C-reactive Protein in Periodontitis and its Comparison with Body Mass Index and Smoking Behaviour

INTRODUCTION

Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. In addition to declining oral health, there is always low grade infection present in periodontitis. Studies show increased levels of systemic biomarkers in periodontal disease such as CRP, which is considered a key-marker of CVD. Research has also shown positive association between BMI and smoking with periodontitis and CRP. The objective of the study was to assess the levels of CRP in patients with and without periodontitis and their relation with BMI and smoking behaviour.

METHODS

Patients visiting the Dental department of Bir Hospital were invited to participate in the study. Total 31 subjects in each group: Case (periodontitis) and Control (without periodontitis) were selected using convenience sampling technique. All subjects underwent periodontal examination by a single examiner. Serum CRP samples were taken before periodontal treatment. Data analysis was done by SPSS 17 software program.

RESULTS

Increase in mean CRP levels in periodontitis (5.8595mg/L) with high statistical significance (P=0.000) in comparison to subjects without periodontitis (1.1214mg/L) was observed. BMI showed positive association with periodontitis (P=0.046) but not with CRP (0.213). Smoking behaviour showed no significant relation with either CRP (P=0.344) or periodontitis (P=0.541).

CONCLUSIONS

We found highly significant association between periodontitis and CRP levels but not always with BMI and smoking. CRP, which is an established marker for CVD was significantly increased in periodontal infections. Hence, a close interaction among Physician, Periodontist and Patient to prevent adverse health situations is recommended.

Blood Lead Level among school children in an Industrial city of Nepal

Background: Widespread use of lead has caused extensive environmental contamination and health problems in many parts of the world. Children are particularly vulnerable and even relatively low levels of exposure can cause serious health conditions. Our objective was to determine the prevalence of blood lead level in children in industrial city of Nepal, Birgunj.Materials and Methods: The cross sectional study was done on 50 school going student in Birgunj city, Nepal from November 2016 to January 2017. Questionnaire was used to collect data. Capillary blood was drawn and Blood Lead Level was measured immediately. SPSS ver. 22 was used to analyze the data.Results: The mean age of children in study was 12.5 ± 1.11 years.Among 50 children, 54% were male and 46% were female. The mean blood lead level was 20.33±9.36 μg/dl (male 21.08±8.87μg/dl, female 19.46±10.92 μg/dl). All the children in the study have elevated blood lead level and 84% of them have >10 μg/dl. About 26% of children have blood lead level between 15-20 μg/dl, 12% have level 20-25 μg/dl and 4% of them have more than 35 μg/dl.Conclusion: The prevalence of blood lead level in children from the industrial city of Nepal is alarmingly high. Children exposed with chipped paints have high level of blood lead level. However, further study in large population is required to address the current situation regarding the lead exposure to children.  

Impact of consultant specialty on discharge decisions in patients admitted as medical emergencies to hospitals in the United Kingdom

BACKGROUND

The Society for Acute Medicine's Benchmarking Audit (SAMBA) annually examines Clinical Quality Indicators (CQIs) of the care of patients admitted to UK hospitals as medical emergencies.

AIM

The aim of this study is to review the impact of consultant specialty on discharge decisions in the SAMBA data-set.

DESIGN AND METHODS

Prospective audit of patients admitted to acute medical units (AMUs) on 25 June 2015 to participating hospitals throughout the UK with subgroup analysis.

RESULTS

Eighty-three units submitted patient data from 3138 patients.Nearly 1845 (58%, IQR for units 50-69%) of patients were referrals from Emergency Medicine, 1072 (32%, IQR for units 24-44%) were referrals from Primary Care. The mean age was 65 (SD 20). One hundred and forty-one (4.5%) patients were admitted from care homes and 951 (30%) of patients were at least 'mildly frail' and 407 (13%) had signs of physiological instability. The median and the mean time to being seen by a doctor were 1 h 20 min and 2 h 3 min, respectively. The median and the mean time to being seen by senior specialist were 3 h 55 min and 5 h 56 min, respectively. By 72 h, 29 (1%) patients had died in the AMU, 73 were admitted to critical care units, 1297 (41%) had been discharged to their own home and 60 to nursing or residential homes. For every 100 patients seen specialists in acute medicine discharged 12 more patients than specialists from other disciplines of medicine ( P  < 0.001). The difference remained significant after adjustment for case mix.

CONCLUSION

Specialist in acute care might facilitate discharge in a higher proportion of patients.

Effects of dietary supplementation of cinnamaldehyde and formic acid on growth performance, intestinal microbiota and immune response in broiler chickens

An experiment was conducted to investigate the effects of replacing antibiotic growth promoter (AGP) with a combination of essential oil and organic acids (EO + OA) on growth performance, gut microbiota and immune response in broiler chickens. In Experiment 1, 320 day-old broiler chicks were randomly distributed to 32 pens with 10 birds in each pen and the pens were equally allotted to four treatment groups. In Experiment 2, 120 day-old chicks were divided into the same four treatment groups, each group containing three replicated pens with 10 birds in each pen. The groups were (1) Negative Control (NC) without AGP or other growth-promoting feed additives; (2) AGP (NC + enramycin; 125 mg/kg feed; (3) OA (NC + OA; 500 mg/kg feed); and (4) EO + OA (NC + a combination of cinnamaldehyde and calcium formate; 500 mg/kg feed). Experiment 1 lasted for 40 days, whereas Experiment 2 continued for 28 days. In Experiment 2, all birds were orally challenged with Escherichia coli (108 bacteria/bird) on Day 14. Overall intake, growth and feed conversion ratio (FCR) on Day 40 had no difference (P > 0.05) among the groups in Experiment 1. In Experiment 2, growth, feed intake and FCR were not affected by any dietary treatments until Day 14, but after being challenged with E. coli, bodyweight gain and FCR improved (P < 0.05) for AGP and EO + OA compared with NC. Mortality rate was also lower (P < 0.05) for AGP and EO + OA than NC in Experiment 2. Villi height was higher (P < 0.001) in OA and EO + OA groups compared with NC and AGP groups. Any treatment did not affect (P > 0.05) the counts of total bacteria, E. coli and Lactobacillus in the contents of ileum and caecum. However, Salmonella counts in the ileal and caecal contents decreased (P < 0.001) for AGP, OA and EO + OA compared with NC group. Clostridium counts were lower for EO + OA group than for NC and AGP groups in the ileum, and for AGP, OA and EO + OA groups than for NC in the caeca (P < 0.05). Antibody titer on Day 35 against Newcastle disease vaccine was higher in EO + OA group than in NC, AGP and OA groups (P < 0.001). In conclusion, EO + OA did not affect growth and FCR in broilers. However, AGP and EO + AO improved growth performance and FCR after being challenged with E. coli. Moreover, EO + OA was effective in reducing the Clostridium count in the small intestine and caecum and increasing the villus height and antibody titer against Newcastle disease vaccine.

Role of S-100 Immunostain as An Auxiliary Diagnostic Aid in Leprosy

INTRODUCTION

Histopathologic diagnosis of leprosy is difficult when Bacillary Index (BI) is zero and neural involvement are not easily identifiable on routine Hematoxylin and Eosin stain. This study was undertaken to study the role of S-100 immunostaining in demonstrating different patterns of nerve involvement in various types of leprosy.

METHODS

Thirty one skin biopsies with clinico-histopathologic diagnoses of leprosy over a period of two years were included in the study. Ten cases of non-lepromatous granulomatous dermatoses (including eight cases of lupus vulgaris and two cases of erythema nodosum) were used as controls. Tissue sections from all cases and controls were stained with Hematoxylin and Eosin (H&E) stain, Fite stain and S-100 immunostain. The H&E stained slides were used to study the histopathological features, Fite stained slides for Bacillary Index and S-100 for nerve changes.

RESULTS

Neural changes could be demonstrated in the entire spectrum of leprosy using S-100 immunostaining. The most common pattern of nerve destruction in the tuberculoid spectrum was fragmented and infiltrated whereas lepromatous spectrum showed mostly fragmented nerve twigs. Intact nerves were not detected in any of the leprosy cases.

CONCLUSIONS

S-100 immunostain is a useful auxiliary aid to the routine H&E stain in the diagnosis of leprosy especially tuberculoid spectrum and intermediate leprosy.

Solid-state colloidal CuInS2 quantum dot solar cells enabled by bulk heterojunctions

Colloidal copper indium sulfide (CIS) nanocrystals (NCs) are Pb- and Cd-free alternatives for use as absorbers in quantum dot solar cells. In a heterojunction with TiO₂, non-annealed ligand-exchanged CIS NCs form solar cells yielding a meager power conversion efficiency (PCE) of 0.15%, with photocurrents plummeting far below predicted values from absorption. Decreasing the amount of zinc during post-treatment leads to improved mobility but marginal improvement in device performance (PCE = 0.30%). By incorporating CIS into a porous TiO₂ network, we saw an overall drastic improvement in device performance, reaching a PCE of 1.16%, mainly from an increase in short circuit current density (J_sc) and fill factor (FF) and a 10-fold increase in internal quantum efficiency (IQE). We have determined that by moving from a bilayer to a bulk heterojunction architecture, we have reduced the trap-assisted recombination as seen in changes in the ideality factor, the intensity dependence of the photocurrent and transient photocurrent (TPC) and photovoltage (TPV) characteristics.

Laparoscopic antireflux surgery - our initial experience

Introduction: Laparoscopic antireflux surgery (LARS) currently represents the gold standard in the surgical management of gastrointestinal reflux disease (GERD) with minimal morbidity and mortality. Routine fundoplication following laparoscopic Heller’s cardiomyotomy is also being recommended to reduce the incidence of pathological gastro-oesophageal reflux after surgery. The aim of the current study was to evaluate patients receiving LARS and to assess their surgical outcomesMethods: Prospective data of all patients admitted in our department with these diseases and undergoing LARS, from May 2014 to November 2015 were reviewed. Patients with Achalasia cardia underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication and those with GERD with hiatus hernia underwent Laparoscopic Toupet’s fundoplication. Age, sex, duration of surgery, surgical morbidity and hospital stay were recorded. Results: Eleven patients underwent LARS. Females were 5(45.5%) and males were 6 (54.5%). Mean age of patients was 36.18 ± 15.79 years (range 18-68 years). 6 patients (54.5%) underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication for Achalasia cardia while 5 patients (45.5%) underwent Laparoscopic fundoplication. The median operating room time was 133.64 ± 15.66 minutes (range, 110–160). There were no conversions. The median hospital stay was 3.45±0.522 days (range, 3-4 days). No postoperative complications or preoperative deaths occurred. No patient had a perforation revealed on the postoperative contrast swallow when performed. Gastro esophageal reflux symptoms were significantly improved and severity of dysphagia was also reduced after surgery. The average follow-up period is 5.45 ± 2.67 months (range, 3- 12).Conclusion: LARS is well established technique and becoming more popular over conventional open surgery in view of its equal safety and efficacy with added advantage of less morbidity and mortality. However larger case series and long term follow up would be warranted.

Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis

Introduction: Standard recommendations for patients recovering from an episode of biliary pancreatitis include cholecystectomy with intra operative cholangiogram or ERCP during the same hospital admission as it is believed that the instigating factor is the passage of stones through the common bile duct. As ERCP is not widely available and expensive, cholecystectomy with IOC is routinely performed to rule out choledocholithiasis. However detection of common bile duct stones is challenging. Whether these patients undergoing cholecystectomy require direct common bile duct evaluation is controversial. Objective of the study was to see the presence of common bile duct stones in patients with resolving acute mild biliary pancreatitis. Methods: Patients admitted in the surgical ward in Patan Hospital and Bir Hospital with the diagnosis of mild acute biliary pancreatitis who underwent cholecystectomy with intra-operative cholangiography from August 2010 to July 2012 were studied. The outcome of cholangiogram was analyzed together with findings of common bile duct exploration. Results: A total of 52 patients with acute mild biliary pancreatitis were operated during this period. The common bile duct stone was found in 1.9%.  Out of four patients with abnormal cholangiogram, only one patient (25%) had stone on exploration, rest of the three cases (75%) had negative exploration.Conclusion: The presence of common bile duct stone in case of mild acute biliary pancreatitis undergoing cholecystectomy is very low (1.96%), and thus policy of selective IOC should be applied for cases with mild biliary pancreatitis.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 11-15

Prevalence of Respiratory Diseases According to Spirometry Findings Among Patients Attending the Spirometry Department of Dhulikhel Hospital

Background Spirometry is a standard test for screening and evaluation of patients with symptoms of cough and shortness of breath. Despite its easy availability, low cost and ease of performance it has not been widely used in clinical practice in Nepal. Objective To assess the prevalence of respiratory diseases in a regional referral centre in patients referred for spirometry. Method This is a descriptive cross-sectional study including patients referred for spirometry to the spirometry unit of Dhulikhel Hospital, Kathmandu University Hospital from 2014 July to 2015 October. The spirometry findings of the patients fulfilling the criteria of American Thoracic Society/European Respitatory Society (ATS/ERS) guidelines were analyzed and categorized as normal, having obstructive lung diseases including chronic obstructive pulmonary disease (COPD) and bronchial asthma or restrictive lung disease. Data were analyzed using SPSS 20.0 software. Result Out of 821 patients, 755 patients (92%) fulfilled ATS/ERS criteria for satisfactory spirometry. The prevalence of COPD was 31.4%, bronchial asthma 24.2% and restrictive lung disease 8.1%. The mean age of patients diagnosed with COPD was 57.8±10.8 years; bronchial asthma 44.3±16.2 years; and restrictive lung disease 44.6±21.5 years. Both COPD and bronchial asthma were common in females. About twenty two percent of the COPD patients were non-smokers and 86.3% of these were females. The most common symptoms for referral was cough and shortness of breath: these symptoms were more likely to be associated with abnormal spirometry findings. Conclusion Spirometry is a crucial preliminary test for evaluation of patients with respiratory symptoms. It should be used more frequently to help stratify patients for appropriate treatment.

Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria

Objective:

Currently, there is controversy regarding the diagnosis of gestational diabetes mellitus (GDM) as per the newer International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. We studied the prevalence and associations of GDM in North Indians, diagnosed by the IADPSG criteria.

Patients and Methods:

We conducted a cross-sectional study on 332 pregnant women, predominantly belonging to lower and middle socioeconomic strata. The women were screened for GDM between 24 weeks and 28 weeks of gestation by 75g oral glucose tolerance test (OGTT) and GDM diagnosed by the IADPSG criteria.

Results:

The prevalence of GDM was 41.9% [95% Confidence interval (CI) 36.6-47.2%]. Amongst the women diagnosed to have GDM, 91.4% had abnormal fasting plasma glucose (FPG), while 1-h and 2-h post-glucose (PG) levels were abnormal in 18.7% and 17.3% of women, respectively. No maternal factors were significantly associated with GDM. Birth weight of the neonates was similar in women with GDM as compared to those with normal glucose tolerance. In the entire group, fasting glucose levels were associated with the weight of the patient while 1-h PG levels were associated with weight, height, socioeconomic score, and parity.

Conclusions:

There is a very high prevalence rate of GDM using the IADPSG criteria in North Indian women of low and middle socioeconomic strata. Further studies are needed to assess the utility of applying these criteria in settings with limited resources.