Evaluation of Structural and Compositional Changes on the Root Surface Exposed to Diode Laser (810 nm): An In?vitro Study

Background: The laser therapy has been used as an adjuvant for conventional periodontal disease as they exhibit a bactericidal effect on scaling and root planning by its thermal and photo disruptive effects on the pathogens. This study focuses on the structural and compositional changes induced on the root surfaces of teeth following diode laser (DL) application with increasing quantum of exposure time. Objective: The objective of this study was to evaluate the structural and compositional changes on the root surface of extracted human permanent teeth after application of DLs (810 nm) with varying time interval. Materials and Methods: Twenty samples of single?rooted periodontally compromised extracted teeth were utilized for this study. Root planning was done and the roughness caused by the instrumentation was measured using profilometric analysis. Then, the samples were divided into four groups, with DL application time: Group 1 – laser application for 15 s, Group 2 – laser application for 30 s, Group 3 – laser application for 45 s, and Group 4 – laser application for 60 s. A scanning electron microscope was used to examine the cemental surface and energy?dispersive X?ray analysis software assesses the compositional changes of the teeth in each group. Results: This study reveals that on exposure of DL (810 nm) on the root surface when time of exposure increases, there were relative increases in surface irregularities and charring. There were significant changes in the chemical composition of the tooth surface.

Unusual case of isolated post-styloid parapharyngeal space metastasis in a treated case of carcinoma supraglottis: A case report and review of literature

Squamous cell carcinoma of supraglottis is a common head and neck malignancy, comprising 30% of laryngeal carcinoma. Supraglottic carcinoma commonly metastasizes to the Levels II, III, and IV cervical nodes, and distant metastases are uncommon. Delayed local and regional recurrences are known, local recurrence being more common. We report a case of carcinoma supraglottis with the advanced locoregional disease at initial presentation and treated with neoadjuvant chemotherapy followed by chemoradiotherapy with a complete response on post-treatment positron emission tomography-computed tomography (PET-CT) scan. Surveillance PET-CT showed an isolated lesion in the left post-styloid parapharyngeal space, where neurogenic tumors are more common and isolated nodal metastasis is unusual. We did ultrasound-guided FNAC and cytology confirmed the presence of metastatic poorly differentiated carcinoma.

Patient satisfaction of outpatient department at ESIS hospital, Nagpur, India

Background: Employee state insurance scheme (ESIS) is a multidimensional social security system providing medical facilities to the insured persons and their family through large network of hospitals and dispensaries all over India. The present study was done to measure the satisfaction of OPD (Outpatient Department) patients.Methods: A descriptive cross-sectional study was conducted in ESI Hospital, Nagpur, Maharashtra, India on 500 patients attending OPD. Patients were approached at the end of their OPD visits to know their perceptions towards the public health facilities, during the months of September and October 2017. Data collected was analyzed.Results: In present study, out of 500 patients, 210 (42%) said that crowd was average, 270 (54%) were satisfied with queue system, 390 (78%) were satisfied with the availability of drugs, 380 (76%) were satisfied with the behaviour of pharmacist.205 (41%) patients said it was not overcrowded, 310 (62%) patients were happy with the behaviour of registration clerk, 330 (66%) were satisfied with the seating arrangements for the patients and attendants, 265 (53%) were satisfied with the cleanliness, 205 (41%) were satisfied with the condition of toilets.390 (78%) patients said that doctor was available, 270 (54%) said that waiting time was less, 325 (65%) said that doctor listened to the problem attentively, 435 (87%) said that the doctor explained nicely about the disease while 425 (85%) were satisfied with the time given by the doctor.Conclusions: Almost half of the patients were satisfied with the registration facilities, basic amenities, service by doctor and pharmacy services. Mostly, patients chose this hospital as it was free for them due to their insurance and as it was near their house. Still, there is scope for improvement.

General versus spinal anesthesia in percutaneous nephrolithotomy: A comparative study

Background: Percutaneous nephrolithotomy (PCNL) is usually done under general anesthesia (GA). However, it can be done under spinal anesthesia (SA) which can have advantages like less bleeding, less postoperative pain, low dose analgesic requirement and less drug intake. Aim: In our study, we had compared the efficacy and safety of general versus Spinal Anaesthesia in PCNL. Materials and methods: In prospective randomized study, 100 patients undergoing PCNL were randomly assigned into two groups; group A (n = 50) underwent PCNL under GA, by injecting thiopentone, succinylcholine and vecuronium and group B (n = 50) received SA, by injecting bupivacaine and fentanyl in spinal space L4 in sitting position. Thereafter, a urethral catheter was placed in lithotomy position, head of the table was tilted down for 5 to 10 minutes, and the level of anesthesia was checked. Then, PCNL was done by standard technique. Results: Hemodynamic stability was more in SA group. Heart rate and mean arterial pressure intraoperatively at 5, 10, 15 mins and at 60 mins and postoperatively at 0, 2 and 6 hours was significantly less in SA group (P < 0.05) as compared to GA group. The VAS score was 5.29±0.62 in GA group and 0.98±0.89 in SA group at 0 hour, 5.58±0.49 in GA group and 1.88±0.84 in SA group at 2 hours and 4.26±1.30 in GA group and 2.10±1.02 in SA group at 6 hours which was significantly Meena M, Mantan K, Saxena M, Dhawan S, Sethia S, Meena A. General versus spinal anesthesia in percutaneous nephrolithotomy: A comparative study. IAIM, 2017; 4(9): 59-66. Page 60 lower in SA group in comparison with GA group (P < 0.05). Mean analgesic requirement within 24 hours was lower in SA group (76±36.05) than GA group (140±28.57) and it was statistically highly significant (p<0.001). Postoperative nausea and vomiting was more in GA group than SA group. Conclusion: Spinal anaesthesia is a safe alternative to GA for PCNL with better pain relief, less analgesic requirement, less side effects.

Salivary reservoir designs for patients with xerostomia: a review

Aim: The present paper aims to review the literature available on various approaches to salivary reservoir designs, the functional aspects, cleansibility, type of attachments used, and different techniques used for the fabrication of salivary reservoirs in patients suffering from xerostomia. Material and Methods: A search in the National Library of Medicine's Pub Med database, Google search and Science Direct was performed to include all case reports and reviews on prosthodontic rehabilitation of dentulous/partially edentulous/edentulous patient with xerostomia. Results: Out of the 35 articles found in the database search, 18 articles were included based on the designs they adopted for fabrication of salivary reservoirs. Conclusions: The various designs available in literature enable an operator to choose the most suitable reservoir design based on specific patient requirements. Innovations in reservoir design promise a more customized prosthesis for every patient. Further research and innovation will enable increasingly efficient salivary substitute delivery systems for the xerostomic patient.

Study of AgNOR count in FNAC of breast lesions.

Background:ArgyrophilicNucleolar Organizer Region technique has a potential value in the diagnosis of malignancy and can be used in cases with equivocal and inconclusive cytological picture. The purpose of this study was to evaluate mean ArgyrophilicNucleolar Organizer Region count and ArgyrophilicNucleolar Organizer Region Pattern Assessment score in fine needle aspirates of breast lumps.Materials and Methods: The present study consists of 80 cases of AgNOR count done in fine needle aspiration cytology of various breast lesions in patients on O.P.D. basis or those admitted in Guru Govindsingh Hospital attached to Shri M.P. Shah Medical College, Jamnagar during the period between August '98 to May 2000. Fine Needle Aspiration smears were studied by conventional methods and silver staining for ArgyrophilicNucleolar Organizer Regions. Histopathologic diagnosis was taken as the gold standard. Results:ArgyrophilicNucleolar Organizer Region count and ArgyrophilicNucleolar Organizer Region Pattern Assessment score were helpful in differentiating benign from malignant lesions. Mean ArgyrophilicNucleolar Organizer Region count and ArgyrophilicNucleolar Organizer Region Pattern Assessment score were 2.63 ± 1.36 and6.26 ± 1.19 respectively in benign lesions while they were 8.42 ± 2.53 and 10.05 ± 2.22 respectively in malignant lesions.With few exceptions, cases with high counts had high scores. Conclusion: Mean ArgyrophilicNucleolar Organizer Region AgNOR count and Subjective ArgyrophilicNucleolar Organizer Region Pattern Assessment score provide useful information regarding cellular proliferation. Both count and score have comparable diagnostic potential but the latter is a more convenient and rapid method for ArgyrophilicNucleolar Organizer Region evaluation.

Utility and limitation of routine SGPT & Hbsag in blood donors.

Background: After the introduction of blood banks and better storage techniques blood is more widely used in patients for various indications. In Pakistan more than 1.5 million pints of blood are collected each year. Hepatitis B and C virus infections are known to occur in the general population and due to their mode of transmission through blood and blood products, it has made safe blood transfusion difficult and screening of blood absolutely necessary. Method: In present study, total 2500 blood donors were screened for ALT estimation and HBsAg at Blood Bank, G.G. Hospital, Jamnagar. Results were tabulated in various observation tables and were compared and dicussed with other workers study. Result: Out of 2500 blood donors, 2097 were replacement donors and 403 were voluntary donors, 2421 were male donors and 79 were female donors. Out of 2500 blood donors, 2415 were healthy donors and 85 were showing high level of ALT ( > 45 KU/ml) or HBsAg positivity or both. Out of 2421 male donors, 34 donors ( 32 replacement + 02 voluntary ) were haviang high level of SGPT, 30 donors ( 26 replacement + 04 voluntary ) were having HBsAg positive and 18 donors (17 replacement + 01 voluntary ) were having HBsAg positivity and high SGPT value. Out of 79 female donors, only 03 replacement female donors were having high SGPT and none of the female donor was HBsAg positive. Mean value of ALT was found to be 26.58+8.86.Male donors have higher level of ALT and also higher incidence of HBsAg than that of female blood donors.Replacement donors have higher level of ALT and also higher incidence of HBsAg than that of voluntary donors. 2.24% of 2500 donors had abnormal or high level of ALT ( >45 KU/ml ) 1.92% of 2500 donors were HBsAg positive. 0.72% of 2500 donors were HBsAg positive as well as having high ALT value ( >45 KU/ml). Conclusion: Routine screening of ALT and HBsAgdefinetly decreases the incidence of post transfusion hepatitis.

Repair of fractured abutment teeth under pre-existing crowns: An alternative approach.

This article describes a technique for repair of abutment tooth which fractured during removal of a provisional restoration before bisque trial. The technique uses plastic templates to fabricate new composite core foundation for the existing crowns. This technique helps the dentist to rebuild the core in a single appointment.

Chlorhexidine allergy due to topical application.

Chlorhexidine is commonly used in dentistry in various forms. Allergic reactions to chlorhexidine of both immediate and delayed type have been reported. Although the incidence is low there may be severe manifestations in some patients. This report presents a case of allergy to chlorhexidine following topical application.

Association of recurrent aphthous ulcers with stress among students in an Indian Dental Institution.

Background: Recurrent aphthous ulcers are painful oral lesions with no proven effective treatment. A definitive cause of these ulcerations still remains elusive. It is believed that psychological stress may be a significant contributor. Aim: The aim of the present study was to determine whether there was any significant association of Recurrentaphthous ulcers with episodes of stress by determining the prevalence of ulcers and levels of stress tolerance among dental students. Materials and methods: A cross sectional survey was carried out on 341 students of Manipal College of Dental Sciences, Manipal, India by distributing questionnaires. The questionnaire had two sections, the first part dealt with ulcers and the later part comprised of a perceived stress scale. The data collected was analyzed with Independent sample t test and ANOVA with post hoc Tukey’s test using the SPSS 16 version software. Results: Prevalence of ulcer was found to be 66.9%. Comparison of mean stress scores between the ‘ulcer-experienced’ and ulcer-free groups showed no difference. Assessment of stress among undergraduates, interns and post graduates who had reported ulcer experience revealed that interns were able to handle the stressful situations significantly better than under graduates and post graduates. Conclusion: The present study did not show any association between episodes of ulcers and stressful events.

A comparison of the accuracy of patterns processed from an inlay casting wax, an auto-polymerized resin and a light-cured resin pattern material.

Background: Traditionally, inlay casting waxes have been used to fabricate patterns for castings. Newer resin pattern materials offer greater rigidity and strength, allowing easier laboratory and intraoral adjustment without the fear of pattern damage. They also claim to possess a greater dimensional stability when compared to inlay wax. Aims: This study attempted to determine and compare the marginal accuracy of patterns fabricated from an inlay casting wax, an autopolymerized pattern resin and a light polymerized pattern resin on storage off the die for varying time intervals. Materials and Methods: Ten patterns each were fabricated from an inlay casting wax (GC Corp., Tokyo, Japan), an autopolymerized resin pattern material (Pattern resin, GC Corp, Tokyo, Japan) and a light-cured resin pattern material (Palavit GLC, Hereaus Kulzer GmbH, Germany). The completed patterns were stored off the die at room temperature. Marginal gaps were evaluated by reseating the patterns on their respective dies and observing it under a stereomicroscope at 1, 12, and 24 h intervals after pattern fabrication. Results: The results revealed that the inlay wax showed a significantly greater marginal discrepancy at the 12 and 24 h intervals. The autopolymerized resin showed an initial (at 1 h) marginal discrepancy slightly greater than inlay wax, but showed a significantly less marginal gap (as compared to inlay wax) at the other two time intervals. The light-cured resin proved to be significantly more dimensionally stable, and showed minimal change during the storage period. Conclusion: The resin pattern materials studied, undergo a significantly less dimensional change than the inlay waxes on prolonged storage. They would possibly be a better alternative to inlay wax in situations requiring high precision or when delayed investment (more than 1 h) of patterns can be expected.

Van der woude syndrome with an unusual intraoral finding.

Orofacial manifestations of Van der Woude syndrome (VWS) include cleft lip or palate, lower lip pits, hypodontia, hypernasal voice, cleft or bifid uvula, syngnathia, narrow high arched palate, and ankyloglossia. Extraoral manifestations include limb anomalies, popliteal webs, accessory nipples, congenital heart defects, and Hirschsprung disease. We report an interesting case of VWS with characteristic orofacial features along with an unusual additional finding of fusion of primary mandibular left lateral incisor and canine in a 7-year-old boy.

Custom sectional impression trays with interlocking type handle for microstomia patients.

Making impressions in microstomia patients is often cumbersome. A modification of standard impression procedure is often necessary while treating such patients. This article describes the fabrication of a custom sectional impression tray with interlocking type of a handle for definitive impression procedures in a microstomia patient.

Lipid storage myopathies with unusual clinical manifestations.

We describe the clinical presentation, course and pathologic findings found in three adult patients with lipid storage myopathy. Excessive lipid storage was found in Type 1 fibers of muscle. Clinical improvement on oral levo-carnitine therapy suggests the possibility of carnitine deficiency as the most likely etiology in two of the patients and one had mitochondrial myopathy confirmed on genetic analysis.

Major histocompatibility complex class I expression can be used as a diagnostic tool to differentiate idiopathic inflammatory myopathies from dystrophies.

Aim: Utility of major histocompatibility complex (MHC) Class I antigen immunostaining was studied to differentiate idiopathic inflammatory myopathies from dystrophies. Materials and Methods: Forty muscle biopsies including seven dermatomyositis (DM), six polymyositis (PM), two sporadic inclusion body myositis (sIBM), 20 dystrophies (one Duchenne, three Becker's, four alpha, one gamma sarcoglycanopathy, nine limb girdle, one myotonic and one fascioscapulohumeral muscular dystrophy) and five controls were stained with antibody for MHC Class I antigen (Novocastra clone W6/32 HL 1:100 dilution). Results: Polymyositis and sIBM showed MHC class I antigen positivity along sarcolemma of single and small groups of muscle fibers. The regenerating fibers in the perifascicular area in DM showed intense cytoplasmic positivity of MHC class I antigen. Muscle fibers in all dystrophies except regenerating fibers and control normal muscle were negative for MHC. Capillaries and lymphocytes were positive controls. There were no false positives in the study. Conclusion: MHC Class I immunostaining can be used as a complementary diagnostic tool for the diagnosis of idiopathic inflammatory myopathies.

Myasthenic crisis: clinical features, complications and mortality.

BACKGROUND AND OBJECTIVE: Myasthenic crisis is a life-threatening complication of myasthenia gravis (MG) and when treated aggressively is associated with good outcome. MATERIALS AND METHODS: Retrospective study of case records of patients with episodes of myasthenic crisis. RESULTS: Twenty-one (22%) of the 95 patients with MG (9 with thymoma), experienced 23 episodes of myasthenic crisis, 3 (33%) in patients with thymoma. The crisis episodes occurred within 2 years of disease onset in 11 (52%) patients. Infection was the most common primary precipitant of the crisis occurring in 65%. The median duration of the crisis episode was 11 days (7-39 days), and the median neurological intensive care unit stay was 15 days (range 9-47 days). Fifteen (65%) episodes were treated with small volume plasma exchange (PE) and 8 (35%) episodes received intravenous immunoglobulin (IVIg). The time taken for disease stabilization, the median number of days for extubation, was 8 days (range 7-12) in the PE group and 10 days (range 7-39) in the IVIg group. Disease stabilization could not be achieved in one patient in the IVIg group. Ventilator-associated pneumonia (VAP) was the commonest complication, seen in 30%. Two (8%) of the 23 episodes of crisis were fatal, one resulting from VAP and septicemia, and the other due to crisis itself. All the 19 patients who survived to discharge had complete resolution of admission symptoms. CONCLUSIONS: In patients with myasthenic crisis, both therapeutic options, PE and IVIg, are equally effective in disease stabilization. To achieve good outcomes all efforts should be directed at decreasing the duration of intubation and also aggressively treating the associated medical complications.

Diagnosis of mitochondrial diseases: clinical and histological study of sixty patients with ragged red fibers.

BACKGROUND: Mitochondrial diseases are caused by mutations in mitochondrial or nuclear genes, or both and most patients do not present with easily recognizable disorders. The characteristic morphologic change in muscle biopsy, ragged-red fibers (RRFs) provides an important clue to the diagnosis. MATERIALS AND METHODS: Demographic data, presenting symptoms, neurological features, and investigative findings in 60 patients with ragged-red fibers (RRFs) on muscle biopsy, seen between January 1990 and December 2002, were analyzed. The authors applied the modified respiratory chain (RC) diagnostic criteria retrospectively to determine the number of cases fulfilling the diagnostic criteria of mitochondrial disease. RESULTS: The most common clinical syndrome associated with RRFs on muscle biopsy was progressive external ophthalmoplegia (PEO) with or without other signs, in 38 (63%) patients. Twenty-six patients (43%) had only external ophthalmoplegia, 5 (8%) patients presented with encephalomyopathy. Specific syndromes were the presenting feature in 8 (13%), Kearns-Sayre syndrome (KSS) in 4 and myoclonus epilepsy with ragged-red fibers (MERRF) in 4. Myopathy was the presenting feature in 5 (8%) and 4 presented with infantile myopathy. Of the 60 patients, 18 (30%) had proximal muscle weakness. Two patients with KSS and one patient with myopathy had complete heart block necessitating pace making. When the modified RC diagnostic criteria were applied, only 26 (43%) patients had one other major criterion in addition to RRFs for the diagnosis of mitochondrial diseases. The remaining 34 (57%) patients with RRFs on muscle biopsy had only some clinical features suggestive of RC disorder but did not fulfill the clinical criteria (of the modified diagnostic criteria) for the diagnosis of mitochondrial diseases. CONCLUSION: In patients with clinical features suggestive of RC disorder, demonstration of RRFs on muscle biopsy helps in confirming the diagnosis of mitochondrial disease in only a subgroup of patients.

Isolation of Burkholderia pseudomallei from a case of septicaemia--a case report.

Meliodosis, an infectious disease caused by Burkholderia pseudomallei has been recognized as an emerging infectious disease in India. The infection is under diagnosed and underreported, and hence considered a rare disease. Majority of the cases have been documented from the states with heavy rainfall. The present case being reported is a middle-aged woman who had developed a fulminant infection following exposure to stagnant floodwater in the city of Hyderabad. To the best of our knowledge, this is the first case of Melioidosis being reported from this part of the country.

Subtypes of Ischemic Stroke in a Metropolitan City of South India (One year data from a hospital based stroke registry).

Limited data exists on the subtypes of ischemic stroke from the Indian subcontinent. The present study was aimed to investigate the frequency, spectrum and risk factors of various subtypes of ischemic stroke in a south Indian referral center. The study was conducted on consecutive patients of ischemic stroke, fully investigated to determine the underlying mechanism and enrolled in the stroke registry of Nizam's Institute of Medical Sciences between Ist February 2000 to 31st January 2001. There were 282 men and 110 women (mean age 54 years; range 2-97 years). Of all ischemic stroke patients, 41%, 18%, 10%, 4%, and 27% were classified as large-artery atherosclerosis, lacunae, cardioembolism, other determined etiology and undetermined etiology respectively. The most notable difference of this registry from western registries was the predominance of intracranial rather than extracranial location of the large artery atherosclerosis. Hypertension, diabetes and smoking were the common risk factors among all the subtypes. Coronary artery disease and rheumatic heart disease were responsible for most of the cardioembolic strokes.

Decompressive craniectomy for stroke : indications and results.

The role of decompressive hemicraniectomy in stroke victims is gaining popularity among neuroscientists as it is found to be beneficial in malignant infarction of middle cerebral artery (MCA) territory which results in massive edema and brain swelling. Recent articles have showed that this procedure not only reduces mortality but also improves the functional outcome. We report our experience of 32 patients, who underwent this procedure. We found a good outcome in patients in whom the procedure was done early and whose pre operative Glasgow coma scale (GCS) score was 8 and above. It offered no benefit in patients whose pre operative GCS was below 5.