Evaluation of platelet-rich plasma alone or in combination with demineralized freeze dried bone allograft in treatment of periodontal infrabony defects: A comparative clinical trial

Aims:

The use of platelet-rich plasma (PRP) alone in periodontal defects has been controversial and inconclusive. Hence, the present study was designed with the aim to assess the clinical and radiographic effectiveness of PRP alone in infrabony defects.

Materials and Methods:

Thirty infrabony defects were treated with either autologous PRP with open flap debridement (OFD) or autologous PRP + demineralized freeze dried bone graft (DFDBA) with OFD or OFD alone. Clinical parameters recorded were gingival index, plaque index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). Radiographic parameters included defect depth reduction, defect resolution, and crestal bone level. All the parameters were recorded at baseline and 12 months postoperatively.

Results:

Mean PD reduction and CAL gain were greater in PRP + DFDBA (4.88 ± 1.12 mm and 4.26 ± 1.85 mm) and PRP (4.86 ± 2.12 mm and 4.10 ± 1.47 mm) groups than the control group (2.69 ± 1.37 mm and 1.27 ± 0.89 mm).

Conclusions:

Within the limits of the study, all the three groups showed significant improvement in clinical parameters from baseline to postoperative 12 months. The amount of defect depth reduction and defect resolution treated with PRP alone group were significantly < PRP + DFDBA. The results pertaining to these parameters were significantly better than the control group.

Screening difficult-to-reach populations for tuberculosis using a mobile medical unit, Punjab India

BACKGROUND

In India, the National Health Mission has provided one mobile medical unit (MMU) per district in the state of Punjab to provide primary health care services for difficult-to-reach populations.

OBJECTIVES

To determine the number of patients with presumptive tuberculosis (TB) and the number of TB cases detected and treated among patients who used the MMU services from May to December 2012 in Mohali district, Punjab, India.

METHODS

A cross-sectional study was conducted and registers of the out-patient, laboratory, radiology, and TB departments of the MMU were reviewed to determine the number of persons presumed to have TB and the number of persons diagnosed with TB.

RESULTS

Of 8346 patients who attended the MMUs, 663 (8%) had symptoms suggestive of TB. Among those with TB symptoms, 540 (81%) were evaluated for pulmonary TB using sputum examination or chest X-ray. In total, 58 (11%) patients had clinical or laboratory evidence of pulmonary TB, of whom 21 (36%) started anti-tuberculosis treatment.

CONCLUSION

As MMUs are an integral part of the general public health system, these units have the potential to detect TB cases among difficult-to-reach populations. Additional research is required to optimise the diagnosis of TB at MMUs and to increase rates of TB treatment initiation.

Elevated plasma and cerebrospinal fluid interleukin-1 beta and tumor necrosis factor-alpha concentration and combined outcome of death or abnormal neuroimaging in preterm neonates with early-onset clinical sepsis

OBJECTIVE

Prematurity and sepsis are the major contributors of neonatal mortality and neurodevelopmental sequelae. The present study was conducted to measure the plasma and cerebrospinal fluid (CSF) concentration of interleukin (IL)-1β and tumor necrotic factor (TNF)-α in preterm neonates with early-onset clinical sepsis (EOCS), and to find out their association with combined outcome of death or abnormal neuroimaging.

STUDY DESIGN

Thirty-two preterm (⩽34 weeks) neonates with EOCS and 32 gestational age-matched, healthy neonates served as cases and controls, respectively. Samples were collected soon after birth. Neonates were followed up clinically and by serial cranial ultrasonography (CUS) until discharge and subsequently by magnetic resonance imaging (MRI) of brain until 1 year. Developmental screening was done by Denver Developmental Screening test-II.

RESULT

In EOCS group, no neonate had any clinical/microbiological evidence of meningitis. Blood culture was positive in 17 (53%). CUS was abnormal in 12 (37%) (intracranial hemorrhage-11, periventricular leukomalacia-1). Ten (31%) neonates expired. Significant elevation of plasma and CSF IL-1β and TNF-α was observed in the EOCS group. On follow-up, seven (22%) neonates showed evidence of white matter damage in MRI, two of them had developmental delay and microcephaly. Plasma and CSF IL-1β and TNF-α concentration were significantly elevated in deceased neonates and those with abnormal neuroimaging. Both biomarkers demonstrated high predictive accuracy for poor outcome in receiver-operating curve analysis.

CONCLUSION

Elevation of plasma and CSF IL-1β and TNF-α is associated with an increase in the combined outcome of death or abnormal neuroimaging in preterm neonates with EOCS in the absence of clinical/microbiological evidence of meningitis with high predictive accuracy.

Neonatal outcome of extremely preterm Asian infants ⩽28 weeks over a decade in the new millennium

OBJECTIVE

To evaluate predischarge neonatal mortality and morbidity and associated risk factors in extremely preterm Asian infants ⩽28 weeks, over a decade, so as to facilitate formulation of perinatal guidelines and counseling.

STUDY DESIGN

Cohort study of 887 liveborn extremely preterm neonates between 2000 and 2009 at KKH, the centralized perinatal center in Singapore. Outcome measures were predischarge mortality, presence of one or more major neonatal morbidities and the composite outcome of mortality or neonatal morbidity.

RESULT

Overall survival to discharge was 709/887 (80%) and was significantly higher with increasing gestational age (GA) (19% at 23 weeks to 93% at 28 weeks, P<0.001). Survival remained unchanged between 78 and 86% during the decade with no significant secular trend. Overall incidence of major morbidities were bronchopulmonary dysplasia (29%), late onset sepsis (23%), severe retinopathy of prematurity (21%), Grade 3 to 4 intraventricular hemorrhage (12%) and necrotizing enterocolitis ⩾Bells' stage II/focal intestinal perforation (9%). Composite morbidity was seen in 465/835 (56%) neonatal intensive-care unit admissions, decreased with increasing GA (P<0.001; odds ratio 0.65 (95% confidence interval 0.56 to 0.75) and was independently predicted by birth weight, Clinical Risk Index for Babies-revised version II score, male gender, presence of patent ductus arteriosus and airleaks.

CONCLUSION

Although there was no significant trend in neonatal survival or composite morbidity over the decade, improved survival and morbidity were seen with increasing GA.

Persistent organochlorine pesticides and oxidant/antioxidant status in the placental tissue of the women with full-term and pre-term deliveries

In India pre-term birth is the leading cause of death of infants and this number is continuously increasing.

Clinical & immunological profile of newly diagnosed patients with youth onset diabetes mellitus

BACKGROUND & OBJECTIVES

There has been a rise in the incidence of diabetes mellitus in the younger population of India. There are limited data available on the immunological profile of youth onset diabetes mellitus (DM) especially in type 2. Therefore, this study was undertaken to evaluate the clinical and immunological profile of youth onset DM in north India.

METHODS

Fifty one consecutive patients of 8-35 yr of age with diabetes mellitus attending the Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, and Hormone Care and Research Center at Ghaziabad, Uttar Pradesh, India, were included in the study. All subjects were tested for glutamic acid decarboxylase (GAD), an islet cell antigen ICA512/IA2, and insulin antibodies. GAD and ICA512/IA2 were done by ELISA and insulin autoantibodies were tested by radioimmunoassay (RIA) method. These patients were also screened for hepatitis A to E, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) as trigger factors for onset of type 1 DM.

RESULTS

o0 f the total 51 patients, 38 were men and 13 were women. The mean age and BMI of the subjects was 19.7 (±7) years and 21 (± 5) kg/m [2] , respectively. Twenty patients were below the age of 18 yr and their height was more than 75 th percentile of Indian standards. All patients were symptomatic and 12 of these presented with ketoacidosis. Only 48 per cent (n=24) were positive for GAD, 14 per cent (n=7) for ICA512/IA-2, and 28% (n=14) were positive for insulin antibody. Five of these patients had evidence of hepatitis E virus infection. None of the subjects had evidence of active CMV or EBV infection.

INTERPRETATION & CONCLUSIONS

About half of the youth onset diabetes mellitus patients from north India had presence of pancreatic autoimmunity in the form of GAD, ICA512/IA2, and insulin antibodies or a combination of antibodies suggestive of having type 1 DM. Further studies need to be done on a large sample size in different parts of the country.

Toothbrush efficacy for plaque removal

OBJECTIVES

To determine the effectiveness of a novel sonic toothbrush in reducing plaque and in maintenance of gingival health when compared to a standard manual brush.

METHODS

This study was a block-randomized, examiner-blind, two-treatment, parallel group, single centre clinical investigation. A total of 84 subjects were enrolled and randomly assigned to receive either the Panasonic EW-DL90 or an American Dental Association-endorsed manual toothbrush. Subjects were instructed to follow a twice-daily brushing regimen without flossing. Plaque levels and gingival health were assessed at baseline and after 1 and 3 weeks of treatment using the Turesky Modification of the Quigley-Hein Plaque Index and the Papillary Bleeding Score.

RESULTS

Subjects assigned to the EW-DL90 group had significantly lower plaque levels after 1 and 3 weeks of treatment than those in the manual group (P = 0.003 and 0.0035, respectively). Both groups showed a reduction in plaque levels at Week 3 relative to baseline. The EW-DL90 group had significantly lower gingival inflammation scores after 1 week of treatment (P = 0.0293), but there was no difference between groups after 3 weeks of treatment.

CONCLUSION

The EW-DL90 toothbrush safely and effectively removes more plaque than a standard manual toothbrush. Improvement in gingival inflammation was observed after 1 week of treatment. There was no difference in Papillary Bleeding Score between the two groups after 3 weeks of treatment.

CLINICAL SIGNIFICANCE

The newly developed sonic brush (Panasonic EW-DL90) tested in this study was found to be more effective than a manual toothbrush at plaque removal. The papillary bleeding scores were significantly lower in the sonic brush group after 1 week of product use. After 3 weeks of product use, both treatment groups had similar papillary bleeding scores almost returning to baseline values.

Immature teratoma of the nose and paranasal sinuses masquerading as bilateral nasal polyposis: a unique presentation

Teratomas are tumors of multipotent cells derived from all three germ cell layers and recapitulate normal organogenesis. Teratomas are hypothesized to arise by misplacement of multipotent germ cells. Teratoma is usually developmental and sometimes congenital neoplasm which displays both solid and cystic components with gross and microscopic differentiation into a wide variety of tissues representative of all three germ layers--ectoderm, mesoderm and endoderm. We are describing a case which was initially diagnosed as bilateral nasal polyposis clinically but histopathology report came out to be immature teratoma. This case is being reported to make aware all ENT surgeons of such unique presentation of sinonasal teratomas as such presentation of these tumors has not been reported in literature previously, and hence teratomas should be considered in the differential diagnosis of nasal polyposis in future.

Do women presenting for first and second-trimester abortion differ socio-demographically?

Background:

To identify the socio-demographic differences between a sample of women who present for first-trimester and second-trimester abortion.

Aim:

To determine whether women presenting late (in the second trimester) for abortion differ socio-demographically from those presenting early (in the first trimester).

Materials and Methods:

Data over 4 years for women presenting for second-trimester abortion were collected from the records of Family Planning Clinic at a public tertiary level teaching hospital in India. Eighty-four cases were analysed. The case presenting for first-trimester abortion after each second-trimester abortion was included for comparison. Information was gathered concerning age, parity, educational background, employment status, educational background of the husband, family expenditure and religion. Data were statistically analysed and significance determined using logistic regression analysis.

Results:

Second-trimester abortions represented 2% (84/4254) of all abortions in the study period. More women of higher age (P = 0.03) and parity (P = 0.02) and higher educational status (P = 0.04) presented for second-trimester abortion as compared to first-trimester abortion. The occupational status of the woman, husband's educational background, monthly family expenditure per person and religion did not significantly influence the time of presentation for abortion.

Conclusion:

Second-trimester abortions are associated with both increasing age and parity and higher education. This group of educated, older and multiparous women should be one of those targeted for counseling to reduce the risks associated with second trimester abortion.

Natural windbreaks sustain bird diversity in a tea-dominated landscape

Windbreaks often form networks of forest habitats that improve connectivity and thus conserve biodiversity, but little is known of such effects in the tropics. We determined bird species richness and community composition in windbreaks composed of remnant native vegetation amongst tea plantations (natural windbreaks), and compared it with the surrounding primary forests. Fifty-one, ten-minute point counts were conducted in each habitat type over three days. Despite the limited sampling period, our bird inventories in both natural windbreaks and primary forests were nearly complete, as indicated by bootstrap true richness estimator. Bird species richness and abundance between primary forests and windbreaks were similar, however a difference in bird community composition was observed. Abundances of important functional groups such as frugivores and insectivores did not vary between habitat types but nectarivores were more abundant in windbreaks, potentially as a result of the use of windbreaks as traveling routes, foraging and nesting sites. This preliminary study suggests that natural windbreaks may be important habitats for the persistence of bird species in a production landscape. However, a better understanding of the required physical and compositional characteristics for windbreaks to sustain bird communities is needed for effective conservation management.

Real-time probe based quantitative determination of material properties at the nanoscale

Tailoring the properties of a material at the nanoscale holds the promise of achieving hitherto unparalleled specificity of the desired behavior of the material. Key to realizing this potential of tailoring materials at the nanoscale are methods for rapidly estimating physical properties of the material at the nanoscale. In this paper, we report a method for simultaneously determining the topography, stiffness and dissipative properties of materials at the nanoscale in a probe based dynamic mode operation. The method is particularly suited for investigating soft-matter such as polymers and bio-matter. We use perturbation analysis tools for mapping dissipative and stiffness properties of material into parameters of an equivalent linear time-invariant model. Parameters of the equivalent model are adaptively estimated, where, for robust estimation, a multi-frequency excitation of the probe is introduced. We demonstrate that the reported method of simultaneously determining multiple material properties can be implemented in real-time on existing probe based instruments. We further demonstrate the effectiveness of the method by investigating properties of a polymer blend in real-time.

Outcomes of manual small incision cataract surgery under topical anesthesia with lignocaine 2% jelly

INTRODUCTION

The manual small incision cataract surgery (MSICS) is the surgery of choice in countries with a huge back-log of cataract blindness.

OBJECTIVE

To evaluate the outcome of manual small incision cataract surgery (MSICS) under topical anesthesia with lignocaine 2 % jelly.

MATERIALS AND METHODS

This study was a prospective interventional case series. One hundred and twenty eight patients of senile cataract were operated by MSICS under topical anesthesia using lignocaine 2% jelly. No intra-cameral anesthesia was used. The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience and complications.

RESULTS

The mean pain score was 0.82 (SD +/- 0.97). Seventy-one patients (55.4 %) had a pain score of zero, that is, no pain. One hundred and twenty one patients (94.5 %) had a score of 3 or less, that is, mild to none pain. All the surgeries except two were complication- free and the surgeon's experience was favorable in terms of the patient's cooperation, anterior chamber stability, difficulty, and complications.

CONCLUSIONS

MSICS can be performed under topical anesthesia with lignocaine jelly, which makes the surgery patient-friendly, without compromising the outcome.

Nonsyndromic tooth agenesis patterns and associated developmental dental anomalies: a literature review with radiographic illustrations

Tooth agenesis is one of the most intriguing phenomena, because it is frequently associated with other oral anomalies, structural variations and malformations of other teeth, late eruption, transposition and crowding. The diagnosis can be quite challenging as radiographic examination is critical for the diagnosis but not always possible and the late developing teeth may be sometimes scored developmentally missing. Accurate diagnosis therefore requires radiographic, clinical, and dental cast examinations. It is an important clinical and public health problem. Patients with missing permanent teeth may suffer from a reduced chewing ability, inarticulate pronunciation, and an unfavorable aesthetic appearance. Clinically, early diagnosis of a dental anomaly can alert the clinician to the possible development of other associated dental anomalies in the same patient or family, and avoid the possible sequelae. Understanding of tooth agenesis patterns and their impact on diagnosis, prevention, and eventually therapeutics are becoming integral parts of comprehensive dental care. Dental examination with radiographic screening of hypodontia in early childhood should be emphasized as part of public oral health policy to allow early diagnosis and timely intervention.

Driving with navigational instructions: Investigating user behaviour and performance

This paper reports the results of an inter-disciplinary study investigating user preferences and performance in relation to spoken in-car route guidance. In-car navigation systems are becoming increasingly popular. However, despite large amounts of research assessing the presentation of spatial information, and the usability and interaction issues surrounding the interfaces, there has been much less investigation of the impacts of auditory presentation of route information. We addressed this issue using a multi-disciplinary approach to collect both qualitative and quantitative data through questionnaires and user experiments. Our research identified a user preference for auditory presentation of route information, as well as a memory advantage for auditory over visual presentation. We also found that simple auditory route instructions could be followed without significant interference to a simulated driving task, whereas more complex auditory instructions did cause interference. Taken together, this research highlights the importance of the design of spoken route guidance instructions in minimising the cognitive demands that they impose.

Lepromatous leprosy with an uncommon presentation: a case report

28 yr old male presented with asymptomatic nodules and few well to ill defined papules on ears, asymmetrical nerve enlargement and evanescent tender nodules on the extremities without any infiltration of the skin and madarosis. Slit skin smear done from normal skin was BI 6+. Skin biopsy showed features of lepromatous leprosy.

Oral health status and needs of homebound elderly in an urban home-based primary care service

OBJECTIVES

This study assessed the oral health status, dental utilization and dental needs of the homebound elderly (HBE) care patients within the Mount Sinai Visiting Doctor program.

METHODS

Of the 334 eligible patients, 57% agreed to participate and 95.4% completed the clinical examinations, the Dental Utilization and Needs survey and Geriatric Oral Health Assessment Index conducted in each subject's home by a trained research team.

RESULTS

Among 75% who were dentate subjects, 40% needed restorative dental care, 45.6% needed dental extractions, and 33% complained of current oral pain. Overall, 92.0% needed some type of dental care and 96% stated that they had not seen a dentist since they became homebound (mean number of years in program = 3.2 ± 2.58).

CONCLUSION

Findings show the oral health status of these homebound elderly was poor and their quality of life was significantly affected by the lack of basic dental care.