Evaluation of the mother's anxiety and child's fear in two different age groups in the child's first and second dental visit

The anxiety of the mother influences the child’s behaviour in a dental setting. Objectives: The study aimed at evaluating the mother’s anxiety and a child’s fear of first and second dental visits in two different age groups. Study Design: The cross?sectional study design consisted of a total of 100 mother?child pairs attending Pediatric Dental clinics was included in the study. Group I consisted of 50 mother?child pairs of 6?8 years of age. Group II consisted of another 50 mother?child pairs between 12?15 years of age. Short Form of the Dental Subscale of the Children’s Fear Survey Schedule (DFSS?SF) was administered to the child. Corah’s Dental anxiety scale was administered to the mother. The Tell?Show?Do (TSD) technique was used in all children before the treatment. Statistical Analysis Used: SPSS software 21 was used for descriptive and inferential statistics. Pearson’s correlation coefficient was used for bivariate correlation between variables in the study. Results: The anxiety level of mothers on both appointment days in both age groups was found to be highly significant. The correlation of maternal anxiety to the gender of the child in both groups was found to be highly significant. Conclusion: The fear of dental treatment was commonly found in children irrespective of gender in both age groups. The TSD technique was found to reduce fear in the subsequent appointment.

A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma

Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

Gross and Histopathological Findings in Fatalities Caused by Pulmonary Disease: An Autopsy Study

Respiratory pathologies are some of the common causes of deaths and it has been reported that in almost 1/3rd cases of sudden deaths the primary pathology may be attributable to pulmonary pathology. One of the important aspect of respiratory pathologies is that they can progress rapidly over a short period of time and in many cases these pathologies may prove to be fatal. In such cases gross and histopathological examination of lung tissue can give valuable insights into the cause of death. We conducted this prospective study to study the pathological findings in the lungs of such cases. Methods: The present study was conducted in the department of forensic medicine and toxicology of a tertiary care medical college situated in an urban area. The duration of study was 2 years. All cases of natural deaths brought for medico-legal autopsy were included in this study on the basis of a predefined inclusion and exclusion criteria. Virchow’s technique for dissection was followed in all the cases. The demographic details, gross and histopathological examination of lungs was done and findings were noted. Statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: The study consisted of a total 54 patients out of which there were 34 males and 20 females with a M:F ratio of 1:0.58. The most common affected age group was found to be between 30-40 years (22.22%). The mean age of males and females were found to be comparable with no statistically significant difference (P>0.05). Most people died within 3-7 days from time of admission (25.92%). Pneumonia was found to be leading cause of deaths in lung pathology which contributed to 74.7% cases. On gross pathology consolidation and pulmonary edema were most common findings whereas on gross as well as histopathological examination. Conclusion: Gross and histopathological examination of lung tissue in individuals dying due to natural causes can give valuable insights into the cause of death.

Peripheral giant cell granuloma manifestation in pregnancy

The peripheral giant cell granuloma (PGCG) is a benign oral lesion occurring on the gingiva and alveolar ridge. It is the most common oral lesion and occurs at an average age of 30 years. The upsurge in the levels of estrogen and progesterone in pregnancy leads to a plethora of changes in various parts of human body, including the oral cavity. In the oral cavity, changes are commonly seen on the gingiva. These include pyogenic granuloma, PGCG and also peripheral ossifying fibroma, etc., The etiology of PGCG in our case might be related to hormonal alterations during the gestation period.

Estimation of serum lactate dehydrogenase in smokeless tobacco consumers.

Statement of Problem: Salivary and serum lactate dehydrogenase (LDH) levels have been correlated with potentially malignant lesions. Salivary LDH levels require special testing and can be expensive. The need for a simple and cost‑effective analysis tool is essential to detect the oral malignant lesions to benefit rural populations. Aim: The aim of this study is to estimate the serum LDH in patients with oral lesions due to the consumption of smokeless tobacco. Materials and Methods: Thirty‑five patients with lesions were selected for this study while twenty patients served as a control. Levels of serum LDH were assessed. Age‑ and sex‑matched controls (n = 10) with no smokeless consumption habit and with the habit but without lesion (n = 10) also had their blood drawn to assess the basal level of LDH. The results were then analyzed through the two‑tailed t‑test and Chi‑square analysis using the SPSS statistics software. Results: The mean LDH value of patients with habit and lesion is 446.8 U/L; the mean LDH value for patients with habit but without the presence of a lesion is 421.2 U/L, and the mean LDH value for patients without a habit or lesion is 269.4 U/L. The patients having the habit of using smokeless tobacco had higher LDH values compared to the other two groups, and it is found to be statistically significant (p < 0.05). Conclusion: Serum LDH values increased in patients with the habit of chewing smokeless tobacco.

Infectious keratitis – a review.

Infectious keratitis is an important problem in the Indian context, and epidemiological studies suggest a higher prevalence of disease as compared to the developed world. Various aspects of the problem, including the host defence, ocular and systemic risk factors and microbial mechanisms that enhance pathogenesis have been discussed. The clinical and microbiological approach to the infected eye and patient and the relevant tests have been outlined. The major classes of medications that are used the methods of delivery are specified. Finally, the approach to patients with non-responsive keratitis that requires surgical manoeuvres is also highlighted. Clinical experience is important in distinguishing an infective from an inflammatory corneal pathology. The role of an experienced microbiologist is inevitable, for good clinical outcome. Therapeutic keratoplasty has to be done at the right time for better clinical outcomes.

Intermediate uveitis – a review.

Intermediate Uveitis (IU) is an inflammatory disease, primarily involving the vitreous and peripheral retina. It accounts for around 8% of cases of uveitis and affects primarily children and young adults. The etiology is unknown but, found as an isolated and idiopathic condition or in association with systemic disorders such as multiple sclerosis and sarcoidosis and infectious diseases. Symptoms include painless blurring of vision, floaters and deterioration of vision. Clinical features seen are anterior segment affection with keratic precipitates and anterior chamber cells, vitritis, vasculitis in the peripheral retina, vitreal snow banks and cystoid macular edema (CME). CME was the major threat for deterioration of vision; other complications include vitreous haemorrhage, periphlebitis, cataract and glaucoma. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulations of the peripheral retina are options in patients when there is an insufficient response to periocular or systemic corticosteroids. Immunomodulatory therapy is used when other therapies fail. Pars plana vitrectomy (PPV) is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous haemorrhage, tractional retinal detachment and epiretinal membranes. IU is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications.

Conjuctivochalasis - a review.

Conjunctivochalasis is an ocular condition that is usually missed, unless specifically looked for. It is defined as a redundant loose non edematous inferior bulbar conjunctiva. Though generally asymptomatic, It may also present as dryness and foreign body sensation. Various grading systems like Mirmura ((based on Lid-parallel conjunctival folds), Mellers (based on lid-parallel conjunctival folds, punctual occlusion and conjunctival fold changes during down gaze and digital pressure) and Zhang’s based on conjunctival folds, dryness, foreign body sensations, epiphora symptoms, punctual occlusion, tear meniscus height, tear film break-up time (BUT), and conjunctival fold changes during down gaze) system has been outlined. Various etiological aspects like dissolution of the Tenon’s Capsule and role of expression of matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-3 (MMP-3) has been dealt in detail. Different surgical approaches like pastepinch- cut conjunctivoplasty and their steps are specified. Conjunctivochalasis has to be understood in a wider depth and more research work is required to understand CCh in better detail so that preventive steps can be implemented with regard to secondary causes.

Dry eye - a review.

Of the myriad reasons for visits to an ophthalmologist, one of the most common maladies afflicting patients is Dry Eye Disease (DED), which can cause mild discomfort in the early stages and endstage ocular surface damage in its more severe forms. Dry eye is a problem of utmost importance, more in the developed rather than developing nations. Various aspects of the manifestation, including the tear osmolarity, ocular surface homeostasis and the role of ocular surface epithelial stem cells in maintaining the ocular surface homeostasis have been discussed. The objective tests to assess and grade dry eye have been noted. A systematic approach to the affected eye and the patient has also been outlined. The major categories of medications used along with the methods of delivery are specified in this review. A systematic approach in understanding the type and grade of Dry Eye Disease is mandatory for good clinical response. Along with clinical management the doctor should also stress on environmental changes that exaggerates dryness.

Correlation between macular thickness and volume with visual acuity in diabetic macular edema by using domain optical coherence tomography.

Introduction: To investigate the correlation between Macular thickness and Volume with Bestcorrected visual acuity (BCVA) in eyes with Diabetic macular edema and Type 2 diabetes. Materials and Methods: A retrospective study including 60 eyes of 60 patients evaluating Retinal thickness and macular volume measured with Spectral Domain Optical Coherence Tomography and best corrected visual acuity was measured with the Snellens Chart. Results: There is significant increase in the macular thickness and macular volume with decrease in the best corrected visual acuity. Conclusion: Diabetic macular edema causes decrease in visual acuity due increase in macular thickness and volume.

Comparison of changes in astigmatism after cataract surgery in temporal versus superior incisions.

Introduction- Patients undergoing cataract surgery develop astigmatism based on location of incision. This retrospective study investigated the “Pre & post operative astigmatism after cataract surgery based on incision”. Purpose of this study was to compare astigmatismobtained in temporal & superior incision. Material and Methods- Out of 50 cataract patients collected, 25 patients were in the temporal incision PHACO group and 25 were in the superior incision PHACO group. Corneal astigmatism and corrected visual acuity were assessed 30 and 90 days after cataract surgery. Results- against the rule astigmatism is more common after superior incision cataract surgery and with the rule astigmatism is more common after temporal incision cataract surgery. Conclusion: The study reveals temporal incision, increase with the rule & superior incision increase against the rule and also concluded astigmatism is least in temporal incision.

Effect of nepafenac 0.1% on macular thickness during immediate post operative period after phacoemulsification in patients with low risk for cystoid macular edema.

Introduction: To evaluate the effect of nepafenac 0.1% after routine phacoemulsification in patient at low risk for cystoids macular edema. Material and methods: This prospective hospital based study consists of 70 eyes of 70 subject with no risk factor for cystoid macular edema who underwent phacoemulsification by an experienced surgeon. All 70 subjects received preoperative nepafenac. 35 subjects received nepafenac post operatively (treatment). SD OCT (Spectral domain optical coherence tomography) and visual acuity measurement were taken pre op and post op (1 week, 1month). Final end point where comparison of macular thickness and visual acuity between two group. Result: All subjects in this study had excellent visual outcome post cataract extraction. There was small increase in macular thickness in both treatment and control group with no difference in visual acuity between first and second post op visits. Conclusion: There is an increase in macular thickness measured by OCT in low risk patients after phacoemulsification there was no clinical effect on final visual acuity.

Study on ageing changes of the optic nerve head in a group of normal subjects.

Introduction: Thickness of RNFL around the different quadrants of the optic disc margin progressively increases. Macular fibers occupying the lateral quadrant are the most resistant to glaucomatous damage and explain the retention of the central vision till end. This study was undertaken to determine the age related changes in the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in a group of normal subjects. Material and Methods: This prospective cross sectional hospital based study consisted of 150 healthy eyes of 75 subjects whom underwent ONH measurement using the Optovue optical coherence tomography (OCT) and examined the result of optic nerve head parameters and RNFL. Results- Mean cup disc ratio was found to be higher with increasing age. And the average RNFL thickness was found to decrease with increasing age. Conclusion: There are changes in optic disc parameters and RNFL with increasing age and the changes were measurable and significant.

Estimation of high sensitivity C‑reactive protein in patients with periodontal disease and without coronary artery disease.

Background: HsCRP (Highly sensitive C reactive protein) is a global indicator for future vascular events in adults detected in blood stream 48 hours before the cardiovascular event. Periodontal disease may increase blood levels of inflammatory markers like IL-6, CRP and HsCRP. Hence the aim of the present study is to evaluate the presence of elevated HsCRP levels in chronic periodontitis patients. Material and Methods: 100 patients who reported for cardiac master health check up were enrolled in the study. The periodontal status was assessed using periodontal probing pocket depth and clinical attachment level. The decayed, missing and filled tooth was recorded using DMFT index. The venous samples of these patients were obtained for recording HsCRP levels. Results: Pearson correlation was used to analyze the relationship between HsCRP level and probing pocket depth, clinical attachment loss and DMFT. The correlation value was 0.051, 0.025 and 0.101 respectively, the correlation is statistically significant for probing pocket depth and clinical attachment level (P>0.05). Chi- square test was performed to study the association between gender and HsCRP, Diabetes Mellitus and HsCRP and Hypertension and HsCRP; the results showed that there is no significant association between any of the above mentioned factors and HsCRP level in blood. Conclusions: We found an increased level of HsCRP in patients with chronic periodontitis which revealed the susceptibility of these patients to cardiac diseases like myocardial infarction and stroke. Hence present day focus in the line of management of cardiac patient has changed from the periodontal perspective.

A rare case of toxic optic neuropathy secondary to consumption of neem oil.

A 35-year-old female was referred to our hospital with bilateral loss of vision of two days duration. She gave history of consumption of about 150 ml of neem oil five days back. Examination revealed no perception of light in both eyes. Both pupils were dilated and sluggishly reacting to light. Her fundus examination showed bilateral hyperemic, edematous discs and also edema extending along the superior and inferior temporal vascular arcade. Magnetic resonance imaging (MRI) scan showed bilateral putaminal regions with altered signal, hypointensities in T1-weighted images, hyperintensities on T2-weighted, images and hyperintense on Fluid Attenuation Inversion Recovery (FLAIR) images suggestive of cytotoxic edema due to tissue hypoxia. Her vision improved to 20/200 in both eyes with treatment after two months. This is the first case report of such nature in the literature to the best of our knowledge.

correlation between electroencephalography amplitude and interictal abnormalities audit study

The aim of this study was to establish the relationship between background amplitude and interictal abnormalities in routine electroencephalography [EEG]. This retrospective audit was conducted between July 2006 and December 2009 at the Department of Clinical Physiology at Sultan Qaboos University Hospital [SQUH] in Muscat, Oman. A total of 1,718 electroencephalograms [EEGs] were reviewed. All EEGs were from patients who had been referred due to epilepsy, syncope or headaches. EEGs were divided into four groups based on their amplitude: group one 50 microV. Interictal abnormalities were defined as epileptiform discharges with or without associated slow waves. Abnormalities were identified during periods of resting, hyper ventilation and photic stimulation in each group. The mean age +/- standard deviation of the patients was 27 +/- 12.5 years. Of the 1,718 EEGs, 542 [31.5%] were abnormal. Interictal abnormalities increased with amplitude in all four categories and demonstrated a significant association [P <0.05]. A total of 56 EEGs [3.3%] had amplitudes that were

Smile regeneration by prosthodontic way- a case report.

The realization of esthetic objectives and functional demands in the reconstruction of severely compromised dentition represents considerable clinical problems. This clinical report represents the prosthetic management of a severe dentofacial deformity with compromised periodontal status. Treatment objectives were based on Aesthetics enhancement, sociopsychological support of the patient, restoration of form function, phonetics and comfort. Following which extraction of upper incisors and alveoloplasty done. An immediate removable partial denture was fabricated, considering aesthetics, phonetics and comfort of the patient followed by replacement of incisors by metal- ceramic fixed partial denture done. Clinical relevance: prosthetic management of severlymalaligned natural maxillary anterior teeth by fixed partial denture, considering aesthetics and phonetics of the patient. Treatment objectives: Aesthetics enhancement, sociopsychological support of the patient, restoration of form function, phonetics and comfort.

Snoring-induced nerve lesions in the upper airway

The prevalence of habitual snoring is extremely high in the general population, and is reported to be roughly 40% in men and 20% in women. The low-frequency vibrations of snoring may cause physical trauma and, more specifically, peripheral nerve injuries, just as jobs which require workers to use vibrating tools over the course of many years result in local nerve lesions in the hands. Histopathological analysis of upper airway [UA] muscles have shown strong evidence of a varying severity of neurological lesions in groups of snoring patients. Neurophysiological assessment shows evidence of active and chronic denervation and re-innervation in the palatopharyngeal muscles of obstructive sleep apnoea [OSA] patients. Neurogenic lesions of UA muscles induced by vibration trauma impair the reflex dilation abilities of the UA, leading to an increase in the possibility of UA collapse. The neurological factors which are partly responsible for the progressive nature of OSAS warrant the necessity of early assessment in habitual snorers

Quantifying the reduction in nonmedical costs after the introduction of a rural county hospital in Ecuador / Cuantificación de la reducción de los costos no médicos mediante la apertura de un hospital en un cantón rural del Ecuador

OBJECTIVE: This study attempts to quantify the impact of the introduction of local second-level health services on nonmedical costs (NMCs) for residents of the rural Ecuadorian county of La Maná. METHODS: NMCs for patients accessing second-level health care were assessed by using a quasi-experimental pre- and postintervention study design. In 2007, before local second-level health care services existed, and then in 2008, after the introduction of second-level health care services in the form of a county hospital, 508 patients from the county who sought second-level health care were interviewed. RESULTS: Mean NMCs per patient per illness episode were US$ 93.58 before the county hospital opened and US$ 12.62 after it opened. This difference was largely due to reductions in transport costs (US$ 50.01 vs. US$ 4.28) and food costs (US$ 25.38 vs. US$ 7.28) (P < 0.001 for each category). CONCLUSIONS: NMCs can be decreased sevenfold with the introduction of a county hospital in a rural province previously lacking second-level health care. Introduction of rural second-level health care reduces financial barriers and thus may increase access to these health services for poorer patients in rural communities.

OBJETIVO: Este estudio tiene por objeto cuantificar la repercusión de la introducción de servicios de salud locales de segundo nivel sobre los costos no médicos para los residentes del cantón rural ecuatoriano de La Maná. MÉTODOS: Se evaluaron los costos no médicos de los pacientes que tuvieron acceso a atención médica de segundo nivel mediante un estudio cuasiexperimental de análisis previo y posterior a la intervención. En el 2007 (antes de que existieran servicios locales de este tipo) y en el 2008 (después de la introducción de atención médica de segundo nivel representada por el hospital del cantón) se entrevistaron a 508 pacientes del cantón que requirieron atención médica de segundo nivel. RESULTADOS: Los costos no médicos medios por paciente y por episodio de enfermedad fueron de US$ 93,58 antes de la apertura del hospital local y de US$ 12,62 después de la inauguración del establecimiento. Esta diferencia se debió en gran parte a la reducción de los costos de transporte (US$ 50,01 frente a US$ 4,28) y de los costos de alimentación (US$ 25,38 frente a US$ 7,28) (P < 0,001 para cada categoría). CONCLUSIONES: Es posible reducir los costos no médicos a una séptima parte mediante la apertura de un hospital local en una zona rural que anteriormente carecía de atención médica de segundo nivel. La introducción de atención médica de segundo nivel en una zona rural reduce los obstáculos financieros y, por lo tanto, podría aumentar el acceso a estos servicios de salud para los pacientes más pobres en las comunidades rurales.