Non-adherence to anti-tubercular treatment during COVID-19 pandemic in Raipur district Central India.

BACKGROUND: Non-adherence is major factor in failure of any drug regimen. The significance of non-adherence is so much that WHO states that increasing the effectiveness of Adherence Interventions may have far greater impact on health of population than any improvement in specific medical treatments. Incidence of non-adherence to Anti Tubercular Treatment (ATT) usually ranges from 8.4% to 55.8%. This study aims to find out the reasons of Non-adherence to ATT in patients receiving anti-tubercular treatment at DIRECTLY OBSERVED TREATMENT SHORTCOURSE (DOTS) Centre at District Tuberculosis Centre (DTC), Kalibadi, Raipur during COVID-19 pandemic. METHODS: A cross sectional study was conducted at Department of Pharmacology, Pt. JNM Medical College and DTC Kalibadi Raipur. 55 Patients taking ATT fulfilling inclusion and exclusion criteria were interviewed using structured questionnaire. The data obtained was analysed to know causes of non-adherence. RESULTS: Study was carried out between March & April 2020. In our study, 80% subjects were male and 20% were female. The main reasons for Non-adherence were Side-effects of drug in 36% cases, missing medication intentionally in 34% cases, lack of encouragement by family members in 32% cases, patient's unawareness of consequences of skipping medication in 25% cases, unaware of treatment duration in 22%, not feeling any change, forgetting to take medication, and burden of concomitant medication besides ATT, each in 20% cases, 13% cases had difficulty in procuring medication due to lockdown, 5% cases did not go to collect their medicine due to fear of contracting COVID-19 infection. CONCLUSIONS: Our study shows reasons for Non-adherence are multi-factorial with drug side -effects & intentionally skipping medication being major factors.

Effect of intracanal and extracanal heating on pulp dissolution property of continuous chelation irrigant.

Context: Extracanal and intracanal heating of sodium hypochlorite (NaOCl) improve its pulp dissolution, but limited literature is available on its effect as a combined single irrigant with etidronate. Aim: The aim of this study is to compare the effect of temperature on the effectiveness of NaOCl and continuous chelation protocol on the time required for the dissolution of vital and necrotic pulp. Materials and Methods: Dissolution time of 120 standardized bovine (buffalo) pulp fragments, divided into 12 subgroups based on tissue type (vital/necrotic), irrigant (NaOCl/continuous chelation), and temperature (extracanal, intracanal, and nonheated irrigant), was noted. Conical glass tips mimicking the root canal were considered specimen containers. About 0.2 ml of irrigant corresponding to the irrigation protocol was taken in them and then pulp samples were added to it. Samples were observed using loupes under 2.5 X magnification. Dissolution time was recorded using a stopwatch. The study was approved by the Institutional Ethical Committee (SDC/2019/591). Statistical Analysis Used: Two-way analysis of variance; statistical product and service solutions version 25. The level of significance was set at P < 0.05. Results: Time for pulp dissolution by continuous chelation mixture was significantly more as compared to NaOCl alone in all subgroups. Pulp tissue dissolution for both vital and necrotic pulp was improved by the increase in temperature of both irrigants and dissolution time was more for necrotic than vital tissue. Pulp tissue dissolution was significantly better by intracanal heating as compared to extracanal heating. Conclusion: Although intracanal heating of continuous chelation mixture improves its pulp dissolution capacity significantly as compared to extracanal heating and nonheating protocol but pulpal dissolution capacity of nonheated 5% NaOCl still remains significantly better as compared to intracanal and extracanal heated continuous chelation mixture.

Effect of prophylactic instrumentation on surface roughness of tooth-colored restorative material: An in vitro study.

AIM: To compare and evaluate the surface characteristics of different restorative materials used for restoration of cervical defects when subjected to periodontal prophylactic instrumentation techniques. MATERIALS AND METHODOLOGY: Sixty box-shaped cavities were prepared on the labial surface of decoronated permanent maxillary anterior teeth which were randomly divided into two groups (n = 30) based on the instrumentation technique Group I: Manual instrumentation using curettes and Group II: Ultrasonic instrumentation. The samples were further divided into three subgroups based on restorative material subgroups I V and II V-restored with Vitremer, subgroups I F and II F-restored with Filtek Z 250 XT and subgroups I D and II D-restored with Dyract flow, respectively. After finishing and polishing, the samples were subjected to surface profilometry analysis for determining the surface roughness values (Ra). Thereafter, the restored surfaces of all the samples in different subgroups were subjected to prophylactic instrumentation with Gracey's curettes (Group I) and ultrasonic scalers (Group II). Ra values were recorded again after prophylactic instrumentation and after polishing. The data thus obtained were subjected to the statistical analysis using the independent t-test and one-way ANOVA (p<0.05). RESULTS: Ra values were significantly higher for both manual and ultrasonic prophylaxis compared to preprophylaxis and postpolishing in all the three restorative materials. Ultrasonic scaling produced significantly higher Ra for subgroup V as compared to subgroup F and subgroup D, whereas the difference between the materials was not significant for manual scaling. CONCLUSION: Manual prophylaxis resulted in significant reduction in surface roughness of all the three restorative materials while ultrasonic prophylaxis resulted in significant reduction for Vitremer only. Polishing after scaling significantly reduced the effect of both manual and ultrasonic prophylaxis on surface roughness.

Effect of mechanical alteration of enamel surface on shear bond strength of different bonding techniques.

AIM: This study was conducted to evaluate the effect of mechanical alteration of enamel surface on shear bond strength in different bonding techniques. MATERIALS AND METHODS: Seventy samples were fabricated and randomly divided into three groups: Group A (n = 30) - prepared enamel surfaces, Group B (n = 30) - unprepared enamel surfaces, and Group C (n = 10) - prepared enamel surfaces + etch and rinse which served as a control group. Group A and Group B were further divided into three subgroups (n = 10), sub-Group A1, B1 (nanohybrid composite + self-etch), sub-Group A2, B2 (self-adhering composite), and A3, B3 (self-adhering composite + self-etch). Teflon ring molds were used to make composite resin cylinders with the specific bonding protocol of each group. Shear bond strength testing was conducted, and data were analyzed. RESULTS: Mean shear bond strength values were as follows: C> A1> A3>A2>B1> B3> B2. CONCLUSIONS: Prepared enamel surfaces resulted in higher shear bond strength values as compared to unprepared enamel surfaces. Prior application of self-etch agent resulted in higher shear bond strength values of self-adhering composite in prepared and unprepared enamel surfaces.

Comparison of fluoride ion release and alkalizing potential of a new bulk-fill alkasite.

AIM: This study was conducted to evaluate and compare fluoride ion release by Cention-N (self-cure and light-cure) and conventional glass-ionomer cement (GIC) at different pH and time intervals. METHODOLOGY: Cavities of similar dimensions were prepared in mandibular molars and restored with Cention-N (by self-cure and light-cure techniques) and GIC. Samples were stored in deionized water, and the cumulative fluoride ion release and change in pH were assessed utilizing spectrophotometer and pH meter, respectively, at the end of 7 days, 14 days, and 21 days. The data thus obtained were statistically analyzed. RESULTS: All the tested materials released fluoride ions in both acidic and neutral pH at all time intervals, and the fluoride ion release was significantly higher (<0.05) in acidic pH as compared to neutral pH except in GIC. All the groups showed a statistically significant increase in pH in acidic medium, whereas no significant increase was observed in neutral medium. CONCLUSIONS: Cention-N (self-cure) has the highest fluoride ion release and alkalizing potential in acidic pH as compared to Cention-N (light-cure) and GIC.

Effect of Different Finishing and Polishing Systems on the Surface Roughness of Resin Composite and Enamel: An In vitro Profilometric and Scanning Electron Microscopy Study.

AIM: The aim is to compare and evaluate the different finishing and polishing systems for the change in surface roughness of resin composites and enamel. MATERIALS AND METHODS: To conduct the study, 30 extracted human maxillary central incisors were selected, decoronated, and molded in self-cure acrylic molds. A box-shaped cavity of dimensions 3 mm × 3 mm × 2 mm was prepared in all the teeth. A nanohybrid composite resin (Filtek Z250) was then used to restore the prepared cavities. Thirty samples were divided into two groups, control group (Group A, n = 10) and experimental group (Group B, n = 20). The samples in Group A were cured through the Mylar matrix. The experimental group, i.e., Group B was divided into two subgroups, i.e., Subgroup BX, n = 10 in which Sof-Lex polishing system was used for polishing the tooth surface and Subgroup BF, n = 10 in which Shofu composite polishing system was used. The mean surface roughness (Ra in µm) of the composite restoration as well as for the enamel surface of all the samples before and after polishing was measured with a contact profilometer, and the values were correlated with scanning electron microscopy. RESULTS: The statistical analysis was carried out using paired t-test. The results exhibited a significant decrease in the surface roughness of the resin composite and enamel surface irrespective of the finishing and polishing system used. The mean surface roughness values demonstrated by Mylar matrix was the lowest followed by Sof-Lex polishing system. Shofu polishing system demonstrated the highest surface roughness values. CONCLUSION: Finishing and polishing of composite restoration can achieve a surface roughness similar to that of enamel. Involvement of marginal enamel in finishing and polishing procedures carried out for composite restoration results in smoother enamel surface.

Evaluation of marginal sealing ability of self-adhesive flowable composite resin in Class II composite restoration: An in vitro study.

AIM: The aim of this study is to evaluate the marginal sealing ability of self-adhesive flowable composite resin when used as a liner in Class II composite restoration with and without aging. MATERIALS AND METHODS: A total of 120 standardized Class II tooth preparations with gingival margins 1 mm coronal and apical to cementenamel junction (CEJ) were prepared on 60 extracted permanent mandibular molars and were randomly divided into eight equal Groups: Group 1: cavities coronal to CEJ and restored with Dyad flow liner + Herculite ultra, Group 2: same as Group 1 but cavities margins apical to CEJ, Group 5: cavities coronal to CEJ and restored with only Herculite ultra, and Group 6: same as Group 5 but cavities apical to CEJ. Groups 3,4,7,8 were similar to Groups 1,2,5,6, respectively, but were aged for 6 months. After thermocycling, microleakage testing was done using 0.5% basic fuchsin dye. RESULT: At cervical level, Group 5 exhibited statistically lower (P = 0.006) microleakage than Group 6, and Group 1 showed lesser microleakage than Group 5 (P = 0.162). Group 2 exhibited significantly less microleakage than Group 6 (P = 0.002). Increased microleakage was observed in aging Groups; however, the difference with nonaging Groups was not statistically significant (P > 0.005). CONCLUSION: Margins of the cavity in cementum can be better sealed by placing self-adhesive liner and is not affected by aging.

In vitro evaluation of the contact angle formed between AH Plus, Hybrid Root Seal and mineral trioxide aggregate Plus sealer with dentin and gutta-percha.

AIM: The purpose of this study was evaluation and comparison of the contact angle of new root canal sealers - Hybrid Root Seal, mineral trioxide aggregate (MTA) Plus, and the conventional AH Plus sealer with dentin and gutta-percha. MATERIALS AND METHODS: Two groups (Group D - dentin and Group G - gutta-percha) of 18 samples each were further randomly divided into 3 subgroups based on the type of sealer used, that is, AH Plus, Hybrid Root Seal, and MTA Plus. Contact angle measurement device (Phoenix 300) was used to measure the contact angle of the sealers on both dentin and gutta-percha. The results thus obtained were analyzed using one-way analysis of variance and Student's t-test. RESULTS: MTA Plus recorded significantly higher values of contact angle on both the substrates, that is, dentin and gutta-percha when compared to AH Plus and Hybrid root canal sealer. The lowest value of contact angle in gutta-percha and dentin was shown by Hybrid root canal sealer and AH Plus, respectively. CONCLUSION: Both AH Plus and Hybrid Root Seal exhibited lower contact angle values, and hence, better wettability on both dentin and gutta-percha as compared to MTA Plus.

Efficacy of Deferasirox as an Oral Iron Chelator in Paediatric Thalassaemia Patients.

INTRODUCTION: Thalassaemia Major patients require frequent blood transfusion leading to iron overload. Excessive iron gets deposited in vital organs and leads to dysfunction of the heart, liver, anterior pituitary, pancreas, and joints. Our body has limited mechanism to excrete iron, so patients with iron overload and its complications need safe and effective iron chelation therapy. AIM: To assess the efficacy of Deferasirox (DFX) as an iron chelator, with specific reference to reduction in serum ferritin level. MATERIALS AND METHODS: This is a prospective; observational study done in 45 multitransfused Thalassaemia Major Children receiving DFX therapy at registered Thalassaemia society Raipur Chhattisgarh. DFX was given in an initial dose of 20 mg/kg/day and according to response increased to a maximum of 40 mg/kg/day. Serum ferritin level was estimated at time of registration and at every three monthly intervals (four times during study period). The primary end point of the study was change in serum ferritin level after 12 months of DFX therapy. RESULTS: The mean serum ferritin before DFX therapy of all cases was 3727.02 ng/mL. After 12 months of mean dose of 38 mg/kg/day of DFX, the mean decline in serum ferritin was 1207.11 ng/mL (drop by 32.38%, p-value <0.001). CONCLUSION: DFX monotherapy has a good safety profile and effectively chelates total body iron in Thalassaemia major patients.

Effect of phytic acid, ethylenediaminetetraacetic acid, and chitosan solutions on microhardness of the human radicular dentin.

AIM: The purpose of this study was to evaluate the effect of phytic acid, ethylenediaminetetraacetic acid (EDTA), and chitosan solutions on the microhardness of human radicular dentin. MATERIALS AND METHODS: Thirty dentin specimens were randomly divided into three groups of 10 specimens each according to the irrigant used: G1 - 1% phytic acid, G2 - 17% EDTA, and G3 - 0.2% chitosan. A standardized volume of each chelating solution was used for 3 min. Dentin microhardness was measured before and after application at the cervical, middle, and apical levels with a Vickers indenter under a 200-g load and a 10-s dwell time. The results were analyzed using one-way analysis of variance (ANOVA) and Student's t test. RESULTS: Microhardness of the radicular dentin varied at the cervical, middle, and apical levels. EDTA had the greatest overall effect, causing a sharp percentage reduction in dentin microhardness with a significant difference from phytic acid and chitosan (P = 0.002). However, phytic acid and chitosan differed insignificantly from each other (P = 0.887). CONCLUSION: All tested chelating solutions reduced microhardness of the radicular dentin layer at all the levels. However, reduction was least at the apical level. EDTA caused more reduction in dentin microhardness than chitosan while phytic acid reduced the least.

CDC Group EO-4 and Candida tropicalis Peritonitis in a Patient on Peritoneal Dialysis after Upper Endoscopy, Colonoscopy and Coil Embolization of the Gastroduodenal Artery.

Peritoneal dialysis (PD) is an excellent form of renal replacement therapy for many patients with end-stage renal disease (ESRD). Over 10,000 patients receive PD in the United States [United States Renal Data System: 2015 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, 2015]. PD has superior outcomes compared to hemodialysis in the first 2 years of ESRD [Sinnakirouchenan and Holley: Adv Chronic Kidney Dis 2011;18: 428-432]. However, peritonitis is a known complication and may result in significant morbidity and necessitate transition to hemodialysis, which increases medical costs [Holley and Piraino: Semin Dial 1990;3: 245-248]. We report the first case of a PD patient who underwent endoscopy, colonoscopy and CT angiogram with coil embolization for gastrointestinal bleeding without antibiotic prophylaxis and subsequently developed CDC group EO-4 organism and fungal peritonitis.

Prostate Cancer for the Internist.

In the United States, approximately 240,000 men are diagnosed annually with prostate cancer. Although effective treatment options are available for clinically localized cancer, the potential burdensome co-morbidities and attendant healthcare costs from over diagnosis and over treatment have escalated the discussion and controversy regarding appropriate screening, diagnosis, and optimal management of prostate cancer. Although the lifetime risk of developing prostate cancer is approximately 1 in 6 (~16%), the risk of dying from the disease is only ~2%. The discrepancy between the cancer incidence and lethality has led to widespread scrutiny of prostate cancer patient management, particularly for low-grade, low-stage (indolent) disease. The vast majority of men diagnosed with clinically localized prostate cancer are treated with interventional therapies despite studies demonstrating that even without treatment, prostate cancer-specific mortality is low. A MedLine/PubMed search was performed using PICO format (Patient, Intervention, Comparison and Outcome) identifying all relevant articles. No restrictions were used for publication dates. The terms "Prostate Cancer", "Screening", "Mortality", "Morbidity" yielded 307 results. "Diagnosis", "Prognosis" and "Survival" yielded 1504 results. Further filters were applied to narrow down the results using keywords "Prostate cancer screening guidelines 2014", "Beyond PSA", "NCCN Guidelines prostate", "MRI guided Prostate biopsy" yielding 72, 274, 54 and 568 results respectively. Of these, approximately 137 articles were found relevant and were reviewed. References from the reviewed articles were included in the final article.

Evaluation of effect of addition of 2% chlorhexidine on the sealing ability of Biodentine: An in vitro study.

AIM: To evaluate the effect of the addition of 2% chlorhexidine on the sealing ability of Biodentine. MATERIALS AND METHODS: Forty-six extracted human premolar teeth with single canal and apical foramen were selected, cleaned, and decoronated to standardize the length of 17 mm. Canals were prepared using ProTaper rotary files till size F4. The samples were divided into 2 experimental groups of 20 samples each on the basis of absence/presence of 2% chlorhexidine in liquid: Group BM = Biodentine mixed with the provided liquid, Group BC = Biodentine mixed with 2% chlorhexidine in provided liquid. Three samples, each were assigned to control groups: Group BP (positive control) = No root end filling was placed, Group BN (negative control) = Root ends were filled as in Group BM, and entire external surface was coated with sticky wax. The samples were then evaluated for the apical sealing using fluid filtration method. RESULTS: Results were analyzed using Student's t-test (P ≤ 0.05). Group BC showed the better sealing ability (3.06) as compared to Group BM (3.85). However, the difference was statistically insignificant (P > 0.05). CONCLUSION: Addition of 2% chlorhexidine to the liquid enhanced the sealing ability of Biodentine.

Comparing gray and white mineral trioxide aggregate as a repair material for furcation perforation: an in vitro dye extraction study.

INTRODUCTION: Furcation perforation can have a negative impact on the prognosis of the affected tooth by compromising the attached apparatus. Hence these perforations require immediate repair. A variety of materials have been suggested for repair, of that MTA is the most promising material. The purpose of this study was to compare the ability of Gray and White MTA to seal furcation perforations using a dye extraction method under spectrophotometer. MATERIALS AND METHODS: A total of 60 permanent mandibular molars were randomly divided into four experimental groups of 15 samples each as follows: Group A: Perforation repaired with White MTA. Group B: Perforation repaired with Gray MTA. Group C: Perforation left unsealed (positive). Group D: without perforation (negative). Dye extraction was performed using full concentration nitric acid. Dye absorbance was measured at 550 nm using spectrophotometer. The data analyzed using one-way-Anova Ratio and Unpaired t-test showing statistically significance difference among the groups. RESULT: It was seen that Group D samples without perforation showed least absorbance followed by Group A (perforation repaired with White MTA) and Group B (perforation repaired with Gray MTA). Group C (perforation left unsealed) showed highest absorbance. CONCLUSION: The White and Gray Mineral Trioxide Aggregate performed similarly as a furcation perforation repair material. There was no significant difference between the Gray MTA and White MTA.

Severe resistant hypocalcemia in multiple myeloma after zoledronic acid administration: a case report.

INTRODUCTION: Hypercalcemia is one of the most common metabolic abnormalities encountered in any form of malignancy. Hypocalcemia, however, is a rare manifestation, especially in cancers with bone involvement. Here we present a case of hypocalcemia in a patient with multiple myeloma that was refractory to treatment. CASE PRESENTATION: A 73-year-old African American woman recently diagnosed with multiple myeloma, presented with a 2-day history of fever, vomiting and hypocalcemia. Ten days prior to admission she received zoledronic acid, Velcade® (bortezomib), Revlimid® (lenalidomide) and dexamethasone. Treatment was started with intravenous antibiotics and calcium gluconate boluses. After 24 hours of treatment her calcium level became undetectable (<5mg/dL). Continuous intravenous calcium gluconate infusions in addition to boluses were started. She remained persistently hypocalcemic and eventually developed tonic-clonic seizures. Vitamin D levels were found to be low and intravenous paricalcitol was initiated, which improved her calcium level. CONCLUSIONS: Underlying vitamin D deficiency can precipitate severe hypocalcemia in patients with multiple myeloma receiving bisphosphonates. This warrants baseline screening for vitamin D deficiency in these patients.

Marginal zone mucosa associated lymphoid tissue diffuse large B cell lymphoma.

CONTEXT: Non-Hodgkin's lymphomas (NHL) primarily involving the orbit, is relatively uncommon. Rarely two pathologically different NHL cell types have been found to be coexistent. CASE REPORT: We report a case of orbital lymphoma in a 62-year-old male with rare histopathological findings secondary to transformation of once cell type into another. Tissue diagnosis and molecular studies led to revelation of diffuse large B cell lymphoma evolving from MALT lymphoma. CONCLUSION: Proliferation of two morphologically and phenotypically different B cells resulting in malignancy has not been found in the orbit so far. They are usually aggressive tumors and require chemo-immunotherapy.

Comparative evaluation of microleakage in Class II restorations using open vs. closed centripetal build-up techniques with different lining materials.

BACKGROUND: Evaluation of microleakage is important for assessing the success of new restorative materials and methods. AIM AND OBJECTIVES: Comparative evaluation of microleakage in Class II restorations using open vs. closed centripetal build-up techniques with different lining materials. MATERIALS AND METHODS: Standardized mesi-occlusal (MO) and distoocclusal (DO) Class II tooth preparations were preparedon 53 molars and samples were randomly divided into six experimental groups and one control group for restorations. Group 1: Open-Sandwich technique (OST) with flowable composite at the gingival seat. Group 2: OST with resin-modified glass ionomer cement (RMGIC) at the gingival seat. Group 3: Closed-Sandwich technique (CST) with flowable composite at the pulpal floor and axial wall. Group 4: CST with RMGIC at the pulpal floor and axial wall. Group 5: OST with flowable composite at the pulpal floor, axial wall, and gingival seat. Group 6: OST with RMGIC at the pulpal floor, axial wall, and gingival seat. Group 7: Control - no lining material, centripetal technique only. After restorations and thermocycling, apices were sealed and samples were immersed in 0.5% basic fuchsin dye. Sectioning was followed by stereomicroscopic evaluation. RESULTS: Results were analyzed using Post Hoc Bonferroni test (statistics is not a form of tabulation). Cervical scores of control were more than the exprimental groups (P < 0.05). Less microleakage was observed in CST than OST in all experimental groups (P < 0.05). However, insignificant differences were observed among occlusal scores of different groups (P > 0.05). CONCLUSION: Class II composite restorations with centripetal build-up alone or when placed with CST reduces the cervical microleakage when compared to OST.

Ventricular standstill: An uncommon electrophysiological abnormality caused by profound vagal tone.

CONTEXT: Ventricular standstill (VS) is an uncommon electrophysiological phenomenon and usually manifests as syncope. Rarely has a case been reported where the patient has been totally asymptomatic, and it has resolved spontaneously. CASE REPORT: We report a case of complete VS and high-degree atrioventricular (AV) block in a 50-year-old female, who was admitted for nausea, vomiting, and chest pain. The patient never had a syncopal episode, even though she was in VS for more than 10 s. CONCLUSION: Such degree of conduction abnormality without any syncope has not been reported so far. Her electrophysiological abnormality was attributed to profound vagotonic effect and was treated with a permanent pacemaker.

Endodontic management of permanent mandibular left first molar with six root canals.

The endodontic treatment of a mandibular molar with aberrant canal configuration can be diagnostically and clinically challenging. This case report presents the treatment of a mandibular first molar with six root canals, of which three canals were located in the mesial root and three in distal root. Third canals were found between the two main root canals. This case presents a rare anatomic configuration and points to the importance of expecting and searching for additional canals.