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The most prevalent malnutrition issues in Sri Lanka are the protein-energy malnutrition (PEM), vitamin A deficiency, and iron deficiency. Childhood and adolescence are the crucial stages of life which mostly susceptible to malnutrition since their major physiological and psychological changes take place. Although a balanced, nutritious diet is essential to them, present socio-economical and higher academic expectations have created a complex environment that often pushes them towards junk foods and unhealthy snacks. The objective of the present study was to develop ready-to-reconstitute convenient mid-day meals in three categories of chicken, fish, and soya, which match to the Sri Lankan local culinary style, with acceptable sensory properties to upgrade the nutritional status of school children (5-10 yrs) and adolescents (11-19 yrs). Those mid-day meals were designed according to the Food-Based Dietary Guidelines (FBDG) of Sri Lanka. The selected ingredients were processed; rice to instant rice, vegetables to dehydrated vegetables, and protein source of chicken, fish, and soya to pre-cooked sterilized curry pouches. The convenient mid-day meal packages were prepared using three portions of instant rice containing 10% of green gram flakes, dehydrated vegetables, and retorted curry mix respectively. Labeling was performed according to the type of curry mix inserted into the package as Chicken, Fish, or Soy mid-day meals. Physicochemical and sensorial properties of meals were evaluated. The caloric value of mid-day meals ranged 575 - 640.82 kcal. The protein content of meals ranged from 25.88 g to 32.68g and there was no significant difference (p<0.05) between protein contents in chicken and fish meals. The fat contents and dietary fiber contents significantly (p<0.05) differed and the highest contents of fat (3.15 g) and dietary fiber (4.40 g) were observed in chicken meal and soy meal respectively. The mineral contents of tested meals significantly differed (p<0.05) and the significant highest Ca, Fe, K, Fe, and P were observed in soya mid–day meals. The highest mean rank scores for all sensory attributes in terms of odor, appearance, texture, taste, and overall acceptability were observed in the chicken mid-day meal. Ready-to-reconstitute mid-day meals in three categories of chicken, fish, and soya, which could match to the Sri Lankan local culinary style, were developed with acceptable sensory properties.
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Background: Obesity is associated with increased rate of mortality and morbidity if untreated. Obesity is a health hazard it required attention towards adolescent and adult age group. Generally, body fat is distributed into two main compartments that are subcutaneous adipose tissue and visceral adipose tissue. Waist Hip Ratio measures the subcutaneous adipose tissue, determination of visceral adiposity will further helpful for determination of cardiovascular disease.Methods: The study comprised of 120 subjects, of these adolescents comprised of 60 healthy adolescent childrens. The adults comprised of 60 healthy individuals. In all the subjects, Height was estimated in centimetres and Weight was measured in kilogram measured and BMI was calculated. The waist hip ratio and visceral adiposity index was calculated. In all the subjects, venous blood was collected from all the subjects for lipid profile estimation.Results: In present study BMI more than 25 have soon increased waist hip ratio and visceral adiposity index value than BMI less than 25 and it’s statically significant in both adolescent and adult group. It is also reported that BMI more than 25 have increased level of mean serum triglycerides, serum total cholesterol, LDL cholesterol and VLDL the increase was statistically significant. The mean serum HDL cholesterol was significantly decreased in BMI>25 group when compared with BMI<25.Conclusions: It was concluded that different age groups of adolescent and adult, appropriate methods should be planned specifically for adolescent and adult age group. Regular educational sessions are needed to make changes adolescent and adults toward obesity.
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Background: Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. Aims and Objectives: to evaluate and compare the degree of post-operative analgesia, patient compliance and frequency of adverse events between transdermal ketoprofen patch and transdermal fentanyl patch following third molar extraction. Methods: Total 7 patients aged 18-65 years with impacted mandibular third molar teeth were included in the study. The study drugs transdermal patches of fentanyl and ketoprofen was applied one hour before the surgical procedure on the skin, preferably in an area devoid of any hair. The selected mandibular third molar tooth of either of the side was extracted in the first appointment using an aseptic protocol. Every patient was given a Verbal Pain Intensity and Pain Relief chart ( both 5- point scales with values 0-4 ) for assessing pain intensity and pain relief for all the three post-operative days. Results: During the first four hours of operative day, the difference observed between the two groups was not found to be statistically significant (p=0.881). Whereas during the first eight hours of operative day the difference observed between the two groups was not found to be statistically significant (p=0.141). During the first twelve hours of operative day, the difference observed between the two groups was not found to be statistically significant (p=0.276). At the end of operative day, the difference observed between the two groups was found to be statistically significant (p=0.048). Conclusion: Transdermal fentanyl patch was more effective for immediate pain relief than transdermal ketoprofen patch for pain control following removal of mandibular impacted third molars.
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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.
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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.
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Background: Nonspecific low backache is a pain, muscle tension, or stiffness localized between the costal margin and inferior gluteal folds, without sciatica. Only 10% of the cases have a specific cause. One of the risk factors is poor hamstring flexibility. Mulligan’s BLR and IASTM have shown to improve hamstring flexibility. No studies have compared both. Therefore the study was undertaken. Methods: 48 subjects, mean age 34.27 ± 5.30 were recruited. Group A (24 - 15 male and 9 female) received TENS, Mulligan’s BLR and conventional exercises. Group B (24 - 12 male and 12 female) received TENS, M2T for Hamstrings and conventional exercises. Outcome measures were taken pre-treatment session 1 and post-treatment session 6. Results: Pre and post mean the difference in group A [BLR] was 5.96 ± 0.95 for NPRS, 19.38 ±7.28 for Right AKET, 20.54 ± 6.78 for Left AKET, 2.07 ± 6.49 for Lumbar lordosis and 28.38 ± 9.73 for QBPDS. Pre and post mean the difference in group B [M2T] was 5.71 ± 1.20 for NPRS, 17.00 ± 6.94 for Right AKET, 15.75 ± 6.50 for Left AKET, 1.20 ± 4.76 for Lumbar lordosis and 26.42 ± 11.38 for QBPDS. The intragroup comparison was statistically significant, p = 0.0001 for all outcome measures. Intergroup comparison was statistically significant, p < 0.05 for Left AKET (p=0.0161). Conclusion: Interventions given were equally effective in reducing pain, improving hamstring flexibility, and reducing disability within the group but not between the groups except left AKET.
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Background: Chronic Kidney Disease (CKD) is characterized by irreversible sclerosis and loss of nephrons. The renal mass progressively declines over a prolonged period, depending on the underlying etiology. In CKD the most common feature is hypovitaminosis D which alter the vascular smooth muscle cell proliferation and reprogram the osteoblastic changes, finally leading to increase arterial wall thickness.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 CKD patients with stage 3 to 5. In all the participants serum creatinine, blood urea, serum triglycerides serum total cholesterol, HDL cholesterol estimated and serum 25 OH vitamin D are estimated.Results: The diagnostic criteria for CKD like blood urea, serum creatinine and eGFR were significantly higher in CKD when compared to control. In the present study, systolic and diastolic blood pressure was significantly increased in CKD compared with control. The Carotid Intima Media Thickness (CIMT) both left and right side were significant higher in CKD when compared with control. There is a significantly decreased levels of serum vitamin D in CKD (14.53 ng/mL±6.88) when compared with control (28.87 ng/mL±6.28).Conclusions: Present study finding suggested that there is a raised value of CIMT in CKD patients. High triglycerides, cholesterol and decreased HDL and declined vitamin D low hemoglobin, decreased eGFR, increased systolic blood pressure, raised CIMT value were found to be significantly increased in CKD patients.
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Background: Several clinical trials have been reported that sedentary lifestyle modification including physical activity (PA) and weight loss significantly alters the sort-term as well as long-term incidence of diabetes. The present study explored the level of physical activity and its barriers among south Indian naïve patients who are attending the tertiary care teaching hospital.Methods: A prospective observational, questionnaire-based study. Patients with diabetes (both Type-1 and 2) who were attended diabetic clinic in the Department of General Medicine, Maharaja Institute of Medical Sciences (MIMS), Vijayanagaram, Andhra Pradesh, India was selected and recruited. Demographic data, clinical data were collected from the study participants. International Physical Activity questionnaire was used to determine each patient level of physical activity (PA). Physical activity is graded into low (<600 metabolic equivalent (MET)), moderate (600-3000 MET) and high (>3000 MET).Results: A total of 300 subjects were completed the entire study. Majority (62.7%) of the patients were suffering from Type-2 diabetes mellitus. Both male and female study subjects had low physical activity (70.5% and 74.1%) and moderate PA was seen in only one thirds of the patients. Patients with low physical activity had low glycaemic control compared to patients who were involved in moderate PA. Moderate PA patients had adequate glycaemic control (65.9 vs 34.1%, P <0.001). A total of 42.0% of subjects were suffering from one of the joint pains and friction joints, due to the following reason subjects were not involved in the PA.Conclusions: Low level of physical activity was observed in the study population, which is a risk factor for several micro-vascular complications over a period of time. It is very important to address the barriers of PA and vigorous counselling is needed which directs towards increasing PA.
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Background: In Chronic kidney Disease (CKD) a significant risk factor for mortality is Cardiovascular disease (CVD) and the most prevalent cardiovascular risk factor is left ventricular hypertrophy (LVH). Anemia, hypertension and volume overload are risk factors for LVH in CKD. So, the present was aimed at comparing the risk factors between CKD with and without LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh. A total of 120 patients are included in this study and divided in to CKD stage III to V based on estimated GFR. Based on 2D echocardiography data CKD cases are further divided in to CKD with LVH and CKD without LVH.Results: The Left ventricular mass index was significant higher in CKD with LVH (128.89±19.28) when compared with CKD without LVH (108.20±10.28). The left ventricular mass index was noted in more number in stage V of CKD. It is also observed that the left ventricular mass index was negatively correlated with haemoglobin and eGFR and was positively correlated with systolic blood pressure and serum NT-proBNP.Conclusions: Present study finding suggested that the incidence of LVH is higher in CKD patients. LVH was positively correlated with hypertension and NT-proBNP and negatively correlated with anemia and estimated GFR.
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Background: Several observational studies, well controlled randomized trials and meta-analyses reported that patients treated with statins has high risk of new onset diabetes mellitus (NODM), but the exact incidence and mechanism is still unclear and controversy. The present study was planned to find out the incidence of prediabetes and NODM and possible mechanism of action.Methods: This was a prospective, cross‑sectional study carried out at the Department of General Medicine for a period of one and half year between August 2017 and February 2019. Normoglycemic patients whose fasting blood glucose levels below 100 mg/dL and at least one year of treatment with statins were recruited in the study. Glycaemic status, development of prediabetes and NODM and insulin resistance were the primary outcomes whereas lipid profile, adverse drug effects of statins were secondary outcomes. Collected data was analysed by suitable statistical methods.Results: A total of 146 patients were recruited and 120 completed the entire study. Mean fasting blood glucose levels before initiation of statin therapy was 89.45±10.21. After one year of statin therapy, patients were separated as prediabetics and new onset diabetics and there mean fasting blood glucose levels were 116.24±12.86 (n=10) and 152.44±20.12 (n=12) respectively. A total of 12 (10.0%) patients were developed NODM and 10 (8.2%) patients developed prediabetes at the end of statin therapy. Atorvastatin 40mg was most frequency prescribed statin followed by Atorvastatin 20mg. A total of 70 (58.3%) study participants developed mild to moderate drug related adverse effects (ADRs), statin‑induced myalgia (55.7%) was the most common ADR.Conclusions: Patients treatment with statins had developed prediabetes and NODM. Atorvastatin 40mg and greater dose significantly induced NODM. Fasting blood glucose levels should be measured periodically with prescription contains higher doses of statins
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Background: The incidence of ischemic heart disease/ myocardial infarction is rapidly increasing in India. However, the traditional risk factors alone could not explain this excess of Coronary Heart Disease (CHD). So, we are in need of a tool to assess the severity and prognosis of these acute coronary syndromes. Lipoprotein (a) [Lp(a)] and High Sensitive C-Reactive Protein (hs-CRP) have been recognised as independent risk factors for CHD in many retrospective case control studies. As the data shows inconsistency in the prediction of risk by Lp(a) and hs-CRP, the study is carried out to compare and correlate the levels of Lp(a) and hs-CRP in coronary heart disease patients with controls.Methods: An observational case control study was conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, with 120 participants. 80 admitted with CHD were categorised as type 2 diabetic and non-diabetic. Remaining 40 participants were age matched controls, who have attended the OP for general health check-up. Samples collected from the participants were analysed for Lp(a), hs-CRP and HbA1c.Results: Lp(a) levels were significantly elevated in CHD patients with diabetes (69.2±27.5) and non-significant in CHD patients without diabetes (50.4±24.3) as compared to their controls (36.6±22.5). There was significant correlation and elevation of hs-CRP in CHD patients with diabetes (6.0±2.6) and without diabetes (3.7±2.0) as compared to their controls (0.7±0.4).Conclusions: The present study shows a lack of association of Lp(a) levels in CHD patients with and without diabetes. A strong correlation of the inflammatory marker, hs-CRP was observed between the CHD patients with and without diabetes and even as compared to their controls. It may be concluded that hs-CRP is a better and independent marker than Lp(a) in patients with CHD.
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Aim To compare the occurrence of the butterfly effect in the roots of incisors, canines and premolars. Materials and methodology A total of 30 extracted teeth were selected (incisors, canines and premolars of 10 each) and embedded in the clear acrylic and then sectioned into six thin sections of 1-mm thickness and are observed under light microscope at 5× magnification. Scoring was given on the presence or absence of the butterfly effect. Results 80% of the incisor and canine groups showed the presence of butterfly effect, whereas it is 70% in case of premolar group. Conclusion No significance difference in presence of butterfly effect in incisors, canines and premolars, with very slight predominance in incisors and canines. If present, this was uniform all along the root.
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The aim of this study was to report the endodontic management of maxillary incisors having two canals with rare type IV vertucci canal configuration. Internal morphology of root canals is variable and often complex. Therefore, to achieve a technically satisfactory endodontic outcome, the clinician must have an adequate knowledge of the internal canal morphology and its variations to debride and obturate the root canal system thoroughly. This case report describes the successful endodontic treatment of both the mandibular central incisors having two-root canals in same individual.
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Aim To evaluate the bleaching efficacy of 16% carbamide peroxide, 30%hydrogen peroxide for intracoronal bleaching of root filled discoloured tooth. Methodology Extracted teeth were artificially stained using human blood then centrifuged under 3,200 rpm speed for 30 min thrice daily for a period of 2 days to enhance penetration of the haemolysed red blood cells into the dentinal tubules. The precipitate was removed, and the teeth were immersed in the remaining haemoglobin-rich haemolysate for further 2 days, centrifuging it thrice daily for 30 min. The resultant discoloured teeth were then washed in distilled water. Root canal treatment was performed. After obturation, a 2-mm intermediate base of Intermediate restorative material IRM was placed to 1-mm apical to the cementoenamel junction. Teeth were divided into three groups with 10 teeth per group. Intracoronal bleaching was performed using either 35% carbamide peroxide gel (group CP) in one group, 35% hydrogen peroxide gel (group HP) in another group and distilled water in the control group as the third group. The bleaching agents were replaced after 5 days. The shade of the teeth was evaluated at day 0, 5 and 10 using VITA Zahnfabrik, Bad Sa¨ckingen, Germany) shade guide. The results were analysed using Kruskal–Wallis one-way analysis of variance and Mann–Whitney U-test. Results When superoxol and control group are compared, there shows a clear difference of significance between these two materials. But when superoxol and carbamide peroxide are compared, there is no difference of significance. Both superoxol and carbamide peroxide showed same results. Both are effective bleaching agents. Conclusion In our study we noticed that 16% carbamide peroxide and 30% hydrogen peroxide are equally effective in the treatment of intracoronal bleaching which we observed in a 5,10,15 days of regular intervals.
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Trauma to anterior tooth is a relatively common event. Crown-root fractures are often difficult to treat and are time consuming, which causes psychological trauma to the patient during that period. Fracture of tooth after trauma is distressing to a person because of the discomfort and pain due to pulpal injury. Crown root fractures of anterior teeth cause concomitant periodontal injury and there will be concern about appearance and aesthetics. Management of pulpal and periodontal tissue relieves pain and restoration of tooth form regains patient's confidence. Restoration of fractured tooth will be accepted readily if it is minimally invasive, less expensive, and aesthetically acceptable. Reattachment is an option for restoration of anterior teeth compared to other artificial replacements because of its appearance as natural. This method is favourable when the fractured fragment is intact and available. Utilization of pulp space for retention of fragment is achieved by the insertion of a dentine bonding post. This case report describes a case of tooth reattachment after trauma in which the pulp space is utilized to bond a fibre-reinforced post for retention after periodontal tissue management.