A Prospective Observational Study on the Outcome Assessment of Conservative Management Versus Intercostal Drainage (ICD) in Blunt Chest Injury Patients With ≤3 Rib Fractures in a North Indian Tertiary Care Center.

Introduction Trauma is the third most common cause of death in all age groups. One out of four trauma patients die due to thoracic injury or its complications. Seventy percent of thoracic traumas are due to blunt injury. This indicates the importance of chest trauma among all traumas. Quick and precise assessment bears paramount importance in deciding life-saving and definitive management. Often, the initial management in blunt injury patients is based on subjective assessment by the attending clinician. A scoring system that provides early identification of the patients at the greatest risk for respiratory failure and more likely to require mechanical ventilation and require prolonged care, as well as those with a higher mortality risk, may allow the early institution of intervention to improve outcomes. Thoracic Trauma Severity Score (TTSS) poses to be a precise tool in directing the management modality to be employed. Methodology This was an observational study including 112 patients of age >12 years, with blunt chest injury, sustaining ≤3 rib fractures, and with a stable chest wall. The patients with penetrating injury, those with blunt chest injury having flail segment, patients in the pediatric age group (<12 years), or polytrauma patients were excluded from our study. Of the 112 patients, 56 had been managed by intercostal drainage (ICD), and the rest (56) had been managed conservatively. Result Road traffic accidents (RTA) were the most common mode of injury in both groups. The percentage of the patients with one, two, and three rib fractures was 57.14%, 32.14%, and 10.71%, respectively, in the ICD group and 85.71%, 7.14%, and 7.14%, respectively, in the conservative management group (p = 0.124). The mean TTSS score was significantly more in the ICD group as compared to the conservative management group in the single rib fracture patients (p = 0.001*), as well as all patients of any number of rib fractures (p < 0.01*) (significance was defined as a value of p less than 0.05 {indicated by an asterisk}). The mean hospital stay was significantly lower in the conservative group as compared to the ICD group (p < 0.01*). The mean SF-36 (outcome) was significantly more in the conservative management group as compared to the ICD group (p = 0.020*). The mean cost of treatment was significantly more in the ICD group as compared to the conservative management group (p < 0.001*). Conclusion In our study, a TTSS (as measured by the primary care surgeon) of >7, across any number of rib fractures, was preferably predictive of management by ICD, while a <7 value was favorable for conservative management. TTSS can be used as an important tool to predict the management modality in blunt chest injury patients with ≤3 rib fractures.

Isolated Spontaneous Mesenteric Artery Dissection: A Rare Entity.

Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aorta or its branches is an uncommon vascular entity. It is generally seen in males and presents with gastrointestinal symptoms due to mesenteric ischemia. However, asymptomatic cases are increasingly being diagnosed due to increased use of computed tomography (CT) angiography. The course is usually self-limiting, and conservative management with bowel rest, strict blood pressure control, anticoagulants, sedatives for pain, and close observation usually suffices. Surgery or endovascular stenting is usually reserved for those exhibiting bowel ischemia or impending rupture. We report a case of a young female with isolated spontaneous mesenteric artery dissection with thrombus, which did not improve with medical therapy and was managed promptly by surgery due to the presence of bowel ischemia.

Data on periodontal health among elderly people in Bushland, Jharkhand, Magadha and Patna, India.

It is of interest to report data on periodontal Health among elderly people in Bushland, Jharkhand, Magadha and Patna, India. The sample comprised of a 130 elderly people. The studies device comprised of a semi-structured survey with thirteen questions. Data shows that old people in Jharkhand suffered from advanced periodontal ailment (47.6%) with easy gingivitis (33.8%). Data also shows that grownups (88.2% grownup males, 64.5% girls in Jharkhand and 34.5% grownup males and 88.9% girls in Bihar) used toothpaste and toothbrush as their primary style for tooth cleansing. These data help in providing improved dental service to rural population in India.

Analytical study of the psychosocial impact of malocclusion and maxillofacial deformity in patients undergoing orthodontic treatment.

Patients whose with facial appearance involves dental anomalies and malocclusion face an increased prevalence of various psychosocial problems such as a high level of social anxiety, social avoidance, and low quality of life. This study investigates the patients with craniofacial anomalies and their psychological adjustment concerning the facial and dental appearance. It also evaluates the expectations of this patient group from the orthodontic treatment. Two steps were done in this study. In the first step, translation and validation of the Derriford Appearance Scale (DAS59), The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Patient Expectation from the Orthodontic Treatment (PEOTQ) questionnaires into Maithili were done, and then the main study was conducted using these valid questionnaires. This was a cross-sectional study conducted on the patients with congenital craniofacial anomalies visiting the orthodontics department of Patna Dental College and Hospital, Patna (Bihar). All the patients received the Maithili DAS, Maithili PIDAQ and Patients' Expectation from the orthodontic treatment questionnaires. The Maithili version of DAS59, PIDAQ and PEOTQ were developed with outstanding reliability and validity. A significant difference between PIDAQ (p<0.001) and DAS59 scores (p<0.001) was found. In females, the total PIDAQ score was significantly higher as compared to males, but there was no association of DAS scores with gender. Place of residence showed no association with PIDAQ and DAS59 scores in patients. Patients and controls had significant differences between various items, and a comparison was made in terms of expectation from the orthodontic treatment. Altered facial and dental appearance in patients with craniofacial anomalies showed a significant psychological impact.

Comparative Evaluation of Shear Bond Strength of Brackets Bonded with self Etch Primer/Adhesive and Conventional Etch/Primer and Adhesive System.

INTRODUCTION: The shear bond strength obtained with an acid primer might not be clinically reliable. The present study evaluated the use of a new self-etch primer as compared with the conventional bonding procedure. The findings indicated that the use of a self-etch primer to bond orthodontic brackets to the namel surface provided lower, but clinically accept-able, shear bond forces (mean, 7.1 ± 4.4 MPa). Hence, this study has been designed to evaluate the shear bond strength of orthodontic brackets bonded with a self-etching primer system, and compare it with the conventional acid etching priming system. MATERIALS AND METHODS: This study was designed to compare the shear bond strength of orthodontic brackets bonded with conventional acid etching- priming and a self-etching primer. For this purpose, one hundred and twenty noncarious, not subjected to any pretreatment chemical agents (e.g. hydrogen peroxide), no cracks caused by the presence of the extraction forceps, no caries and unrestored human maxillary 1st and 2nd premolars, freshly extracted for orthodontic treatment were collected and stored in distilled water before bonding. Separate molds of cold-cure acrylic were prepared and the extracted premolar teeth were embedded in the cold cure acrylic up to the cement enamel junction. RESULTS: For the control group, the mean shear bond strength was 9.38 ± 6.02 MPa and for the experimental group, it is 6.91 ± 3.58 MPa. Group comparison using Chi-square test for the self-etching primer group adhesive remnant index (ARI) scores shows that more than half of the adhesive left over the tooth surface (score 3 and 4). For the conventional group, ARI scores show that there was no or slight amount of adhesive left over the tooth surface (score 5). The proportion of ARI score is significantly (P < 0.001) more in conventional (68.33%) as compared to self-etch primer (SEP) (28.33%). The proportion of ARI scores 4 and less is significantly more in SEP (71.67%) as compared to Conventional (6.67%) with P = 0.004 as per the Chi-square test. CONCLUSION: The bond strength of SEP is comparatively lesser than the conventional acid etching technique, but is definitely more or less to the required bond strength to resist masticatory forces. Majority of the studies conducted on self-etching primer are in vitro studies. Results of these cannot be extrapolated to the intraoral environment. Hence, further long-term clinical studies need to be carried out before actually recommending the use of self-etching primer in routine orthodontic bonding.

Immediately Loaded Single Unit Dental Implants: A Clinical Study.

BACKGROUND: Immediate loading of dental implants is an obvious advantage. A long treatment period that involves the wearing of a temporary prosthesis may be of great inconvenience, and is sometimes the reason for not choosing implant-supported restorations at all. AIM: In our study, an attempt was made to immediately load single tooth implants in the aesthetic zone of the dentition. MATERIALS AND METHODS: Patients were selected from Government Dental College, Patna. Twenty-four single tooth implants were placed in 24 patients; 12 male and 12 female patients desiring replacement of one or more missing teeth in anterior region were selected. Surgery for the placement of the implant was carried out, and implants of the Uniti Implant System were placed. The abutment was then attached and the flap was sutured. A temporary acrylic resin crown was fabricated and cemented on the same day. Permanent prosthesis was inserted on sixth month after implant placement. RESULTS: A clinical study was performed to evaluate the treatment outcomes of dental implants installed according to a one-stage surgical procedure followed by immediate loading with prosthesis. Of the 24 implants, 23 showed signs of successful osseointegration over a 1-year follow-up. CONCLUSION: Within limits of the evaluated data, it was observed that immediately loaded implants osseointegrate, so this alternative was used over conventional procedures that take 6 months for osseointegration. This has advantages, both for patient and practitioner.

Evaluation of Dental Health in Terminally Ill Patients.

Dental health plays an imperative role in the general health and well-being of an individual. Terminally ill patients due to a compromised immune response are susceptible to a wide array of oral complications, which may affect their ability to speak and chew, leading to malnutrition. The present study was conducted to evaluate dental health and various oral manifestations in terminally ill patients. One hundred twenty terminally ill patients hospitalized with diseases of the respiratory tract, gastrointestinal tract, circulatory system, liver, and endocrinal disorders were included in the study. The evaluation of oral manifestations and their prevalence was done by a single examiner. The oral health was evaluated according to symptoms exhibited by the patients and clinical presentation. Of the patients included in the study, 78 were male, and 42 were female. All the individuals were adults between 25 to 55 years of age. Out of 120 admitted terminally ill patients, 27 subjects had respiratory diseases, 17 had gastrointestinal disorders, 5 had disorders of the circulatory system, 39 had liver disorders, and 32 had endocrine disorders. A need for added comprehension is mandatory to link the inter-relationships between dentistry and medicine to further perk up the management of the overall health of patients, which will further reinforce the partnership between dental and medical communities.

Evaluation of salivary flow rate, pH, and buffer capacities in end-stage renal disease patients versus control - A prospective comparative study.

BACKGROUND: Saliva plays a major role in preserving the integrity of oral tissues. Chronic renal failure patient undergoes many oral and salivary changes for which they require special oral health care. The patient undergoing hemodialysis session has altered salivary composition. Many changes occur during hemodialysis that severely affect the flow rate and the biochemical composition of saliva. METHODS: A total of 50 patients of end-stage renal disease undergoing hemodialysis for renal insufficiency were selected based on inclusion and exclusion criteria set prior to the study. These patients were compared with the control group who had already undergone hemodialysis. A total of 30 patients were selected as a control group. In this study, unstimulated whole saliva was collected by the spitting method before and after the dialysis session. Salivary flow rate, pH, and buffering capacities were measured. RESULTS: Hemodialysis had a significant effect on the salivary flow rate. The mean pH of unstimulated whole saliva showed no significant changes before and after dialysis. The concentrations of urea, creatinine, chloride, and potassium in the whole saliva changed markedly before and after a hemodialysis session, whereas no significant difference was seen in the concentration of sodium and calcium. CONCLUSION: Through this study, we came into a conclusion that hemodialysis had a significant effect on salivary secretion and the biochemical composition of saliva. We conclude that the observed changes in salivary concentrations and the flow rate are mainly due to an increased watery secretion from the salivary glands and also saliva can be used as a tool for monitoring hemodialysis.

Left-sided transmesocolic herniation of small bowel in an otherwise unaffected abdomen.

Transmesocolic hernia is an uncommon type of internal hernia with incidence ranging from approximately 5-10%. To the best of our knowledge, this is the first reported case of a transmesocolic hernia through a gap within the descending mesocolon presenting clinically as an intestinal obstruction. A 75-year-old man was admitted with clinical features of intestinal obstruction. An abdominal X-ray showed multiple small bowel loops with air fluid levels. Contrast-enhanced CT of the abdomen revealed small bowel obstruction not only on the right, but also on the left side of the collapsed descending colon. Emergency surgery was performed. Strangulated bowel loops with gangrenous changes were resected and double-barrel ileostomy was carried out. The postoperative period was uneventful. Restoration of bowel was performed after 6 weeks. Preoperative diagnosis of bowel obstruction caused by a transmesocolic hernia remains difficult despite the currently available imaging techniques. Prompt surgery can prevent serious complications such as peritonitis and sepsis.

Chronic empyema thoracis after percutaneous nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is presently the treatment of choice for large or multiple kidney stones or stones in the calyx. PCNL is generally safe and associated with low but indisputable complication rate. Pleural injury in PCNL is a rare but severe complication which can occur during or immediately after operation. Pleural injury may lead to chronic empyema thoracis. Until now no such case has been reported in literature.

Unsuspected pheochromocytoma of the urinary bladder: reminder of an important clinical lesson.

Bladder pheochromocytoma creates an extremely rare situation (0.06% of all bladder tumours). We came across a case with a complaint of intermittent episodes of haematuria. Cystoscopy revealed a solid, bluish submucosal growth with increased vascularity. Immediately after taking biopsy, the patient developed a sharp headache, chest heaviness and marked rise in blood pressure. The procedure was abandoned. Later, serum and urinary markers for pheochromocytoma were within normal limits. The histopathology report came out to be pheochromocytoma of the bladder. Later, partial cystectomy was carried out under general anaesthesia and histopathology confirmed the same. Thus, a surgeon/urologist should have a high index of suspicion for bladder pheochromocytoma while dealing with such cases if he comes across the characteristic symptoms of sharp headache, hypertension, palpitation, sweating, fainting or blurring of vision immediately after voiding or during the cystoscopic manipulation of tumour or cystoscopic findings of a submucosal supratrigonal vascular tumour with a bluish hue.

Trans-anal barotrauma by compressed air leading to sigmoid perforation due to a dangerous practical joke.

To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.

Seminal gold content in healthy fertile men in India.

OBJECTIVE: Since centuries Ayurveda, mentions the role of gold in the treatment of male infertility 'Swarna Bhasma' (Ash of gold) has been used with good results by Ayurvedic practitioners in the treatment of infertility. Hence, a study was planned to estimate gold in whole semen by atomic absorption spectrophotometry. MATERIALS AND METHODS: Whole semen from 11 healthy males of proved fertility from Lucknow (India) was analyzed for gold content by Atomic Absorption spectrophotometry at wavelength 242.8 nm with Hollow Cathode Gold Lamp. Prior to analysis, all the samples were subjected to digestion procedure, achieved by treating them with mixture of concentrated Nitric acid and concentrated Perchloric acid in 6: 1 ratio. OBSERVATION: On analysis all semen samples were found to contain gold ranging from 0.36 to 1.98 µg/ml with a mean value of 0.88 µg/ml and a standard deviation of 0.51 µg/ml. CONCLUSION: In the present study, gold was estimated after complete digestion (oxidation of organic matters; hence, whatever amount of gold detected, denotes the levels in seminal plasma as well as the sperm itself) in whole semen (seminal plasma and sperm). It seems that the hypothesis made for presence of gold in sperm might be true. However, the literature available in this connection is very scanty and further studies are needed for scientific documentation of gold in male infertility.

A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult.

A 26-year-old man presented with an irreducible right inguino-scrotal swelling and fecal discharge from the scrotum. Exploratory laparotomy and inguinal exploration revealed that the caecum, appendix, and terminal ileum had herniated into the scrotum and had perforated through the skin forming a fecal fistula. The herniated gangrenous bowel was resected and a stoma fashioned. Spontaneous entero-scrotal fistulae are very rare and eight pediatric cases have been mentioned in literature till date. We report the first case of true sliding hernia presenting as spontaneous entero-scrotal fistula in an adult.

Mild conditions for releasing mono and bis-biotinylated macromolecules from immobilized streptavidin.

The high affinity (kd= approximately 10(-15)M) of streptavidin and avidin for biotin is key to a large number of biological applications and is essentially irreversible unless the complex is exposed to harsh conditions (e.g. heat (100 degrees C for 10 min)), detergents, and/or denaturants which damage macromolecules. Thus, high binding affinity becomes a disadvantage when a biotinylated target must be released for further processing. This work describes relatively mild conditions that release biotin and mono- and bis-biotinylated macromolecules from immobilized streptavidin on monodispersed magnetic beads.