Rhino-Orbital Mucormycosis in a COVID-19 Patient: A Dreadful Challenge.

Coronavirus disease 2019 (COVID-19) is a pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). COVID-19 infections may be associated with a wide range of bacterial and fungal co-infections. Recent studies are reporting invasive fungal infection associated with severe COVID-19. Herein, we report a case of COVID-19 rhino-orbital mucormycosis infection caused by Rhizopus sps in a 32 year old diabetic patient who was successfully managed with early aggressive debridement of infected tissue endoscopically with extended ethmoidectomy by modified Denker's approach along with orbital decompression and antifungal therapy with Liposomal Amphotericin B and Posaconazole. Serial diagnostic nasal endoscopy showed no evidence of progression of the infection. The patient was discharged on 21st day of hospitalization still on oral Posaconazole for a total of 3 months.

Crown Lengthening Surgery for Enhancing Restorative Treatment in Esthetic Zone.

For obtaining adequate retention for restoring cases like subgingival caries or extensive caries that shortens the tooth, short clinical crown, and fractures, it is usually necessary to disclose more tooth structure. Crown lengthening procedure is done to increase the clinical crown length for restorative or esthetic reasons without breaching the biologic width. These procedures are also utilized to improve the appearance and retention of restorations placed within the esthetic zone. We report a case of crown lengthening surgery with an internal bevel gingivectomy which was done in our department without compromising tooth support and esthetics.

Human Resources for Cardiovascular Disease Management in Nepal: A National Need Assessment.

Background Human resources are the mainstay of the healthcare system. Higher numbers of health workers have better healthcare coverage and outcomes. Availability of trained human resources to address the exponential rise in cardiovascular disease in Nepal is a national concern. Objective To assess the need of human resources for cardiovascular disease management in Nepal. Method We conducted an exploratory sequential mixed-method study. We developed a task force and organized a national workshop to engage stakeholders and collect feedback on the research process. We did a desk review and conducted 24 key informant interviews. We did thematic analysis from the codes generated. Result There is no clear definition and required estimation of health workers for cardiovascular disease management. There is a shortage of health workers with 8.9 doctors, 20.8 nurses, 0.05 cardiologist/cardiac surgeon, 4.2 pharmacist, 10.2 laboratory technicians per 10,000 population. There is a comprehensive human resource plan but it does not provide details of human resources for cardiovascular disease management. There is a lack of public private collaboration for human resource management. However, there is production of human resources for cardiovascular disease management through pre-service specialized courses and inservice training. Conclusion A clear definition and estimation of health workers with stringent human resource plan for cardiovascular disease management is essential. The government can still address these gaps by establishing a well-equipped central health workforce unit and expanding collaboration with private sectors.

Assessment of Palatal Throat Form in Lateral Cephalogram and its Correlation with the Skeletal Base and Facial Divergence: An Institutional Based Study.

Background Along with peripheral seal, palatal throat form also has significant value to achieve good retention and stability of maxillary complete denture. The palatal throat form also determines the posterior extention of maxillary dentures and affects the comfortability of the patients. Objective To analyse the palatal throat form in a Nepalese population based on age, gender malocclusion and facial divergence. Method This study consisted of 300 randomly selected radiographs with a mean age of 21.46±5.62 years. Skeletal malocclusion in lateral palatal throat form outlines. Patient were also categorized according to different Schudy's facial divergence angle (SNMP). The obtained data was tabulated based on the age, gender, palatal throat form, type of malocclusion and facial divergence. The results obtained were subjected to a statistical analysis to find the relation between variants of the soft palate and types of malocclusion in different gender groups. Result Proportion between palatal throat form and malocclusion found to be significant. There is no significant difference in proportion of different class of palatal throat form between genders. Whereas Class II palatal throat form found to be most common in all facial divergence. Conclusion It was observed that Class II malocclusion was most common among three types. The relation between palatal throat form and malocclusion, was found to be statistically significant.

Asprosin and type 2 diabetes mellitus: a novel potential therapeutic implication.

Diabetes is a group of metabolic disorders that is characterized by hyperglycemia which increases the risks of cardiovascular, microvascular, and macrovascular complications. Innovative therapeutic trials regarding diabetes control and management are continually being undertaken. The present review was aimed to explore the potential effects and mechanisms that lead to the pathogenesis of type 2 diabetes mellitus (T2DM) and its relation with asprosin. Asprosin is a newly discovered hormone that is encoded by protein fibrillin 1 (FBN1 gene), secreted by white adipose during fasting conditions at 5-10 nM levels, which acts on the liver through cell membrane receptors and activates the G protein cAMP- PKA pathway. Asprosin secretion is increased during fasting as the compensatory mechanism in hypoglycemia. Asprosin concentration is higher in patients with T2DM and impaired glucose regulation compared to healthy subjects. Genetic deficiency of asprosin may cause problems of poor appetite and extreme leanness in humans. Attenuating asprosin activity or depleting asprosin may serve as a novel therapeutic innovation for the treatment of T2DM and obesity. Hence, asprosin may serve as a beacon for the target of a future therapy in diabetes management.

Association Between use of Interdental Cleansing Aids Gingival Conditions in Fixed Dental Prosthesis Patients.

Background The fixed dental prosthesis are one of the most commonly used prosthesis which are difficult for cleansing in dental clinical practice especially the interproximal areas. As a result, periodontal disease most commonly develops in interproximal areas. The efficacy of using dental floss and interdental brushing in addition to tooth brushing reduce plaque and gingival inflammation. Objective To assess gingival condition in patients after placement of fixed dental prosthesis for a period of 3 months who regularly use or do not use dental floss and interdental brushing. Method Patients visiting the Dental Outpatient Department of Dhulikhel Hospital were selected for study. The examination was conducted using basic diagnostic tools (Mouth mirror, periodontal probe and explorer). The total number of patients involved in the study were 200. Teeth and gingiva were examined using the Plaque (Silness and Loe) and Gingiva Index (Löe and Silness). The examinations were conducted after 15 days and 3 months of placement of fixed dental prosthesis along with the oral hygiene instructions. Chi-square test and McNemar Bowker test were done to find statistical association using SPSS 20.0. Result Statistical analysis showed that there was association between frequency of interdental cleaning and plaque index (p=0.012) and gingival index (p=0.036) examined in 15 days and 3 months. Conclusion Use of Interdental cleansing aids was statistically significant to oral hygiene outcomes i.e. plaque index and gingival index. Oral hygiene instructions play a vital role in improving overall oral health.

Assessment of Level of Expectation and Awareness towards Dental Implants among Complete Denture Patients and Partial Denture Prostheses Wearers.

Background Among many options to replace missing teeth, dental implant is widely popular but willingness to have implant treatment and its success depends on patients' knowledge and expectations as well as the care, skill, and judgment of clinicians. Objective The main objective of this study was to assess awareness, expectation and source of information about dental implant among complete and removable partial denture wearers and to find association between them. Method A questionnaire consisting of 6 close-ended questions was used to assess the level of knowledge and awareness among patients visiting Dental Outpatient Department of Dhulikhel Hospital regarding dental implants as a treatment option for replacing missing teeth. Chi-square test was used to study the association between demographic variables and awareness about implantation. Statistical software SPSS 20.0 was used for data analysis. Result Our results revealed significant difference in age (p=0.001), education level (p=0.03) and occupation (p=0.004) in awareness of dental implant and no significant difference in gender (p=0.567), compared between complete and removable partial denture wearers. Due to lack of awareness, lower educational status and advanced age the patients responded that they "did not know " in answer to almost all the questions. Conclusion The awareness level of dental implant was low among complete and removable denture patients and this was associated with a low level of education and lack of accurate information about dental implants.

Perception about Medicines among the General Public in the Semi-rural Areas of Nepal.

Background Patients' perceptions and beliefs about medicine are affected by their culture, tradition, socioeconomic status, peer influence, educational level, advertisements among other factors. Objective To explore the perception about medicines among the general public in different semi-rural areas of Nepal. Method Cross-sectional study was conducted at different locations within Kathmandu valley from July 2015 to December 2016; 385 individuals were approached using simple random sampling but only 260, aged 18 years and above, who were taking medicines for their health problems, completed the interviewer-administered survey. Their perceptions about medicines were studied using a structured questionnaire based on the WHO booklet "How to investigate the use of medicines by consumers" and analysed using SPSS version 22. Association between respondents' age, gender, education level and perception were statistically analysed using χ2 test and/or Fisher's exact test and multivariate analysis of variance. Result Sixty-one respondents (23.5%) were in age group 56-65 years. Patients' perceptions of medicine safety based on colour, shape, name of medicine, method of administration, compatibility, etc. was statistically different among respondents with regard to their level of education (p = 0.022). More individuals with lower education believed that expensive medicines were more effective (p < 0.001). Increased level of education made them more aware of negative consequences of reusing previous prescriptions (p=0.039). Conclusion Problems with knowledge about medicines were noted among lesser educated individuals. Based on findings, policy makers may develop educational strategies to increase awareness about medicines.

Full Coverage Crowns and Resin-bonded Bridge Combination for Missing Mandibular Anterior Teeth.

Most often the anterior teeth and those that are visible when a patient speaks or smiles are chosen for esthetic restorations. The mandibular anterior fixed bridge often presents problems to the dentist due to the size of the natural teeth and their visibility. In addition, due to high cost factor, many patients are not able to afford fixed partial denture for missing anterior teeth. This article describes a cost effective technique for the restoration of missing mandibular anterior teeth by fabrication of full coverage crowns and resin-bonded fixed bridge combination.

Assessment of The Relationship of Incisive Papilla to Maxillary Central Incisor and Canine-Papilla-Canine Line among the Dentate population of Central Nepal.

Background Incisive papilla has been used as a fixed anatomical landmark to guide in teeth arrangement. Objective To assess the relationship of distance from central incisor to incisive papilla with various types of arch forms, shapes of incisive papilla and types of canine-papillacanine relation. Method Two hundred maxillary stone casts were prepared. Eighteen casts were excluded as they had voids and the final study was carried out in 182 participants. The arch form was assessed according to Testut L. and shape of incisive papilla was recorded according to Filho IE et al. A digital Vernier caliper was used to measure the distance from posterior point of incisive papilla to the mesio-incisal edge from the labial side of maxillary central incisor. The inter-canine line was drawn and its position with incisive papilla was assessed. The analysis was done using SPSS version 20.0. One way ANOVA was done. Result Result showed that parabolic type of arch was the most common i.e. 76.4%. Mean distance of central incisor to incisive papilla was 11.093±1.894 mm. No significant difference was observed in the distance of Central incisor to Incisive Papilla among different arch forms (p=0.854) and various shapes of incisive papilla (p=0.091). The mean distance of central incisor to incisive papilla was significantly greater when canine-papilla-canine line passed from the middle than from posterior part of incisive papilla. Conclusion These results suggest that incisive papilla is a reliable biometric guide which would help to reduce the clinical time of both the dentist and the patients in placement of the anterior teeth.

Safety and Efficacy of Azathioprine as a Second Line Therapy for Primary Immune Thrombocytopenic Purpura.

INTRODUCTION: Immune thrombocytopenic purpura remains common blood disease in Nepal. Azathioprine is an oral immunosupressive medicine which has been used widely in various autoimmune disease and solid organ transplant patients. It is inexpensive, easily available and well tolerated medicine. This study was carried out to evaluate efficacy and safety of azathioprine as a second line medicine for primary ITP patients who were refractory to steroid therapy. METHODS: The observational, pre-post study was conducted at Government of Nepal Civil Service Hospital, Kathmandu from January to October 2014. Twenty four primary ITP patients who were steroid refractory were treated with Azathioprine. Patients were termed steroid refractory if platelet counts were less than 30,000/ul on day 21st of steroid therapy. From day 22 onwards oral azathioprine 2mg/kg was started and steroids were tapered 10mg/week and stopped. Platelet counts of more than 30000/ul after one month of stopping steroid, while still on azathioprine, were termed response to azathioprine. Platelet count of more than 100,000/ul was termed complete response. The associations among age, gender, duration and platelets counts were analyzed by chi square test and Fisher's exact test (when individual cell frequency was less than 5). The comparison of platelets counts among the start and day 90 of Azathioprine therapy was performed by the paired t-test. RESULTS: The study showed that there was not significant association among age and gender of the patients and their platelets count on the start of Azathioprine therapy (p value 0.354 and 0.725 respectively) and on day 90 of Azathioprine therapy (p value 0.082 and 0.762 respectively). The duration-wise comparisons of platelets count on both the start and day 90 of Azathioprine therapy were significant (p values 0.029 and 0.008 respectively). The paired comparison among platelets count on the start and day 90 of Azathioprine therapy was highly significant (p value 0.000). CONCLUSIONS: The study showed the therapeutic implication of azathioprine in ITP patients. It also showed that efficacy of azathioprine was comparable with other modes of treatment. In low income countries like Nepal azathioprine can be considered as second line treatment for steroid refractory ITP patients.

Oral Hygiene and Gingival Health in Patients with Fixed Prosthodontic Appliances - A Six Month Follow-up.

Background Gingival inflammation and periodontal disease are the common complications of fixed dental prosthesis. They can be overcome by good oral hygiene maintenance. Objective The objective of this study was to assess the oral hygiene and gingival condition in patients after placement of fixed dental prosthesis for a period of six months. It was also analyzed how factors like type of fixed dental prosthesis (Single crown, fixed partial denture) and material (Metal, Porcelain fused to metal) are statistically associated with oral hygiene and gingival health. Method The sample consisted of 50 patients visiting the Dental Outpatient Department of Dhulikhel Hospital. The oral examinations were conducted using basic diagnostic tools (Mouth mirror, periodontal probe and explorer). Teeth and gingiva were examined using the Plaque and Gingiva Index by Silness and Löe. The examinations were conducted after 14 days and six months after placement of fixed dental prosthesis along with the oral hygiene instructions. Paired sample t-test were done to find statistical association using SPSS 16.0. Result Our results revealed no significant difference in plaque index among patients with single crown whereas fixed partial denture showed statistical significance. No significant differences were found for type of material. The statistical analysis showed similar results for gingival index. Conclusion Our research showed that single crown had no significant difference on Plaque index and Gingival index of the patient after 14 days and six months, whereas, Fixed partial denture showed significant difference. Both metal and porcelain fused to metal crown revealed no statistically significant difference on Plaque index and Gingival index.

Pattern of occlusal contacts in lateral excursions (canine protection or group function).

BACKGROUND: Establishing or providing occlusion that successfully permits efficient masticatory function is basic to dentistry. To maintain harmony of the occlusal condition, the posterior teeth must pass close to but not contact their opposing teeth during mandibular movement. Anterior guidance is essential to a harmonious functional relationship in the masticatory system. OBJECTIVE: The objective of this study was to find out the frequency of pattern of occlusal contacts in lateral position and to compare the accuracy of shim-stock and articulating paper. METHOD: This study was conducted in the Department of Prosthodontics, Kathmandu University School of Medical Sciences. The study consisted of 80 healthy subjects between the age group of 18-30 years. They were selected randomly from undergraduate students and dental hygienist of college of dental science and written consent was taken. This age was selected because of minimal occlusal wear. RESULTS: In the present study with 80 participants the majority of the contact patterns with shimstock on the working side were group function( 84%), the canine protected occlusal patterns were found to be 12% and the unclassifiable pattern were found to be 4%. On the otherhand, the data with articulating paper were group function type (94%), the canine protected occlusal patterns as 2.5% and the unclassifiable pattern were found to be 3.5%. In this study, with shim stock, the majority of the contact patterns were group function being 84% whereas with the articulating paper it was 94%. When shim stock occlusal strip (12 µm thick) was compared to commonly used articulating paper (40 µm), the excessive thickness of articulating paper that exceed the maximum recommended thickness of occlusal recording strips markedly must have given much more false contacts. CONCLUSION: It was concluded that the majority of the contact pattern were group function being 84% with shim stock and 94% with articulating paper. Also shim stock exhibits superior accuracy and reliability.

Epidemiological Survey on Edentulousness in Elderly Nepalese Population.

BACKGROUND: A lot of epidemiological surveys have been conducted in dental caries and periodontal problems, but prosthetic sector is lacking such study. OBJECTIVE: The aim of this study was to assess the level of edentulousness, the cause of edentulousness, the denture wearing and denture needs of selected Nepalese population. It will also analyze how factors, such as habits, built, educational needs influence edentulousness. METHOD: Patients visiting the Dental Outpatient Department of Dhulikhel Hospital and various dental camps organized by the hospital were selected for study. The examination was conducted using basic diagnostic tools (Mouth mirror, straight probe and explorer). Statistical software SPSS 16.0 was used for data analysis, chi-square test was performed for each parameter. RESULT: The statistical analysis showed that age was statistically associated to edentulousness, but gender and built were not associated to edentulousness. Furthermore educational status and habit were statistically associated with edentulousness. CONCLUSION: Oral health awareness and education programs should be conducted at the community level for every individual. The role of oral hygiene practice, the negative effect of various oral habit, especially smoking and tobacco chewing habits, the need to replace missing teeth and care of artificial denture should be explained.

A simple ball milling method for the preparation of p-CuO/n-ZnO nanocomposite photocatalysts with high photocatalytic activity.

The p-n junction photocatalyst, p-CuO/n-ZnO, was prepared via ball milling of ZnO and CuO nanoparticles in water. The structural, optical, and surface properties of the p-n junction photocatalyst p-CuO/n-ZnO were characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM), UV-Vis spectroscopy, and Zeta potential analyzer. The Photocatalytic activity of the photocatalyst was evaluated via photocatalytic oxidation of Methylene Blue (MB) in the presence of UV light. This study demonstrates a novel p-n junction oxide photocatalyst p-CuO (wt. 10%)/n-ZnO having superior photocatalytic activity (PCA) for the degradation of model dye under the illumination of UV-Vis light. The MB solution was only PCA, degraded by 100% within 15 min by the use of CuO (wt. 10%)/ZnO photocatalyst. Effectivley 365% increase in degradation rate constant was noticed for CuO (10 Wt.%)/ZnO nanocomposite as compared to that of pure ZnO nanoparticles. The enhanced PCA is anticipated from the presence of many micro p-n junctions formed between ZnO-CuO nanoparticles upon ball milling, which helps in efficient electron/hole pair charge separation upon excitation. The study highlights the fact that PCA of p-n junction CuO/ZnO photocatalyst can be effectively tuned by manipulating the interface of the heterostructure and by adjusting the parameters affecting the PCA. The result obtained from PCA is further verified by the zeta potential study.

A study of assessment of partial edentulous patients based on Kennedy's classification at Dhulikhel Hospital Kathmandu University Hospital.

BACKGROUND: Oral health contributes significantly towards quality of life(QOL). Edentulousness falls in a special category among the various conditions of dental origin. Dietary intake and nutritional status is affected by poor oral health and loss of teeth. This will ultimately compromise general health. OBJECTIVE: To identify the frequency of Kennedy's classification among partial edentulous patients and to compare occurrence among gender and between upper and lower arches and also to compare edentulousness among employed and unemployed population. METHODS: This study was carried out at Dhulikhel Hospital Dental Department. The study was conducted randomly among 194 patients in dental OPD who were partially edentulous. A structured pro forma was used to find out the edentulousness based on Kennedy,s classification. RESULTS: Among the Kennedy's classification ClassIII was found to be most common. Among them females and unemployed group were found to have more edentulousness and upper arch was more common. It was also found that females were more conscious and get the replacement of missing teeth among which those having Class IV missing were replaced most often. CONCLUSION: The Kennedy Class III partial edentulousness type is most commonly found in this study.

Intended location of future career practice among graduating medical students: perspective from social cognitive career theory in Nepal.

BACKGROUND: Medical workforce shortages and mal-distributions world-wide make understanding how, where and what our future doctors wish to practice is increasingly important. Understanding of factors such as available infrastructure, provision of incentives and many others influences the decisions of doctors to leave or to stay. Therefore the strategies effective for retention, is imperative in conducting the study based on a sound theoretical framework in predicting future medical workforce needs. The study used the theoretical framework of Social Cognitive Career Theory to identify the predictors on future practice location. METHODS: The study was cross-sectional descriptive in design targeting the Nepalese medical students in the final year and doing internships in Nepal. Anonymous self administered questionnaire was distributed among 480 students but 393 students were involved due to non response and incompleteness. Findings of the study were presented in frequency tables for univariate descriptive analysis and bivariate findings were presented by cross tabulation. RESULTS: About two thirds 259 (65.9%) of the participants had chosen within country location for future practice. Among those who had chosen within country choice, about an equal percentage of the respondents had chosen rural 131 (50.8%) and urban 128 (49.2%) location. Among those who had chosen within country for future practice location, less than one fifth of the participants had chosen private sector for future practice. CONCLUSIONS: Majority of the medical graduates wish to practice within country location. Most of which chose public sector for future practice. None of the SCCT construct had any significant association within country location.

Using magnetic and chemical measurements to detect atmospherically-derived metal pollution in artificial soils and metal uptake in plants.

Quantification of potential effects of ambient atmospheric pollution on magnetic and chemical properties of soils and plants requires precise experimental studies. A controlled growth experiment assessing magnetic and chemical parameters was conducted within (controls) and outside (exposed) a greenhouse setting. Magnetic susceptibility (MS) measurements showed that while initial MS values were similar for the sample sets, the overall MS value of exposed soil was significantly greater than in controls, suggesting an additional input of Fe-containing particles. Scanning electron microscope images of the exposed soils revealed numerous angular magnetic particles and magnetic spherules typical of vehicular exhaust and combustion processes, respectively. Similarly, chemical analysis of plant roots showed that plants grown in the exposed soil had higher concentrations of Fe and heavy (toxic) metals than controls. This evidence suggests that atmospheric deposition contributed to the MS increase in exposed soils and increased metal uptake by plants grown in this soil.

The effect of systemic corticosteroid therapy on the expression of toll-like receptor 2 and toll-like receptor 4 in the cutaneous lesions of leprosy Type 1 reactions.

BACKGROUND: Leprosy is complicated by immunological reactions which can occur before, during and after successful completion of multidrug therapy. Genetic studies have suggested that polymorphisms in toll-like receptors (TLRs) may affect the susceptibility of an individual with leprosy to developing Type 1 reactions. OBJECTIVES: To examine the gene and protein expression of TLRs in the cutaneous lesions of leprosy Type 1 reactions at the onset of reaction and during systemic corticosteroid therapy. METHODS: Patients who were being treated for leprosy type 1 reactions with corticosteroids as part of a randomized controlled trial of corticosteroid treatment had skin biopsies performed before, during and at the end of treatment. The gene and protein expression of TLR2 and TLR4 were measured. RESULTS: We have demonstrated that the gene hARP-P0 is a suitable control gene for TLR gene expression studies in this population. The gene and protein expression of TLR2 and TLR4 were both reduced significantly during corticosteroid treatment. CONCLUSIONS: This is the first study to examine the expression of TLR2 and TLR4 in vivo in individuals experiencing leprosy Type 1 reactions. The data support the possibility of an important role for TLR2 and TLR4 in the pathogenesis of this important complication of leprosy.