Biodentine™ as a temporary filling in deep carious lesions in permanent teeth: a prospective observational 33-month follow-up study.

PURPOSE: The study aimed to evaluate temporary fillings using Biodentine™ in asymptomatic deep carious lesions after 12, 24, and 36 months in school children from the remote village of Kerung, Nepal. METHODS: From November 2018 to November 2019, 91 temporary fillings were placed using Biodentine™ (a hydraulic calcium silicate cement) in permanent molars with deep carious lesions of schoolchildren in the remote district of Kerung, Nepal. These restorations were performed after selective caries removal in a non-dental setting with hand instruments and cotton roll isolation, as electric motors and saliva ejection systems were unavailable. In total, 78 single-surface and 13 multi-surface fillings were placed. Clinical and radiographic follow-up periods encompassed 12, 21, and 33 months, respectively. RESULTS: After 12 months, all single-surface fillings (100%) survived, whilst all multi-surface fillings were partially or entirely lost. The survival rate of single-surface restorations after 21 and 33 months was 67.6% and 50%, respectively. Radiographically, no pathology was observed. CONCLUSION: This study showed that Biodentine could be used in deep carious lesions as a temporary filling in single-surface lesions for at least up to 1 year and in a substantial number of cases for up to 21 and 33 months.

General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study.

Reported data suggest that 99% of transfemoral, transcatheter aortic valve implantations in the UK are performed under general anaesthesia. This before-and-after study is the first UK comparison of conscious sedation vs. general anaesthesia for this procedure. Patients who underwent general anaesthesia received tracheal intubation, positive pressure ventilation, radial arterial and central venous access and urinary catheterisation. Anaesthesia was maintained with propofol or sevoflurane. Patients who received conscious sedation had a fascia iliaca and ilioinguinal nerve block and low-dose remifentanil infusion, without invasive monitoring or urinary catheterisation. Recruitment took place between August 2012 and July 2015, with a 6-month crossover period between November 2013 and June 2014. A total of 88 patients were analysed, evenly divided between the two groups. Patients receiving conscious sedation had a shorter anaesthetic time (mean (SD) 121 (28) min vs. 145 (41) min; p < 0.001) and recovery room time (110 (50) min vs. 155 (48) min; p = 0.001), lower requirement for inotropes (4.6% vs 81.8%; OR (95% CI) 0.1 (0.002-0.050); p < 0.001) and a lower incidence of malignant dysrhythmia (0% vs 11.4%; p = 0.020). Conscious sedation appears a feasible alternative to general anaesthesia for this procedure and is associated with a reduced requirement for inotropic support and improved efficiency.

Anti-venom-induced myelopathy in a semipoisonous snakebite.

A 40-year-old woman developed myelopathy manifesting as Brown Sequard syndrome after administration of Anti-venom (polyvalent enzyme-refined equine globulin supposed to neutralise 0.6 mg of standard cobra venom, 0.45 mg of standard krait venom, 0.6 mg of standard Russel's viper venom and 0.45 mg of saw scaled viper venom, manufactured by Serum Institute of India, Pune, India). It was concluded to be an immunological inflammation of the spinal cord after ruling out hematomyelia on imaging. The necessity of antivenom in semipoisonous snake bites have been addressed further in the article.

In vitro immunity of rat peritoneal macrophages to Candida albicans.

Phagocytic, germ tube inducing and candidacidal activities were investigated in monolayers of peritoneal macrophages of rats. The phagocytic activities observed in macrophages of the healthy rats in the presence of normal serum, those in the presence of immune serum and of immunized rats in the presence of normal serum were 40%, 45.3% and 44.8% respectively. The percent of macrophages in which intracellular Candida formed germ tubes in the above three situations were 10, 9.59 and 10.19, respectively and the percent of intracellular Candida that formed germ tubes were 6.6, 3.7 and 4.1, respectively. The candidacidal activity observed in the above three sets of macrophages were 5.33%, 22.66% and 19.88%, respectively. Induction of germ tube in C. albicans in supplemented tissue culture medium containing normal serum was 15 per cent. These observations indicate that immunisation/sensitisation of individuals with C. albicans organisms does provide some degree of cell mediated immunity by activating macrophages. This may partly be due to the appearance of specific antibodies. It is likely that this type of immunity can be produced by subclinical infections during invasion by the commensal organism thus preventing further invasion establishment of infection and keeping the organism (C. albicans) in a state of commensalism. However, the degree of immunity so produced is so low that predisposing factors suppress it and allow establishment of infection.

Cerebral chromoblastomicosis--a rare case report of cerebral abscess and brief review of literature--a case report.

A rare case of Cerebral Chromomycosis caused by chromogenic fungus Cladosporium trichoides in a 35 year old male with classical presentation of cerebral abscess is being presented. The case report lays emphasis on the histological diagnosis of chromogenic fungus in the wall of the abscess cavity, surgically removed from a well delineated circumscribed lesion in the frontal lobe of the cerebrum. The causative fungus could be detected even in unstained paraffin sections. The diagnosis could be made only after surgical removal and histopathological examination. The mycological culture could not be made as the material was received in formaldehyde fixative. The unique features of the case is its recurrence free uneventful survival five years after surgical excision. This is probably the fifth reported case of cerebral chromomycosis from India and first of its type from arid zone of Rajasthan.

Seroprevalence of toxoplasmosis in Jodhpur, India.

Toxoplasma gondii specific IgG and IgM antibody levels were determined in sera of 135 healthy human volunteers comprising of students (85), staff (50) and 115 patients comprising of 65 adults and 50 children whose blood was taken for some other investigations. None of the subjects had congenital disease or any other sign or symptom suggestive of Toxoplasmosis. None of the women had had obstetric history or gave birth to infants with congenital defects. Toxoplasma gondii specific IgG and IgM antibodies were assayed by ELISA. Sero positivity to one or both classes of antibodies was observed in 17.2%. However, active infection i.e. IgM positive or high (> 210 Eu/ml) level, IgG was observed only in 4.4%. Antibody levels and seropositivity rate increased with age. No statistically significant differences in the levels of antibodies were observed in relation to sex, socioeconomic status, place of living (rural/urban) and dietary habit (vegetarian/non vegetarian). However, relatively higher prevalence of seropositivity was observed in males and villagers.

A simple synthetic liquid medium for development of yeast and mycelial form of pathogenic species of Candida.

Thirty two known strains of Candida species were used for evaluation of glucose, serine, ornithine, methionine, GSOM medium and its comparison with Lee's medium for the production of yeast and mycelial phase at different temperatures and on prolonged incubation. No mycelial form was observed when various Candida species in GSOM and Lee's medium were incubated at 25 degrees C up to 72 hours. Percentage of mycelial forming cells of Candida species were more in GSOM medium than Lee's medium in 48 hours at 37 degrees C. Among various species of Candida, albicans and C. parapsilosis showed maximum mycelium formation. GSOM medium can be used for growing Candida species particularly C. albicans in mycelial phase.

Immunoglobulin profile in mycetoma.

Serum samples obtained from 25 patients of mycetoma caused by Madurella mycetomi in 18, Streptomyces somaliensis in 5, Streptomyces madurae and streptomyces palletierii from 1 each and also from 25 healthy controls were evaluated for immunoglobulins IgG, IgM and IgA by radial immunodiffusion method using tripartigen plates. All the three classes of immunoglobulins showed increased concentration in cases of mycetoma by M. mycetomi and S. pelletierii. The raised levels of IgG and IgM in cases of mycetoma caused by S. madurae and S. somaliensis where bones were involved, were not statistically significant. IgA was consistently high in all cases of mycetoma irrespective of causative agent and tissue involved. These alterations may possibly reflect relatively poor IgG and IgM response in individuals with extension of mycetoma lesion to bones.

Dermatophytoses in a desert district of Western Rajasthan.

Clinico-mycological study of 250 cases of dermatophytoses was undertaken in a desert district of Western Rajasthan. Incidence of dermatophytoses in this area was 8.60% with tinea cruris (34.4%) as the major clinical type followed by tinea corporis (24.0%) Incidence of tinea capitis was 16.8% and 90% of those affected were in the age group of 0-10 years. Male preponderance was observed (M:F=2:1). There were 15 cases of tinea faciei (6%), majority belonging to 0-10 years age group. Trichophyton violaceumwas isolated In majority (55.76%) from all clinical types followed by Trichophyton rubrum(42.3%).

Aqueous penetration of orally administered ciprofloxacin in humans.

The aqueous penetration of orally administered Ciprofloxacin (CPX) was studied in twenty-two human volunteers undergoing cataract surgery. CPX in a dose of 250 mg, was given p.o. at 12 hourly intervals in 3 groups such that a maximum dose of 0.5 grams was delivered in one group, 1.0 grams in another and 1.5 grams in the last group. A fourth group consisted of 6 individuals who were controls and received lactose tablets. Twelve hours after the last dosing aqueous samples were collected and assayed by the Grove-Randall technique. The aqueous penetration of Ciprofloxacin achieved was 1.51 +/- 0.15 mgL-1 in group II and 2.49 +/- 0.52 mgL-1 in group III. In group I, the aqueous concentration was experimentally indeterminate and the control samples in group IV did not show any antibacterial activity. Divided oral doses of 1.5 grams of CPX were found to produce an aqueous titre up to 2.5 times the MIC of Ps. aeruginosa.

Morphological identification of Candida species on glucose agar, rice extract agar and corn meal agar with and without Tween-80.

A comparative study for the identification of 32 known strains of Candida species on the basis of morphology on glucose agar, rice extract agar and corn meal agar with and without Tween 80 revealed that when Tween 80 is incorporated in the media identification is possible for 96.8% of the species within 48 hours on rice extract agar and for 96.8% of the species within 48 hours on rice extract agar and for 90.6% of the species on glucose agar. The germ tubes and chlamydospores were also produced more on rice extract agar than on 0.1% glucose agar. Rice extract agar with Tween 80 can be used as single medium for morphologic identification of Candida species. The inoculated medium is first incubated at 37 degrees C for 3 hours and examined for germ tube formation and then incubated at 25 degrees C for 24 to 72 hours and examined for appearance of chlamydospores and mycelial morphology.

A bacteriological study of the environment of pediatric ward and neonatal nursery.

The hospital environment is full of pathogens which may cause nosocomial infections. A bacteriological survey of hospital air, floor, water, milk and fomites was done. The air survey showed large number of bacteria carrying particles in air. A direct relation between floor area per person and bacterial contamination of air was established. The floor survey showed that there is abundance of bacteria on the hospital floors, much more than the accepted fair standards of house keeping. The hospital water had a high coliform and total bacterial count and stored tank water was more dirty. Neonatal nursery milk also had high total bacterial and coliform counts. Regular surveillance of hospital environment may help to reduce the incidence of cross infection.

Clinical & virological study of dengue fever outbreak in Jalore city, Rajasthan 1985.

An epidemic of acute febrile illness caused by dengue virus occurred in Jalore town, in south-west Rajasthan, in April and May, 1985. Most patients had classical signs and symptoms of dengue fever or had only a mild atypical febrile illness. A few patients had in addition haemorrhagic manifestations/shock or encephalitis. Virological studies (carried out by the National Institute of Virology, Pune) showed that dengue type 3 virus was the main etiological agent. This is the first reported outbreak of dengue in the arid zone in western Rajasthan, that occurred in summer (April-May) in contrast to other parts of India, where such outbreaks are commonly reported after the rains (between August and November).