Evaluation of Musculoskeletal Disorders in Dentists and Application of DMAIC Technique to Improve the Ergonomics at Dental Clinics and Meta-Analysis of Literature.

INTRODUCTION: Musculoskeletal disorders (MSD) result in discomfort, pain and illness that can result in disruption or impairment of dental practice. MATERIALS AND METHODS: A cross-sectional study consisting of 60 dentists was carried out to determine musculoskeletal work related pain in major cities of Northern India. The study was planned in two phases. In the first phase, the subjects were given questionnaire related to the musculoskeletal pain happened over the last twelve months. In the second phase of study, improvement was carried out by recommending the subjects to implement ergonomics at their workplace. After three months subjects were again approached and given questionnaire about the musculoskeletal disorders. DMAIC (define, measure, analyse, improve and control) methodology of six sigma strategy was used to access the MSDs. Chi-square test was used for the analysis and a p-value of less than or equal to 0.05 was considered statistically significant. RESULTS: The overall prevalence of musculoskeletal problems in the present study was found to be 68.3%. After three months only 23 respondents applied ergonomics at their work place, prevalence of pain was reduced in neck from 47.8% to 21.7% out of total 23 respondents, shoulder pain 39.1% to 17.3%, pain in elbows from 26% to 21.7%, as well as in other locomotor organs. The p-value was significant with p <0.05. CONCLUSION: MSD represents a major occupational health issue for dentists in India as well as worldwide and result revealed necessitates the need of workshops to create awareness of ergonomics as effective measures for reducing MSD among dentists.

Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: preliminary report.

BACKGROUND AND PURPOSE: MR techniques have proved useful in assessing brain injury from perinatal asphyxia when the injury is subacute or chronic. Recent advances in understanding the molecular mechanisms of brain injury have made medical intervention plausible, creating a need for assessment of the brain within the first few hours of life. We report the results of early (first 24 hours after birth) MR imaging in seven patients, including proton MR spectroscopy in six. METHODS: MR studies were performed within the first 24 hours of life in seven consecutive patients who were encephalopathic after complicated deliveries. Standard T1-, T2-, and diffusion-weighted sequences were performed in all patients; single-voxel MR spectroscopy was performed in two locations in six of the seven patients. Follow-up MR studies were performed in four patients at ages 7, 8, 9, and 15 days, respectively. RESULTS: T1-weighted images were normal in all seven patients. T2-weighted images were normal in three patients and showed T2 prolongation in the basal ganglia or white matter in the other four. Diffusion images showed small abnormalities in the lateral thalami or internal capsules in all seven patients. Comparison with clinical course in all seven patients and with follow-up MR studies in four showed that the diffusion images underestimated the extent of brain injury. Proton MR spectroscopy showed substantial lactate elevation in all six of the patients studied. Two patients died in the neonatal period and the other five were left with clinically significant neurologic impairment. CONCLUSION: MR spectroscopy performed in the first 24 hours after birth is sensitive to the presence of hypoxic-ischemic brain injury, whereas diffusion imaging may help identify but underestimate the extent of the injury. Further studies are ongoing in an attempt to expand upon this observation.

Global myocardial revascularization without cardiopulmonary bypass using innovative techniques for myocardial stabilization and perfusion.

BACKGROUND: In off-pump coronary bypass grafting (CABG), invasiveness is reduced but technically perfect anastomosis is jeopardized by cardiac motion and the need to hurry to reduce the time of ischemia. Also, a major cause of postoperative morbidity and mortality is ungrafted circumflex coronary artery disease. We have devised a means of overcoming these shortcomings and performing multivessel CABG. The objective of this study was to assess the safety and efficacy of our technique. METHODS: One hundred patients with severe triple-vessel disease underwent multivessel off-pump CABG. For cardiac stabilization, a combination of local pericardial stabilization sutures and lifting and rotating the heart by means of posterior pericardial sutures were used. For myocardial perfusion, a technique of retrograde coronary sinus perfusion by arterial blood from the ascending aorta was used. RESULTS: Each patient received an average of 3.8 grafts (range 3 to 5). Complications included conversion to cardiopulmonary bypass (CPB) in 1 patient and a perioperative myocardial infarction in the same patient. In all other patients we were able to perform a satisfactory grafting in all territories with no operative mortality. Rapid recovery allowed 95% of our patients to resume normal activity within 1 month. A predischarge graft angiogram in 35 patients showed 97.8% patency. CONCLUSIONS: These results suggest that off-pump CABG with our techniques is effective and safe. Early clinical outcome and excellent patency rates suggest its more widespread use in selected cases.

Osteosarcoma of the scapula arising in osteogenesis imperfecta.

A case of osteosarcoma arising in the scapula of a 37 year old woman with severe congenital sporadic white sclera type osteogenesis imperfecta (OI) is presented. Osteosarcoma occurs as a sporadic rather than a related occurrence in patients with OI. A delay in the diagnosis of osteosarcoma may occur due to the similarity in symptomatology between the two conditions and because of the difficulty in differentiating between hyperplastic callus and tumor using conventional radiographic imaging techniques.

Differences in impulse distribution in patients with plantar fasciitis.

The impulse distribution based upon vertical foot-floor reaction forces and time under the fore-, mid-, and hindfoot was determined using Tekscan's F-Scan system. This was compared in 40 barefoot patients with long-standing plantar fasciitis with an equal number of normal subjects. The patient group tended to load the hind- and midfoot to a lesser extent than the control group. Consequently, a greater proportionate load was borne by the forefoot. This result was highly significant for both the midfoot (P < 0.001) and forefoot (P = 0.002) comparisons. An objective biomechanical method such as this may be useful as a diagnostic aid, to identify individuals predisposed to this condition, and for evaluating the efficacy of various treatment modalities.

An audit of early hospital readmission after primary knee joint replacement.

BACKGROUND: Hospital readmissions following arthroplasty represent a considerable burden to the community. The present study investigates the magnitude of this problem and the reasons for early readmission. METHODS: The medical records of patients who underwent primary knee joint replacements between July 1989 and December 1994 were reviewed retrospectively. Readmission within 12 months of surgery was noted and the prognosis of these patients assessed. RESULTS: A total of 160 patients (180 arthroplasties) were appropriate for review. The readmission rate for knee-related morbidity was 18%. The main reasons for this included pain, stiffness, and the investigation/management of an inflamed joint. Notably, patellofemoral disease was common, particularly in the group without resurfaced patellae, manipulation of a stiff joint was rarely effective unless instituted early and aetiologies aside from sepsis often resulted in the patient returning with an inflamed joint. CONCLUSIONS: Readmission is a significant problem which heralds a poor 12-month prognosis.

Morphometric analysis of the right gastroepiploic artery and the internal mammary artery.

BACKGROUND: The internal mammary artery (IMA) and the right gastroepiploic artery (RGEA) are frequently used as conduits for coronary artery bypass grafting. METHODS: Morphometric measurements and histologic characteristics of the RGEA and the IMA were studied in 25 patients undergoing coronary artery bypass grafting. RESULTS: External radius was found to be more in the IMA (range, 18 to 56 microns; mean, 39.56 microns) in comparison with the RGEA (range, 24 to 51 microns; mean, 32.52 microns; p < 0.01). There was no significant difference between the vessels in intimal thickness (IMA: 0.0 to 0.25 micron; mean, 0.05 micron; RGEA: 0.0 to 0.28 micron; mean, 0.09 micron), internal radius (IMA: 5 to 47 microns; mean, 28.40 microns; RGEA: 16 to 42 microns; mean, 23.56 microns), area of media (IMA: 1,690 to 3,476 microns2; mean, 2,777.52 microns2; RGEA: 1,659 to 3,600; mean, 3,012.44 microns2), intimal thickening index (IMA: 0.0 to 0.02; mean, 0.01; RGEA: 0.0 to 0.13; mean, 0.01), and medial index (IMA: 0.14 to 0.60; mean, 0.36; RGEA: 0.18 to 0.63; mean, 0.39). Histologic examination of the RGEA showed more defects in continuity of internal elastic lamina and rich smooth muscle cells in the media. CONCLUSIONS: There was no difference in the morphometric measurements of the IMA and the RGEA except external radius, which was greater for the IMA. The histologic differences found in the RGEA may indicate an increased propensity for atherosclerosis of the RGEA as compared with the IMA. Some concern regarding the long-term patency of the RGEA in myocardial revascularization is warranted.

Geographical variations in the presentation of ruptured aneurysms of sinuses of valsalva: evaluation of surgical repair.

From 1981 to 1992, 13 male and 7 female patients underwent surgical correction for ruptured aneurysms of sinus of valsalva. A total surgical experience of 22 procedures including 2 reoperations is presented, accounting for 1.37% of open heart surgery for congenital heart disease at PGIMER Chandigarh. Ninety percent were in the 20- to 40-year age group. Forty-five percent of patients had symptoms of > 1-year duration (range 2 months to 20 years) and catastrophic onset of symptoms was noted in four (18%). All patients had localized aneurysms originating either in right coronary sinus (14 pts) or noncoronary sinus (8 pts). Sites of origin and rupture are detailed. Associated congenital abnormalities such as ventricular septal defect (VSD) (13 pts), aortic regurgitation (3 pts), and left superior vena cava and atrial septal defect (ASD) (1 pt each) were noted. The data pertaining to Oriental and Western groups of patients were analyzed, and the differences in age, mode of presentation, site of origin, rupture, and the spectrum of associated abnormalities were elucidated. The majority of the patients (86.4%) were operated by the Bicameral approach. Repair was tailored according to the extent and severity of the defect in the sinus of Valsalva and aortic valve annulus and also the presence and site of VSD.