Oral health related quality of life among dental students in a private dental institution in India

Background:

The compartmentalization involved in viewing the mouth separately from the rest of the body must cease. This is because oral health affects general health by causing considerable pain and suffering; and, by changing what people eat and their speech, can bring about a change in their quality of life and well-being. There are several instruments for measuring oral health related quality of life, and, OIDP (Oral Impact on Daily Performance) is one among them.

Aim:

The aim of this study is to assess the OIDP among dental students and to know whether students in different stages of the dental course had any difference in impact on their daily performance.

Materials and Methods:

372 students of Bachelor of Dental Sciences’ (BDS) course at Manipal College of Dental Sciences, Manipal, Karnataka, India, from the first to final year, and interns answered a structured questionnaire recording their demographic characteristics, behavioral characteristics and eight items of OIDP.

Results:

The mean OIDP Additive scores (ADD) and OIDP Simple count scores (SC) scores were 7.02 (sd = 3.3, range 8 - 40) and 2.16 (sd = 1.55, range 0 - 8), repectively. A total of 36.6%, 12.9% and 12.9% of the dental students confirmed difficulties with eating, enjoying contact with other people and carrying out major college work, respectively. Logistic regression analysis revealed that compared with the first BDS dental students, the Odds ratio (OR) for the second, third, fourth year and intern dental students for being without oral impacts, despite reporting poor oral health, were 0.21 (95% CI: 0.24 – 1.9), 0.61 (95% CI: 0.06 – 6.2), 0.70 (95% CI: 0.61 – 8.2) and 0.54 (95% CI: 0.3 – 9.3), respectively.

Conclusion:

The study reported the OIPD among dental students and provided evidence of importance of social and behavioral characteristics in shaping the response by dental students.

Conservative management of diabetic foot osteomyelitis

In this retrospective study, 130 patients with diabetic foot osteomyelitis were analysed. 66.9% of these healed with antibiotic treatment alone and 13.9% needed amputation, of which 1.5% were major. Presence of MRSA was associated with adverse outcome (53.3% vs 21.1%, p=0.04) which was defined as death, amputation and failure to heal.

Efficacy of extrinsic stain removal by novel dentifrice containing papain and bromelain extracts

To evaluate the stain removal efficacy of a novel dentifrice containing papain and bromelain extracts (Glodent) in comparison with a control dentifrice (Colgate regular). This was a randomized, positive-controlled, double-blinded, clinical study. Subjects were randomly divided into one of the two study groups. Pre-treatment and post treatment photographs of the 4 anterior teeth were recorded under standardized conditions and analyzed for lightness or luminosity values using Adobe Photoshop. The difference between the mean pre-treatment luminosity of test and control groups was not statistically significant. In both test and control groups, the post-treatment luminosity was significantly higher than pre- treatment luminosity (P < 0.001 and P = 0.003 respectively). The mean post-treatment luminosity for test group was found to be significantly higher than control group. The mean percentage removal of stains for test group was significantly higher than control group. The test dentifrice showed significant stain removal when compared to control which could be attributed to the role of proteolytic enzymes in the test dentifrice.

Change in Nox4 expression is accompanied by changes in myogenic marker expression in differentiating C2C12 myoblasts

Myoblast differentiation is mediated by a cascade of changes in gene expression including transcription factors such as myogenin. Subsequent to myoblast differentiation, there is an increase in expression of the transmembrane protein NADPH oxidase (Nox). Nox is one of the primary factors for the generation of reactive oxygen species (ROS) in myogenic (C2C12) cells. Recently, ROS have been shown to be important regulators of several intracellular signaling pathways, and the full extent of their regulatory roles is yet to be discovered. In the present study, qRT PCR analysis demonstrated that Nox4 isoform is primarily expressed in differentiating C2C12 cells and contributes to the generation of ROS in C2C12 myoblast during differentiation. Over-expression and silencing of Nox4 expression during myoblast differentiation was accompanied by a reduction in intracellular ROS concentrations and an alteration in the expression patterns of Myf5, Pax7, MyoD1, and myogenin. This modulation was found to be associated with ERK1/2 phosphorylation. In both over-expression and reduced expression of Nox4, we found significant reductions in ERK1/2 phosphorylation. This indicates that cellular differentiation may be affected by Nox4-mediated endogenous ROS generation. These data suggest a new opportunity to study the temporal expression of Nox4 in the generation of ROS accompanying changes in myogenic differentiation.

Cesarean section without urethral catheterization: a randomized control trial

BACKGROUND

Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay.

OBJECTIVE

To determine the feasibility and safety of cesarean section without urethral catheterization.

METHODS

A prospective, randomized controlled trial was carried out from April 2008 to March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences. Among 150 patients who had undergone cesarean section 75 were catheterized and 75 were uncatheterized.

RESULTS

First void discomfort was significantly associated with the use of indwelling catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P less than 0.001).Significant number of patients with indwelling catheter had signs and symptoms of urinary tract infection (OR 6,CI 95%, 2.59 to 13. 86; P less than 0.001). Positive urinalysis for urinary tract infection was high in catheterized group (P less than 0.001). Hospital stay was shorter in patients without catheter (p less than 0.05). None of the patients had bladder injury. There were no significant differences in duration of surgery and ambulation time between two groups of patients.

CONCLUSIONS

Cesarean section can be done safely without urethral catheterization with reduced morbidities.

Dental neglect and adverse birth outcomes: a validation and observational study

OBJECTIVES

The objectives of this study were to validate the Indian translation of the Dental Neglect Scale (DNS) among a sample of parturient Indian women and to investigate dental neglect as a possible risk indicator in adverse birth outcomes.

SUBJECTS AND METHODS

Three hundred and sixteen parturient women were administered the DNS and the Modified Dental Beliefs Scale (MDBS) and were also clinically examined for oral health status. Information regarding socio-economic status, weeks of gestation and birth weight was also collected. A gestation period of less than 37 weeks was considered as preterm and a birth weight of less than 2500 gm as 'low birth weight'.

RESULTS

The Indian version of the DNS was found to be reliable (Cronbach's Alpha = 0.72) and valid for assessing dental neglect among the women. Factor analysis of the DNS revealed a two-factor structure accounting for 56% variance. Dental neglect was higher among those with poorer oral health status, lower socio-economic and educational status. Multinomial logistic regression showed high dental neglect and negative dental beliefs and not poor oral health, as significant risk indicators for occurrence of adverse birth outcomes.

CONCLUSION

The finding of an association of adverse birth outcomes with dental neglect and beliefs, but not with poor oral health could be due to the influence of other more important general factors which had a direct bearing on birth outcomes. There is a need for further research to assess the role of behavioural factors like dental neglect as risk indicators for adverse birth outcomes.

Assessment and validation of the oral impact on daily performance (OIDP) instrument among adults in Karnataka, South India

OBJECTIVES

The objective of the study was to test the applicability of abbreviated version of the oral impact on daily performance (OIDP) inventory among the adults visiting dental outreach centre in Karnataka, South India.

BASIC RESEARCH DESIGN

Cross sectional study.

CLINICAL SETTING

Dental outreach centre in Udupi District, Karnataka.

PARTICIPANTS

312 adults aged 35-44 years attending the centre.

INTERVENTIONS

Face-to-face interview followed by oral health examination. The questionnaire in Kannada version of OIDP, perceived general and oral health and satisfaction with dental appearance were used.

MAIN OUTCOME MEASURES

Reliability and Validity of OIDP instrument, Prevalence of oral impacts in study population.

RESULTS

Majority of the participants (71.2%) reported oral health problems affecting at least one daily performance in the 6 months preceding the survey. The performance most affected was 'eating' (52.2%) followed by 'cleaning teeth' (32.4%). Cronbach's alpha for the OIDP frequency items was 0.70. Construct validity was proved by significant association of OIDP scores and self-rated oral, general health status and perceived satisfaction with appearance of teeth; with those more satisfied having fewer oral impacts (p < 0.001). Criterion validity was demonstrated in that the OIDP scores increased significantly as the number of decayed and missing teeth increased (p < 0.001).

CONCLUSION

The Kannada version of OIDP had excellent psychometric properties for applicability among the adults in Karnataka. Thus, the study highlighted the limits of focusing exclusively on normative needs and suggested the incorporation of oral quality of life measures into the oral healthcare services.

Future specialization interests among medical students in southern India

BACKGROUND

A consideration of the future specialization interests of undergraduate medical students might help to understand the needs of higher medical education and future manpower availability for healthcare.

METHODS

A cross-sectional study was conducted among 373 undergraduate students of a medical college in southern India using a self-administered questionnaire.

RESULTS

Of the 373 students, 188 (50.4%) were men. Almost all of them (370 [99.2%]) wanted to pursue postgraduation. Of these, 267 (72.4%) wanted to pursue postgraduation in India. Overall, the first choice subject was surgery (120 [32.2%]) followed by internal medicine (85 [22.8%]) and paediatrics (43 [11.5%]). The third preference for men and women differed, with men choosing orthopaedics and women choosing obstetrics and gynaecology. The factors that influenced the choice of specialization were interest in the speciality (Likert scale score 4.7), job satisfaction (4.6), employment opportunities (4.0), job security (4) and high income potential (3.9).

CONCLUSION

It was evident from the proportion of students desiring to do postgraduation and their choice of specialties that most of them will end up working at hospitals instead of at primary healthcare centres. The deficiencies of certain specialists such as ophthalmologists are likely to persist. This is a cause for concern as the majority of our population lives in rural areas and there is already a maldistribution of doctors.

Carcinoma of Vagina in Utero-Vaginal Prolapse: A Rare Presentation

Primary vaginal carcinoma in uterovaginal prolapse is a rare entity. We report a case of an 84-years-old lady, who presented with long standing vaginal ulcer in association with third degree uterovaginal prolapse. Incisional biopsy was taken from the ulcer. Histopathological examination showed a large cell keratinizing squamous cell carcinoma. Keywords: Squamous cell carcinoma, uterovaginal prolapse, vaginal carcinoma.

Variation in effects of four OP insecticides on photosynthetic pigment fluorescence of Chlorella vulgaris Beij

Effects of the insecticides quinalphos, chlorfenvinphos, dimethoate and phorate on photosystem activity of Chlorella vulgaris were investigated by different chlorophyll fluorescence measurements. Exposure to each of the insecticides increased the proportion of inactivated PS II reaction center. Quinalphos and chlorfenvinphos caused OJIP fluorescence reduction at all levels by decreasing the proportion of Q(A)-reducing PS II reaction centers (RCs). The other two insecticides affected OJIP fluorescence rise by hindering the electron transport beyond Q(A). Insecticide treatment resulted in decrease of the density of active RC and performance indices (PI) by enhanced dissipated energy flux per active RC. Antenna size was severely minimized by quinalphos and chlorfenvinphos treatment whereas other two insecticides had no such effect. Each insecticide treatment caused increase of photosystem antenna/core and PS II/PS I fluorescence ratios. Quinalphos and chlorfenvinphos affected the donor sides of photosystems whereas dimethoate and phorate inhibited electron transfer beyond Q(A) (acceptor side).

Carcinoma of vagina in utero-vaginal prolapse: a rare presentation

Primary vaginal carcinoma in uterovaginal prolapse is a rare entity. We report a case of an 84-years-old lady, who presented with long standing vaginal ulcer in association with third degree uterovaginal prolapse. Incisional biopsy was taken from the ulcer. Histopathological examination showed a large cell keratinizing squamous cell carcinoma.

Fictitious pseudo Meig’s syndrome: A medical emergency

The present case scenario deals with an acute on chronic symptomatology, and collapsed state of the patient with poor vitals on admission in casualty. Clinical work up pointing to an elevated serum CA 125 levels and USG pelvis suggesting peritoneal adhesions with cystic to firm mass in left ovary and minimal free fluid in abdomen and cul de sac, X Ray chest suggesting right sided Pleural effusion. It was after careful evaluation of the case, with past and present history along with signs, symptommatology and intraoperative findings that differentials like Chronic granulomatous lesions, endometriosis, Neoplastic lesions with metastasis and Meig’s syndrome or Pseudo Meig’s were evaluated. Finally, a diagnosis of genital tuberculosis with enodmetriosis was confirmed on histopathological evaluation. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5975 JCMSN 2011; 7(1): 57-64

Malocclusion and orthodontic treatment need measured by the dental aesthetic index and its association with dental caries in Indian schoolchildren

OBJECTIVE

To assess prevalence of malocclusion and orthodontic treatment needs among 12 year old Indians using the Dental Aesthetic Index, and to find its association with dental caries.

METHOD

927 schoolchildren were randomly selected and their DAI and dentition status scores were recorded as per 1997 World Health Organization criteria. Clinical exams were carried out by one trained and calibrated examiner. The Chi-square test, Z-test and Spearman's correlation test were carried out.

RESULTS

Mean DAI score was 19.2 (sd 6.8). Differences were found between male and female DAI scores (Z < or = 0.05). 82% of children had DAI scores < 26 with no or minor malocclusion requiring no or little treatment, 3.2% had DAI scores 31-35 with severe malocclusion requiring highly desirable treatment and 1.8% DAI scores > 35 with handicapping malocclusion requiring mandatory treatment. A mean DMFT of 1.15 (sd 1.62) was recorded. Severe and handicapping malocclusions were associated with dental caries.

CONCLUSIONS

The distribution of DAI scores among Indian schoolchildren differs from that reported in other populations. Positive correlation was found between severe and handicapping malocclusion with dental caries.

Relationship between body mass index and dental caries among adolescent children in South India

OBJECTIVE

To evaluate the relationship between body mass index (BMI) and dental caries and to study the role of sweet consumption in predicting this relationship among adolescent children in Udupi district, India.

METHODS

The study population consisted of 463 school children in the 13-15-year age group. Anthropometric (height in metres and weight in kilograms) and caries measurements and decayed missing filled teeth (DMFT) index, were carried out by a trained recorder according to standard criteria.

RESULTS

The majority of the children were having low normal weight (BMI < 25) with 18.6% classified as overweight (BMI 25-29.9) and 3.5% as obese (BMI > 30). The frequency of sweet consumption significantly increased from low normal weight children to overweight and obese children. Analysis showed that the obese group of children had more caries than the overweight and low normal weight children. Correlation analysis showed significant positive relation with BMI, decayed teeth (DT) [r = 0.254, p < 0.001] and DMFT (r = 0.242, p < 0.001). Binomial logistic regression showed that males (OR = 2.09, CI = 1.01, 4.33), obese/overweight children (OR = 3.68, CI = 1.79, 7.56) and those who consumed sweets more than once a day (OR = 3.13, CI = 1.25, 7.85) were more likely to have high caries experience.

CONCLUSION

There was a significant association between overweight/obesity and caries experience among school children of the Udupi district. Obesity and dental caries have common risk determinants and require a comprehensive multidisciplinary approach by both medical and dental healthcare professionals.

Efficacy of IV Iron Compared to Oral Iron for Increment of Haemoglobin Level in Anemic Chronic Kidney Disease Patients

Introduction: Anemia is the most common finding in chronic kidney disease patients. Iron supplements are commonly prescribed for these patients with or without erythropoietin therapy by means of oral and intravenous iron. Both oral and intravenous irons have their own advantage and disadvantage, and the efficacy is also different. The objective of the study is to analyze the efficacy of oral and intravenous iron in chronic kidney disease patients on erythropoietin therapy, an erythropoiesis stimulating agents for increment of haemoglobin. Methods: This is a prospective study comparing intravenous iron to oral iron in chronic kidney disease patients who underwent maintenance hemodialysis at different centers and visited Kathmandu Medical College Teaching Hospital from April 2010 to April 2011. Patients having a haemoglobin level of < 11 g/dl, transferrin saturation (TSAT) < 25%, ferritin < 300ng/ml and who were on erythropoietin therapy were allocated alternately into two groups to receive oral iron (iron fumarate) or IV iron (iv sucrose). Haemoglobin was measured after 30 days of therapy. Results: A significant increase in haemoglobin levels was observed in both groups. But the mean haemoglobin increment was more in the IV iron group than in the oral iron group. Sixty percent 60% of patients in the IV iron group had an increase in the haemoglobin level of more than 1gm/dl while only 20% of the oral iron group had this increase. Conclusions: Intravenous iron therapy is more effective in raising the hemoglobin level in hemodialysis dependent chronic kidney disease patients. Keywords: anemia; chronic kidney disease; iron.

Subcutaneous Emphysema in Pregnancy

Spontaneous pneumomediastinum and subcutaneous emphysema are rare complications of labor, especially in the late pregnancy period, but they are usually self-limiting. Management includes avoidance of exacerbative factors and close observation with supportive treatment. A 19-year-old primi gravida at 36 weeks pregnancy presented with swelling over the right side of the face, neck and chest. Her general examination was normal. Systemic examination revealed swelling with palpatory crepitation over the right side of chest, neck and face, and other examination findings were normal. Chest X-ray revealed subcutaneous emphysema without pneumothorax. The patient left hospital against medical advice. Keywords: Pregnancy; subcutaneous emphysema; pneumomediastinum.

Subcutaneous emphysema in pregnancy

Spontaneous pneumomediastinum and subcutaneous emphysema are rare complications of labor, especially in the late pregnancy period, but they are usually self-limiting. Management includes avoidance of exacerbative factors and close observation with supportive treatment. A 19-year-old primi gravida at 36 weeks pregnancy presented with swelling over the right side of the face, neck and chest. Her general examination was normal. Systemic examination revealed swelling with palpatory crepitation over the right side of chest, neck and face, and other examination findings were normal. Chest X-ray revealed subcutaneous emphysema without pneumothorax. The patient left hospital against medical advice.