An analysis of the timing and materials associated with pulp disease following restorative dental treatment.

AIM: To assess whether the timing of pulp disease after tooth restoration was associated with type of restorative dental material used, extent of the restoration or tooth type. METHODOLOGY: A comprehensive search and analysis of data using the Titanium Oral Health Management software program at The Oral Health Centre of Western Australia were performed to correlate procedural codes for teeth that had restorations placed and subsequently developed pulp disease requiring endodontic treatment or extraction from 1st January 2009 to 31st December 2013. Manual analysis of paper and/or electronic patient record cards was also performed. Data collected included restoration type, restored tooth surfaces, tooth type and the dates of restoration and subsequent endodontic intervention or extraction. RESULTS: Of 330 teeth that met the inclusion criteria, 84 (26%) had composite resin restorations, 80 (24%) had amalgams, 119 (36%) had glass-ionomer cement (GICs), and 47 (14%) had crowns. The average time between restoration and further intervention was 330 days with a range from 3 to 1775 days (approximately 5 years). Teeth restored with crowns or five-surface restorations were significantly more likely to require earlier intervention than other restorations. Premolar and anterior teeth were also more likely to require earlier intervention. CONCLUSIONS: Teeth that developed pulp disease requiring further intervention that were restored with crowns and five-surface GIC developed the disease sooner than teeth that were restored with amalgam or composite. In teeth with five-surface restorations that developed pulp disease requiring further intervention, premolar and anterior teeth developed the pulp disease sooner than molars.

Measurement of liver and spleen interstitial volume in patients with systemic amyloid light-chain amyloidosis using equilibrium contrast CT.

OBJECTIVES: To investigate equilibrium contrast-enhanced CT (EQ-CT) measurement of extracellular volume fraction (ECV) in patients with systemic amyloid light-chain (AL) amyloidosis, testing the hypothesis that ECV becomes elevated in the liver and spleen and ECV correlates with other estimates of organ amyloid burden. METHODS: 26 patients with AL amyloidosis underwent EQ-CT, and ECV was measured in the liver and spleen. Patients also underwent serum amyloid P (SAP) component scintigraphy with grading of liver and spleen involvement. Mann-Whitney U test was used to test for a difference between patients with amyloid deposition (SAP grade 1-3) and those without (SAP grade 0). Variation in ECV across SAP grades was assessed using the Kruskal-Wallis test and association between ECV and SAP grades with Spearman correlation. RESULTS: Mean ECV in the spleen and liver was significantly greater (p < 0.0005) in amyloidotic organs (SAP grade 1-3) [spleen, liver: 0.430, 0.375] compared with healthy tissues [spleen, liver: 0.304, 0.269]. ECV increased with increasing amyloid burden, showing positive correlation with SAP grade in both the liver (r = 0.758) and spleen (r = 0.867). CONCLUSION: In patients with systemic AL amyloidosis, EQ-CT can demonstrate increased spleen and liver ECV, which is associated with amyloid disease burden.

Awareness-Knowledge and Practices of Dental Waste Management among Private Practitioners.

Background Dental wastes are materials that have been utilized in dental clinics, which are no longer wanted for use and therefore discarded. Improper disposal of these dental wastes can cause harm to the dentist, the people in immediate vicinity of the dentist. Objective The present study was conducted to assess the knowledge and practices regarding Dental waste management among private practitioners. Method The study population included 186 private practitioners in three districts of Karnataka (Coorg, Mysore, Hassan), south India. A pre-tested self-administered questionnaire was distributed to assess the knowledge and practices regarding dental waste management. Descriptive statistics was used to summarize the results. The data will be statistically analyzed using chi-square test, correlation. Result Out of 186 study subjects, 71(38%) were females and 115(62%) were males, Chisquare analysis showed highly significant association between qualification of the study participants and their knowledge, practice of dental waste management. A statistically significant (0.0001) correlation was found between the knowledge and practice scores. Conclusion There was a lacunae of knowledge regarding proper biomedical waste disposal among the participants. In order to fill this vacuum CDE (Continuing Dental Education) programs have to be conducted in pursuance to maintain health of the community.

Patient compliance with colposcopy information leaflets.

OBJECTIVE: To investigate patient satisfaction and compliance with recommendations in information leaflets sent to women prior to colposcopy clinic attendance and to establish whether alteration to the leaflet improved compliance. STUDY DESIGN: Data was collected prospectively and analysed retrospectively on the first 50 women attending for colposcopy before and after alterations to the information leaflet. RESULTS: All the patients received our patient leaflet and over 90% in each group felt that the information was understandable, clear and adequate. This is in complete contrast to overall compliance of less than 40% in both groups of the women. The first language of the patients did not make any major impact on compliance. CONCLUSION: Patients understanding of the information provided in the leaflets was not reflected in compliance. Compliance was no better in repeat attendees. The compliance with the information provided was not affected by the womens first language. Alterations in the leaflet did not improve compliance. Other methods of information provision should be looked at to try to improve compliance.

Membranous glomerulonephritis and the nephrotic syndrome in a patient with Landry-Guillain-Barre-Strohl syndrome

Membranous glomerulonephritis and the nephrotic syndrome concurrent with the Miller-Fisher variant of the Landry-Guillain-Barre-Strohl syndrome (LGBS), acute post-infective polyneuritis, is reported in a 49-year-old man. The onset of heavy proteinuria coincided with the development of the neurological disturbance. While immunosuppressive therapy appeared to hasten improvement in the neurological disease, no such improvement occurred in the glomerulopathy (AU)

Increasing prevalence of multiple sclerosis in Barbados - abstract

A review of patients diagnosed as having multiple sclerosis (MS) at the Queen Elizabeth Hospital since 1961 has been carried out. Thirty-eight of 45 cases fulfilled the agreed criteria for diagnosis. There has been an eight-fold increase in the incidence of multiple sclerosis seen at the QEH over the last 25 years, and particularly the last decade (22 or 58 percent in the last six years). The gender ratio (1.9:1), age of onset (31 ñ 6.8), the clinical spectrum and course of patients in this series are almost identical to the well-known clinical spectrum of MS. Eight patients were expatraiates - residents and tourists. One of these was made dramatically worse by the heat, perhaps equivalent to the "hot bath test". Of the 30 West Indian patients, 14 had lived overseas for one year or more and two had spent short vacations abroad, but nine had never left Barbados. The greatly increased rate of diagnosis of MS may reflect increased risk through travel - emigration and return, study travel, holiday travel and tourism - as well as improved referral diagnostic practices. Local physicians, therefore, need to be more aware of the possibility of MS in the Caribbean, and its protean forms. A continiung and significant further increase in new cases is predicted (AU)

Regular haemodialysis in Barbados: the first five years

The first five years' experience of a small, Caribbean, hospital-based haemodialysis unit is reviewed with particular reference to the aetiology of end-stage renal failure (ESRF), complications of therapy, causes of death and the factors influencing rehabilitation. Malignant hypertension evolved as an important cause of ESRF, accounting for 42 percent of cases among Black Barbadians on the dialysis programme (AU)

Open study to establish the efficacy and tolerance of detotifen in the prophylactic treatment of bronchial asthma - abstract

Seventeen hospital outpatients with extrinsic bronchial asthma were treated with 1 mg ketotifen for sixteen weeks. The evaluation of overall efficacy was based on five clinical examinations on each patient, including lung function studies, frequency of symptoms and decrease in concomitant drug utilization. The tolerance of the drug and periodic assessment of adverse reactions were also evaluated. Both peak flow and FEV1 showed a progressive increase over four months of treatment with ketotifen. Peak flow increased from an initial value of 225ñ89 1/min. (mean ñ SD) to 303 ñ 122 1/min. Only the values at the fourth month were statistically significant (p<0.01). FEV1 increased progressively from 1.25 ñ 0.45 litres. Again only the values at the fourth month were significant (p<0.025). There was no increase in FVC or FEV1/FVC, even at the fourth month. A number of subjects appeared to have great difficulty grasping the techniques required to perform pulmonary function tests. There were four subjects whose performance was consistently unsatisfactory (wider inter test variation) and well below the others even when clinically asymptomatic; these subjects' values were consistently less than 200 1/min. (peak flow) and 1 l/sec FEV1). The results of re-analysis excluding these subjects were as follow: Both peak flow and FEV1 showed higher values and the differences at the fourth month were greater, reaching a level of p<0.005 for peak flow and p<0.01 for FEV1. Ketotifen was beneficial in reducing the frequency of attacks in 14 out of 17 patients. It was very effective in two patients (not a single attack after starting the trial); nine patients did not have any attacks after 12 weeks. No concomitant medication was used by two patients, while seven have considerably reduced the doses of concomitant medication. One patient showed no response. Tolerance was good in all patients, the only side effect being mild daytime sedation in twelve patients. Cessation of therapy was not warranted in any patient because of this side effect. These results suggest that improvement with ketotifen is most marked after three months of therapy (AU)