49kg/m2, 95% CI -0.57 to -0.41) compared with men. Height reporting bias was highest among Indians (0.28cm, 95% CI 0.12 to 0.44) compared with Chinese and Malays, while weight (-1.32kg, 95% CI -1.53 to -1.11) and derived BMI (-0.57kg/m2, 95% CI -0.67 to -0.47) showed higher degrees of underreporting among Malays compared with Chinese and Indians. Substantially high self-reported versus measured values were obtained for intraclass correlations (0.96-0.99, @*CONCLUSION@#Self-reported anthropometric estimates can be used, particularly in large epidemiological studies. However, sufficient care is needed when evaluating data from Indians, Malays and women as there is likely an underestimation of obesity prevalence.

Management of HIV-positive pregnant women: a Singapore experience

INTRODUCTION@#Perinatal transmission remains one of the important causes of transmission of the human immunodeficiency virus (HIV). Over the years, with better knowledge and awareness of HIV infection, the perinatal transmission rate has been significantly reduced. We previously reported on the pregnancy outcomes of HIV-positive mothers from 1997 to 2007 in our institution. This article aimed to review the standards of care of HIV-positive pregnant women since then.@*METHODS@#A retrospective study reviewed 84 HIV-positive women who delivered in a tertiary centre from January 2008 to December 2015. Patient demographics and antenatal, intrapartum, postnatal and immediate neonatal data were analysed.@*RESULTS@#A total of 97 deliveries with 98 neonates were recorded; 12 women delivered more than once, and there was one set of twins. The mean maternal age at diagnosis of HIV infection was 27.8 years. Of the study population, 63.1% of women were non-Singaporeans. 56 women were known to have HIV infection on presentation and 90.7% were on antiretroviral therapy during pregnancy. 88.7% of the women received intrapartum intravenous zidovudine, and 93.1% of women with detectable and 58.7% with undetectable viral load underwent Caesarean sections. All neonates were HIV-negative.@*CONCLUSION@#The high standards of care for HIV-positive women have successfully reduced our perinatal transmission rate to zero.

Predictors of Functional Outcome in Unstable Ankle Fractures Treated Surgically – A Prospective Cohort Study

@#Introduction: Unstable ankle injuries require anatomical reduction and stabilisation for optimal outcome. In spite of adequate care, a few patients have poor outcome. In this study, we assessed the risk factors that predict the clinical outcomes in surgically treated unstable ankle fractures. Material and methods: This prospective cohort study was conducted on 68 patients who underwent surgical management for an unstable ankle injury. Demographic details, fracture type and associated medical comorbidities were recorded. Pre-operative radiographic assessment was done for all patients. At the end of one year follow-up, clinical (American Orthopaedic foot and ankle societyAOFAS and Olerud-Molander ankle - OMAS) scores and radiological parameters were assessed and analysed. Results: Fracture dislocation (0.008), diabetes mellitus (0.017), level of alchohol consumption (0.008) and preoperative talocrural angle (TCA) > 100° (0.03) were significant predictors of poor outcomes as per AOFAS. Fracture dislocation (0.029), diabetes mellitus (0.004), preoperative TCA > 100° (0.009), female gender (0.001), age more than 60 years (0.002) and open injuries (0.034) had significantly poor outcome as per OMAS. Other parameters (smoking, hypertension, classification, syndesmotic injury, medial clear space and tibiofibular overlap) did not affect the outcome significantly. Conclusion: Our study showed that poor outcome predictors in unstable ankle fractures are age >60 years, female gender, diabetes mellitus, alcohol consumption, fracture dislocation, open fractures and pre-op TCA >100°.

Effectiveness of Foot Reflex Therapy in Post-Operative Pain among Patients Subjected to Major Abdominal Surgery

Most patients experience post–operative pain and it is unavoidable. It is the duty of the nurses to ensure that patients' pain is assessed and managed effectively when they are at the hospital. Foot reflex therapy is one effective way nurses can adopt to manage the patient with pain after surgery. We wanted to evaluate the effectiveness of foot reflex therapy on post-operative pain in patients who are subjected to major abdominal surgery. METHODSThis is a descriptive randomized control study that was conducted at Sri Ramachandra Medical College and Hospital, among 360 patients who underwent major abdominal surgery. They were equally divided into two groups as control and study groups and the results were analyzed statistically. RESULTSMajority of the patients in the study group showed a positive effect on pain control during 4th and 5th [ (Mean: 1.27 with SD: 1.12) (Mean: 0.03with SD: 0.32) at p < 0.001] post-operative day following foot reflex therapy. CONCLUSIONSThe existing pain and the post-operative pain can be managed by nurses, patients, their care takers or families together, whenever appropriate, in a multidisciplinary manner. Foot reflex therapy is one such alternative complementary therapy which the nurses can adopt to implement the techniques independently.

Eccrine porocarcinoma from the abdominal wall in an elderly female: a case report

Eccrine porocarcinoma (EPC) is a rare malignancy arising from the sweat gland. It is commonly seen in elderly female patients. There is no characteristic appearance for this malignancy and so making a clinical diagnosis is difficult. The diagnosis is confirmed by histopathological examination (HPE). Authors present a case of a 53-year-old female who presented with an ulceroproliferative lesion on the left side of the abdominal wall. After the lesion was radiologically ascertained to be localized and having a diagnosis of porocarcinoma from wedge biopsy, a wide local excision was done.  The HPE confirmed the diagnosis of EPC.

Estradiol and lipid levels in men with acute myocardial infarction

Background: The incidence of myocardial infarction (MI) is more common in men when compared with women and women after menopause are at high risk of MI. This gender difference in CVD risk might be because of the difference in the circulating estrogen levels in men and women. Dyslipidemia is also one of the major causes of MI. The present study was aimed to estimate the levels of serum estradiol and serum lipids in newly diagnosed male MI cases and to find out any correlation between these two.Methods: The study was conducted on 50 newly diagnosed MI admitted in Cardiology department Narayana general hospital and Medical College, Nellore. Only males were included in the study. Fifty age and sex-matched healthy individuals were selected as controls. Lipid levels are estimated by endpoint colorimetric assay (HUMANSTAR kit) and estradiol was estimated by Chemiluminance immune assay (CLIA).Results: Significantly raised levels of estradiol (p-value <0.0001) and low HDL cholesterol (p-value =0.0085) levels were noticed among the cases compared to controls. No significant correlation was observed between estradiol and lipoproteins (HDL and LDL).Conclusions: The results of the present study in acute MI compared to controls show hyper estrogenemia in Male MI cases, which may be the underlying cause for thrombosis in acute MI. Decreased levels of HDL cholesterol are observed in the MI cases which are known to increase the risk of Atherosclerosis. No significant correlation were noticed between Estradiol and HDL cholesterol in men with acute MI.

A prospective closed loop audit on the quality of the operative notes in a general surgical unit in a quaternary care centre

Background: Proper documentation of the surgery done in the form of operative notes is a very important aspect of surgical practice. The aim of this clinical audit was to identify the existing standard of the operative notes written in a general surgical unit in a quaternary care hospital; and to compare it with the recommendations given by Royal College of Surgeons, England (in Good Surgical Practice, 2014) and if needed, to improve the standard of practice.Methods: In the first loop of this prospective audit, 75 consecutive operative notes which were written were compared with the RCS guidelines and the areas which had missing data were identified. These areas were informed to the residents, who are primarily involved in the documentation of the operative notes. The second loop of the audit was conducted after a gap of 4 months involving 75 consecutive operative notes again.Results: The areas which were initially deficient were better documented when analysed in the second loop.Conclusions: Documentation of operative notes does not always comply with the set guidelines as highlighted in the first loop of our audit. But by employing a clinical audit it is possible to identify the existing deficiencies and thereby improving the standards of practice. Also, operative note writing should be taught as part of surgical training. Definitions should be clearly provided, and specific guidelines should be established to improve the quality of the operative notes and their use to improve patient safety.

Pattern of acute kidney injury and its outcome in a tertiary care centre

Background: Acute kidney injury is a multiplex disease with severe morbidity and mortality. The trends of acute kidney injury vary according to the regions and the population under study. The aim of this study is to evaluate the trends of acute kidney injury and its outcome in a tertiary care hospital.Methods: The study was a prospective observational study conducted at a tertiary care hospital in a metropolitan city. A total of 102 patients of acute kidney injury were selected based on the Kidney Disease Improving Global Outcomes guidelines of acute kidney injury. The main trends of acute kidney injury presentation and its outcome were assessed.Results: Of 102 patients admitted, 42 had a sepsis related diagnosis (42.41%), 17 patients (17.16%) had cardiovascular disease related acute kidney injury and 12 patients (12.12%) had developed acute kidney injury due to drugs and poisons. According to RIFLE (risk of renal failure, injury to kidney, failure and loss of function and end-stage kidney disease) category, 43.96% of patients belonged to the risk category and 30.77% to the injury category. Of 34 patients in failure category, 23 recovered and 11 did not recover. Authors compared the trends of acute kidney injury in patients who recovered and who deteriorated. The mean serum creatinine values were 3.42 mg/dl in patients who didn’t recover from acute kidney injury and 2.05 mg/dl in patients who recovered. In patients of the recovered group, the mean urine output value is 783 ml/day; in deterioration group, 445 ml/day.Conclusions: Most common etiologies of acute kidney injury in this study include sepsis, drugs and poisons, cardiovascular diseases and diarrheal diseases in order of occurrence. High serum creatinine at admission and oliguria were the most common factors that contributed to deterioration in acute kidney injury.

Predictors Of Functional Outcomes In Traumatic Brain Injury At 4 Months Post Injury In South Indian Population

Background: Goals of Rehabilitation after Traumatic Brain Injury (TBI) focus on preventing complications and improving the level of functional independence. The expectation of TBI survivors and family members following rehabilitation are focused on the quality of outcomes such as reintegration into the community, return to work, and maximal functional capacity. Multiple factors may affect recovery after TBI when interacting with the primary condition and predicting the degree of recovery helps in framing realistic goals. The purpose of this study was to analyze the factors influencing the functional outcome in TBI patients at four months post-injury. Methodology: This observational study was carried out in the Neurosurgery outpatient department when TBI patients returned for review at four months post-injury. 50 TBI patients who were able to follow commands participated in this study. Factors like Admission Glasgow coma scale (GCS), Discharge GCS, Length of Hospitalization, Associated fractures of the upper and lower limb, Co-morbid conditions like Diabetes and Hypertension were obtained from the discharge summary of the patient. Caregiver literacy was obtained from the person who took care of the patient completely. Admission CT scan was graded using the Marshall CT classification. Finally, all these factors were compared to the functional status of the patient evaluated using the Barthel Index. Results: Logistic regression was used to predict the factors affecting the functional outcome. Beta value of Caregiver literacy, Discharge GCS, and Co-morbid conditions was .561, .369 and .234, respectively which influences the functional outcome of TBI patients at four months post-injury. Conclusion: The study concludes that caregiver literacy, Discharge GCS, and Co-morbid conditions influence the functional outcome of TBI patients, which emphasizes the need for awareness and education of the caregiver and along with post-discharge rehabilitation program specific exercises addressing the co-morbid conditions would enhance the recovery.

Thyroid hormones as a marker to diagnose the severity of fungal sepsis in neonates

Background: Sepsis due to fungi in the neonatal period occurs in infants admitted to the ICU for long periods of time, especially affecting infants with a birth weight <1500 g. In this case series thyroid insufficiencies have been used as a marker to diagnose the severity of fungal sepsis and outcome of those babies. Objectives of this study was to describe thyroid hormone variations in new-borns with fungal sepsis and to find the correlation between thyroid hormone deficiency and severity of fungal sepsisMethods: It is a prospective observational study of 100 infants done in Sree Balaji Medical College, chrompet. Thyroid profile was done to all patients. Patients with Low T3 syndrome and Low T3, T4 syndrome were divided into group A and B and statistical analysis was done to find the correlation between thyroid insufficiency and severity of the fungal sepsis.Results: Significant correlation was noted between low T3, low T4 levels and fungal sepsis.Conclusions: Thyroid insufficiency, with the variables described, could be a marker of disease severity with the possible need for hormone supplementation to decrease the mortality.