Anemia and inflammation, a link between end stage kidney disease and left ventricular hypertrophy

Background: Based on Glomerular Filtration Rate (GFR) Chronic Kidney Disease patients are classified into five stages. It starts with early stage of CKD and finally ends with End Stage Kidney Disease (ESKD). Anemia and inflammation are major medical complication in End Stage Kidney Disease and leads cardio vascular complications like LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh, India 120 in which 60 are normal healthy individuals and 60 are End stage kidney Disease. In all the participants Serum creatinine, blood urea, Serum Iron, TIBC, TSAT% Serum ferritin, Serum CRP, IL-6 and TNF-α was measured. All the EDTA blood samples were analyzed for complete blood count. Results: The diagnostic criteria for CKD like blood urea and serum creatinine were significantly higher in ESKD. There is a significantly increased level of Left ventricular mass index in ESKD when compared with Control. The mean erythrocyte indices are decreased in ESKD. The mean serum iron, TIBC and TSAT% decreased ESKD. Whereas serum ferritin significant increase in ESKD group and the mean serum CRP IL-6 and TNF-α significant increase in ESKD group when compared with controlConclusion: Present study finding suggested that there is a raised inflammatory marker in ESKD patients due to inflammation and it further changes serum ferritin, serum iron and TIBC. The above altered factors leads to changes in erythrocyte indices and leads to anemia which ends with cardiovascular complication like Left Ventricular Hypertrophy.

Dyslipidemia and oxidative stress are causative factors for atherosclerosis changes in hemodialysis patients

Background: Cardiovascular disease is one of the leading cause of death in chronic kidney disease. The increased cardiovascular mortality observed in all stages of Chronic kidney disease patients. In hemodialysis cardiovascular mortality is more than 60%. In hemodialysis dyslipidemia contribute for the triggering of atherosclerosis. Endothelial dysfunction and oxidative stress are serves as main precursor for the progression of atherosclerosis. So the present study was aimed at studying lipid profile and oxidative stress in hemodialysis patients.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh, India. A total of 60 hemodialysis patients are included. In all the participants Lipid profile, SOD, MDA and Serum Nitrate was measured. Results: There is a significantly increased levels of serum triglycerides and VLDL in hemodialysis patients when compared with Control. The HDL-C was significant Lower in hemodialysis patients when compared with control. The serum total cholesterol and LDL-C not shown any significant change. The Serum MDA and Serum Nitrate was significantly higher in hemodialysis patients compared with Control and it is statistically significant (p<0.001). Whereas the serum SOD value was significantly decreased in hemodialysis patients when compared with control and it is statistically significant (p<0.001).Conclusion: Present study finding suggested that the incidence of atherosclerosis changes are higher in hemodialysis patients. Early detection and correction of atherosclerosis changes can help us to reducing the deleterious effects.

Reno-protective effect of angiotensin converting enzyme inhibitor and angiotensin II receptor blockers in type 2 diabetic nephropathy with elevated urine albumin to creatinine ratio

Background: Nephropathy is responsible for an End Stage Renal Disease (ESRD) in type 2 diabetics if uncontrolled. The monotherapy/combination of Angiotensin Converting Enzyme inhibitor (ACEi) and Angiotensin II Receptor Blockers (ARBs) can retard the progression of urine albumin to creatinine ratio in diabetic nephropathy but, the data shows an inconsistency in the efficacy of these drugs. So, the present study was aimed at comparing the reno-protective effect of ACEi/ARBs in type 2 diabetics.Methods: A prospective, randomized study is conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India with 100 patients, who are randomly categorised and equally distributed among the two groups and treated with Enalapril (ACEi) and Losartan (ARBs) for 6 months. 24-hour urine albumin to creatinine ratio and HbA1c are recorded before and after the treatment.Results: Enalapril and losartan showed a non-significant reduction in urine albumin to creatinine ratio from 196.2±17.5 to 185.9±15.2 (p=0.66) and 236.8±16.3 to 193.7±20.6 (p=0.11) respectively. A strict glycemic control has shown a reduction in HbA1c in both the groups.Conclusions: Present findings suggested that losartan is relatively more effective than enalapril in reducing the 24-hour urine albumin to creatinine ratio of diabetic nephropathy patients. Along with these drugs, regulation of blood glucose will assist in retarding the progression of nephropathy in type 2 diabetics.

A study of root canal morphology of human primary molars using computerised tomography: An in vitro study.

Knowledge of the size, morphology and variation of the root canals of primary teeth are useful in visualizing the pulp cavity during treatment. This study was carried out to investigate the applicability of Computed Tomography in studying the root canal morphology of the primary molars. A total of 60 primary molars.without any macroscopic root resorption were collected and divided into four groups. The samples were arranged in wax block and then scanned for evaluation in the CT Scanner both in axial and coronal plane. The results obtained from the scanned images were statistically analyzed to know the frequency, mean and standard deviation for all the groups. The images showed the complexity of the root canals of the primary molars and also several capabilities of the CT Scan in advance Endodontic research in primary teeth were observed.

A compound composite odontoma associated with unerupted permanent incisor--a case report.

Odontomas are the most common type of odontogenic tumors and generally they are asymptomatic. Frequently it may interfere with the eruption of the teeth. This is a case report of a compound composite odontoma in a 9 year old girl, which results in failure of eruption of the permanent upper right central incisor while the contralateral tooth had erupted. A calcified mass was seen in the radiograph and was provisionally diagnosed as odontoma following which the odontoma was enucleated. Routine follow up was done for more than a year and no recurrence was seen. This case report indicates that early diagnosis and management ensures better prognosis.

Comparative evaluation of glass ionomer and resin based fissure sealant using noninvasive and invasive techniques--a SEM and microleakage study.

The efficacy of using invasive and non-invasive techniques was assessed by Scanning electron microscopy, and by microleakage of Glass ionomer (GC VII, Fuji) and Resin based sealant (Helioseal-F, Ivoclar Vivadent). 100 young premolars were used for this study, and they were divided into four groups: Group I: non-invasive technique GC VII, Group II: Invasive GC VII, Group III: Non-Invasive Helioseal-F, Group IV: Invasive, Helioseal-F. 5 teeth from each group were evaluated under SEM. It was seen that the flow and adaptation of GC VII was slightly better than Helioseal F, and the invasive technique provided the best flow and adaptation. For microleakage analysis 5% methylene blue was used. It was seen that minimal microleakage was seen in Group IV (P<0.01). Considering the recent controversies using resin based sealants, it can be said that GC VII can be a viable alternative for pit and fissure sealants.

Evaluation of efficacy of Sofscale. A clinical and SEM study.

Efficacy of Sofscale in the case of removal of calculus from the root surface as claimed by manufacturers was evaluated in the present study. 32 patients suffering from chronic periodontitis, having calculus deposits in the lower incisors were selected for the study. A double blind study was conducted to evaluate the ease with which calculus could be removed. In the second part of study, a SEM study of the root surface subjected to root planing alone and root planing after application of Sofscale was done to see whether any remnants of calculus was left behind. In the double blind study conducted on 32 patients, it was found in 21 patients, calculus could be removed with greater ease and less time in experimental area compared to the control. 17 patients were able to correctly identify the product side as easier to Sofscale. Patients did not complain of increased sensitivity of teeth or discomfort following application of Sofscale. Under SEM the root surface after root planing showed the presence of smear layer whereas after Sofscale application root surface appeared devoid of smear layer. No other significant difference were noticed between the root surfaces.

Efficacy of minocycline as a root conditioner in comparison to citric acid and tetracycline. An in vitro evaluation.

This study compared the root surface characteristics produced by Minocycline HCl, Citric acid and Tetracycline HCl. when used as a root conditioner. This study included 5 groups of 10 extracted teeth each with advanced periodontal disease. Diseased root surfaces of group B,C,D and E were planed with Gracy curets and solutions of Citric acid, Tetracycline HCl, Monocycline Hcl and Tween 80 of PH 2.5, were applied to the surface in respective groups with cotton pellets for 5 mts. Group A was not subjected to root planning or application of any root conditioner and was used as a control. The teeth in all five groups were then washed, sectioned processed and examined under scanning electron microscope. These results revealed that the surfaces of acid treated sites differed from each other and with specimens treated sites differed from each other and with specimens treated with root panning alone. The efficacy of Minocycline and tetracycline in the removal of smear layer and exposure of dentinal tubules were comparable and Minocycline HCl though not as effective as Citric acid can probably be recommended in view of its antibactrial activity, anti collagense and substantivity properties.

Biodegradable dental implants of ciprofloxacin beta-cyclodextrin inclusion complex in the treatment of periodontitis.

Dental implants of ciprofloxacin beta-cyclodextrin inclusion complex were formulated using poly (epsilon-caprolactone), a biodegradable polymer and evaluated. Clinical evaluation was carried out in ten patients with acute peridontitis. Various clinical parameters, viz. gingival index, plaque score, attachment gain, reduction in pocket depth were evaluated at 10, 20, 30, 40 days of treatment and compared with placebo as control. A significant (P < 0.0001) improvement in the healing of periodontal pockets treated with ciprofloxacin beta-cyclodextrin implant was observed in most of the clinical parameters. Estimation of gingival crevicular fluids (GCF) for the drug content revealed that drug levels above the minimum inhibitory concentration (10.2 micrograms/mg) for many of the periodontal pathogens were maintained throughout the period of study (40 days). This confirms the clinical efficacy of the dose and the duration of the study. It was found that biodegradable carrier was better accepted than the non-biodegradable carriers reported earlier.

Efficacy of Chitra granule and powder (hydroxyapatite) in alveolar bone regeneration in rabbits. A histological evaluation.

The reconstruction or restoration of osseous defects caused by inflammatory periodontal disease is a continuing challenge in periodontal therapy. Great strides are being made to this effect using alloplasts such as hydroxyapatite. The present study was designed in Newzealand dwarf rabbits to observe the biologic response of periodontal tissues to synthetically prepared hydroxyapatite in both powder and granule forms by Srichitra Tirunal Institute for Medical Sciences & Technology, Trivandrum and to compare it with that of a commercially available, pure resorbable hydroxyapatite, OsteoGen (HA Resorb). The test materials were implanted in the artificially created bonydefects in the mandible via an intraoral approach. The wounds were allowed to heal upto 26 weeks postimplantation. The clinical evaluation at 12 weeks and 26 weeks postimplantation revealed neither any evidence of inflammation, infection or abscess formation nor any exposure or exfoliation of test materials. The histological examination of the implant sites at 12 and 26 weeks postimplantation revealed varying extent of formation of new osseous tissue and periodontal fibers. A comparison between test materials and control suggested that Chitra granules exhibit a relatively greater potential for newbone and periodontal fibre formation.

Metastasis to maxillary gingiva from carcinoma of breast. A case report.

A rare case of metastatic infiltrating duct carcinoma involving gingiva in relation to maxillary left canine-premolar of a 40 year old female is presented. The unilateral gingival enlargement in canine-premolar region was quite unusual. Pertinent history and histological examination revealed that the tumor was a metastatic carcinoma, the primary lesion of which was in the breast. The differential diagnosis of gingival enlargements is discussed in this paper. The resemblance of this mass to an inflammatory hyperplastic condition reflects the need for a detailed case history and examination.

Enamel etching by carbon dioxide laser. An in-vitro comparative evaluation.

The enamel surfaces etched with carbon dioxide laser and 37% phosphoric acid were compared with regard to surface topography. The shear bond strengths of composite bonded to enamel etched by laser and acid were also compared in the study. Out of the 72 human healthy premolars selected for the study, 12 teeth were used for studying the surface topography using scanning electron microscope. The shear bond strengths were evaluated using a Hounsfield Tensometer in the remaining 60 teeth. Under scanning electron microscope, carbon dioxide laser etching of enamel produced a poor etch pattern. The shear bond strengths of composite bonded to laser etched enamel appeared inferior as compared to those on acid etched enamel. Paired t-test gave a statistically significant difference between the shear bond strengths of composite bonded to laser etched and acid etched enamel surfaces.

Periodontal implications of Class II restorations. Clinical and SEM evaluation.

30 subjects with class II silver amalgam restorations were studied to evaluate the influence of these restorations on periodontal health of the adjacent region. The incidence of overhangings were noted. The periodontal changes were recorded with the help of indices. The surface of the restoration and the interface between the restoration and the cavity margin were observed on extracted teeth under SEM. The gingival and periodontal status at the site of the restoration were affected by the restoration and the restoration showed a rough surface as compared to the enamel on SEM examination.

Antibacterial activity of ciprofloxacin-beta-cyclodextrin complex and its efficacy in dental implants.

Ciprofloxacin forms an inclusion complex with beta-cyclodextrin. The in vitro antibacterial activity of ciprofloxacin on E. coli and Staphylococcus aureus was found better on complexation. The complex was found very effective as a local antibacterial agent when used in dental implants. Significant reduction in the gingival index, probing pocket depth and microbial growth coupled with gain in attachment at the test site compared to control on the 14th day was observed when the implants containing 2.0 mg of the complex equivalent to 0.4 mg of ciprofloxacin was used in clinical trials.

Changes in Na and K ions in mouse liver following in vivo exposure to ultrasound.

Mouse liver was exposed in vivo to a continuous and unfocussed ultrasound of 875 KHz at 5, 10 or 15 W/cm2 for 300 sec spread over five days and excised on day 0, 1, 5 and 10 for studying the changes in Na+ and K+ reserves and Na-K-ATPase activity. At 5 and 10 W intensities the change in ionic concentrations and Na-K-ATPase activity were almost in linear. At 15 W intensity the loss of both the ions and suppression of Na-K-ATPase indicated the damage of hepatic tissue caused by high intensity ultrasound. By day 10, all the animals of three exposures showed a normal ionic concentration with an optimum Na-K-ATPase activity in liver indicating the recovery process. The results indicate that ultrasound induces permeability changes in a glandular tissue exposed in vivo.