A STUDY TO EVALUATE THE IMPORTANCE OF FASTING LIPID PROFILE ESTIMATION AS THE PART OF INITIAL EVALUATION OF HIV POSITIVE PATIENTS BEFORE STARTING HAART

BACKGROUND:-There is evidence that ART is associated with lipodystrophy syndrome, a disturbance of lipid metabolism characterised by insulin resistance, dyslipidaemia, and fat maldistribution, metabolic bone disease (osteopenia and/or osteoporosis), and lactic acidosis. ART- associated dyslipidaemia is characterized by elevated serum concentrations of total cholesterol, triglycerides, low density lipoprotein 2(LDL-c), very low-density lipoprotein (VLDL), and Apo lipoprotein B (apoB) and low levels of high density lipoprotein (HDL-c) constituting an atherogenic lipid 1pro?le . In this study 143 young patients who were attending the Antiretroviral Therapy Plus MATERIAL AND METHODS:- Centre & Medicine Wards, ACSR GMC NELLORE were included randomly. 5ml Sample preparation and Biochemical assay :- of venous blood sample was collected by venipuncture from 12 hours overnight fast and centrifuged at 3000 cycles per minute and serum was separated for lipid pro?le measurement within one hour of blood collection. The serum levels of TC, HDL-C, LDL-C, VLDL and TG were measured using AU480 BECKMANS random access fully automated auto analyzer at Biochemistry laboratory, ACSR GMC, NELLORE. TC, LDL and TC/HDL lipid pro?les are signi?cant. F-Signi?cant values are RESULTS;- <0.05, reject null hypothesis. It means that the difference among the lipid pro?les of TC, LDL and TC/HDL in the study group is statistically signi?cant with respect to regimen groups. HDL, TG and VLDL lipid pro?les are not signi?cant. F-Signi?cant values are >0.05, no evidence to reject null hypothesis. It means that the no signi?cant difference among the lipid pro?les of HDL, TG, and VLDL in the study group is not statistically signi?cant with respect to regimen groups. Signi?cant CONCLUSIONS:- metabolic and morphological alterations occur in HIV infected patients especially in patients on HAART. The patients on HAART had an elevated Castelli Index I, indicating an increased risk for atherosclerotic cardiovascular disease in this population. There is need to assess lipid pro?les at baseline before initiation of HAART treatment and lipid pro?le monitoring during therapy to monitor any rising trends. New medications with more lipid friendly pro?les within existing drugs such as darunavir (PI), etravirine (NNRTI), new classes of drugs such as integrase inhibitors (raltegravir) and CCR5 inhibitors (maraviroc) can be used to avoid dyslipidaemia

MARPE as an adjunct to orthodontic treatment

ABSTRACT Introduction: Miniscrew or microimplant-assisted rapid palatal expansion (MARPE) devices are used to achieve a skeletal expansion of the palate and to increase the arch perimeter. Objective: To describe the treatment of a 23-year-old woman with an Angle Class II, division 1 malocclusion with constricted maxillary and mandibular arches. Case report: The patient's main complaint was mandibular anterior crowding. The treatment plan included expansion of the mandibular arch concurrent with maxillary expansion, using a MARPE appliance in combination with a full-fixed appliance to align and level the crowded mandibular teeth, along with miniscrews as anchorage for the maxillary teeth and for distalization of the molars and premolars. A successful non-extraction orthodontic treatment was accomplished after 28 months, and the occlusion and teeth alignment, as well as facial goals, were resolved in a clinically satisfactory manner. Conclusion: The treatment objectives were met, and the outcome of the expansion of the maxillary arch with a MARPE appliance as an adjunct to a fixed appliance was considered a success. An esthetic, functional, and stable result after a 1-year follow-up was achieved and was satisfactory to the patient.

RESUMO Introdução: Os aparelhos para expansão rápida da maxila (ERM) apoiada em mini-imlantes (MI) (MARPE) são usados para obter uma expansão esquelética do palato e aumentar o perímetro da arcada dentária superior. Objetivo: Este relato de caso descreve o tratamento de uma paciente do sexo feminino de 23 anos de idade, com má oclusão Classe II de Angle, divisão 1, com constrição das arcadas superior e inferior. Relato de caso: A queixa principal da paciente era o apinhamento anteroinferior. O plano de tratamento incluiu a expansão maxilar usando o aparelho MARPE, em combinação com aparelho fixo para a expansão da arcada inferior, concomitante ao alinhamento e nivelamento. Utilizou-se MI como ancoragem para a distalização dos molares e pré-molares superiores. O tratamento ortodôntico sem extrações foi realizado em 28 meses, e a oclusão e o alinhamento dos dentes, assim como os resultados faciais obtidos, foram clinicamente satisfatórios. Conclusão: Os objetivos do tratamento foram alcançados, e o resultado da ERM com aparelho MARPE junto ao aparelho fixo foi considerado um sucesso. Observou-se resultados estéticos e funcionais estáveis após um ano de acompanhamento, satisfatórios para a paciente.

Metabolic syndrome among patients taking second generation antipsychotics: does obstructive sleep apnoea and sleep quality play any role?

Background: Metabolic syndrome (MetS) is common among patients who have been exposed to second generation antipsychotics (SGA). Obstructive sleep apnoea (OSA) and sleep quality may also contribute to MetS. Aims: To study the contribution of sleep quality and OSA on the development of MetS in patients taking SGA. Methods: Total 60 patients taking SGA for more than three months were taken for the study. It was an observational, cross-sectional study. The diagnosis of OSA was done using Hindi translation of Berlin questionnaire. Hindi version of the Pittsburg Sleep Quality Index was used to assess the sleep quality. MetS was diagnosed using Adult Treatment Panel III criteria. Results: Forty two subjects did not have MetS, out of which 35 had low risk of OSA and seven had high risk of OSA, while 18 subjects had MetS of which nine each had high and low risk of OSA. The results were highly significant with a p-value of 0.007 (p?0.05). Subjects without MetS (n=42) comprised four good sleepers and 38 poor sleepers. Subjects with MetS (n=18) comprised of one good sleeper and 17 poor sleepers. The results were non-significant with a p-value of 0.525 (p?0.05). The high risk of OSA had around seven times higher likelihood of contribution to MetS. Conclusions: Sleep quality did not play a significant role in increasing the likelihood of MetS and OSA increased the likelihood of MetS in subjects exposed to SGA by seven times.

Occlusal plane canting: a treatment alternative using skeletal anchorage

ABSTRACT A canted occlusal plane is the cause of unaesthetic smile, and also represents a challenge, due to the complex orthodontic procedures involved in its treatment. The skeletal anchorage allows successful treatment of this asymmetry in the majority of cases, with less dependency on the patient cooperation and reducing the necessity of orthognatic surgery. Given this condition, this article aims at discussing the main aspects related to the diagnosis of occlusal plane canting, treatment plan, and orthodontic mechanics using skeletal anchorage either by mini-implants or miniplates. In this context, five cases will be reported, showing the main details related to the orthodontic mechanics used to correct the occlusal plane, avoiding side effects and successfully reaching treatment objectives and long-term stability.

RESUMO O plano oclusal inclinado é causa de um sorriso esteticamente desagradável e representa um desafio, devido à complexidade dos procedimentos ortodônticos envolvidos no seu tratamento. A ancoragem esquelética permite a correção da inclinação do plano oclusal, na maior parte dos casos, sem a necessidade de cirurgia ortognática e com menor dependência da colaboração dos pacientes. Com base nisso, o objetivo desse artigo é discutir os principais aspectos relacionados ao diagnóstico, plano de tratamento e mecânica ortodôntica envolvida no tratamento do plano oclusal inclinado com mini-implantes ou miniplacas. Nesse contexto, cinco casos serão apresentados, demonstrando os principais detalhes relacionados à mecânica utilizada na correção do plano oclusal inclinado com a utilização de ancoragem esquelética.

Comparison of treatment effects between four premolar extraction and total arch distalization using the modified C-palatal plate / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to compare the skeletal, dental, and soft-tissue treatment effects of nonextraction therapy using the modified C-palatal plate (MCPP) to those of premolar extraction (PE) treatment in adult patients with Class II malocclusion. METHODS: Pretreatment and posttreatment lateral cephalographs of 40 adult patients with Class II malocclusion were retrospectively analyzed. The MCPP group comprised 20 patients treated with total arch distalization of the maxillary arch while the PE group comprised 20 patients treated with four PE. Fifty-eight linear and angular measurements were analyzed to assess the changes before and after treatment. Descriptive statistics, paired t-test, and multivariate analysis of variance were performed to evaluate the treatment effects within and between the two groups. RESULTS: The MCPP group presented 3.4 mm of retraction, 1.0 mm of extrusion, and 7.3° lingual inclination of the maxillary central incisor. In comparison, the PE group displayed greater amount of maxillary central incisor retraction and retroclination, mandibular incisor retraction, and upper lip retraction (5.3 mm, 14.8°, 5.1 mm, and 2.0 mm, respectively; p < 0.001 for all). In addition, the MCPP group showed 4.0 mm of distalization and 1.3 mm of intrusion with 2.9° distal tipping of the maxillary first molars. CONCLUSIONS: These findings suggest the MCPP is an effective distalization appliance in the maxillary arch. The amount of incisor retraction, however, was significantly higher in the PE group. Therefore, four PE may be recommended when greater improvement of incisor position and soft-tissue profile is required.

Changes in buccal facial depth of female patients after extraction and nonextraction orthodontic treatments: A preliminary study / 대한치과교정학회지

OBJECTIVE: This study was performed to investigate buccal facial depth (BFD) changes after extraction and nonextraction orthodontic treatments in post-adolescent and adult female patients, and to explore possible influencing factors. METHODS: Twelve and nine female patients were enrolled in the extraction and nonextraction groups, respectively. Changes in BFD in the defined buccal region and six transverse and two coronal measuring planes were measured after registering pretreatment and posttreatment three-dimensional facial scans. Changes in posterior dentoalveolar arch widths were also measured. Treatment duration, changes in body mass index (BMI), and cephalometric variables were compared between the groups. RESULTS: BFD in the buccal region decreased by approximately 1.45 mm in the extraction group, but no significant change was observed in the nonextraction group. In the extraction group, the decrease in BFD was identical between the two coronal measuring planes, whereas this differed among the six transverse measuring planes. Posterior dentoalveolar arch widths decreased in the extraction group, whereas these increased at the second premolar level in the nonextraction group. The treatment duration of the extraction group was twice that of the nonextraction group. No differences were found in BMI and Frankfort horizontal-mandibular plane angle changes between the groups. BFD changes in the buccal region moderately correlated with treatment duration and dental arch width change. CONCLUSIONS: BFD decreased in adult female patients undergoing extraction, and this may be influenced by the long treatment duration and constriction of dentoalveolar arch width. However, nonextraction treatment did not significantly alter BFD.

Alveolar ridge expansion-assisted orthodontic space closure in the mandibular posterior region / 대한치과교정학회지

Orthodontic closure of old, edentulous spaces in the mandibular posterior region is a major challenge. In this report, we describe a method of orthodontic closure of edentulous spaces in the mandibular posterior region accelerated by piezoelectric decortication and alveolar ridge expansion. Combined piezosurgical and orthodontic treatments were used to close 14- and 15-mm-wide spaces in the mandibular left and right posterior areas, respectively, of a female patient, aged 18 years and 9 months, diagnosed with skeletal Class III malocclusion, hypodontia, and polydiastemas. After the piezoelectric decortication, segmental and full-arch mechanics were applied in the orthodontic phase. Despite some extent of root resorption and anchorage loss, the edentulous spaces were closed, and adequate function and esthetics were regained without further restorative treatment. Alveolar ridge expansion-assisted orthodontic space closure seems to be an effective and relatively less-invasive treatment alternative for edentulous spaces in the mandibular posterior region.

Orthodontic treatment of gummy smile by maxillary total intrusion with a midpalatal absolute anchorage system / 대한치과교정학회지

This article describes the orthodontic treatment of a 31-year-old Korean female patient with gummy smile and crowding. The patient showed excessive gingival display in both the anterior and posterior areas and a large difference in gingival heights between the anterior and posterior teeth in the maxilla. To correct the gummy smile, we elected to intrude the entire maxillary dentition instead of focusing only on the maxillary anterior teeth. Alignment and leveling were performed, and a midpalatal absolute anchorage system as well as a modified lingual arch was designed to achieve posterosuperior movement of the entire upper dentition. The active treatment period was 18 months. The gummy smile and crowding were corrected, and the results were stable at 21 months post-treatment.

Impact of waist circumference measurement variation on the diagnosis of metabolic syndrome

INTRODUCTION: While waist circumference (WC) is widely used as an index for visceral fat accumulation and purportedly the primary pathology responsible for the metabolic syndrome (MS), its proposed cut-off value varies depending on the disparate diagnostic criteria used as well as on the gender, race and ethnic group being evaluated. Due to the strong association between MS and central obesity, waist circumference should be incorporated into the routine physical exam when assessing cardiovascular disease and diabetes risk. Currently however, there is no standard location for the measurement of WC. On literature review, we found no scientific rationale for preferring any one WC site to the others hence, this study.OBJECTIVE: This study aims to (1) determine waist circumference measurement var iat ions among MS patients, (2005 NCEP-ATP III/AHA/NHLB criteria), at three levels: (A) umbilical level, (B) midline level (between the inferior margin of the ribs and the superior border of the iliac crest) and (C) level of the superior border of the iliac crest.RESEARCH DESIGN AND METHODS: Across - sectional analytical study among adult patients, aged 40 to 69 years, diagnosed with MS using 2005 NCEP-ATP III/AHA/ NHLB criteria seen at the Philippine General Hospital, as part of the Asia-Oceania Survey on Metabolic Syndrome and Diabetes initiated by the Japan Diabetes Society.RESULTS: A total of 187 MS individuals were included in the study (56% females). Both males and females were obese stage 1 (25.5 kg/m2 and 26.7 kg/m2 respectively). The mean WC measurements at level A in men was 92.9 cm (81.36 - 104.44 cm) and 93.83 cm (83.4 - 104.26 cm) in women; at level B, the mean WC in men was 90.73 cm (75.49 - 105.97 cm) and 91.51 cm (80.62 - 102.4 cm) in women; and at level C, the mean WC in men was 93.5 cm (81.97 - 105.03 cm) and 95.12 cm (85.11 - 105.13 cm) in women. Results showed that WC measurements at three levels did not significantly differ among MS patients when stratified to age and sex. However, when waist circumference was measured at three levels among all patients with MS, there was significant difference in WC taken at level B and level C (Sig = 0.009). Waist circumference at level A was similar and less variable to WC level B than WC at levelC.CONCLUSIONS: Among patients with MS as defined by NCEPATP III/AHA/NHLB criteria, waist circumference at level B (midpoint level between the lower ribs and superior border of the iliac crest) was smaller than waist circumference at level A (umbilical level) and smaller than level C (superior border of the iliac crest) (WCB

Camouflage treatment in adult skeletal Class III cases by extraction of two lower premolars / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to evaluate the dentoskeletal and soft tissue profile changes after extraction of two lower first or second premolars in "borderline" adult skeletal Class III cases. METHODS: Twenty-eight patients with "borderline" skeletal Class III malocclusion were studied. All of them were treated by extraction of two lower first or second premolars. Lateral cephalometric radiographs taken at the start and end of treatment were analysed. Twenty-five cephalometric variables were calculated and paired t-tests were performed. RESULTS: After treatment, no significant changes were noted in the skeletal parameters (p > or = 0.05). Regarding the dental parameters, the L1-MP angle decreased by 8.1degrees, the U1-L1 angle increased by 7.7degrees (p < 0.01), the overjet distance increased by 5.7 mm (p < 0.01), the L1-NB angle decreased by 7.3degrees and the L1-NB distance decreased by 4.8 mm (p < 0.01). The soft tissue parameters of Li-E, Li-H and Li-RL2 distance decreased by 3.2 mm, 3.4 mm and 4.1 mm respectively (p < 0.01). CONCLUSIONS: Orthodontic camouflage treatment by extraction of two lower first or second premolars provides a viable treatment alternative for "borderline" skeletal Class III cases to achieve a good occlusal relationship.