Oral health status of 6- and 12-year-old school going children in Bangalore city: An epidemiological study.

Background: Oral health is an essential component of health throughout life. However, millions of individuals suffer from dental caries and periodontal disease, resulting in unnecessary pain, difficulty in chewing, swallowing and speaking, and increased medical costs; hence, the present study was conducted to evaluate the oral health status of school children which would help us in planning and implementing necessary preventive measures. Aims and Objectives: 1. To assess the prevalence of dental caries among school children, using the Dentition Status and Treatment Needs Index. 2. To assess the prevalence of malocclusion among the study population, using the WHO criteria. 3. To assess the prevalence of dental calculus among the study population using the criteria of Community Periodontal Index of Treatment Needs. Materials and Methods: The study was conducted at a school in Bangalore city. The study population comprised of school children of two age groups - 6 and 12 years. A total of 430 subjects of both the sexes were surveyed, out of which 229 were in 6-year age group and 201 in 12-year age group. Results: No significant difference was observed between the age groups - 6 and 12 years - with respect to the proportion of dental caries (P > 0.05). Highly significant difference was noticed between the two age groups with respect to calculus (P < 0.01) and malocclusion (P < 0.05).

Peripheral ossifying fibroma.

The peripheral ossifying fibroma (POF) is a reac-tive gingival overgrowth occurring frequently in the anterior maxilla in teenagers and young adults. The pediatric patient with a POF has special manage-ment considerations compared to the adult, as it requires early recognition and treatment by the dentist. It requires proper treatment protocol with close postoperative follow-up. The present report describes a case of POF in a girl, which was surgically excised from the palatal mucosa in the maxillary incisor area. Some features of the differential diagnosis and therapy when it occurs are discussed.

Albumin and Lipid Enriched Albumin for the Critically Ill.

Albumin, the principal transporter of plasma fatty acids, binds to majority of the drugs ingested, traps oxygen radicals and has potent anti-oxidant actions. Albumin binds to its specific binding sites on vascular endothelial cells and thus, prevents endothelial apoptosis. Albumin regulates the enzyme pyruvate dehydrogenase, the flux of glucose and lactate in astrocytes, and enhances the formation of anti-inflammatory lipoxins, resolvins and protectins from docosahexaenoic acid (DHA) and other polyunsaturated fatty acids that, in turn, could limit ischemia-induced neuronal damage. This may explain the beneficial action of DHA-enriched albumin in stroke and other critical diseases. ©

Management of dentoalveolar injuries in children: a case report.

Children aged 6-15 years old experience more injuries to their teeth and the injuries sustained are more serious as evidenced by a higher percentage of luxations, avulsions, fractures and dislocations. The mandible is the most frequently fractured facial bone and mandibular alveolar injuries have been reported to range between 8.1-50.6%. Those with mandibular or midface fractures have a higher incidence of associated chest, extremity, abdomen and cervical spine injuries. The growing patient with facial injuries presents the clinician with a series of thought-provoking circumstances. Dentoalveolar and mandibular injuries are especially important to understand because of the potential complications related to tooth eruption, alveolar development, occlusion and facial growth. However, the principles involved in the treatment for children need to be modified by certain anatomical, physiological and psychological factors specifically related to childhood. This case report documents the trauma, management and follow-up care of an 11-year-old boy who sustained undisplaced infraorbital, nasal fractures and mandibular dentoalveolar fracture along with other associated injuries of the extremities.

Management of facial trauma in children: A case report.

Children are uniquely susceptible to cranio facial trauma because of their greater cranial mass to body ratio. Below the age of 5, the incidence of pediatric facial fractures in relation to the total is very low ranging from 0.6-1.2%. Maxillo-facial injuries may be quite dramatic causing parents to panic and the child to cry uncontrollably with blood, tooth and soft tissue debris in the mouth. The facial disfigurement caused by trauma can have a deep psychological impact on the tender minds of young children and their parents. This case report documents the trauma and follow up care of a 4-year-old patient with maxillofacial injuries.

Aberrant expression of perilipins and 11-beta-HSD-1 as molecular signatures of metabolic syndrome X in south east Asians.

Metabolics syndrome is common in SE Asian. An hypothesis that aberrant expression of perilipins and 11-beta-hydroxysteroid dehydrogenase-1 (11-beta-HSD-1) enzyme plays a significant role in the development of metabolic syndrome X in Indians is proposed. Thus, methods designed to target perilipins and 11-beta-HSD-1 may form a novel approach in the prevention and management of metabolic syndrome X.

Biological significance of essential fatty acids.

Essential fatty acids (EFAs)--linoleic acid (LA) and alpha-linolenic acid (ALA) are critical for human survival. EFAs are readily available in the diet. But, to derive their full benefit, EFAs need to be metabolized to their respective long-chain metabolites. EFAs not only form precursors to respective prostaglandins (PGs), thromboxanes (TXs), and leukotrienes (LTs), but also give rise to lipoxins (LXs), resolvins, isoprostanes, and hydroxy- and hydroperoxyeicosatetraenoates. Certain PGs, TXs, and LTs have pro-inflammatory actions whereas LXs and resolvins are anti-inflammatory in nature. Furthermore, EFAs and their long-chain metabolites modulate the activities of angiotensin converting and HMG-CoA reductase enzymes, enhance acetylcholine levels in the brain, increase the synthesis of endothelial nitric oxide, augment diuresis, and enhance insulin action. Thus, EFAs and their metabolites may function as endogenous ACE and HMG-CoA reductase inhibitors, nitric oxide enhancers, beta-blockers, diuretics, anti-hypertensive, and anti-atherosclerotic molecules. In addition, EFAs and their long-chain metabolites react with nitric oxide (NO) to yield respective nitroalkene derivatives that exert cell-signaling actions via ligation and activation of peroxisome proliferator-activated receptors (PPARs). Thus, EFAs and their derivatives have varied biological actions that may have relevance to their involvement in several physiological and pathological processes.

Hypertension as a low-grade systemic inflammatory condition that has its origins in the perinatal period.

Genetics, oxidative stress: superoxide anion (O2*-) and hydrogen peroxide (H2O2), endothelial nitric oxide (eNO), lipid peroxides, anti-oxidants, endothelin, angiotensin converting enzyme (ACE) activity, angiotensinII, transforming growth factor-beta (TGF-beta), insulin, homocysteine, asymmetrical dimethyl arginine, proinflammatory cytokines: interleukin-6 (IL-6), tumor necrosis factor-a (TNF-alpha), C-reactive protein (hs-CRP), and long-chain polyunsaturated fatty acids (LCPUFAs), and activity of NAD(P)H oxidase have a role in human essential hypertension. There is a close interaction between endogenous molecules: eNO, endothelin, cytokines, and nutrients: folic acid, L-arginine, tetrahydrobiopterin (H4B), vitamin B6, vitamin B12, vitamin C, and LCPUFAs. Statins mediate some, if not all, of their actions through LCPUFAs, whereas these fatty acids (especially omega-3 fatty acids) suppress cyclo-oxygenase activity and the synthesis of pro-inflammatory cytokines, and activate parasympathetic nervous system, actions that reduce the risk of major vascular events. Some LCPUFAs form precursors to lipoxins and resolvins that have anti-inflammatory actions. Low-grade systemic inflammation seen in hypertension seems to have its origins in the perinatal period and availability of adequate amounts of LCPUFAs during the critical periods of brain growth prevents the development of hypertension. This indicates that preventive strategies aimed at decreasing the incidence of hypertension and its associated conditions such as atherosclerosis, type 2 diabetes, coronary heart disease (CHD), and cardiac failure in adulthood need to be instituted during the perinatal period if they are to be effective.

Can COX-2 inhibitor-induced increase in cardiovascular disease risk be modified by essential fatty acids?

Selective COX-2 inhibitors increase the risk of myocardial infarction and stroke. This has been attributed to their ability to inhibit endothelial COX-2 derived prostacyclin (PGI2) but not platelet COX-1 derived thromboxane A2 (TXA2). On the other hand, aspirin blocks both COX-1 and COX-2 enzymes without decreasing PGI2 but blocks TXA2 synthesis that explains its beneficial action in the prevention of coronary heart disease (CHD). The inhibitory action of aspirin on COX-1 and COX-2 enzymes enhances the tissue concentrations of dihomo-gamma-linolenic acid (DGLA), arachidonic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). These fatty acids form precursors to PGE1, PGI2, PGI3, lipoxins (LXs), and resolvins that have anti-inflammatory actions. In contrast, increase in the concentrations of DGLA, AA, EPA, and DHA is much less with specific COX-2 inhibitors since they do not block the formation of eicosanoids through COX-1 pathway. COX-2 inhibitors interfere with the formation of LXs and resolvins that have neuroprotective and cardioprotective actions. EPA and PGI2 have anti-arrhythmic action. EPA, DHA, and AA augment eNO formation that prevents atherosclerosis. This suggests that COX-2 inhibitors increase cardiovascular and stroke risk by interfering with the formation of eNO, PGI2, LXs, and resolvins and implies that combining EFAs with COX-2 inhibitors could prevent these complications.

Angiotensin-II behaves as an endogenous pro-inflammatory molecule.

Angiotensin-II regulates vascular tone, stimulates the release of pro-inflammatory cytokines, activates NF-kappaB, increases oxidant stress, and suppresses nitric oxide synthesis, and thus, it functions as an inflammatory molecule. Since ACE is present in many tissues, this suggests that angiotensin-II may play a significant role in atherosclerosis, congestive cardiac failure, stroke, bipolar disorder, schizophrenia, dementia, Alzheimer's disease, psoriasis, atopic and non-atopic dermatitis, eczema, several acute and chronic inflammatory diseases, and cancer, conditions in which inflammation is an aetiopathogenic factor. Thus, ACE inhibitors and/or angiotensin-II receptor blockers could be of benefit in these conditions. Furthermore, structural analogues of ACE inhibitors and angiotensin-II receptor blockers could be developed that possess anti-inflammatory actions without significant action on the cardiovascular system.

Metabolic syndrome X is common in Indians: but, why and how?

Metabolic syndrome X is common in Indians. But the exact cause for this is not clear. Earlier, I proposed that this could be due to low activities of delta6 and delta5 desaturases and consequent decreased plasma and tissue concentrations of long-chain polyunsaturated fatty acids of omega-6 and omega-3 series since perinatal period. This implies that perinatal to adult life supplementation of long-chain polyunsaturated fatty acids could prevent, arrest or postpone the development of metabolic syndrome X and its complications.

Oxidant stress in pre-eclampsia and essential hypertension.

BACKGROUND: Endothelial cell dysfunction may play a role in the pathobiology of pre-eclampsia and human essential hypertension. Vasodilators and platelet anti-aggregators such as prostacyclin and nitric oxide are produced by endothelial cells. The half-life of prostacyclin and nitric oxide are reduced by superoxide anion, whereas superoxide dismutase antagonizes its action. OBJECTIVES: To estimate the plasma concentrations of nitric oxide and lipid peroxides and those of catalase and superoxide dismutase in patients with pre-eclampsia and essential hypertension. METHODS: Patients of essential hypertension and pre-eclampsia were selected for the study. Nitric oxide and lipid peroxides were estimated in the plasma and anti-oxidants catalase and superoxide dismutase were estimated in the RBC membranes. RESULTS: The ratio between lipid peroxides and nitric oxide was elevated and the activity of superoxide dismutase reduced in patients with pre-eclampsia and uncontrolled essential hypertension. CONCLUSION: These results suggest that oxidants and anti-oxidants are altered in human essential hypertension and pre-eclampsia.

Management of the Budd-Chiari syndrome by balloon cavoplasty.

BACKGROUND: Obstruction of the suprahepatic inferior vena cava (IVC) by a membrane or stricture is the commonest cause of Budd-Chiari syndrome in the eastern hemisphere. We present our experience with the outcome of balloon cavoplasty in such cases. METHODS: We followed up 40 consecutive cases of Budd-Chiari syndrome over seven years. Doppler study of hepatic venous outflow tract (in all cases), liver biopsy (30 cases) and necropsy (two cases) were performed. Balloon cavoplasty was done in selected cases. RESULTS: Of 40 patients with BCS (mean age 35.2 [SD 8.7] years; 26 men) 5, 5 and 30 had fulminant, acute and chronic presentation, respectively. Inferior vena cavography was performed in 32 cases, and showed membranous obstruction of the IVC in 12, segmental occlusion of the IVC in 11 cases, and block in both the IVC and the main hepatic veins in the rest. Successful balloon cavoplasty was done in 18 cases with obstruction of the IVC (membrane or stricture); 15 of them are well over a mean follow up of 56 (14.6) months. Three patients developed restenosis; two of them, treated with redilatation, are doing well, and one died of septicemia and hepatic failure following a surgical bypass. Pressure gradient between the IVC and right atrium decreased significantly after cavoplasty (15.4 [2.8] vs 6.6 [2.0] mmHg; p< 0.001). CONCLUSION: Balloon cavoplasty gave encouraging results in the management of Budd-Chiari syndrome due to membranous obstruction or stricture of the IVC.

Etiology and management of obscure gastrointestinal bleed--an appraisal from eastern India.

OBJECTIVES AND METHOD: Forty patients (mean age 45 years; 24 men) attending a tertiary care hospital in eastern India during the period 1996-2000 were investigated to evaluate the etiology and clinical spectrum of obscure gastrointestinal bleed. RESULTS: The patients presented to hospital after mean symptom duration of 2.5 years. They had received an average of 15 units of blood transfusion. Most patients presented with recurrent melena (85%); all had iron-deficiency anemia. A total of 230 investigations (89 gastroscopies, 54 colonoscopies, 25 double-contrast meal and follow-through studies, 14 small bowel enemas, 24 radionuclide scans, 16 mesenteric angiographies and 8 intraoperative endoscopies) yielded positive diagnosis in 87.5% of cases. The diseases encountered were small bowel and colonic angiodysplasias (32.5%), ileal Crohn's disease (20%), intestinal tuberculosis (10%), intestinal tumors (10%), nonspecific small bowel ulcers and strictures (7.5%), Meckel's diverticulum (5%) and hemobilia (2.5%). The etiology remained obscure in 5 (12.5%) cases. Overall success of surgery was 63%; in-hospital mortality was 7.5%. CONCLUSION: Though obscure gastrointestinal bleed is commonly caused by angiodysplasias, it can be an atypical presentation of Crohn's disease.

Multidrug resistant Salmonella typhi in Rourkela, Orissa.

Out of 5410 blood samples 715 samples were found positive for Salmonella typhi. Enteric fever was prevalent for last three years in Rourkela. In last two years, a number of multidrug resistant strains of Salmonella typhi was isolated which constituted almost 16.1% of the total isolates. In this study, chloramphenicol sensitivity was found quite high (86.5%) and ceftriaxone showed 100% sensitivity. Resistance to ciprofloxacin was found 2.5% which due to direct consequence of indiscriminate use of antibiotics, either singly or in combination.

Occurrence of Salmonella typhi infection in Rourkela, Orissa.

Between January 1996 and December 1998, the isolation rate of Salmonella typhi in Rourkela was found to be on a steady rise. Of the 7866 samples (blood and bone marrow) tested, 988 were found positive for S. typhi giving an overall per cent positivity of 12.56. Enteric fever was found to occur almost throughout the year with a peak from early winter up to the end of summer. In this study, chloramphenicol was found to have an average sensitivity of 87.46 per cent. Ceftriaxone showed 100 per cent sensitivity.