All-cause hospitalizations and mortality in systemic lupus erythematosus in the US: results from a national inpatient database.

Systemic lupus erythematosus (SLE) is a multisystem disorder. While several studies have outlined risk factors for hospitalization and mortality in SLE; the frequency of hospitalizations from various causes has varied among studies and over the years. We aimed to assess the causes of SLE hospitalizations and inpatient mortality compared to those without SLE in the United States in a recent year (2016) using a large national inpatient database. We used National Inpatient Sample (NIS) to identify hospitalizations with SLE using the ICD-10 code M32. Among hospitalizations with SLE as secondary diagnosis, we used ICD-10 codes to assess the primary diagnoses associated with hospitalizations and mortality. Our study included 174,105 SLE hospitalizations matched to controls (similar age, sex, and NIS stratum) in the year 2016. Mean age of hospitalization with SLE was 51.82 years, and 89% of hospitalized SLE patients were females. Mean length of stay, cost and mortality for SLE were 5.6 ± 7.2 days, US $ 14,450 and 1.96%, respectively. SLE was the primary diagnosis in 10,185 (5.85%) of all SLE related hospitalizations. Among SLE hospitalizations, infection was the most common primary diagnosis (15.80%) followed by cardiac and renal manifestations (7.03% and 4.91% respectively). Infection was the leading cause of mortality (38.18%) followed by cardiac manifestations (12.04%). Infections and cardiac involvement were the leading causes of hospitalizations and in-hospital mortality in SLE. Whether this is related to the disease itself, its associated comorbidities or immunosuppressive agents would require further studies.

Risk, Outcomes, and Predictors of Clostridium difficile Infection in Lymphoma: A Nationwide Study.

OBJECTIVE: The risk of Clostridium difficile infection (CDI) has not been well studied in patients with lymphoma. We thus sought to determine the risk of CDI in hospitalizations with lymphoma along with its trend, outcomes, and predictors using a large database. METHODS: Hospital discharge data from the Nationwide Inpatient Sample (NIS) from 2007 to 2011 were used for the study. Using the International Classification of Diseases, Ninth Revision, Clinical Modification codes, all adult patients aged 18 years or older having a primary diagnosis of lymphoma were queried for the presence of CDI as any of the secondary diagnoses. The risk of CDI in lymphoma and its yearly trend were assessed. We performed multivariate logistic regression to determine the independent risk factors of CDI in lymphoma. Furthermore, we studied mortality and other adverse outcomes of CDI in patients with lymphoma. RESULTS: There were 236,312 discharges (weighted) with the primary diagnosis of lymphoma. CDI was present in 2.13% of patients with lymphoma versus 0.8% in the nonlymphoma group (P < 0.001). On multivariate analysis, the significant predictors of CDI in lymphoma were presence of infection (odds ratio [OR] 3.1, 95% confidence interval [CI] 2.7-3.6), stem cell transplant (OR 2.7, 95% CI 2.3-3.4), graft-versus-host disease (OR 1.9, 95% CI 1.4-2.8), race (Asian vs white, OR 1.6, 95% CI 1.1-2.4), chemotherapy (OR 1.6, 95% CI 1.4-1.8), gastrointestinal surgery (OR 1.4, 95% CI 1.2-1.7), and Charlson Comorbidity Index (CCI) (CCI of 2 vs 0-1: OR 1.2, 95% CI 1.1-1.4; CCI of 3 vs 0-1: OR 1.3, 95% CI 1.03-1.6). CDI in lymphoma was associated with worse hospital outcomes such as increased mortality (17% vs 8%), increased length of stay (23.6 vs 9.9 days), mean total hospital charges ($197,015 vs $79,392), rate of intubation (13% vs 4% vs 13%), and rate of total parenteral nutrition (11% vs 3%). CONCLUSIONS: Hospitalization with lymphoma was associated with an increased risk of CDI. The significant predictors for CDI in lymphoma were infection, stem cell transplant, graft-versus-host disease, race, chemotherapy, gastrointestinal surgery, and Charlson Comorbidity Index. CDI in lymphoma was associated with increased mortality and other adverse outcomes warranting a need of more vigilance for CDI in patients with lymphoma.

Oral health awareness in school-going children and its significance to parent's education level.

BACKGROUND: The oral health imparts a major impact on one's quality of life. Since last decades, there is an increase in the prevalence of dental afflictions which can be avoided by the knowledge of simple preventive measures. AIM: The aim of this study was to assess the oral health status of children and to analyze its association with the education level of their parents. MATERIALS AND METHODS: Two randomly schools were selected and all the children from 5-15 years willing to participate in the present cross-sectional study were assessed for oral health status using the World Health Organization for the oral health awareness in children, 2004. Both child and parents were directly interviewed to avoid any bias in understanding the questionnaire. Statistical Package for the Social Sciences (16.0) was used for data analysis. Chi-square/Fisher's exact test was used to compare the dichotomous variables. RESULTS: A total of 210 (133 males and 77 females) children were assessed along with their parents for the awareness of child's oral health condition. Totally 134 (63.3%) children were of age group 5-10 years, while 76 (36.7%) children were of age group 11-15 years. Children with uneducated parents have often experienced toothache, brushes once a daily and frequently visits the dentist for toothache compared to children of educated parents, and this association was observed to be statistically significant (<0.001). CONCLUSION: The oral health status of children was average. However, education level and awareness of parents regarding oral health preventive measures play a key role in determining the oral health of children.

The incidence of facial injuries in children in Indian population: A retrospective study.

OBJECTIVE: To determine the incidence and pattern of facial fracture in children of age 0-16 years of age. MATERIAL & METHODS: Patients with trauma reporting to department of paediatric and preventive dentistry and department of oral & maxillofacial surgery from January 2011 to December 2011 were selected for the present study. The records of patients treated for maxillofacial injuries were retrospectively retrieved and analyzed for prevalence, pattern, etiology, and management of maxillofacial trauma. The data collected were subjected to statistically analysis. SPSS software version 16.0 was used for the data analysis. RESULTS: Total 5049 patients were screened and fifty one was reported to have facial injury. The incidence of facial trauma was 1.01% for the present study. The age wise distribution of the fracture amongst groups (I, II and III) were found 17.65%, 54.9% and 27.45% respectively. The sex-wise distribution of facial fracture was reported twice in male than females. The mandibular fracture was found the most common fracture (0.59%) followed by dento alveolar (0.30%) and midface (0.12%) fractures. Most of the mandibular fractures were found in the para symphysis region. Compound fractures seem to be commonest in the mandible. CONCLUSION: The fall was the predominant cause for most of the facial fractures in children followed by road traffic accident. The pattern of facial injury is influenced by the age and the growth of facial skeleton.

Acute Isolated Hyperbilirubinemia as a Presentation of Alcoholic Liver Disease: A Case Report and Literature Review.

Isolated hyperbilirubinemia as a manifestation of alcoholic liver disease without significant liver abnormalities is seen very rarely. We report such a case where a patient with chronic alcoholism presented to the ER with acute jaundice with bilirubin of 24.8 mg/dl, predominantly conjugated in nature along with mild elevation of AST (76 IU/L). There were no other abnormalities of the liver function. The patient underwent extensive laboratory and imaging tests that excluded extrahepatic cholestasis, viral and autoimmune hepatitis, ischemic hepatitis, and so forth. Liver biopsy excluded hemochromatosis, dysplasia, or malignancy and other differentials. Bilirubin gradually trended down to 7.3 mg/dl when alcohol consumption was stopped.

Long-term effects of traumatic dental injuries of primary dentition on permanent successors: A retrospective study of 596 teeth.

BACKGROUND/AIMS: Traumatic dental injuries of the primary dentition (TDI-p) have a global prevalence of approximately 11%-47%. They have immediate and long-term effects. Original research analysing the long-term sequelae of TDI-p on permanent dentition (LSP) are few in number. The aim of this study was to explore the correlation between age of TDI-p, type of TDI-p and LSP. MATERIAL AND METHODS: Retrospective analysis of patient data from 2008-2017, reporting with LSP due to TDI-p, was performed. Uniform protocols and complete radiographic-photographic records were analysed. There were 638 LSP reported with 596 teeth having complete records. RESULTS: There were 286 children with 153 males (53.5%) and 133 females (46.5%). Mean age of TDI-p causing LSP was 36.57 ± 11.51 months, with severity increasing in the younger age group. The highest number of LSP was associated with avulsion injuries (218, 36.58%), and the odds ratio of the type of TDI-p affect the severity of LSP was 2.0163. Mean age of reporting was 8.54 ± 2.19 years and was lowest for enamel discolorations. Most LSP were not associated with any associated feature (AF), although impaction was highest among all AF (63, 10.57%). CONCLUSION: Age and type of TDI-p affect LSP, with the former being the stronger determinant of its severity. Mean age of reporting of LSP is dependent upon both type of LSP and AF. LSP due to TDI-p can further be graded in terms of severity.

Concomitant hypodontia and hyperdontia: A report of two cases.

"Concomitant hypodontia and hyperdontia" is a very rare dental anomaly of number, having a prevalence rate of 0.002%-3.1%. It describes the simultaneous presence of hypodontia or missing teeth and supernumerary teeth in the same individual. It represents the opposite forces of nature acting simultaneously. Two rare cases of this anomaly involving different jaws and a classification based on the literature review have been presented here.

Acquired Thrombotic Thrombocytopenic Purpura in a Patient with Pernicious Anemia.

Introduction. Acquired thrombotic thrombocytopenic purpura (TTP) has been associated with different autoimmune disorders. However, its association with pernicious anemia is rarely reported. Case Report. A 46-year-old male presented with blood in sputum and urine for one day. The vitals were stable. The physical examination was significant for icterus. Lab tests' results revealed leukocytosis, macrocytic anemia, severe thrombocytopenia, renal dysfunction, and unconjugated hyperbilirubinemia. He had an elevated LDH, low haptoglobin levels with many schistocytes, nucleated RBCs, and reticulocytes on peripheral smear. Low ADAMTS13 activity (<10%) with elevated ADAMTS13 antibody clinched the diagnosis of severe acquired TTP, and plasmapheresis was started. There was an initial improvement in his hematological markers, which were however not sustained on discontinuation of plasmapheresis. For his refractory TTP, he was resumed on daily plasmapheresis and Rituximab was started. Furthermore, the initial serum Vitamin B12 and reticulocyte index were low in the presence of anti-intrinsic factor antibody. So with the concomitant diagnosis of pernicious anemia, Vitamin B12 was supplemented. The rest of the immunological workups were negative. Subsequently, his symptoms resolved and his hematological parameters improved. Discussion. While pernicious anemia can masquerade as TTP, an actual association between the two can also occur and needs further evaluation and characterization.

Antibacterial effect and physical properties of chitosan and chlorhexidine-cetrimide-modified glass ionomer cements.

AIMS: To compare antibacterial effect and physical properties of chitosan (CH) modified glass ionomer cement (GIC) (10% v/v), chlorhexidine-cetrimide (CHX-CT) modified GIC (2.5/2.5% w/w) and conventional GIC. MATERIALS AND METHODS: A total of fifty healthy children of age 7-12 years were selected and randomly assigned to class A and B for in vivo analysis. Slabs of CH modified GIC (Group II) along with slabs of conventional GIC (Group I, control) were cemented on buccal surfaces of maxillary molars (split-mouth technique) for class A children. Similarly, slabs of CHX-CT modified GIC (Group III) were cemented against control (Group I, control) in class B children. Slabs were assessed after 48 h for microbial load of Streptococcus mutans and Lactobacillus (LB) on mitis salivarius-bacitracin and Man Rogosa Sharpe agar media, respectively. Agar diffusion test was done to access the antibacterial effect of each group against Streptococcus muatns and LB. Slabs and cylinders of GICs were made for in vitro evaluation of compressive and flexure strength in each group. RESULTS: Comparison was done by nonparametric Kruskal-Wallis analysis followed by Dunn's multiple comparison test. Categorical groups were compared by Chi-square test. The increase in antibacterial activity (Group II > III > I) (P < 0.001) and marked increase in compressive and flexure strength (Group II > I > III) were observed. CONCLUSIONS: In the view of findings, it is concluded that CH modified GIC would be effective in inhibiting the bacteria associated with dental caries along with improved physical properties when compared with CHX-CT modified GIC and conventional GIC.

Sleeping Habits among School Children and their Effects on Sleep Pattern.

Introduction: Sleep problems can occur at any age. Inadequate sleep affects the physiological as well as psychological well-being of an individual. Thus, the objective of the present study is, to determine the pre sleep habits, duration and pattern of sleep among school children and to determine association between their sleep schedules and sleep habits. Methods: This cross-sectional study comprised of 1050 children attending the government school. Based on inclusion and exclusion criteria children were from three age groups: 4-5 years, 6-10 years and 11-15 years of age. A questionnaire about demographical data, sleep problems and habits, was duly filled by the parents. The parents of children were questioned for bed time, wakeup time, sleep time and sleep duration during both weekdays and weekends. Results: Total sleep time during weekdays was 8.9 (1.2) hours and 10.7 (1.1) hours during weekends. The wakeup time was significantly delayed during weekends in all age groups. Moreover, total sleep time increased significantly during weekends in all age groups. Children using media after 8 pm and sleeping alone are also in significant sleep debt. Screen activities such as TV, internet and cellular phones in a child's bedroom had a negative effect on children's sleep/wake patterns and duration of sleep. Children in higher grades are sleep debt compared to younger ones. Practices such as co sleeping and sharing bed with parents significantly improve the duration and quality of sleep. Conclusion: The sleep durations reported in the present study were lower than recommended sleep duration for children.

Fibro-epithelial polyps in children: A report of two cases with a literature review.

A fibro-epithelial polyp is the most common epithelial benign tumor of the oral cavity. Such a polyp is of mesodermal origin and it is a pink, red, or white knob-like painless growth that is sessile or pedunculated. A fibro-epithelial polyp commonly occurs on buccal mucosa, the tongue, or the gingiva. A fibro-epithelial polyp is an inflammatory hyperplastic lesion in response to chronic irritation due to calculus, sharp tooth edges, irregular denture borders, or overhanging restorations. Such a polyp rarely occurs before the fourth decade of life and its prevalence is not sex-specific. The current paper presents two cases where an intraoral fibro-epithelial polyp was successfully managed in children. Conservative surgical excision was performed in both cases. A follow-up at 3 months revealed uneventful healing of the site without reoccurrence of the lesion.

A multidisciplinary approach to the management of traumatic intrusion in immature permanent teeth.

Intrusion in a developing permanent tooth is an extremely complicated traumatic injury and is rarely seen in the permanent dentition. The damage caused by the trauma to the surrounding tooth structures results in a multitude of complications during the healing process. Careful repositioning of the intruded tooth by orthodontic means, revascularisation of the immature tooth to regain vitality, and periodontal treatment to provide the most acceptable aesthetic outcome are described in this case report. It outlines the treatment options to overcome the complications and variable outcomes. The present report emphasises the importance of a multidisciplinary approach to provide complete rehabilitation of a traumatically intruded developing tooth.

A comparative evaluation of dermatoglyphics in different classes of malocclusion.

AIM: To study associations of dermatoglyphic features with malocclusion in Indian children. MATERIALS AND METHODS: A total of 237 children aged 12-16 years, who attended our outpatient clinic in a government medical college, were selected. Finger and palm prints were collected, and fingertip pattern frequencies, total ridge counts (TRCs), and atd angles (formed by the triradii below the first and last digits and that in the hypothenar region of the palm) were calculated. These parameters were analyzed with their Angle's class of malocclusion using appropriate statistical tests. Dermatoglyphic parameters were examined and asymmetry analysis was conducted in subjects with different occlusion patterns. RESULTS: Although no fingerprint pattern was found to be specific for a particular class of occlusion, increased tendencies toward high frequencies of whorls in subjects with class II malocclusion and plain arches in those with class III malocclusion were observed. Significant differences in atd angle and TRC were observed among malocclusion types (p = 0.0001). Asymmetry scores did not differ significantly. CONCLUSION: Dermatoglyphic analysis can be used as an indicator of malocclusion at an early age, thereby aiding the development of treatments aiming to establish favorable occlusion. Inheritance and twin studies, as well as those conducted in different ethnic groups, are required to examine these relationships further.

Evaluating intrusive injuries in primary dentition from computed tomographic scans: a preliminary report.

CONTEXT: Children sustaining maxillofacial trauma may undergo computed tomographic (CT) examination to exclude potential complications, which pave way for spread of infection into the meningeal region. Following treatment, these children report for management of their dental injuries as out-patients for which a separate conventional radiographic examination is usually done. The usefulness of the initial maxillofacial CT scan in evaluating dental injuries needs to be assessed so as to possibly avoid children from being subjected to a separate radiographic examination. AIMS: The objective of this study was to evaluate the ability of pediatric dentists to assess intrusive injuries in primary dentition from preexisting maxillofacial CT scans of children. SETTINGS AND DESIGN: Hospital based cross-sectional study. SUBJECTS AND METHODS: Among 70 pediatric patients who were admitted following maxillofacial injuries, 10 children underwent CT examination. CT segments displaying the tooth bearing portions of the jaw were reformatted using the Dentascan software and three precalibrated pediatric dentists clinically examined the selected children and with the use of Dentascan based CT sections assessed the relative position of the intruded teeth in relation to the permanent successor and planned treatment for each individual intruded tooth. STATISTICAL ANALYSIS: Fleiss Kappa statistics. RESULTS: There was perfect agreement between the interpretations of all participants (κ = 1.0000, 95% confidence interval = 0.6861-1.3139) and the interpretations of each participant with the "gold standard" evaluator (κ = 1.000). CONCLUSION: Maxillofacial CT scans made to assess maxillofacial injuries in children can also be reliably used for assessing intrusive injuries in primary dentition.

The antimicrobial effectiveness of 25% propolis extract in root canal irrigation of primary teeth.

CONTEXT: The choice of irrigating solution used in root canals of primary teeth is complicated by their complex morphology and paucity of associated literature. Propolis is a natural product that has gained interest in this context due to its antibacterial effectiveness against several endodontic pathogens. AIM: The present study was undertaken to assess the potential of water-soluble 25% propolis extract against microorganisms present in root canals of primary teeth during endodontic procedures. SETTINGS AND DESIGN: The child patients in the age group of 4-7 years with radiographic evidence of carious pulp exposure were included in the study. Definitive selection was done after gaining access into the pulp chamber and root canals of the selected teeth. The clinical and radiographic evidence of pathosis was ruled out for inclusion in the study. MATERIALS AND METHODS: The selected teeth were divided into two groups randomly. In Group A 0.9% isotonic saline and in Group B 25% extract water-soluble propolis were used as irrigating solution, respectively. The bacterial samples were collected both pre- and post-irrigation and were transferred for microbial assay. STAISTISTICAL ANALYSIS: Wilcoxon matched signed rank test was used to compare the pre-and post-irrigation bacterial counts. Mann-Whitney test was used to compare the mean change (pre-post) in bacterial colony counts of groups in the study. RESULTS: Antimicrobial effectiveness of 25% water-soluble extract of propolis in the root canals of primary teeth was confirmed in the present study. The reduction in the mean bacterial colony counts of all the isolated bacteria was noticed higher in Group B than Group A. CONCLUSION: The results of the present study have confirmed that the antibacterial effectiveness of water-soluble extract of propolis in the root canals of primary teeth in vivo. Considering the low toxicity concerns and antibacterial effectiveness, water-soluble extract of 25% propolis can be advocated as a root canal irrigant in endodontic treatment of primary teeth.

Management of internal resorption of central incisor using hybrid technique.

Internal inflammatory root resorption is characterised by progressive destruction of intraradicular dentin and dentinal tubules along the root canal wall. A number of theories have been proposed as a possible cause for internal resorption. It is usually asymptomatic and detected during routine radiographic investigations. Prompt diagnosis and early management of such defects is essential to maintain the integrity of the tooth. Non-surgical and surgical methods are the two main strategies involved in the management of internal resorption. The non-surgical method is usually preferred, but in cases of extensive resorption with external root perforation, surgical intervention has been advocated. The present case illustrates repair of perforating internal resorption by hybrid method, using mineral trioxide aggregate and gutta-percha, following surgical exposure. After a 10-month follow-up, no clinical and radiographic abnormalities were observed. Additionally, there was also marked reduction in periodontal pocket depth.

Marfan syndrome.

Marfan syndrome is a rare autosomal dominant disorder of the connective tissue, with skeletal, ligamentous, orooculofacial, pulmonary, abdominal, neurological and the most fatal, cardiovascular manifestations. It has no cure but early diagnosis, regular monitoring and preventive lifestyle regimen ensure a good prognosis. However, the diagnosis can be difficult as it is essentially a clinical one, relying on family history, meticulous physical examination and investigation of involved organ systems. Patients of Marfan syndrome portray very typical physical and orofacial characteristics, suggesting obvious recognition, but due to variable phenotypic expression, cases often go unnoticed unless a full range of attributing features is apparent. Dental practitioners are very likely to encounter patients of Marfan syndrome at an early age as they frequently present for dental treatment. The present case report illustrates the preliminary screening of Marfan syndrome in a dental office followed by timely diagnosis and appropriate referrals.

Aesthetic management of non-syndromic secondarily retained permanent mandibular canine.

Primary failure of eruption (PFE) is a rare eruption anomaly, incorporating two independent conditions-primary retention and secondary retention. Primary retention is a localised cessation of eruption before gingival emergence without any identifiable cause. Secondary retention is a localised cessation of eruption after gingival emergence with no identifiable cause. Early diagnosis and treatment planning of this condition are important to avoid orthodontic and prosthodontic complications. With this background, the present case of PFE affecting a single permanent mandibular canine in a girl, aged 15 years is presented. Sequential diagnosis, treatment planning and possible aetiologies are discussed.

Non-syndromic multiple supernumerary teeth: report of a case with 13 supplemental teeth.

The presence of supernumerary teeth (STs) may give rise to a variety of clinical problems. These include failure of a tooth to erupt, delayed eruption, ectopic eruption, diastema, rotation of adjacent teeth, displacement of teeth and crowding. This case describes a 14-year-old male patient who presented with the complaint of pain in the left mandibular posterior region. Intraoral examination revealed the presence of carious retained deciduous second molar in this region. An orthopantomogram was advised which 'initially' revealed 11 STs, positioned in all four quadrants in posterior regions. Two more STs were detected in the following investigations totalling 13. Dental literature rarely reports presence of STs in such a large number. The objective of this case is to report detection of STs, radiographic examination, extraction of the retained deciduous molars and STs in the mandible to facilitate eruption of mandibular premolars.