Deep vein thrombosis risk stratification in intensive care unit patients: a pressing need

Background: Risk stratification of deep vein thrombosis in patients admitted to ICU and incorporating DVT risk assessment score as a regular practice were the aim of the present study.Methods: This study was carried out in 67 patients admitted in ICU >18 years of age, over one year. Patients with confirmed DVT, <48 hours of stay, thrombocytopenia, diagnosed coagulation disorders, those who have received DVT prophylaxis in last 1 month and those with active bleeding were excluded. It was a cross sectional observational study. A SMART assessment score and pretest probability scoring card was used. Mechanical or pharmacological prophylaxis was given to those with moderate and high risk for DVT.Results: As per SMART assessment score 4.5%, 41.8%, 6% and 23.9% had no, moderate, high and highest risk of developing DVT. As per the pretest probability scores 76%, 20.9% and 3% were in low, moderate and high-risk group. Both scoring systems are comparable (p=0.001). There was significant association between paralysis (p value was 0.003), central venous access (p value was 0.006), patient bed ridden for >72 hours (p value was 0.009) and risk group.Conclusions: Prolonged bed rest, paralysis and central venous access are the most important contributing conditions for high risk of DVT. Risk stratification should be routinely performed in ICU.  SMART assessment tool and pre-test probability scores are both equally efficacious in identifying high risk patients for DVT. Both mechanical and pharmacological means of DVT prophylaxis are equally effective in preventing DVT.

Management of Large Mandibular Ameloblastoma Crossing Midline: Reconstructed by Bilateral Iliac Crest Graft: A Rare Entity.

Ameloblastoma is a true neoplasm of odontogenic epithelial origin. It is the second most common odontogenic neoplasm. It’s incidence approximately 1% of all oral tumors and 18% of all odontogenic tumors. More than 80% of cases of ameloblastoma occur in mandible. The ameloblastoma occurs in three variants solid or multicystic, unicystic, and peripheral. A painless expansion of the jaws is the most common clinical presentation. The correct diagnosis can be easily made with the help of plain X-rays and tissue biopsy. The standard management of ameloblastoma is marginal resection but sometimes a large tumor requires complete resection of affected part. Untreated tumors may lead to tremendous facial disfigurement, a severe malocclusion and pathological fractures of the jaw. Here we present a case of a young man with the chief complaint of facial asymmetry. The orthopantomogram of the patient was showing a multilocular radiolucency with Buccal and lingual cortical expansion. A diagnosis was made on the basis of the biopsy as multicystic ameloblastoma, and resection of the mandible was carried out. The mandibular primary reconstruction was done with avascular bilateral iliac crest bone graft. Long term prognosis showed satisfactory healing and good facial esthetics.

Identification and characterization of a potent anticancer fraction from the leaf extracts of Moringa oleifera L.https://docs.google.com/forms/d/1RkQLeYfiMvE7SKcdOXv9Acm5eXRjmvleic5FYjjX1TE/viewform?fbzx=6173639259593088622

Anticancer potential of Moringa oleifera L. extracts have been well established. However, there are no reports on the isolated molecules/fractions from these extracts which are responsible for the anticancer/cytotoxic activity. Thus, in the present study, we explored the same. The n-hexane, chloroform, ethyl acetate, methanol extracts of the M. oleifera leaves and 15 fractions (F1 to F15) of ethyl acetate extract were evaluated for their in vitro and in vivo anticancer activity using Hep-2 cell lines and Dalton’s lymphoma ascites model in mice, respectively. Among the tested samples, the F1 fraction showed potential cytotoxic effect in Hep-2 cell lines with a CTC50 value of 12.5 ± 0.5 µg/ml. In vivo studies with the doses 5 and 10 mg/kg, p.o. demonstrated significant reduction in body weight and increased the mean survival time compared to the control group. These results were also comparable to the standard, 5-Fluorouracil, treated animals. We have also successfully isolated and characterized the anticancer fraction, F1 from the leaves of M. oleifera L.

Epidemiological study of Paediatric Seizures and Its Management in Paediatric Emergency Department.

Introduction: Pediatric seizures are a common occurrence and frequent presentation to emergency department (ED). Seizures result from paroxysmal involuntary disturbance of brain function. The history and physical examination guide us to manage and assist in differentiating seizures from nonepileptic disorders. Methodology: This study was carried out to know the trends of paediatric seizures and their management in ED. We had included all patients less than 12 years of age with seizures, admitted to our hospital's pediatric ED between May and August 2012. All demographic findings, seizure characteristics and laboratory findings were recorded. Results: A total of 53 children were enrolled in the study of which 38 (71.7%) children were male and 15 (28.3%) were female. The mean age of presentation was 2.42 years. 66.7% of patients had generalized seizures and 33.3% of patients had partial seizures. Out of total study population, 49% had febrile seizures and 20.8% had afebrile seizures. The majority of seizures (69.8%) lasted less than 10 minutes of which 54% were afebrile. Status epilepticus (SE) was found most commonly in 30.2% children. Out of 16 patients with SE 10 (62.5%) were less than two years of age. The common causes of SE were fever, Central Nervous System (CNS) infection, and epilepsy, accounting for 31.3%, 37.5% and 31.2% respectively. The children with underlying CNS abnormalities (cerebral palsy) had poorer outcomes. Mortality found in SE (9.4%) was related to an acute neurologic insult or a chronic CNS condition. Metabolic abnormalities were detected in 28.3% patients. The frequency of metabolic abnormalities was significantly higher in patients under two years of age (66.7%). 53.7% had hypocalcemia, 33.3% had hypoglycaemia and 20% had hyponatremia. MRI (Magnetic resonance imaging) of brain or EEG (electroencephalogram) or both was carried out in only 13.2% patients. 85% of patients had undergone laboratory investigations. Lumbar puncture was performed in 26.4% patients.

Botulinum toxin – The new paradigm a review article.

Application of Botulinum toxin-A (Botox) in the field of dentistry is a new and upcoming. It acts by preventing the release of Acetylcholine at neuromuscular junction, which inhibits the contraction of muscles. This blockade is temporary, inhibiting the masticatory efficiency and function. It will return to its original levels once the effect of Botox has subsided, varying from three to four months. Botox is a viable treatment for many facial, TMD and oral dysfunctions when they are musculature based. Using Botox requires minimal training for a general dentist. It is most appropriate in patients who are refractory to other treatments.

Periodontitis and cardiovascular disease - A much discussed relationship.

Periodontitis and atherosclerosis have many potential pathogenic mechanisms in common. Both diseases have complex etiologies, genetic and gender predispositions, and potentially share many risk factors—the most significant of which may be smoking status. The objective of this review is to consider the mechanisms whereby diseases such as Periodontitis, which is chronic and inflammatory in nature and initiated by microbial plaque, can predispose to cardiac conditions.

Role of squash smear technique in intraoperative diagnosis of CNS tunmors.

Background: Neurosurgical practice frequently requires intraoperative consultation to optimize surgical procedure. Frozen section and Squash smear cytology can offer the same. As brain tissue is friable & predisposed to show ice crystal artefacts, frozen section is often difficult to interpret. Squash smear examination provides good cytological details to offer diagnosis in most cases except where anatomical correlation is needed. Present study was undertaken to evaluate the efficacy of Squash smear in absence of frozen section facility. Aims & Objective: To evaluate the value of Squash smear cytology for rapid intraoperative diagnosis in CNS lesions and its correlation with final histomorphological diagnosis. Material and Methods: Total 35 case of CNS tumours were examined by squash smear technique for cytomorphological analysis followed by histomorphological correlation on paraffin section. Results: Complete correlation with histomorphological findings was observed in 82.35% of cases. Complete correlation was observed more with glial neoplasm. Conclusion: Squash smear preparation proved to be a simple, inexpensive and rapid technique for intraoperative consultation of CNS tumours and can be effectively utilized as a diagnostic tool for intraoperative diagnosis in absence of frozen section facility.

Periodontitis and diabetes mellitus-a two way relationship.

Periodontal disease (PD) and diabetes mellitus (DM) hold a consistent relationship. DM not only increases the risk of having PD and with that its prevalence, but it also augments the progression of more aggressive and quickly defining signs. There is a bidirectional relationship between DM and PD. The treatment of periodontitis in diabetic patients favors a reduction in mediators responsible for the destruction of periodontal tissue and decreases with it, resistance to insulin. PD is characterized by low grade chronic inflammation that may remain silent in diabetics causing damage that is not locally limited but may extend systemically. Our aim of this article is to make aware, both general dental and medical practioner about interrelationship between periodontal disease and diabetes with special emphasis on importance of mutual consultation between the two fraternity, which in turn significantly contributes to general well being of an individual.

Smoking and periodontal health.

Tobacco smoking is very common with cigarettes being the main product smoked. Most smokers start the habit as teenagers, with the highest prevalence in the 20-24 year old age group. Socioeconomic differences also exist with higher smoking in the lower socioeconomic groups.

Diagnosis of acute malaria by laser based cell counter with comparison of conventional and recent techniques in Indian scenario.

Malaria is one of the most important parasitic diseases in humans affecting 103 countries worldwide. AIMS: The present study aims to determine the diagnostic utility of cell counter data--hemoglobin, total leukocyte count, platelet count and depolarized laser light (DLL)-based purple-coded events (PCEs) in detection of acute malaria. This is a retrospective study of 523 patient data that came for complete blood count for the first time. RESULTS: One hundred thirty-five of the 523 patients showed microscopic evidence of malaria. Platelet count showed the highest sensitivity of 77.77% (105/135). PCEs (> or = 1) showed 43.7% (59/135) sensitivity. CONCLUSIONS: It is concluded that a low platelet count (< 150 x 109/L) is a good hematological parameter for presumptive diagnosis of malaria. If we change the cut-off for PCEs from > or = 1 to > or = 2, the sensitivity would be 56.29% (76/135) and the specificity would be 94.58% (367/388), respectively. The sensitivity of DLL was low, particularly with a low parasitic index (PI). The number of PCEs does not correlate with the PI. The cut-off number of PCEs in DLL-based malaria detection should be modified in highly endemic areas.