Survey of patient experiences of orthognathic surgery: health-related quality of life and satisfaction.

The objective of this study was to assess changes in patient quality of life (QoL) after orthognathic surgery at the Kuwait University Dental Clinic. A self-administered Arabic version of the Orthognathic Quality of Life Questionnaire (OQLQ) and two different visual analogue scales (VAS) were used. Sixty-six patients participated (63.6% female). The deformities were corrected by bimaxillary jaw surgery (83.3%), Le Fort I (9.1%), and bilateral sagittal split osteotomy (7.6%). The most important reasons given for undertaking the surgery were facial aesthetics (80.3%) and bite correction (75.8%). Of the patients who had reported moderate to high levels of problems pre-surgery, the majority reported improvements in facial appearance (91.3%), appearance of the teeth (97.0%), biting (96.3%), chewing (92.3%), and eating function (76.5%). Overall, 93.9% of patients reported better conditions after surgery, and the satisfaction level was very high (VAS 91.6%). The VAS score for QoL increased significantly from pre-surgery (73.0%) to post-surgery (93.6%) (P=0.0001). The OQLQ score was also significantly decreased after surgery, reflecting improvements in the 'social aspects of dentofacial deformity', 'facial aesthetics', 'oral function', and 'awareness of dentofacial aesthetics' domains (P=0.0001). Overall, the patients who underwent orthognathic surgery were satisfied and had improved QoL. The satisfaction rate in the present study reflects successful treatment with orthognathic surgery.

Haematological indices and haematinic levels after mini gastric bypass: a matched comparison with Roux-en-Y gastric bypass.

Many surgeons believe mini gastric bypass (MGB) is more likely to cause micronutrient malabsorption compared to Roux-en-Y gastric bypass (RYGB). Till date, there is no published study evaluating haematological indices and haematinic levels in patients undergoing MGB and comparing these with a matched cohort of RYGB. Two hundred patients who underwent MGB between October 2012 and October 2015 were matched to 200 patients who underwent RYGB for age, sex, body mass index and time of surgery. We then compared haemoglobin, mean corpuscular volume, iron, ferritin, vitamin B12 and folic acid levels preoperatively and at 6 monthly intervals after surgery until 2 years. The percentage total weight loss was significantly higher in the MGB group compared to the RYGB group at all time points. At 2 years, MGB and RYGB both led to an increase in anaemia rates but the difference was only significant for MGB group. Compared to RYGB, MGB patients were more likely to be anaemic at 2 years, although the difference was not significant statistically (16.6% vs. 12.7%; P value = 0.55). There was a trend for lower iron and folate levels in MGB group compared to RYGB group but the difference was statistically significant at some of the time periods only (significantly lower folate at 6 and 12 months and lower iron at 6 months in the MGB group). MGB leads to a significant increase in anaemia rates in a supplemented cohort. There is a trend towards lower iron and folate levels and higher anaemia rates in MGB group in comparison with RYGB. Larger studies with longer follow-up should evaluate results of MGB with a shorter biliopancreatic limb.

Economic Evaluation of a Pilot School-Based Dental Checkup Program.

The objectives of this study were to perform an economic evaluation of a targeted school-based dental checkup program in northern metropolitan Melbourne, Victoria. A 12-mo retrospective case-control cohort analysis using the decision tree method evaluated the incremental cost-utility and cost-effectiveness ratio (ICUR/ICER) for passive standard care dental services and an outreach pilot intervention completed in 2013. A societal perspective was adopted. A total of 273 children ( n = 273) aged between 3 and 12 y met the inclusion/exclusion criteria: 128 in the standard care group and 145 in the intervention group. The total society costs included health sector costs, patient/family costs, and productivity losses in 2014 Australian dollars. Outcome measures were evaluated using quality-adjusted tooth years (QATY) and the combined deciduous and permanent decayed, missing, and filled teeth prevented (DMFT-prevented). A generic outcome variable was created to determine the impact of the intervention to reach underserved populations based on government concession eligibility (cardholder status). Uncertainties were incorporated using 95% confidence intervals. The mean total society cost per child is $463 and $291 ( P = 0.002), QATY utility difference is 0.283 and 0.293 ( P = 0.937), effectiveness difference is 0.16 and 0.10 ( P = 0.756), and cardholder status is 50.0% and 66.2% ( P = 0.007), respectively, for the standard care and intervention groups. On average per child, there was a cost saving of $172 and improvement of 0.01 QATY, with an additional proportion of 16.2% of cardholder children reached. The calculated ICER was $3,252 per DMFT-prevented. The intervention dominates standard care for QATY and per 1% cardholder reached outcome measures. Our study found the pilot checkup program was largely less costly and more effective compared with the current standard care. Further research is needed to quantify the value of outreach interventions to prevent dental caries development and progression in populations from low socioeconomic status. Knowledge Transfer Statement: The findings of this research demonstrated that an outreach dental program can be less costly and more effective than standard models of dental care. It showed that a school-based dental checkup program is beneficial despite other opinions that dental screening is ineffective as a method to improve public dental health. There is fiscal economic evidence to support broader expansion of similar programs locally and internationally to reduce dental caries for children from low-income families.

Single-center prospective study of Plummer-Vinson syndrome.

Post-cricoid web is an uncommon cause for dysphagia and is most frequently reported in middle-aged women. Triad of web, iron deficiency anemia (IDA), and dysphagia is known as Plummer-Vinson syndrome (PVS). Literature on PVS is very limited. Here we report the first prospective study of PVS with predefined diagnostic criteria and management plan. Adults with dysphagia or those incidentally found to have esophageal web were prospectively enrolled between July 2011 and June 2013. Participants were evaluated with hemogram, barium swallow, and esophagogastroduodenoscopy. PVS was diagnosed if a person had IDA and a post-cricoid web in barium swallow and/or endoscopy. Patients were managed with dilation using through-the-scope controlled radial expansion balloon followed by oral iron and folic acid supplementation. Thirty-seven patients (age, median [range] 40 [19-65] years; 32 [86%] women) were enrolled. Thirty-one symptomatic patients had dysphagia grade 1 (n = 12, 39%), 2 (n = 13, 42%), and 3 (n = 6, 19%) for a median (range) duration of 24 (4-324) months. Barium swallow, done in 29, showed web in 25 which were either circumferential or anterior in position. Twenty-nine (29/31, 94%) patients had complete and two had partial response after the first session of endoscopic dilatation without any complication. Dysphagia recurred in three (10%) of the 30 patients who were followed for a median (range) of 10 (1-24) months. Esophageal-web related dysphagia in patients with PVS responds favorably after single session of endoscopic dilation.

Amla prevents fructose-induced hepatic steatosis in ovariectomized rats: role of liver FXR and LXRα.

OBJECTIVES: Increased fructose consumption causes dyslipidemia and fatty liver in postmenopausal women, both independent risk factors for cardiovascular disease. This study explored the potential mechanisms by which amla (Emblica officinalis) reduced hypercholesterolemia and hypertriglyceridemia and prevented fatty liver in a fructose-fed, ovariectomized rat model of menopause. METHODS: Sham-operated and ovariectomized rats were put on a chow or high fructose diet. They were further divided into groups with or without amla. After 18 weeks of treatment, livers were harvested and subjected to Western blot and histological analyses. RESULTS: In all groups, amla increased the protein expression of liver farnesoid X receptor (FXR) and liver X receptor (LXR), key proteins involved in lipid metabolism. Fructose-fed rats developed fatty liver and amla prevented this. Here amla produced an exceptional rise in LXR and insulin-induced gene-2 (Insig-2) which prevented the maturation of sterol regulatory element-binding protein-1 and steroyl CoA desaturase-1, responsible for triglyceride synthesis. Amla also increased the protein expression of ATP binding cassette transporter A1 (ABCA1), involved in high density lipoprotein (HDL) synthesis as well as low density lipoprotein receptor (LDLR) responsible for uptake of LDL cholesterol. Besides this, amla increased the protein expression of peroxisome proliferator activated receptor α (PPARα) involved in ß oxidation of fatty acids. CONCLUSIONS: Amla increased the protein expression of liver FXR, LXRα, PPARα and their downstream proteins Insig-2, ABCA1 and LDLR. This property of amla to modulate some of the key proteins involved in lipid metabolism promises its usefulness as a preventive agent for dyslipidemia and hepatic steatosis.

Qualitative and quantitative OCT response of diffuse diabetic macular oedema to macular laser photocoagulation.

PURPOSE: To assess the quantitative and morphological changes of the macula in response to macular grid laser for diabetic macular oedema (DMO) using optical coherence tomography (OCT). PATIENTS AND METHODS: Cirrus OCT macular cube scans of 30 eyes of 25 patients were retrospectively analysed before and 4 months after macular grid laser for diffuse DMO. The oedema was quantified and response evaluated in the nine early-treatment diabetic retinopathy study (ETDRS) zones of the macula. Post-laser OCT changes were compared with the baseline features, including morphology patterns, changes in both logarithmic transformed (logOCT) and standardised average macular thickness (AMT), total macular volume, number of parafoveal quadrants involved, and the presence of intact 3rd hyper-reflective band (HRB). RESULTS: The rate of change of retinal thickness in response to laser was maximum in the central (8.17%) and perifoveal inferior quadrants (0.04%). Diffuse retinal thickening on OCT responded best to treatment. The AMT of 300-350 µm had the worst response (+0.94%). Eyes with less than four quadrants of oedema showed good response. Disrupted HRB was associated with poor visual gain (-0.33 ETDRS letters). CONCLUSION: The topographic location of oedema on the retinal map and the morphological patterns of the oedema on OCT are useful predictors of treatment response in diffuse DMO.

An accessory digastric abductor pollicis longus muscle: report of a case

During routine dissection, a variant musclehad a proximal fleshy belly arising from theupper part of the posterior surface of theradius, an intermediate tendon and a distalfleshy belly that joined the abductor pollicisbrevis muscle. A branch from the posteriorinterosseous nerve innervated the proximalbelly and the median nerve innervated the distalbelly. It was adjacent to the abductor pollicislongus muscle. It was a digastric musclethat can be called the ‘accessory digastricabductor pollicis longus muscle’. The tendonof the palmaris longus muscle divided intotwo. One tendon joined the flexor retinaculumand the other tendon attached to theabductor pollicis brevis muscle. This slip towhich the abductor pollicis brevis attachedcrossed over the median nerve. The two belliesof the variant muscle, which were supplied bythe nerves of the flexor and extensor compartmentsof the forearm, had developed fromextensor and flexor muscles and were connectedby an intermediate tendon. Although asimilar muscle has been mentioned previously,here we report this variant muscle with anerve supply and a new name for the first timein the Southern Indian population. This accessorymuscle may be associated with joint andneural symptoms (AU)

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Distribution of zinc iodide-osmium positive dendritic cells in the human appendix

Dendritic cells are antigen-presenting cellsfound in almost every type of tissue, includinglymphatic tissue, blood and skin. In the intestinaltract, these cells are likely to play a pivotalrole in the initiation and regulation of immuneresponses. Our earlier study of the human colonand ileum revealed the presence of zinc iodideosmium-positive dendritic cells. In the presentstudy we demonstrate the presence of ZIO-positivedendritic cells in the human appendix.ZIO-positive cells were seen in the region ofcrypts of Lieberkühn as well as in the surfaceepithelium. The cells showed a single longprocess directed towards the lumen. They werelong, slender, and triangular. In the region ofthe lymphoid follicle, two different types ofdendritic cells were noted. The follicular dendriticcells present in the germinal center werefew in number, larger in size and with thickdendritic processes. However, in the mantlezone typical dendritic cells were seen. Theywere smaller in size and had many thin processes.The distribution of dendritic cells in thehuman appendix confirms the role of theappendix in the immune response (AU)

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Supernumerary cleidocervicalis (levator claviculae) muscle: case report of its rare incidence with clinical and embryological significance

During routine dissection by medical students atthe Department of Anatomy of the posteriortriangle of the neck of a South Indian muscularmale cadaver, aged 67 years, a variant of the raresupernumerary cleidocervicalis muscle wasfound bilaterally. This muscle arose from thetransverse processes of the atlas and axis. It terminatedby inserting into the posterior aspect ofthe lateral third of the clavicle, merging with theanterior fibres of the trapezius muscle. It wasinnervated by branches from the second, third,and fourth cervical nerves. No variation wasnoted in the other muscles in this region. Thepresent report addresses another variant of thecleidocervicalis muscle with a combination oforigin, insertion, and nerve supply different frommost previous reports. The aim of the presentcase report is to highlight its clinical significanceto physicians, surgeons, and radiologists in orderto differentiate it from other soft tissue lesions,together with its embryological significance toanatomists (AU)

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Dendritic cells in the human ileum: A light microscopic zinc iodide-osmium study

The presence of dendritic cells in human and animal epithelium and subepithelial tissue is demonstrated. The present study used human ileal specimens, resected for carcinoma, and revealed zinc iodide-osmium positive dendritic cells in the crypts of Lieberkühn and throughout the lamina propria. There were more cells in the lamina propria than in the crypts. Dendritic cells were polygonal with multiple short, thick processes in the lamina propria and were triangular, often with a single long process directed toward the crypt lumen, in the crypts. The cells did not have a typical, mature phenotype (AU)

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Two anatomical variations associated with potential vascular entrapment in the upper limb / Dos variaciones anatómicas asociadas con potencial atrapamiento vascular en la extremidad superior

During routine dissection of the right upper limb of a South Indian male, aged 56, at this department, a supracondylar process was found, from which a fibrous arch extended to the medial intermuscular septum. A triple-headed pronator teres muscle arose by a narrow head from a supracondylar process, a bulky head from a fibrous arch, the medial intermuscular septum, and the medial supracondylar ridge of the humerus, and the other head from the coronoid process of the ulna. The brachial artery and median nerve crossed behind the supracondylar process and fibrous arch, enclosed in a supratrochlear foramen, reached the front of the elbow, and passed through the pronator teres between its bulky and coronoid heads. The cubital fossa was absent. The brachial artery divided into the radial, common interosseous, and ulnar arteries. The median artery was enlarged, arose from the anterior interosseous artery, and passed through the carpal tunnel. The superficial palmar arch was incomplete. Digital arteries from the ulnar artery supplied the medial three and a half fingers and those from the median artery supplied the lateral one and a half fingers. A phylogenetic, clinical and embryological interest of the anatomical variations in the case is presented (AU)

Durante la disección rutinaria en un hombre del sur de la India, de 56 años de edad, se encontró un proceso supracondíleo del que se extendía un arco fibroso hacia el septum intermuscular medial. El músculo pronador redondo, con tres cabezas, se originaba por una cabeza estrecha desde el proceso supracondíleo, una cabeza abultada desde un arco fibroso, el septum intermuscular medial y la cresta medial supracondílea del húmero, y la otra cabeza desde el proceso coronoideo del cúbito. La arteria braquial y el nervio mediano cruzaban por detrás del proceso supracondíleo y el arco fibroso, incluidos en un agujero supratroclear llegando a la parte anterior del codo, y pasaron a través del pronador redondo entre sus cabezas abultada y coronoidea. La fosa cubital estaba ausente. La arteria braquial se dividía en las arterias radial, interósea común y cubital. La arteria mediana era alargada, originándose desde la arteria interósea anterior y pasó a través del túnel del carpo. El arco arterial palmar superficial era incompleto. Las arterias digitales de la arteria cubital irrigaban los tres dedos y medio mediales y las de la arteria mediana irrigaban el dedo y medio lateral. El caso presenta un interés filogenético, clínico y embriológico por estas variaciones anatómicas (AU)

An aberrant independent origin of the serratus anterior pedicle: Case report

During routine dissection of the right upper limb in a male cadaver by the medical students in the department, an unusual artery was found on the side of the chest wall. The anomalous, aberrant artery was the first branch from the first part of the axillary artery. It crossed deep to the superior thoracic and lateral thoracic arteries, passed in front of the subscapular artery on the serratus anterior muscle and terminated, distributing that muscle, opposite the 8th intercostal space. There are known vascular anatomical variations in the supply to the serratus anterior. Due to serratus anterior or serrato-costal flap reconstructive surgery, an anomalous and aberrant vascular pedicle to the serratus anterior muscle is of interest to anatomists, surgeons, reconstructive surgeons and radiologists (AU)

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The changing role of the apicectomy operation in dentistry.

Enormous progress has been made in the last quarter of a century in understanding the nature of root canal infection and periapical disease. New techniques and materials may be expected to increase the already high success of conventional root canal treatment. Surgical intervention is required for cases where retreatment has failed or is not an option, and the tooth is to be retained rather than extracted. This article reviews the operation of apicectomy and how this minor oral surgical procedure has evolved. Recent modifications to techniques and materials are likely to improve its success, allowing conservation of previously unsaveable teeth.

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort.

AIM: To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. METHODS: Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied. RESULTS: Orbicularis oculi weakness (4.62%), lagophthalmos (4.20%), ectropion (0.42%), trichiasis (0.84%), blocked nasolacrimal ducts (1.68%), pterygium (11.34%), impaired corneal sensation (53%), corneal opacity (10.5%), corneal nerve beading (1.68%), punctate keratitis (1.26%), keratic precipitates (4.62%), iris atrophy (1.68%), and cataract (12.6%) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6% had blind eyes. Increasing age was associated with ocular complications. 80% of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71% had some limb deformity. 44% had only leprosy related ocular complications (LROC), 28% had only general ocular complications (GOC) while 14% had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100%) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions. CONCLUSIONS: Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.

Radiographic practices of dentists undertaking endodontics in New Zealand.

OBJECTIVES: To determine the radiographic practices of New Zealand dentists undertaking root canal treatment, and to investigate the relationship between radiographic practices and educational and clinical factors. METHODS: A questionnaire was sent to all 1200 general dental practitioners and five specialist endodontists in New Zealand. Data were subjected to descriptive and analytical statistics. RESULTS: The response rate was 79%. The mean number of root canal treatments done by general dentists in the previous 12 months was 103, and for the specialists 938. Pre-operative views were taken by 57.1% of respondents all the time and by 34.8% in most cases. The long cone paralleling and bisecting angle techniques were in regular use by similar numbers of respondents, and over one half of the practitioners regularly used film holders and electronic apex locators. Working length films were taken by 67% of practitioners all the time and by 18% in most cases. One-quarter of practitioners took a master point view all the time, and 15% did this for most cases. Almost 65% always took a film of the completed root filling and 21% did for most cases. Twenty-three per cent of practitioners did not follow up their work. CONCLUSIONS: The majority of respondents used radiographs pre-operatively, for working length assessment and to assess the final root filling. There was a general improvement in radiographic practices compared with data from a previous national survey held in 1980.

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort

Aim: To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. METHODS: Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied. RESULTS: Orbicularis oculi weakness (4.62 per cent), lagophthalmos (4.20 per cent), ectropion (0.42 per cent), trichiasis (0.84 per cent), blocked nasolacrimal ducts (1.68 per cent), pterygium (11.34 per cent), impaired corneal sensation (53 per cent), corneal opacity (10.5 per cent), corneal nerve beading (1.68 per cent), punctate keratitis (1.26 per cent), keratic precipitates (4.62 per cent), iris atrophy (1.68 per cent), and cataract (12.6 per cent) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6 per cent had blind eyes. Increasing age was associated with ocular complications. 80 per cent of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71 per cent had some limb deformity. 44 per cent had only leprosy related ocular complications (LROC), 28 per cent had only general ocular complications (GOC) while 14 per cent had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100 per cent) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions. CONCLUSIONS: Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.