Comparison of palonosetron-dexamethasone and ondansetron-dexamethasone for prevention of postoperative nausea and vomiting in middle ear surgery: a randomized clinical trial / Comparação entre palonosetrona-dexametasona e ondansetrona-dexametasona na prevenção de náuseas e vômitos no pós-operatório de cirurgia do ouvido médio: estudo clínico randomizado

Abstract Background: Postoperative nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60-80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron-dexamethasone and ondansetron-dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery. Methods: Sixty-four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron-dexamethasone and ondansetron-dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded. Results: Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2-6 hours only (p = 0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0-24 hours postoperatively) was 37.5% in group O and 9.4% in group P (p = 0.016). Absolute risk reduction with palonosetron-dexamethasone was 28%, the relative risk reduction was 75%, and the number-needed-to-treat was 4. The patient's satisfaction score was higher in group P than group O (p = 0.016). The frequency of rescue medication was more common in group O than in group P patients (p = 0.026). Conclusion: The combination of palonosetron-dexamethasone is superior to ondansetron-dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries.

Resumo Justificativa: Náusea e vômito no pós-operatório é a segunda queixa pós-operatória mais frequente após a dor. Sem profilaxia antiemética, a incidência de náusea e vômito no pós-operatório foi de 60−80% após cirurgia do ouvido médio. Dada a alta incidência relatada de náusea e vômito no pós-operatório, nosso objetivo foi avaliar o efeito da combinação de palonosetrona-dexametasona e ondansetrona-dexametasona na prevenção de náusea e vômito no pós-operatório em pacientes submetidos a cirurgia do ouvido médio. Método: Sessenta e quatro pacientes programados para cirurgia de ouvido médio foram aleatoriamente divididos em dois grupos. Um recebeu a combinação de palonosetrona-dexametasona (grupo P) e o outro ondansetrona-dexametasona (grupo O) por via intravenosa antes da indução anestésica. A técnica anestésica foi padronizada em todos os pacientes. No pós-operatório, foram registradas incidência e gravidade das náuseas e vômitos, necessidade de antiemético de resgate, efeitos colaterais e índice de satisfação dos pacientes. Resultados: As características demográficas foram semelhantes nos grupos estudados. A diferença na incidência de náusea foi estatisticamente significante entre os grupos O e P apenas no intervalo de tempo entre 2 e 6 horas (p = 0,026). A incidência e gravidade de vômito não foram estatisticamente significantes entre os grupos O e P durante todo o período do estudo. A incidência geral de náusea e vômito no pós-operatório (0−24 horas de pós-operatório) foi de 37,5% no grupo O e de 9,4% no grupo P (p = 0,016). A combinação palonosetrona-dexametasona associou-se com redução do risco absoluto de 28%, redução do risco relativo de 75%, e o número necessário para tratar foi 4. O escore de satisfação do paciente foi maior no grupo P (p = 0,016). A frequência da medicação de resgate foi mais comum no grupo O (p = 0,026). Conclusão: A combinação de palonosetrona-dexametasona é superior à ondansetrona-dexametasona na prevenção da náusea e vômito no pós-operatório após cirurgia de ouvido médio.

Consanguinity and Inbreeding Coefficient F in Aligarh city, India: A Cross Sectional Study

Objective: To determine the coefficient of inbreeding of consanguinity (F) and its correlates in Aligarh city, India. Material and Methods: Cross sectional household survey with a sample size of 2000 (1600 non-consanguineous and 400 consanguineous couples) using systematic random sampling. Researcher conducted the study by visiting every tenth household of every tenth ward of Aligarh city. Information was recorded on a pre-tested questionnaire, which had questions pertaining to religion, details regarding relationship between couples (consanguineous / non consanguineous marriage), type of consanguinity (first cousin/second cousin/third cousin), level of education and occupation (a proxy for socioeconomic status). Descriptive statistics, Chi-square, and multivariate logistic regression were used. Results: Multivariate logistic regression analysis showed that Islam (p<0.001) and Christianity (p<0.001) were significantly associated with consanguinity. Private employment with (-) B value (p<0.001) showed a significant association of the variable with non-consanguineous group. Coefficient of inbreeding for the present study was 0.0538, highest reported from any part of India. Conclusion: Consanguinity is a prevailing problem in Aligarh city, India. Evidence based guidelines needed. Information ­ education ­ communication and pre-marital counseling suggested to make population aware of the consequences of consanguinity and to help couples make a decision.

Comparison of Two Different Non-Radiographic Mixed Dentition Analysis

Objective: To evaluate the applicability of two different non-radiographic mixed dentition analysis in school going children of Aligarh district, India. Material and Methods: Mesiodistal dimension was measured on the dental casts of 120 school going children with electronic digital vernier caliper. The following inclusion criteria were adopted: presence of all fully erupted permanent teeth; no congenital craniofacial anomalies; no previous history of orthodontic treatment; and presence of intact dentition with no proximal caries, restoration, or age related attrition. Predicted values of canines and premolars were obtained from Moyer's at 75th percentile and Tanaka and Johnston mixed dentition analysis. Descriptive statistics were used to calculate the mean and standard deviation. Paired observations were compared by t­test. The level of significance was at p<0.001. Results: The mean difference between the predicted and the actual value of canines and premolars using Moyer's probability table at 75th percentile and Tanaka and Johnston regression equation were statistically significant. No significant differences were found between Moyer's analysis 75th percentile and Tanaka and Johnston mixed dentition analysis in both arch and sexes. Conclusion: These two non-radiographic mixed dentition analysis overestimated the mesiodistal width of canines and premolars.

Knowledge, Attitude and Awareness to Dental Caries Among Indian Children and Adolescents: A Case-Control Study

Objective: To assess paternal education, parental occupation, family income, level of knowledge and to determine the attitude and awareness of cases and controls in relation to dental caries and its risk factors in 6-18 years old respondents. Material and Methods: A case-control study was carried out in the outpatient Department of Pediatric and Preventive Dentistry. A total of 800 subjects, 400 each in case and control group were enrolled. The cases were subjects in designated age group with dental caries while controls were subjects without dental caries but matched with the cases on three confounding factors ­ age, sex, and religion. Multivariate logistic regression was used, with a significance level set at 5%. Results: Paternal education [illiterate (p=0.002), high school (p=0.005), intermediate (p=0.001), graduate (p=0.002)], family income per month [2000 INR (30 USD) (p=0.016); 5000-10,000 INR (75USD -145 USD) (p=0.035)], attitude of short visit duration to dentist (p<0.001), knowledge about sweets causing dental caries (p<0.001), awareness about symptoms of dental caries (p<0.001) and need of lifestyle change (p<0.001) were significantly associated with dental caries. Conclusion: The present research showed that in cases, knowledge was higher as compared to controls whereas contrasting results were observed with attitude and awareness. These results necessitate an urgent need of national programme integrated with primary health care under school health and community outreach programmes, so as to encourage the population to adopt and as well as sustain dental health promoting lifestyles and practices and help in reducing the disease burden.

Tuberculosis of Gallbladder A Case Report

Gall bladder is considered a rare site for occurrence of tuberculosis and is usually found in association with gallstones or cystic duct obstruction. The diagnosis is very difficult prior to surgery unless there is strong suspicion of tuberculosis, with the confirmation being possible only after histopathological examination of gall bladder. Here we present a case of gall bladder tuberculosis in a 40-year-old female, who came with symptoms of chronic cholecystitis due to gallstones. Ultrasound of abdomen revealed a single gall stone located in the fundal region. The patient underwent laparoscopic cholecystectomy and was treated with anti-tubercular drugs. .

Assessment of biochemical and antioxidative status in patients suffering from dengue fever / 华中科技大学学报（医学）（英德文版）

A multi-centred study was designed to collect dengue epidemiologic data from government and registered private hospitals/clinics and maintained archive of frozen specimens in bio-bank to be used for future dengue epidemic control program, and assess the epidemiology of dengue fever (DF) by evaluating biochemical and oxidative status of patients. ELISA IgM antibodies test was done to confirm DF. From August 2010 to December 2011, 101 confirmed blood samples of DF patients referred to pathology lab of Jinnah Hospital Lahore were subjected to the epidemiologic assessment by evaluating the biochemical and physiological indices and alterations of circulating antioxidants. Clinical features of DF patients and effect of fever on blood components and serum proteins of liver were recorded. The hospital stay in DF, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) showed significant difference. Significant increases in serum alanine amino transferase (ALT) (P=0.000), aspartate amino transferase (AST) (P=0.000), alkaline phosphatase (ALP) (P=0.000), malondialdehyde (MDA) along with significant decreases in total protein (TP) (P=0.000), reduced glutathione (GSH) (P=0.000), superoxide dismutase (SOD), catalase (CAT) (P=0.000), and sialic acid contents (P=0.016) were observed. A positive correlation existed between bound sialic acid levels, liver enzymes and circulating antioxidants (r=0.656, P=0.016). In the present study, alterations of circulating antioxidants in DF suggest that DF might be a metabolic response to an acute, self-limiting tropical viral infection, and a consequence of the viral inflammatory process.

Influence of Paternal Socioeconomic Variables on Dental Caries in Lucknow City (India): A Case- Control Study.

Introduction: Dental caries, an important public health problem of children and adolescent has multi factorial causation. Different studies have brought out varying prevalence and attributed its increase to dietary factors, poor oral hygiene, lack of knowledge and paternal sociodemographic factors. The present Case – Control study was conducted to investigate the association between paternal variables and dental caries among 1 -18 year old children and adolescent of Lucknow city, India. Methods: Study was carried out in the Outpatient Department of Pedodontics and Preventive Dentistry, Saraswati Dental College and Hospital, Lucknow (U.P) India. Study included 400 cases with dental caries and equal number of controls without dental caries. Cases were matched with controls on three variables (age, sex and religion). Clinical examination (DMFT/deft) was done in accordance with W.H.O. criteria for epidemiological studies. Participants with fluorosis, discernible enamel hypoplasia were excluded. Patients and their fathers were interviewed using a selfprepared questionnaire. Results: In Clinical examination; mean (DMFT/deft score) was 2.77±2.25, major contribution by “D” component. Mandible was most affected arch with posteriors as most affected teeth. Educational status of father’s in control group was significantly better than the study group (p<0.001). A Statistically significant difference was observed between both the study groups as regards father’s occupation (p<0.001). The monthly income of father’s in control group was significantly higher than the study group (p<0.001). The association and strength of association was judged by Chi square test and Odds ratio at 95% confidence interval between father’s socioeconomic variables and dental caries. Conclusion: Paternal socioeconomic variables are significantly associated with dental caries among their children. Preventive measures are needed towards healthy oral practices keeping in view the paternal socioeconomic variable inequalities.

Psychology As A Tool For Fostering Better Dentist Patient Relationship : A Practical Guide.

Why are some dental practices more successful than others? Skill, though undoubtedly important is not the complete answer.Simply put, a successful practice is directly proportional to the number of satisfied patients. And for a patient to be satisfied, it his needs that have to be met – voiced and unvoiced! Thus to be able to deliver effective dental care, needs as perceived by the patient and dentist need to be in sync. But to achieve this first and foremost a dentist must acknowledge the existent gulf that exists between professional and lay perception of needs and then proceed to bridge the gap between the two. This article looks at various ways in which the science of psychology can aid the dentist overcome this ubiquitous impasse. Psychology helps not only in assessing the underlying concerns of a patient but also in addressing them. And this in turn lays the foundation for a long lasting dentist-patient relationship which is what lies at the heart of any successful practice!