RESUMEN
Background and objectives: Henoch Schonlein purpura (HSP) is a small vessel vasculitic disorder common in children and has been extensively studied. Although it is known to also occur in adults there is relative paucity of data as regards to its clinical spectrum, complications and outcome, particularly in Indian context. Hence the study was undertaken with the objective to evaluate the various skin manifestations, systemic complications of HSP in adults and also compare it with data available in children in various published clinical studies. Study design, materials, methods : In this retrospective, observational,hospital-based cohort study conducted at Goa Medical College the premier teaching institute from Goa, clinical data of adult patients (>18 years age) fulfilling the diagnostic criteria as per European League Against Rheumatism (EULAR) 2010 criteria for HSP was obtained, over period of 6 years. All the clinical manifestations, complications, investigations, outcomes were recorded. Skin biopsy histopathology and immunofluorescent test findings were also obtained. The data was analysed and results were compared to the data available in pediatric studies to ascertain the similarities and differences.
RESUMEN
Replacement of single missing tooth in the aesthetic region presents a challenge for a dentist.1 Various treatment considerations have to be dealt before decision making. Treatment options for such cases are removable partial denture, conventional or resin - bonded fixed partial denture (FPD), and implant-supported fixed prosthesis. Each modality is a possible treatment option and has its advantages and disadvantages.2,3 The treatment option selected would depend on patients’ age, desires, compliance, also the treatment cost, adjacent teeth conditions, bone availability and aesthetics being of prime concern. However, it is found that implant-supported crown is the most preferred option in case of single missing tooth in the aesthetic zone.2,4,5 Implants besides being advantageous over resin-bonded or traditional fixed partial dentures, they also prevent the unnecessary restoration on the adjacent sound teeth as required in an FPD. Hence, implants help in saving the integrity of the existing tooth in situations where the adjacent tooth is vital and have no restorations.2 Also, many authors have suggested implant as a predictable treatment option in case of single tooth replacement.6,7The success of implant is not only defined by the Osseo integration achieved but also its proper placement and with harmonious and naturally blending prosthesis.8 Yet sometimes, there may be situations wherein misaligned placement of implant and reduced interarch space for future prosthesis may pose a challenge for the Prosthodontist, especially in aesthetic zone. Methods like angulated abutments, castable abutments or in severe cases even removable prosthesis have been suggested to surmount such complications.4 The following article presents with two such case scenarios dental implants were restored with castable abutment.Restoration of missing teeth in aesthetic zone is of concern for any individual. Treatment options like removable partial denture, fixed partial denture or implant retained prosthesis can be opted. The treatment option selected would depend on patients’ age, desires, compliance, also the treatment cost, adjacent teeth conditions, bone availability and aesthetics being of prime concern.Keeping in mind the patients’ age bone and periodontal conditions, implant-supported crown is the most preferred option in case of single missing tooth in the aesthetic zone. The success of implant is not only defined by osseointegration achieved, but also its proper placement and with harmonious and naturally blending prosthesis. Yet sometimes, there may be situations wherein misaligned placement of implant and reduced interarch space for future prosthesis may pose a challenge for the prosthodontist, especially in the aesthetic zone. In such complex cases, restoration with a customized treatment plan has to be carried out in order to fulfil patients’ aesthetic requirement as well as restore the implant with a fixed prosthesis. The following article presents with two such case scenarios where the misaligned dental implant placed and the other with reduced interarch space were restored with castable abutment.
RESUMEN
Background & objectives: Scrub typhus is one of the differential diagnoses of haemorrhagic fevers especially if associated with jaundice and/or renal failure. Goa State in the western region of India has been witnessing increased incidence of such fevers, therefore, the present study was undertaken to identify whether scrub typhus is the aetiological agent. Methods: Adult patients presenting with undiagnosed febrile illness between June 2009 to October 2010, were evaluated. Testing was done using a commercial ELISA kit for specific IgM antibodies against Orientia tsutsugamushi. Results: Of the 44 patients included in the study, 15 (34%) were found to be positive for IGM antibodies against O. tsutsugamushi. The cases were seen mainly in the months between July to November. The common symptoms noted were fever, myalgias, gastrointestinal complaints, followed by breathlessness, rash and jaundice. The pathognomonic features such as eschar and lymphadenopathy were seen only in two patients. Nearly two third of the patients had leukocytosis (67%) and low serum albumin (60%). The most common complication noticed was hepatitis (80%) followed by acute respiratory distress syndrome (ARDS) (60%), thrombocytopenia (40%) and acute renal failure (33%). Five patients died in the course of illness. Interpretation & conclusions: Our results showed that scrub typhus should be considered in the differential diagnosis of acute febrile illness associated with gastrointestinal symptoms, rash, myalgia , including those with organ dysfunctions such as hepatorenal syndrome, coagulopathy or ARDS. Empirical treatment with doxycycline or macrolides may be given in cases with strong suspicion of scrub typhus.