Comprehensive Dental Management of a Medically Compromised Individual under Anticoagulant Therapy – A Victim of Rabid Dog Bite

In India, about 15 million people are bitten by animals, mostly dogs, every year and need post-exposure prophylaxis. Most animal bites in India (91.5%) are by dogs, of which about 60% are strays and 40% pets. The incidence of animal bites is 17.4/1000 population. Oral anticoagulants are usually prescribed for patients recovering from cardiovascular diseases, ischemic incidents such as myocardial infarction and angina pectoris followed by cerebrovascular accidents. Patients are usually placed under antiplatelet or oral anticoagulants increase the hemorrhage risk after oral surgical procedures. Here, we report a case of a patient on anticoagulants who, while seeking dental treatment, was bitten by a rabid street dog and shed light on the decisions faced by a dental professional while treating such patients.

Bilateral suppurative parotitis in a neonate: a case report

Acute suppurative parotitis is a very rare ailment to be encountered in the neonatal period. Here, we report a 13-day old hemodynamically stable neonate, who presented to us with bilateral tender, erythematous parotid swelling and purulent discharge exuding from stensen's duct. He was exclusively breast fed and had no other risk factors. Provisional diagnosis of acute suppurative parotitis was made with clinical examination. On investigating, there was neutrophilic leukocytosis, elevated acute phase reactants, ultrasonogram showed hypoechoic areas and a heavy growth of Staphylococcus aureus was isolated on pus culture. Baby underwent incision and drainage on the day of admission and was started on appropriate parenteral antibiotics along with supportive management. There was a significant clinical response over next 24 hours. He was doing well throughout the hospital stay and antibiotic course was completed based on culture sensitivity pattern. He neither had any immediate complications during hospital stay nor developed any late complications on follow up. Prognosis of the condition is excellent with adequate timely management. Authors would like to report this case for its rarity and to emphasize on fact that though the condition is uncommon, acute neonatal parotitis should be included in the differentials of any unilateral or bilateral neonatal parotid swelling, as early diagnosis and prompt management of this entity is mandated for a favorable outcome and to limit complications drastically.

Clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy

Background: Patients with diabetes mellitus (DM) are at an increased risk of dying from cardiovascular diseases, the reason for which is not completely understood. Aim: To study the clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy (CAN). Materials and methods: This was a cross sectional study involving 100 patients attending the diabetic clinic of a tertiary care hospital. Demographic data was collected and autonomic function testing was done with Ewing and Clark’s tests. Results: The prevalence of CAN was 58 %. CAN had statistically significant association with increasing duration of diabetes (p < 0.00001), increasing values of HbA1c (p < 0.00001), and with combined use of insulin and oral medications (p < 0.05). Conclusion: There is a high prevalence of CAN in the diabetic population providing a large pool of patients awaiting effective interventions.

Electrocardiographic Abnormalities and Cardiac Autonomic Neuropathy In Type 2 Diabetes Mellitus Patients.

Abstract: Background and Objectives: As Cardiac Autonomic Neuropathy (CAN) in Type 2 Diabetes Mellitus patients is implicated in arrhythmogenesis and sudden cardiac death; we aimed to determine the prevalence of Cardiac Autonomic Neuropathy and to compare the mean CAN scores of those patients with and without electrocardiographic abnormalities. Methodology: After a detailed history and clinical examination, 100 diabetic patients were subjected to Ewing’s and Clark’s cardiac autonomic function tests. CAN scores were computed and their electrocardiograms (ECGs) were studied. Results: 72% had severe CAN (CAN score ≥ 5). 76% had abnormal ECGs with mean CAN scores being higher in those with abnormal ECGs (Mean=7.0 ± 1.7 vs 4.3 ± 1.2, p<0.001). Significant associations were found between CAN scores and age (p=0.013), peripheral neuropathy (p=0.04) and symptoms of dysautonomia (p=0.03). There was a significant difference between the mean CAN scores of those with Coronary Artery Disease (CAD) when compared to those without CAD (Mean 7.26 ± 0.57 vs 6.12 ± 1.93, p=0.012) and between those with longer compared to shorter duration of diabetes(Mean 6.9±1.8 Vs 5.7±1.9, p=0.002). Interpretation and Conclusions: Diabetics with abnormal ECGs, CAD and longer duration of diabetes had higher mean CAN scores. As this complex inter-relationship between Diabetes, CAN & CAD can cause abnormalities in heart rate control, a high index of suspicion for asymptomatic cardiovascular disease is needed in diabetics.

Sympathovagal imbalance in thyroid dysfunctions in females: Correlation with thyroid profile, heart rate and blood pressure.

The aim of the study was to investigate the role of spectral analysis of heart rate variability (HRV) for assessing the type and degree of sympathovagal imbalance (SVI) and their link to cardiovascular morbidities in thyroid dysfunctions. Forty-five female subjects (15 control subjects and freshly diagnosed untreated 15 hypothyroid and 15 hyperthyroid patients) were recruited for the study. Thyroid profile, body mass index (BMI), basal heart rate (BHR), blood pressure (BP) and spectral indices of HRV (TP, LFnu, HFnu and LF-HF ratio, mean RR, SDNN and RMSSD) were assessed in all the three groups. LF-HF ratio was correlated with thyroid profile, BMI, BHR and BP. SVI was more prominent in hyperthyroid (P<0.001) compared to hypothyroid (P<0.05) subjects. LF-HF ratio was correlated with thyroid profile in both hypo and hyperthyroid subjects; but correlation with BHR and BP was significant only in hyperthyroidism. Though the SVI was found to be due to both vagal withdrawal and sympathetic activation, especially in hyperthyroidism, contribution by vagal inhibition was prominent. Vagal inhibition contributes significantly to SVI in thyroid dysfunctions, especially in hyperthyroidism. As the present study indicates poor cardiovascular health due to vagal inhibition in patients suffering from thyroid dysfunctions, attempt should be made to improve vagal tone especially in hyperthyroid subjects to attain a stable sympathovagal and cardiovascular homeostasis.

Invasive thymoma with intraorbital metastases.

Thymomas are epithelial neoplasm of thymus and most common primary neoplasm of anterior and superior mediastinum affecting males and females equally. It occurs usually in the fifth to seventh decade. Approximately one-third of thymomas are invasive. Metastases to distant extrathoracic sites such as the liver, lung, lymph node, kidneys, ovary and brain occur infrequently. This is more common with invasive thymomas. Although brain has been shown to be a site of infrequent metastases, intraorbital metastases has not yet been reported. Here we report one such case of invasive thymoma of anterior superior mediastinum, which later metastasized to orbit as well as the brain.

Detection of slime production by coagulase-negative Staphylococcus: an assessment of two methods.

The detection of slime can be helpful in determining the diagnostic value of coagulase-negative Staphylococcus (CNS). Here, we have made a comparative study of two phenotypic methods of slime production test from 28 clinically significant blood culture isolates of CNS. A total 16 out of 28 isolates (57.1%) were positive for slime by either of the tests, whereas only 5 out of 28 isolates (17.9%) were positive for slime by both the tests. The tube method detected slime in significantly more number of isolates than the spectrophotometric method (14 vs. 7; p<0.0483279). A weak correlation was found between the tube method and the spectrophotometric method (rs=0.2474). The tube test was found to be superior to the spectrophotometric test in terms of sensitivity, ease of performance and interpretation, and cost effectiveness.