Evaluation of compressive load required to fracture premolar restored with different restorative materials-an in vitro.

Background: Restored teeth are generally weaker than sound teeth due to loss of tooth structure caused by caries and restorative procedures. The loss of both tooth structures as a result treatment will increase the likelihood of fractures during functional loading. Objective: To evaluate the fracture resistance of premolars with class II disto occlusal preparations restored with light cured composite with light cured composites layered incrementally and silver amalgam in comparison with intact and unrestored teeth. Material and methods: 50 freshly extracted premolars were randomly divided into 5 groups of 10 teeth each. All the 50 specimens were then subjected to a compressive load in a Universal Testing Machine (Hounsfield). The loads required to fracture the teeth were recorded and the data, obtained were subjected to statistical analysis and the following results were arrived. Result: Teeth restored with light cured composite incrementally placed in oblique layers produced a higher fracture resistance than any other group and showed the closest value to the intact teeth. This was followed in descending order by light, cured composite placed in horizontal increments and silver amalgam. Conclusion: Result concluded that teeth restored with light cured composite incrementally placed in oblique layers produced a higher fracture resistance than any other group and showed the closest value to the intact teeth.

Pulmonary nocardiosis mimicking tuberculosis.

Pulmonary nocardiosis is an infrequent and severe infection due to Nocardia species, microorganisms that may behave both as opportunists and as primary pathogens. Diagnosis of pulmonary nocardiosis is frequently delayed and a high level of suspicion is required in patients with underlying diseases or chronic corticosteroid therapy. Hereby we are presenting a case of pulmonary nocardiosis mimicking tuberculosis in an immonocompromised patient.

Adverse drug reactions profile of antimicrobials: A 3‑year experience, from a tertiary care teaching hospital of India.

Aim of Study: To evaluate adverse drug reaction (ADR) profile of antimicrobials over 3‑year period. Material and Methods: A retrospective cross‑sectional study was undertaken using suspected adverse drug data collection form available under Pharmacovigilance Programme of India (PvPI). Results: A total of 2,586 ADR events were recorded in 3 years, out of which 392 (15.15%) were because of antimicrobials. Male: female was 1.02:1. Medicine department contributed maximally (98.97%). The intravenous (IV) route of drug administration accounted maximum ADRs (53.32%), followed by oral route (45.41%). Monotherapy was responsible for 80.87%, whereas combination therapy for 19.13%. Combinations therapy was irrational in 79.67%. The most common antibiotic resulting in ADRs was injection ceftriaxone (35.71%), followed by tab. azithromycin (7.39%), tab. ofloxacin + ornidazol (5.35%), ofloxacin (3.57%), ciprofloxacin (2.29%), amoxicillin (2.55%), tab. cefixime (2.29%), inj. linezolid (2.04%). Rash remained the most common ADR, followed by diarrhoea and gastritis. Most common organ system involved was dermatological (47.44%), followed by gastrointestinal (GI) (39.28%), central nervous system (CNS) (5.35%), cardiovascular system (CVS) (3.57%) and renal and genitourinary (1.78%). While 47.96% ADR’s were latent, 26.785% were acute and 25.26% were sub‑acute. Moreover, 89.79% of ADRs were moderate in nature, whereas 26.88% were severe and 3.33% mild in nature. Furthermore, 92.86% were non‑serious and 7.14% serious in nature. Also, 65.06% of antimicrobial caused ADRs were type A and 34.64% were type B reactions. As per World Health Organization‑The Uppsala Monitoring Centre (WHO‑UMC) scale, 73.98% of ADRs were probable/likely and 26.02% as possible. However, 99.47% of ADRs required intervention. Conclusion: The current study suggest that ADRs due to antimicrobials is a significant health problem.

Prevention of respiratory diseases.

Chronic respiratory diseases are silent killers, neglected but leading cause of death. These diseases erode the health and wellbeing of the patients and have a negative impact on families and societies. Research on prevention and control of lung diseases is lagging behind and prevention and control programmes of respiratory diseases should be given high priority. This is because of the reason that respiratory diseases, perhaps more than any other types of diseases, are more easily prevented than cured.

Assessment of atherosclerosis by carotid intimomedial thickness in patients with rheumatoid arthritis.

OBJECTIVES: To determine the prevalence of subclinical (asymptomatic) atherosclerosis in patients with rheumatoid arthritis (RA) and to study the variables affecting such an occurrence. METHODS: Case control study which included 100 patients with RA having disease duration more than 5 years and 100 healthy age and sex matched controls. Cases and controls symptomatic for atherosclerosis or having traditional risk factors for atherosclerosis were excluded. Both cases and controls were subjected to carotid ultrasound examination in addition to detailed history and physical examination. RESULTS: The study population (both cases and controls) included 94 females and 6 males. The mean age of cases and controls was similar (44.06 +/- 11.32 years and 44.1 +/- 11.52 years). The mean disease duration was 155.04 +/- 48.8 months. The mean carotid intimo-medial thickness (CIMT) of the RA patients (0.519 +/- 0.18 mm) was significantly greater than the controls (0.387 +/- 0.085). Age and disease duration were the only factors found to significantly affect CCIMT. RA patients had higher prevalence of carotid plaques (21%) compared to controls (1%). Erosions on hand radiographs were the only significant predictor of plaques in patients with RA. CONCLUSION: Patients with RA exhibit premature atherosclerosis by way of increased CIMT and carotid plaques when compared to age and sex matched controls.

Optimizing local control in anorectal melanoma.

Background: Wide local excision (WLE) of anorectal melanoma is associated with a high incidence of local recurrence. There is a paucity of literature on adjuvant radiation in this malignancy. Aim: To identify the optimal method of local treatment in anorectal melanoma. Settings and Design: Retrospective study in a tertiary cancer centre. Materials and Methods: Records of 63 patients who presented between 1980 and 2004 were reviewed. Results: Of the 63 patients, 18 were treated by either surgery with or without adjuvant radiation, or by radiation alone. The remaining had advanced disease and were offered only symptomatic treatment. The median overall survival in stage I patients was 12 months, while it was seven and four months in those with stage II and III disease respectively. The median survival in patients treated by WLE with adjuvant radiation (RT), WLE alone or Abdominoperineal resection (APR) was 34, 12 and 10 months respectively. Patients in whom the disease was confined to the mucosa had a better median overall survival than those in whom it had infiltrated beyond the mucosa (102 vs 11 months). The pattern of recurrence following WLE with adjuvant RT or APR was similar. None of the patients who received adjuvant RT after wide excision had a local or nodal recurrence. Conclusion: Local treatment of anorectal melanoma should be individualized. WLE with adjuvant radiation seems to offer good locoregional control without reducing the survival and may be an option of treatment for patients with small, superficial anorectal melanoma. However, APR should be offered for patients with locally advanced disease or as a salvage following recurrence.

Penile metastasis from rectal carcinoma.

Penile metastases are infrequent and often originate from genitor-urinary organs including bladder and prostate. In the present communication, we report an unusual case of penile metastasis from rectal adenocarcinoma. Though uncommon, this presentation is not unknown. A review of literature of penile metastases in colorectal cancers is also summarized here.

Epidemiology of a new focus of localized cutaneous leishmaniasis in Himachal Pradesh.

A new focus of localised cutaneous leishmaniasis has emerged along the Satluj River valley in the mountainous region of north west Himachal Pradesh. The main endemic region extends from Pooh subdivision of Kinnaur district to Kumarsain subdivision of Shimla district with adjoining Nirmand subdivision of Kullu District comprising 86 villages. The climate of the affected areas varies from temperate to subtropical. A total of 285 cases were recorded from 1988 to January, 2005. The age of these patients varied from 10 months to 75 years, with 63 children (<12Years), and a male to female ratio of 1: 0.9. The duration of disease was 15 days to 48 months with majority (85%) presenting between 1-6 months. The number of lesions varied from 1-8, and were mostly seen on exposed parts of the body. Morphologically, lesions were asymptomatic, dry, nodular or crusted nodulo-ulcerative plaques. Tissue smear positivity for amastigotes was 43%. The characterization of 14 strains of these Leishmania revealed presence of both Leishmania tropica (n=3) and Leishmania donovani (n=11). Identification of the 42 sandflies collected from the peridomestic environment of the patients, revealed Phlebotomus longiductus - 29, P. major 8, P. kandelaki 2, while 2 remained unidentified. The patients were treated with intralesional sodium stibogluconate and majority showed excellent response.

A new focus of cutaneous leishmaniasis in Himachal Pradesh (India).

This paper highlights a new focus of cutaneous leishmaniasis (CL) in the temperate area of Himachal Pradesh (India), a previously non-endemic area. In this hospital-based study, 38 new cases of CL, acquired indigenously have been detected from 1988-2000. Of these, 26 were from Kinnaur district and 12 from adjoining areas of bordering districts situated along the river: Satluj. There were 18 males and 20 females. They were between 4-75 years of age and had the disease for one month to 2 years at the time of presentation. Face involvement was seen in majority of the patients. Nodulo-ulcerative plaque was the commonest lesion. Muco-cutaneous lesions were seen in four cases. Tissue smears and biopsies were positive for LD bodies in 61.7% and 29.4% cases respectively. Intralesional sodium stibogluconate produced a consistent therapeutic response. The possible mode of its introduction in the region is postulated. The reservoir of infection, identity of the vector at this altitude (9,002,900 meters above sea level) and the strain of leishmania, remain to be identified.

Trends in detection of new leprosy cases at two centres in Himachal Pradesh, India: a ten-year study.

An impressive decline in leprosy prevalence rate (PR) in all endemic districts of India is seen in the post-MDT era. However, the new case-detection rate, an important statistical indicator in leprosy control programmes, has not shown significant decline in spite of all efforts. In Himachal Pradesh, a decline in PR from 7.8 to 0.56/10000 between 1991 to 2000 is seen, and recently the State has won national acclaim for having achieved the goal of elimination of leprosy in all the districts. The vertical leprosy programme has been integrated into general health services of the state. An analysis of data from 1991 to 2000 of two leprosy control units of Himachal Pradesh, the Urban Leprosy Clinic in Shimla (ULC-S) and the District Leprosy Control Unit in Mandi (DLCU-M), showed no significant decline in the new cases detected. 277 and 271 new cases were detected at these centres respectively; these included 2.2% and 1.5% children of less than 14 years of age. Almost 75% of these cases were males and of MB type. A steadily increasing trend in the annual detection of new cases was seen at both the centres during the decade. The cases registered at DLCU-M were mainly indigenous to the district. At ULC-S, 45 migrant cases from other endemic areas-mainly from Nepal, Bihar, and Uttar Pradesh-had also contributed to the increased number of new cases. Other possible causes discussed for this higher new case detection, e.g. overdiagnosis, detection of backlog "hidden cases" and voluntary reporting of patients, do not differ from those seen in other parts of the country or the world.

Management of chyle fistulae following surgery in the neck.

Chyle fistulae are seen in less than twenty percent of cases following head and neck surgery. At the Cancer Institute, Madras, India, chyle leaks were seen in 19 patients between 1990 and 1999. The leak subsided spontaneously in sixteen patients on conservative management. The neck was re-explored in three patient. The thoracic duct was ligated in one and the wound packed in two. Conservative management in the form of aspirations and strapping is more likely to succeed when the volume of drainage is low or decresing over time and the surgical incision and skin flaps remain healthy. Rightsided leaks and late appearing fistulae are also likely to close on conservative management. Dietary modifications may help in this process. Re-exploration of the neck would be required when conservative management fails. Early exploration would be advised when the drainage is large or does not decrease over a few days or if there is a tendency to wound breakdown. A thorough knowledge of the anatomy of lymphatic pathways from the thorax and abdomen, identification of the thoracic duct during surgery and detection and ligature of all lymphatic leaks intraoperatively using a trendelenburg position and valsalva maneuver will help reduce the occurrence of this problem.

AgNORs in endometrial lesions.

Silver nucleolar organizer region (AgNOR) staining was employed in one hundred specimens of endometrium. These included fifteen normal controls (Proliferative + Secretory endometrium) and eighty five lesions. Endometrial lesions comprised of endometritis (15), endometrial hyperplasia (25) and endometrial carcinoma (45). Three micron thick sections of paraffin embedded tissue were subjected to AgNOR staining as described by Crocker and Smith with a little modification of 0.01% safranin counterstain--The mean AgNOR scores were found to increase steadily from normal to endometritis to endometrial hyperplasia and carcinoma--The observations revealed statistically significant differences in values between atypical hyperplasia and carcinoma also. AgNOR staining and scoring is simple, inexpensive and a useful adjunct to routine histopathology to evaluate endometrial lesions especially to differentiate borderline lesions. Though scores cannot be standardized and fixed for a particular lesion as there are intralaboratory variations.

Isolated involvement of the mandible by non-Hodgkin's lymphoma.

A case report of isolated involvement of the mandible by non-Hodgkin lymphoma is presented. The patient presented with a non-healing ulcer following a tooth extraction. Biopsy revealed an undifferentiated cancer. Investigations failed to reveal any involvement of the organs. A hemimandibulectomy was performed followed by radiotherapy on receipt of the histopathological diagnosis of non-Hodgkin lymphoma. The patient is asymptomatic two and a half years after treatment.