Acquisition of Streptococcus mutans and dental caries experience in pediatric sickle cell anaemia patients under various prophylactic therapies.

OBJECTIVES: To determine the acquisition of Streptococcus mutans and dental caries experience in children with sickle cell anaemia (SCA) under various prophylactic therapies. METHODS: This study involved a total of 200 children who were divided into five groups comprising of 40 children each. Group SP included children who received prophylactic penicillin, Group SV who received pneumococcal vaccination, Group SPV who received both prophylactic penicillin and pneumococcal vaccination, Group SW who did not receive any prophylactic therapy and Group CC who were controls. Stimulated saliva samples from volunteers were collected and cultured in Mitis Salivarius Bacitracin (MSB) agar for estimation of Streptococcus mutans. Decayed, Missing, Filled (DMFT) index/decayed, exfoliated, and filled tooth (deft) index was used for assessment of dental caries. RESULTS: Group SP, Group SV, and Group SPV showed statistically significant difference in Streptococcus mutans count and dental caries experience in children when compared to Group SW and Group CC (p < 0.05) with the maximum reduction in Group SPV. No significant differences were observed in Group SW and Group CC. CONCLUSIONS: Reduction in the Streptococcus mutans acquisition and dental caries experience was seen in children with SCA who received prophylactic therapy with the least acquisition in combination therapy (Group SPV).

Pseudoexfoliation as a risk factor for peripheral vascular disease: a case-control study.

AIM: To determine the association between pseudoexfoliation (PEX) and peripheral vascular disease (PVD) among age-related cataract. SETTING: Iladevi Cataract and IOL Research Center, Ahmedabad, India. MATERIAL AND METHODS: An observational age-matched case-control study of 160 patients over 60 years of age with age-related cataract. A total of 40 subjects with PEX (cases) were compared with 120 subjects with cataract but without PEX (controls). A detailed medical history, including hypertension, diabetes mellitus, cerebrovascular stroke and ischaemic heart disease, was recorded. Ankle brachial index (ABI) was used to determine the risk of PVD among age-related cataract patients. Color Doppler imaging was performed on the brachial and dorsalis pedis artery to measure ABI and detect PVD. Least mean ABI was the main outcome measure, as low ABI indicates higher risk for PVD. The lowest mean ABI was measured for each subject. An ABI ratio of <0.90 was considered abnormal. The Mann-Whitney U-test and logistic regression were used for analysis. RESULTS: The lowest mean ABI in the controls was 0.98 ± 0.03 (SD; a range of 0.86-1.08) as compared with 0.88 ± 0.02 (SD) among the cases (a range of 0.79-0.92; P < 0.001). When compared with controls, cases had a lower ABI (P < 0.001) irrespective of the presence or absence of systemic illness. On multiple regression analysis adjusting for systemic illness, the presence of PEX increased the odds of a low ABI group 150 times (P < 0.001). CONCLUSION: Subjects with cataract and PEX had a significantly lower ABI as compared with controls (cataracts without PEX). PEX is associated with and may be a risk factor for PVD.

Novel F-releasing composite with improved mechanical properties.

In recent years, the authors have been developing novel fluoride-releasing dental composites containing ternary zirconium fluoride chelates. The aim of this study was to improve the physical and mechanical properties of these composites by improving the formulation of the monomers and photoinitiators. The hypothesis was that reduction of hydrophilic monomers and improvement of the photoinitiators could reduce water sorption and significantly increase the mechanical properties of the composite. The degree of conversion of the composites containing different compositions of photoinitiators was studied by Fourier transform near-infrared spectroscopy (FT-NIR). Ten experimental composites containing different compositions of ethoxylated bisphenol-A dimethacrylate (EBPADMA), 1,6-hexanediol dimethacrylate (HDDMA), triethylene glycol dimethacrylate (TEGDMA), and 2,2-bis[4-(2-hydroxy-3-methacryloyloxypropoxy) phenyl]-propane (BisGMA) were tested for flexural strength, viscosity, and water sorption. The experimental composite containing 20% synthesized fluoride-releasing monomer, 30% BisGMA, 30% EBPADMA, and 20% HDDMA showed significantly higher fluoride release and recharge, but physical and mechanical properties similar to those of the control composite containing 40% BisGMA, 40% EBPADMA, and 20% HDDMA.

Clinico-laboratory findings of patients during dengue outbreak from a tertiary care hospital in Delhi.

There are outbreaks of dengue every year in India. They vary in the predominant serotype involved, clinical features and predominant laboratory findings. This study of the 2006 outbreak in Delhi highlights clinical features and laboratory parameters of dengue cases and compares the clinical features among the adult and paediatric age groups. The 2006 outbreak had higher bleeding manifestations and a greater involvement of the adult male population than in previous outbreaks. No correlation was observed between platelet count and different bleeding manifestations until they dropped <20,000 per microL. Few patients developed a florid picture before seroconversion, highlighting a greater stress on the haematological rather than immunological profile of such patients. Atypical symptoms, such as diarrhoea, menorrhagia and seizures were often the presenting complaints rather than the typical clinical features of dengue.

Diagnosis of Malaria Infection Using Non Radioactive Malaria Diagnostic System (NOMADS).

BACKGROUND: Malaria remains one of the leading causes of morbidity and mortality. A definitive and early diagnosis remains the biggest challenge world-wide. Light microscopy of blood smears has been the gold standard in diagnosis of malaria for decades. This routine microscopic diagnosis is often unreliable and may not be available at many peripheral health centers. Hence newer diagnostic techniques have been developed based on antigen detection. METHOD: Microscopy and Non-radioactive Malaria Detection System (NOMADS) to diagnose falciparum malaria were compared. Specificity and sensitivity of this technique and applicability of the kit for rapid and reliable malaria diagnosis were evaluated. 2579 samples of blood were processed. Both thick and thin blood smear examination and NOMADS was carried out on each of them. All smear positive samples and highly suspicious clinical cases were also subjected to detection of HRP-2 antigen by ICT Malaria Pf test. RESULTS: The detection rate for malaria on smear examination (both vivax and falciparum) was highest at Dimapur (7.41%), followed by Tezpur (7.13%), Kolkata (7%), Guwahati (6%) and Changsari (3.6%). All centers had greater incidence of falciparum compared to vivax except Kolkata where only vivax was detected. The sensitivity of NOMADS was 0%, 4.8%, 13.5%, 42.9% and 52.8% at Kolkata, Tezpur, Guwahati, Changsari and Dimapur respectively. The specificity of the test ranged between 91.8% at Changsari to 95.9% at Dimapur. The specificity at Tezpur, Kolkata and Guwahati was 92.3%, 94% and 95.3% respectively. CONCLUSION: The study revealed that the test kit developed needs to be standardised as regards calculation of cut off values for each of the test runs and reproductibility of optical density readings. Immuno-Chromatography Test (ICT) is helpful in early diagnosis, management and follow-up of cases of malignant malaria.

Blood Ordering Strategies in the Armed Forces - A Proposal.

Over ordering blood is a common practice in medicine. This can be corrected by a simple means of changing the blood ordering pattern. A retrospective study was carried out in a tertiary care hospital of Armed Forces for a three year period to study the blood ordering strategies in the hospital. The total units demanded and the corresponding units issued were estimated. Thereafter, transfusion probability and ratio of units cross-matched to actual units transfused (C/T ratio) was calculated. In this study, using Mead's criterion, transfusion probability and C/T ratio, transfusion guidelines for all cases requiring transfusion is proposed. The study also identifies the common cases where 'Type and Screen' (T&S) procedure could be introduced in cases where the transfusion probability is low. The other group where transfusion probability is high, a maximum surgical blood ordering schedule (MSBOS) has been determined to identify the number of units to be cross-matched and kept ready before the procedure. The implementation of this proposal will avoid over-ordering of blood and will promote maximum utilization.

Role of Molecular Typing in Live Related Donor Renal Transplantation.

In renal transplantation, a good HLA-DR match is associated with higher success rate of graft outcome. It is particularly so In high risk recipients. Serological HLA-DR typing is not always easy due to a number of technical problems. In view of this, a comparison of serological and molecular typing was done in our institutions. A total of 64 live related donor patients of renal transplantation were studied. Serological typing was done by conventional methods. Molecular HLA class II typing was done by polymerase chain reaction (PCR) based sequence specific oligonucleotide probe (SSOP) hybridization technique. An overall discrepancy of 19.5% was observed in the DR typing obtained by serology and PCR-SSOP of all the recipients and donors. 14.5% of cases showed discrepancy in the results of only one DR antigen. Serological typing failure was seen in 10.9% of total cases. In 19.5% cases, only one DR antigen was assigned by PCR-SSOP as compared to two antigens by serological methods. Maximum number of discrepancies were seen in DR 2 antigens. There was no appreciable difference of graft survival shown in the patients typed by both methods. However, higher incidence of acute graft rejection episodes were seen in patients with 1 antigen mismatch as compared to zero mismatch. It is concluded that HLA-DR typing should be carried out by molecular methods as these have been found to be more specific and accurate.

Continuous axillary block for upper limb surgery in a patient with epidermolysis bullosa simplex.

We report the use of continuous regional block with light general anaesthesia in epidermolysis bullosa simplex. A 4-year-old girl suffering from florid epidermolysis bullosa simplex was scheduled for external fixator (JESS) for manus valgus deformity of the left forearm. Haemoglobin was 7.6 g.dl(-1) and blood chemistry was normal. She had no history of oral bullae, although a younger sibling had died of Bart syndrome with oral lesions. She was sedated with nasal midazolam 0.5 mg.kg(-1). All pressure points were cushioned. Inhalational anaesthesia was given by holding a mask above her face. Only oximetry and capnography were monitored. ECG and noninvasive blood pressure monitoring were avoided. The intravenous cannula was fixed by sutures. An epidural catheter of 0.63 mm OD (21-G) was passed into the axilla for continuous axillary block. Intra- and postoperative course was uneventful with slight bullae at the i.v. site and at the fixator which healed without further damage. The axilla remained free of problems. Continuous peripheral plexus or nerve blocks can be an option in these difficult patients, and can minimize the amount of general anaesthesia along with problems of airway handling and potential subsequent mucosal lesions. The postoperative period was pain free and comfortable.

Continuous caudal epidural analgesia for congenital lobar emphysema: a report of three cases.

IMPLICATIONS: In congenital lobar emphysema, positive pressure ventilation can expand the emphysematous lobe, compressing the normal lung during anesthesia induction. We managed the dual challenges of safe induction and analgesia for thoracotomy by placing thoracic epidural catheters via the caudal insertion site and retaining spontaneous ventilation until thoracotomy.

Eosinophilic gastritis--an unusual cause of gastric outlet obstruction.

Eosinophilic gastroenteritis is a rare entity. We report a 41-year-old man who presented with features of gastric outlet obstruction due to a submucosal lesion in the distal end of the stomach. Distal gastrectomy with Billroth II reconstruction was done. Histology showed eosinophilic gastritis infiltrating the muscular and serosal layers of the pylorus and antrum.

Pattern waxes and inaccuracies in fixed and removable partial denture castings.

It is the desire of every dentist and dental technician to produce a restoration that will fit the patient with a minimum of adjustments and certainly one that does not require remaking. Yet many abuse the materials with which they work, either through improper manipulation, lack of familiarity with their properties, or by attempting to reduce laboratory time by taking short cuts. Wax is one of the materials that requires more knowledge and skill to manipulate accurately because it has a considerably higher coefficient of thermal expansion (and contraction) than any other dental material. It often contributes considerably to the inaccuracies of cast dental restorations. This article provides a review of dental waxes used to make prosthodontic castings and points out some of the properties of waxes that must be controlled to make accurate restorations.

The effect of storage time of removable partial denture wax pattern on the accuracy of fit of the cast framework.

STATEMENT OF PROBLEM: Situations may arise in dental laboratories that could result in a time lapse between preparing the wax pattern of the removable partial denture framework and its casting into the cobalt-chromium alloy. PURPOSE: This study investigated the effect of storage time of the wax pattern before casting and the influence of the palatal major connector design on the accuracy of its fit on the master casts. MATERIAL AND METHODS: Forty-two frameworks were prepared with two designs of major connectors, which were divided into three subgroups according to the storage time of the wax patterns: 24 hours, 1 week, and 1 month. Discrepancies in the fit of the connectors to their respective casts were measured at specific locations for both connector designs. RESULTS: In both framework design groups, there was a significant deterioration in fit (p < 0.0005) of the major connectors with the increase in storage time of their wax patterns on their respective refractory casts. Gap discrepancies were more pronounced towards the center of the palate. CONCLUSIONS: The greatest discrepancies appeared at the middle sections of the connectors more than at the lateral section (p < 0.0005). Furthermore, frameworks with modified palatal plate major connectors exhibited greater inaccuracies in their fit than those with the anterior posterior palatal strap design, as evidenced by the increase in mean gap discrepancies under the palatal plate design (p < 0.0005).

The use of microwave energy to cure denture acrylic resins.

Experiments have been carried out on the curing of poly(methyl methacrylate) denture base material in a microwave oven, using conventional dental flasks and flask clamps. It has been shown that it is important (a) to maintain sufficient pressure on the materials, (b) to avoid gaseous porosity by not heating too rapidly initially, and (c) to ensure that all metal is protected from exposure to microwaves. When the appropriate conditions of polymerisation were used, microwave-cured samples had satisfactory physical and mechanical properties according to American Dental Association specification number 12.

Cellular localization of retinoic acid receptor-gamma expression in normal and neoplastic skin.

Retinoids profoundly affect the normal growth and differentiation of epithelial tissues. Retinoic acid receptor-gamma (RAR-gamma) is a member of a family of retinoid receptors, and has been shown to be expressed almost exclusively in skin. However, little is known about the cellular localization of this receptor in human skin. The authors studied the expression of RAR-gamma in normal skin and human skin tumors by Northern blot analysis and in situ hybridization. RAR-gamma mRNA was detected in normal skin as well as in cultures of neonatal keratinocytes. Using an oligonucleotide specific for the RAR-gamma cDNA isoform 1 (RAR-gamma 1), RAR-gamma 1 mRNA was localized to all layers of the epidermis, the outer root sheath of hair follicles, follicular hair bulbs, eccrine and sebaceous glands. Basal cell carcinoma constitutively expressed gamma-1 mRNA and one of seven squamous cell carcinomas showed loss of gamma-1 mRNA expression, relative to adjacent epithelium. By contrast, normal melanocytic nevi and tumor-associated lymphocytes expressed little or no RAR-gamma mRNA. These results suggest that RAR-gamma 1 may play an important role in the maintenance and differentiation of normal epidermis and skin appendages.

Autografting and PUVA. A combination therapy for vitiligo.

A novel approach to the management of vitiligo is described using a combination of epidermal autografts transplanted into the depigmented areas and psoralen-ultraviolet-A (PUVA) therapy. Epidermal autografts can be obtained rapidly and in large numbers using a device that combines the synergistic effects of suction and heat on the skin. Subsequent exposure to PUVA therapy promotes spread of pigmentation out of the grafts resulting in even and complete pigmentation. In certain situations, the combination therapy appears to offer the potential for avoiding the disadvantages of both of the two treatments when they are used alone. This article presents our preliminary work in the development of the methodology for this combined approach.

Laser therapy in the treatment of congenital vascular abnormalities.

Portwine stains, especially on the face, have serious psychological and emotional impact for affected children. Laser therapy has been the only effective means for treating these lesions. The argon laser has been the mainstay, but more recently the flashlamp-pumped pulsed dye laser has added significantly to the management of portwine stains as well as to the effective treatment of other vascular lesions such as telangiectasias and angiomas.

A comparative study between three ethnic groups to derive some standards for maxillary arch dimensions.

A sample of 91 adult Philippinos, 45 males and 46 females, were selected for maxillary arch measurements. The intercanine width (C-C), intermolar width (M-M), molar incisor (M-I) and molar canine (M-C) length were measured. The measurements were compared to previous studies of maxillary arch dimensions for adult male and female Egyptians and Saudi Arabians. The results showed wider (M-M) measurements for the Egyptians than for the Philippinos, who also showed wider (C-C) arch dimensions than the Saudi Arabians.