Comparative Evaluation of Changes in Salivary pH and Streptococcus mutans Count in Saliva by Natural Sugar Substitutes: An In Vivo Study

Aim

The purpose of this study was to compare the effect of natural sugar substitutes-stevia, jaggery, and honey on salivary pH and Streptococcus mutans (S. mutans) count in saliva.

Materials and methods

Children aged between 7 and 12 years with no active carious lesion were selected. A total of 80 subjects were randomly selected and divided into three experimental groups and one control group, with 20 subjects in each group. Prior to rinsing with the respective solutions, the baseline pH and S. mutans count were evaluated for each individual. All solutions were freshly prepared whenever required. After rinsing with the respective solutions, saliva samples were collected to evaluate pH and S. mutans count. The pH was analyzed at different time intervals, that is, 0 (immediately after rinsing), 15, and 30 minutes. The S. mutans count was analyzed after 30 minutes of rinsing with the respective solutions.

Results

The results were tabulated and statistically analyzed using one-way analysis of variance (ANOVA) and post hoc tests. The results depicted that group I (stevia) showed a maximum increase in salivary pH, followed by group III (honey) and group III (jaggery) at different time intervals (0, 15, and 30 minutes). The maximum number of subjects who had shown a decrease in S. mutans count were from group III (honey), followed by group I (stevia), and group II (jaggery) after 30 minutes of rinsing with the respective solutions when compared to baseline S. mutans count.

Clinical significance

It is a universally known fact that dental caries is a multifactorial disease process, one of the key factors of which is the consumption of sugar. Of all the fermentable carbohydrates, sucrose is considered the archcriminal in the carious process. Hence, this advocates the need for developing suitable sugar substitutes that help in controlling dental caries. An ideal sugar substitute should not only minimize the risk of dental caries but also should have nutritional benefits.

Conclusion

Natural sugar substitutes (stevia, jaggery, and honey) have the ability to reduce caries risk in children.

How to cite this article

Sharma W, Bhola M, Bajaj N, et al. Comparative Evaluation of Changes in Salivary pH and Streptococcus mutans Count in Saliva by Natural Sugar Substitutes: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(5):728-733.

Comparative Evaluation of the Remineralizing Potential of Silver Diamine Fluoride, Casein Phosphopeptide-amorphous Calcium Phosphate, and Fluoride Varnish on the Enamel Surface of Primary and Permanent Teeth: An In Vitro Study

Introduction

With the paradigm shift in the management of dental caries, the focus is now laid on remineralization therapies that can arrest the progression of the disease and remineralize the subsurface lesions.

Objectives

The purpose of this study was to determine and compare the remineralizing potential of silver diamine fluoride (SDF), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and fluoride varnish (FV) on enamel surfaces in primary and permanent teeth.

Materials and methods

A total of 120 primary anterior teeth and 120 premolars were used to prepare enamel blocks in acrylic resin. The mean baseline surface microhardness (SMH) for each sample was determined using a microvickers hardness testing machine. Thereafter, the samples were randomly and equally distributed into groups and subgroups based on the materials used, that is, SDF, CPP-ACP, FV, and distilled water (control). After subjecting the samples to a pH cycling regime, SMH was determined again and the percentage change in SMH was calculated.

Results

The data were tabulated and subjected to statistical analysis using an independent t-test and one-way analysis of variance (ANOVA). In primary teeth, the least mean percentage reduction in SMH was observed after the application of FV followed by SDF, CPP-ACP, and control. In permanent teeth, both SDF and FV showed the least percentage reduction of enamel SMH followed by CPP-ACP and control.

Conclusion

Silver diamine fluoride (SDF), FV, and CPP-ACP showed remineralizing potential in both primary and permanent teeth.

How to cite this article

Kaur S, Bhola M, Bajaj N, et al. Comparative Evaluation of the Remineralizing Potential of Silver Diamine Fluoride, Casein Phosphopeptide-amorphous Calcium Phosphate, and Fluoride Varnish on the Enamel Surface of Primary and Permanent Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-1):S91-S96.

Comparative Evaluation of Smear Layer Removal Efficacy of Neem Leaf Extract, Propolis, and Orange Oil when used as Endodontic Irrigants: An in vitro Scanning Electron Microscopic Study

Introduction

In root canal treatment, chemical debridement of the root canal with the help of irrigants is important due to the complex internal anatomy of the teeth. Biomechanical root canal preparation produces a smear layer. It covers the dentinal tubules, which may interfere with the penetration of various irrigants and intracanal medicaments, so the smear layer has to be removed. The potential side effects and certain limitations of chemical irrigants for smear layer removal have led to a shift toward herbal alternatives.

Objective

The aim of the present study was to evaluate and compare the smear layer removal efficacy of Neem leaf extract, Propolis, and Orange oil as endodontic irrigants using the scanning electron microscope.

Materials and Methods

Ninety samples were taken and then randomly (simple random sampling method) divided into three experimental groups (n = 30) depending upon different endodontic irrigants used: Group 1-Neem leaf extract, Group 2-Orange oil and Group 3-Propolis and smear layer removal evaluation was done under the scanning electron microscope Scanning Electron Microscope (SEM) at all the levels, i.e., coronal, middle, and apical.

Results

The collected data were analyzed using the Chi-square test. Group 1 (Neem leaf extract) showed the highest smear layer removal efficacy, which was followed by Group 2 (Orange oil) and the least efficacy of smear layer removal was shown by Group 3 (Propolis) at coronal, middle, and apical levels.

Conclusion

Group 1 (Neem leaf extract) performed significantly better in removing the smear layer at coronal, middle, and apical levels as compared to the other two groups.

Bariatric surgery reverses ventricular repolarisation heterogeneity in obesity: mechanistic insights into fat-related arrhythmic risk

Background

Obesity is a growing global health problem that confers higher risks of atrial arrhythmias and sudden cardiac death. Despite this, the proarrhythmic substrate in obesity and its reversibility with weight loss has not been studied in-depth.

Purpose

To characterise the proarrhythmic substrate in obese patients, and its reversibility with bariatric surgery, using electrocardiographic imaging (ECGi).

Methods

ECGi was performed in 16 obese patients pre-bariatric surgery (PreSurg; mean age 43±12 years, 13 female) and 16 age- and sex-matched non-obese (lean) individuals (42±11 years). 12 of the 16 obese patients also underwent ECGi after bariatric surgery (PostSurg). Over 2000 atrial and ventricular epicardial electrograms were computed using high density body surface mapping (256-lead ECG) and heart-torso geometries from cardiac magnetic resonance imaging, by solving the inverse problem of electrocardiography. Local atrial and ventricular epicardial activation times (AT) were calculated as the steepest downslope of their respective activation complexes, and local ventricular repolarisation times (RT) as the steepest upslope of the T-wave. Atrial activation gradients (ATG) and ventricular repolarisation gradients (RTG) were calculated as the maximum difference within 10 mm radius divided by the corresponding distance.

Results

Body mass index was greater in PreSurg vs lean (46.7±5.5 vs 22.8±2.6 kg/m2, p<0.0001) and decreased with surgery (PostSurg 36.8±6.5 kg/m2, p<0.0001). Epicardial adipose tissue (EAT) was greater in PreSurg vs lean (83±56 vs 28±13 ml, p<0.0001) and decreased post-surgery (PostSurg 69±45 ml, p=0.0010). Total atrial AT was prolonged in PreSurg vs lean (62±15 vs 46±12 ms, p=0.0028), which persisted post-surgery (PostSurg 67±15 ms, p=0.86). Atrial ATG were also greater in PreSurg vs lean (26±11 vs 14±8 ms, p=0.0007) and did not change with weight loss (PostSurg 25±12, p=0.44). Ventricular RTG were greater in PreSurg vs lean (26±11 vs 15±7 ms/mm, p=0.0024) and decreased with weight loss (PostSurg 19±8, p=0.0009). Ventricular RTG were similar between PostSurg and lean (p=0.20). EAT from lean and PreSurg individuals correlated with atrial ATG (r=0.36, p=0.044) and ventricular RTG (r=0.54, p=0.0014). Ventricular AT were similar between lean (31±6 ms), PreSurg (34±5 ms) and PostSurg (35±9 ms); all p>0.05.

Conclusion

Steep ventricular repolarisation gradients and prolonged atrial activation contribute to the proarrhythmic substrate in obesity. Ventricular repolarisation gradients correlate with epicardial adiposity and both regress post-bariatric surgery. By contrast, atrial activation remains prolonged after weight loss. These results provide mechanistic insights into obesity-related arrhythmic risks and their reversibility with weight loss following bariatric surgery.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): British Heart FoundationNational Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).

Bariatric surgery reduces ventricular repolarisation gradients in obese patients - results from an electrocardiographic imaging study

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) British Heart Foundation

Background

Obesity confers higher risks of atrial arrhythmias and is associated with abnormal ventricular repolarisation. Despite this, the proarrhythmic substrate in obesity and its reversibility with weight loss has not been studied in-depth.

Purpose

To characterise the proarrhythmic substrate in obese patients, and its reversibility with bariatric surgery, using electrocardiographic imaging (ECGi).

Methods

ECGi was performed in 8 obese patients before (PreOb) and after (PostOb) bariatric surgery (mean age 39+/-11years, 7 female), and in 8 age- and sex-matched non-obese controls (NOb) (40+/-11 years). ECGi recordings were made at rest, on exercise, and during recovery from exercise. For ECGi analysis, >2000 atrial and ventricular epicardial electrograms were calculated from body surface potential recordings from 256 sites and information from cardiac magnetic resonance imaging, by solving the inverse problem. Local atrial and ventricular epicardial activation times (AT) were calculated as the steepest downslope of their respective activation complexes, and local ventricular repolarisation times (RT) as the steepest upslope of the T-wave. Atrial activation gradients (ATG) and ventricular repolarisation gradients (RTG) were calculated as the maximum difference within 10mm radius divided by the corresponding Euclidean distance.

Results

BMI was greater in PreOb vs NOb (46.6+/-4.8 vs 23.8+/-2.6kg/m2, p<0.0001) and decreased with surgery (PostOb 35.3+/-4.2kg/m2, p<0.0001). Total atrial AT was prolonged in PreOb vs NOb (68+/-12 vs 45+/-10ms, p=0.016) and did not change post-surgery (PreOb vs PostOb: 68+/-12 vs 67+/-16ms, p=0.81). Atrial ATG were also greater in PreOb vs NOb: max 254+/-111 vs 106+/-58ms, p=0.035; mean 24+/-6 vs 12+/-6ms, p=0.0087) and did not change with weight loss (PreOb vs PostOb: max 254+/-111 vs 222+/-69ms/mm, p=0.61; mean 24+/-6 vs 21+/-7ms/mm, p=0.52). Ventricular RTG were greater in PreOb vs NOb (max: 287+/-73 vs 131+/-89ms/mm, p=0.012; mean: 33+/-10 vs 17+/-9ms/mm, p=0.0052). Ventricular RTG decreased with weight loss (PreOb vs PostOb: max 287+/-73 vs 151+/-54ms/mm, p=0.0070; mean: 33+/-10 vs 21+/-8ms/mm, p=0.018), and were similar between PostOb and NOb (max, p=0.81; mean p=0.58). Ventricular AT and RT were non-different in NOb, PreOb and PostOb.

Conclusion

Obesity is associated with pro-arrhythmic electrophysiological remodelling, including steeper ventricular repolarisation gradients and slower atrial activation. At 6 months post-bariatric surgery, there was a reduction in ventricular repolarisation gradients though atrial conduction abnormalities persisted. These findings provide a mechanistic insight into obesity-related arrhythmic risks and its potential reversibility with weight loss surgery.

Fracture resistance of lab composite versus all-ceramic restorations in class II inlay cavity preparations: An in vitro study

Aim

The aim of this study was to evaluate and compare the fracture resistance of inlay preparations restored with indirect lab composite, conventional and translucent monolithic zirconia-based ceramics.

Materials and Methods

Fifty freshly extracted human maxillary premolars were selected for the study. Standardized inlay cavities were prepared and restored with indirect lab composite, conventional monolithic zirconia-based ceramic and translucent monolithic zirconia-based ceramic. After restoration each sample was subjected to axial compressive load with Universal testing machine. The force required to induce fracture was recorded in Newton (N).

Statistical Analysis Used

The data were analyzed using the one-way ANOVA test and Post hoc Bonferroni multiple comparison test.

Results

Results revealed that fracture resistance of prepared inlay cavities restored with conventional monolithic zirconia-based ceramics was found to be best followed by other groups. Group I > Group IV > Group V > Group III > Group II.

Conclusion

The fracture resistance of conventional monolithic zirconia-based ceramic inlays and translucent monolithic zirconia-based ceramic inlays were comparable with intact teeth but, indirect lab composite inlays showed lower fracture resistance than all.

Clinical Evaluation of Root Resorption and its Correlation with Obturation Quality in Pulpectomized Deciduous Teeth with Different Obturating Materials: An In vivo Study

Aims and Objectives:

The aim was to evaluate the root resorption in pulpectomized deciduous teeth and its correlation with obturation quality using zinc oxide and eugenol (ZOE), Metapex and Endoflas at the interval of 6 and 12 months.

Materials and Methods:

A total of 150 infected primary mandibular molars were randomly and equally divided into three subgroups (n = 50 each): Group 1 (ZoE), Group 2 (Metapex), and Group 3 (Endoflas) based on the obturation material preferred. The teeth were clinically and radiographically evaluated at 6 and 12 months' postoperatively by another investigator who was blinded to the type of filling material that was used in each tooth. Kruskal–Wallis test, Mann–Whitney Test, and Wilcoxon Signed-Rank Test was used for statistical analysis.

Results:

When the obturation quality was assessed, the optimal filling was found in 78% of the cases while the rest have underfilling (9%) and overfilling (13%). The incidence of overfilling was higher in the cases with some root resorption. After 12 months, Group 2 showed maximum variation with the highest incidence (70%) of extensive resorption both interradicular and intraradicular (Grade 3 score) followed by Group 1 (26%) and Group 3 (16%), respectively.

Conclusion:

Among all the materials, Endoflas showed the highest success rate with least incidence of resorption both outside and within the root canal (hollow tube effect) whereas least success rate was observed with Metapex having the hollow tube effect in majority of the cases (70%) after the follow-up of 12 months.

Comparative evaluation of push-out bond strength of root-end filling materials in root-end cavities prepared by laser or ultrasonic technique: An in vitro study

Context:

The use of mineral trioxide aggregate (MTA) and Biodentine as a root-end filling materials used in the root-end cavities prepared by laser or ultrasonic technique is a current topic in the branch of dentistry and push-out bond strength is used to measure the adhesiveness provided by the root-end filling materials.

Aim:

The aim of this study is to evaluate the push-out bond strength of MTA and Biodentine in root-end cavities prepared by erbium:yttrium-aluminium-garne (Er:YAG) laser and ultrasonic retrotip.

Materials and Methods:

A total of 40 extracted maxillary central incisors and canines were selected. Chemomechanical preparation and obturation were done. Root-end resections were performed followed by the root-end cavity preparation and root-end filling. Specimens were divided into four groups. Root-end cavities prepared by Er:YAG laser and filled with MTA, root-end cavities prepared by Er:YAG laser and filled with Biodentine, root-end cavities prepared by ultrasonic retrotip and filled with MTA and root-end cavities prepared by ultrasonic retrotip and filled with Biodentine, respectively. The apical end was again sectioned perpendicular to the long axis. The push-out bond strength was evaluated using a universal testing machine.

Statistical Analysis Used:

The data were analyzed using the analysis of variance and post hoc Tukey test.

Results:

Difference between push-out bond strength of root-end filling materials to root-end cavity walls prepared by laser and ultrasonic retrotips was statistically nonsignificant. Push-out bond strength of MTA and Biodentine did not differ significantly.

Conclusion:

Difference between push-out bond strength of MTA and Biodentine to root-end cavity walls prepared by Er:YAG Laser or ultrasonic retrotip were statistically nonsignificant.

Assessment of consistency in the dimension of gutta-percha cones of ProTaper Next and WaveOne with their corresponding number files

OBJECTIVES

To compare the dimensions of gutta-percha (GP) cones of ProTaper Next (25/0.06) and WaveOne (25/0.08) in relation to their corresponding instruments of the same dimension, respectively.

MATERIALS AND METHODS

Two groups of GP cones were made with 25 cones in each group. Group 1 consisted of 25 GP cones # 25/0.06 (ProTaper Next). Group 2 consisted of 25 GP cones # 25/0.08 (WaveOne). Measurements were done at D1 (1 mm short of the tip), D3 (3 mm short of the tip), and D11 (11 mm short of the tip) for GP cones of both groups and were compared with their corresponding instruments.

RESULTS

Group 1 (ProTaper) 25/.06 GP points showed greater diameters than those of the corresponding instrument, which was statistically significant. Group 2 (WaveOne) 25/0.08 GP points showed greater diameters than those of the corresponding instrument which was statistically significant whereas it was nonsignificant at level D1.

CONCLUSION

Diameters of both ProTaper Next and WaveOne GP cones were greater than their corresponding instruments. Hence, there are chances of under obturation with both systems.

Association of physical properties and maintenance of sterility of primary teeth in human tooth bank

BACKGROUND

This study was carried out to evaluate the sterility and structural integrity of stored primary teeth in artificial saliva over a storage period of 12 weeks (3 months) in human tooth bank (HTB).

MATERIALS AND METHODS

A total of 80 freshly extracted teeth were taken and were categorized into four groups of 20 each. The samples were stored at 4°C for 12 weeks (3 months) in the refrigerator. During their storage time of 3 months, they were repetitively evaluated for their sterility, enamel hardness, calcium and phosphate solubility and color stability at regular intervals of 3 weeks.

OBSERVATIONS AND RESULTS

That teeth stored in artificial saliva maintained their sterility throughout the storage time of 12 weeks, but changes in their physical and chemical properties occurred with an increase in storage time.

CONCLUSION

Storage time not more than 9 weeks is recommended for deciduous teeth to be stored in artificial saliva in a HTB.

Congenital epidermal nevus

Epidermal nevi are hamartomas that are characterized by hyperplasia of the epidermis and adnexal structures, and may be associated with serious disfiguration. Germline mutations in the FGFR3 gene have found to be the etiology of epidermal nevus. Patients often seek treatment from dermatologic surgeons but even an alert dentist can help to diagnose the lesion from its clinical appearance. Various treatment modalities are available and it is the clinician's choice to choose depending upon the patient's condition.

How to cite this article: Arora B, Khinda VIS, Bajaj N, Brar GS. Congenital Epidermal Nevus. Int J Clin Pediatr Dent 2014;7(1): 43-46.

Characteristics of progressive supranuclear palsy presenting with corticobasal syndrome: a cortical variant

Aims

Since the first description of the classical presentation of progressive supranuclear palsy (PSP) in 1963, now known as Richardson's syndrome (PSP-RS), several distinct clinical syndromes have been associated with PSP-tau pathology. Like other neurodegenerative disorders, the severity and distribution of phosphorylated tau pathology are closely associated with the clinical heterogeneity of PSP variants. PSP with corticobasal syndrome presentation (PSP-CBS) was reported to have more tau load in the mid-frontal and inferior-parietal cortices than in PSP-RS. However, it is uncertain if differences exist in the distribution of tau pathology in other brain regions or if the overall tau load is increased in the brains of PSP-CBS.

Methods

We sought to compare the clinical and pathological features of PSP-CBS and PSP-RS including quantitative assessment of tau load in 15 cortical, basal ganglia and cerebellar regions.

Results

In addition to the similar age of onset and disease duration, we demonstrated that the overall severity of tau pathology was the same between PSP-CBS and PSP-RS. We identified that there was a shift of tau burden towards the cortical regions away from the basal ganglia; supporting the notion that PSP-CBS is a ‘cortical’ PSP variant. PSP-CBS also had less severe neuronal loss in the dorsolateral and ventrolateral subregions of the substantia nigra and more severe microglial response in the corticospinal tract than in PSP-RS; however, neuronal loss in subthalamic nucleus was equally severe in both groups.

Conclusions

A better understanding of the factors that influence the selective pathological vulnerability in different PSP variants will provide further insights into the neurodegenerative process underlying tauopathies.

Cytochrome P450 2S1 depletion enhances cell proliferation and migration in bronchial epithelial cells, in part, through modulation of prostaglandin E(2) synthesis

Cytochromes P450 (P450s) contribute to the metabolic activation and inactivation of various endogenous substrates. Despite years of research, the physiological role of CYP2S1 remains unknown. CYP2S1 has demonstrated NADPH P450-reductase-independent metabolism of cyclooxygenase (COX)-derived prostaglandins [e.g., prostaglandin G(2) (PGG(2))] at nanomolar concentrations. Arachidonic acid is converted to prostaglandin precursors [PGG(2) and prostaglandin H(2) (PGH(2))] through COX. These precursors are used to synthesize numerous prostanoids, including PGE(2). Prostaglandin E(2) (PGE(2)) promotes cell proliferation and cell migration and inhibits apoptosis. CYP2S1 metabolism of PGG(2) presumably sequesters PGG(2) and PGH(2), making them unavailable for synthesis of prostanoids such as PGE(2). Whether CYP2S1 contributes to prostaglandin metabolism and influences cell physiological remains to be determined. The purpose of this study was to evaluate the physiological role of CYP2S1, if any, in human bronchial epithelial cells [SV40-derived bronchial epithelial cell line (BEAS-2B)]. To do this, we used small interfering RNA to deplete CYP2S1 mRNA and protein by approximately 75% and evaluated the impact of CYP2S1 depletion on cell proliferation and migration. CYP2S1 depletion enhanced both cell proliferation and migration in BEAS-2B cells. Consistent with the proposed role of CYP2S1 in PGE(2) synthesis, the reduction in CYP2S1 expression doubled intracellular PGE(2) levels. Pharmacological administration of PGE(2) enhanced cell proliferation in BEAS-2B cells but failed to promote migration. Our data reveal an important role for CYP2S1 in the regulation of cell proliferation and migration, occurring in part through modulation of prostaglandin synthesis.

Cessation in root development: ramifications of 'Stevens-Johnson' syndrome

The case presented here is of a 15-year-old girl in whom nearly all the teeth except for lower first molars and lower central incisors showed short roots as observed through panoramic radiograph. At the same time there was difference in the length of roots of various teeth. The patient suffered an acute attack of Stevens-Johnson syndrome (SJS) at the age of 8 years and since no other possible explanation for the short roots anomaly could be found, it could be concluded that the cessation in root development may have been caused by the destruction or damage of the epithelial root sheath during the SJS disease.

Dependence and psychosis with 4-methylmethcathinone (mephedrone) use

'Legal highs' are recreational drugs sold over the internet and the so-called 'head shops' all over the UK. They are freely available to buy and use as they are not covered by the Misuse of Drugs Act 1971. Mephedrone (4-methylmethcathinone) was sold as a 'legal high' until 17 April 2010 when it was made a class B drug under the Misuse of Drugs Act 1971. Numerous deaths and self-harm has been associated with mephedrone use. Effects of mephedrone are reported to be empathogenic similar to 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) and stimulant properties similar to cocaine. Not much is known of the effects of mephedrone on mental health. We present a case of dependence and psychosis in a patient using mephedrone (4-methylmethcathinone). The patient needed inpatient hospital care, was treated with antipsychotic olanzapine and recovered well.

Bilateral retinoblastoma in early infancy: a case report

Retinoblastoma is the most common primary intraocular tumour of childhood. Though congenital, it is not diagnosed at birth, and is usually seen between 1-2 years of age. We here report a case of bilateral retinoblastoma with early presentation at the age of one month.

Internal carotid artery dissection presenting with ipsilateral tenth and twelfth nerve palsies and apparent mass lesion on MRI

We report the case of a 47-year-old man who presented with a few months' history of right-sided headache and dysphagia, with ipsilateral tenth and twelfth cranial nerve palsies on examination. The initial MRI showed an enhancing mass lesion in relation to the right carotid sheath and jugular foramen, and was reported as a possible paraganglioma. Subsequent angiography performed to assess tumour vascularity demonstrated a dissection involving a tonsillar loop of the right internal carotid artery (ICA). Imaging findings at MRI and angiography and the presentations and mechanisms of ICA dissection are briefly discussed.

Plasmodium berghei infection: dichloroacetate improves survival in rats with lactic acidosis

The kinetics of Plasmodium berghei infection and the development of lactic acidosis, hypoglycemia, and anemia were defined in young Wistar rats. This model of metabolic dysfunction, which is similar to that of severe human malaria, was used to test the hypothesis that dichloroacetate, a treatment for lactic acidosis, prolonged survival in rats receiving a single antimalarial dose of quinine (20 mg/kg). Rats with hyperlactatemia (lactate > 5 mmol/liter, N = 183) were randomized to receive either dichloroacetate (100 mg/kg, N = 99) or saline (N = 84) and were monitored for outcome (survival or death) for 50 hr. Logistic regression modeling adjusting for baseline venous lactate concentration demonstrated that dichloroacetate increases survival rates in rats with venous lactate concentrations between 5 and 8.9 mmol/liter (odds ratio > 2.2, P < 0.021). This is the first demonstration that specific intervention to treat lactic acidosis can prolong survival and suggests that dichloroacetate may be useful as adjunctive therapy in the management of lactic acidosis complicating severe falciparum malaria.

Hunter Disease: A Case Report

DOI = 10.3126/jnps.v28i2.1389J. Nepal Paediatr. Soc. Vol.28(2) 2008 p.62-65

Febrile Convulsions

Febrile convulsions are seizures that occur in association with fever but without evidence of intracranial infection or other definable cause in children in the age between 6 months to 5 years. Febrile convulsions have a strong genetic predisposition and a benign outcome in the majority. Febrile convulsions are clinically distinguishable as simple febrile convulsions or they are called complex febrile convulsions when they have focal features and /or are prolonged and/or recurrent in the same illness. Complex febrile convulsions are associated with higher risk of developing subsequent epilepsy. The condition of mesial temporal lobe sclerosis has been linked to prolonged febrile convulsions in childhood. Majority of febrile convulsions need only parental assurance. In few cases intermittent or continuous prophylaxis with antiepileptic drugs may have to be advised.   DOI = 10.3126/jnps.v28i1.1403   J. Nepal Paediatr. Soc. Vol.28(1) p.23-26