Correlates of disability among primary care patients with common mental disorders and chronic medical conditions- a cross-sectional study from rural South India.

PURPOSE: We examined the correlates of disability among people with non-communicable diseases (NCDs) and comorbid common mental disorders (CMDs) from rural India. METHODS: The sample comprised 2,486 participants enrolled in a cluster randomized trial (cRCT), Healthier OPtions through Empowerment (HOPE). Participants were 30 years or older, with a diagnosis of major depressive disorder, dysthymia, generalized anxiety disorder, and/or panic disorder on the MINI-International Neuropsychiatric Interview, with hypertension, diabetes, dsylipidemia and/ or ischemic heart disease. Disability was measured with the 12-item version of WHODAS 2.0. The severity of depression and anxiety was measured using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively. Multiple linear regression analyses were used to examine associations. RESULTS: The mean age was 59 ± 10.0 years, three quarters (1864) of the participants were female, and 64.0% were married. More than half of the participants had no formal education (57.9%). Most of the participants had two or more chronic medical conditions (73.0%). The mean disability score was 24.3. The mean depression score was 8.5, and the mean anxiety score was 6.7. Higher levels of disability were reported by participants ≥ 60 years of age, those with moderate and severe depression, and moderate anxiety. Among female participants, being unmarried was associated with greater disability. Male participants without formal education reported greater levels of disability. CONCLUSION: Higher severity of CMDs is significantly associated with higher levels of disability. For women, being unmarried and for men having no formal education was associated with higher levels of disability. TRIAL REGISTRATION: ClinicalTrials.gov NCT02310932 [URL: https://clinicaltrials.gov/ct2/show/record/NCT02310932 ] registered on December 8, 2014, and Clinical Trials Registry India CTRI/2018/04/013001, registered on April 4, 2018. Retrospectively registered.

A Study to Evaluate the Effect of Cleaning Solutions on Shear Bond Strength of Resin Cement to Saliva-Contaminated Lithium Disilicate (LDS) Ceramic.

BACKGROUND: One of the greatest benefits of contemporary restorative dentistry is the creation of fixed partial dentures. The retention and durability of the fixed partial dentures may be improved by using a variety of tooth preparation methods, surface treatments, and luting resins. AIM: To measure the shear binding strength of resin cement to saliva-contaminated lithium disilicate (LDS) ceramic after being exposed to various cleaning treatments. METHODOLOGY: Over 30 LDS samples were examined. In Group 1, a cleansing solution comprising 15% zirconium oxide (Ivoclean) was employed for a duration of 20 s. This was succeeded by a rinsing phase lasting 15 s utilizing deionized water, followed by a 15-s period for drying. Subsequently, a final stage of air drying was conducted over a span of 15 s. In contrast, Group 2 underwent a washing procedure of 20 s involving a cleansing solution containing 30% sodium silicate. This was then ensued by a rinsing interval of 15 s with deionized water, succeeded by an air-drying process spanning 15 s. After applying cleaning solutions to the surface and adhering the specimens to the composite blocks using resin cement Multilink Automix (Ivoclar Vivadent, Schaan, Liechtenstein), the shear bond strength was assessed. RESULTS: Using a 30% sodium silicate solution (Group 2), we were able to get the highest mean shear bond strength value after saliva-contaminated LDS. Group 1, 15% zirconium oxide (Ivoclean) had the weakest decontamination agents as measured by mean shear bond strengths. The shear bond strength values of the two groups were found to vary significantly between individuals using the independent sample t-test. LDs ceramic cleaned with a 30% sodium silicate solution had a higher shear bond strength than ceramic cleaned with Ivoclean (p<0.05). CONCLUSION: The application of a 30% sodium silicate solution rendered the highest shear bond strength for saliva-contaminated LDS ceramic. In comparison, ceramic cleaned with Ivoclean exhibited notably lower shear bond strength values. The outcome of this investigation highlights the potential of diverse cleaning agents in influencing the adhesive qualities of resin cement, thereby contributing to the enhancement of fixed partial denture durability and efficacy.

Comparative evaluation of color stability of three commercially available provisional restorative materials: An in vitro study.

Aim: Esthetics of the provisional restorations is of prime importance to the patients especially in long term in the esthetic zone. Discolouration of these restorations may result in patient dissatisfaction and an additional expense for their replacement. LuxaCrown provisional material being new in market and claimed to be semi-permanent by the company needs to be evaluated for its colour stability. This in vitro study was aimed to evaluate and compare the colour stability of three provisional restorations using three pigmented solutions. Setting and Design: In vitro - comparative study. Materials and Methods: LuxaCrown, Protemp4, Heat cure PMMA were evaluated. 40 specimens of each material were divided into four groups of ten specimens each. Each group was stored in three staining solutions and artificial saliva. Colour values of each specimen were measured before immersion, after one day, one week, one month, three months and six months with a spectrophotometer. Stastistical Analysis Used: One way ANOVA, Post Hoc Tukey Test, Bonferonni Test. Results: Least colour change was seen in Heat Cure PMMA followed by Protemp4 and highest colour change was seen in LuxaCrown when immersed in artificial saliva, tea and coffee. Whereas in turmeric, Heat Cure PMMA showed the least colour change followed by LuxaCrown and highest colour change was seen in Protemp4 at all time intervals except day one, where LuxaCrown was higher than Protemp4. Conclusion: Heat cure showed the best results as compared to Protemp4 and LuxaCrown in terms of colour stability at all time periods.

Challenges in Taking Sexual History: A Qualitative Study of Indian Postgraduate Psychiatry Trainees.

CONTEXT: In India, psychiatrist is an important point of helpseeking for sexual complaints. A detailed sexual history can go a long way in understanding sexual difficulties. In this background, there is inadequate information on the difficulties that psychiatry postgraduate trainees experience while taking a sexual history as part of a routine mental health evaluation. AIMS: The aim was to study the difficulties experienced by postgraduate psychiatry trainees while taking sexual history as a part of routine mental health evaluation. SETTING: This study was conducted in an Indian medical college general hospital psychiatry setting. MATERIALS AND METHODS: This is a qualitative study using focus group discussions and in-depth interviews with postgraduate psychiatry trainees. STATISTICAL ANALYSIS: Content analysis was used to identify direct and latent themes. RESULTS: Thematic saturation was achieved with 17 participants. Major themes of difficulties that emerged included trainee-related factors such as gender and sociocultural background of the trainee; patient-related factors such as age, gender, and sexual orientation; setting-related factors; and language-related difficulties. CONCLUSIONS: Specific and regular training in taking a sexual history is essential in addressing the difficulties faced by postgraduate psychiatry trainees in India.

Psychosis in a Patient with Davidoff-Dyke-Masson Syndrome.

OBJECTIVES: To report the finding of psychosis in a patient with Davidoff-Dyke-Masson Syndrome. METHOD: Case report. CONCLUSIONS: Right-sided hemiatrophy may be an addition to the list of neuro-developmental and structural cerebral anomalies associated with psychotic disorders including schizophrenia.

Topiramate-induced acute liver injury: A rare adverse effect.

Idiosyncratic drug-induced liver injury (DILI) is damage to liver occurring at recommended dose of a drug in contrast to toxic or predictable DILI. Although it is common in first-generation antiepileptic drugs (AEDs), it is rare in newer AEDs such as topiramate. Topiramate commonly causes neurological adverse effects such as psychomotor slowing and somnolence. Hepatotoxicity by topiramate is rare and has been previously reported in combination with other drugs such as valproate and carbamazepine. Here, we report a case of topiramate-induced asymptomatic elevation of liver enzymes in an adult man diagnosed with alcohol dependence syndrome and alcohol withdrawal complicated with seizures.

A Rare Case of Complicated Opioid Withdrawal in Delirium Without Convulsions.

Opioids are one of the commonly abused substances in India. Opioid withdrawal symptoms classically include severe muscle cramps, bone aches, autonomic symptoms, anxiety, restlessness, insomnia, and temperature dysregulation. However, reports of cases with delirium during withdrawal are few. A 25-year-old male with severe opioid withdrawal symptoms developed delirium. Investigations were normal. There were no comorbidities, no significant past history and family history. Patient treated for opioid dependence with tapering doses of lorazepam and clonidine. He was discharged with naltrexone. Patient lapsed 3 months later with similar presentation. Complications such as convulsions and delirium are recognized in alcohol withdrawal. However, these are rare as a feature of opioid withdrawal. This case illustrates the need for psychiatrists and physicians to be aware of the possibilities of delirium with opioid withdrawal and monitoring for the same is important because of its complications.

Intraoral scanners: A narrative review

Objectives: Accurate impressions are essential in fabricating dental restorations and fixed dental prostheses. During the last decade, digital impression systems have improved substantially. The objective of this narrative review is to discuss the recent research on intraoral scanners with regards to it's technology, accuracy and applications for fabrication of dental restorations and fixed dental prostheses. Materials and methods: A search strategy was performed in MEDLINE/PubMed, Scopus and Google Scholar with keywords - intraoral scanners, accuracy, applications, dentistry. Results: 395 articles were retrieved. After hand search a total of 415 articles were identified. Ultimately, 30 articles were selected and summarized and discussed as they met the selection criteria. Conclusion: Within the scope of this review, reported literature showed that digital intra-oral impressions have presented an achievement in the dental market as they reduce time required and simplify the clinical procedures with better communication with the technician and the patient. The current intraoral scanners (IOS) are sufficiently accurate for capturing impressions for fabrication of prosthetic restorations (inlays/onlays, copings and frameworks, single crowns and fixed partial dentures) on both natural teeth and implants; in addition, they can be used for smile design, and to fabricate posts and cores, removable partial prostheses, obturators, orthodontic aligners and custom made devices. The use of IOS in long-span restorations with natural teeth or implants is still a challenge.

A deviceful approach of managing hollow maxillary complete denture

Retention, stability and support are the most fundamental and basic principles on which the success of an entire denture relies on. However this factor is often compromised in cases of resorption. Residual ridge resorption is the reduction in size of the bony ridge under the mucoperiosteum. The rate of resorption in mandibular arch is at an increased rate as compared to the maxillary arch; but severely atrophic maxillae with large inter-ridge distance often pose a clinical challenge during fabrication of a successful maxillary complete denture because of the increased weight of the denture, retention is compromised. The present article describes a case of a completely edentulous patient who was successfully rehabilitated with a hollow denture where a simple and deviceful technique of fabricating a light-weight maxillary denture. The present article describes a case of a completely edentulous patient who was successfully rehabilitated with a hollow denture where a simple and deviceful technique of fabricating a light-weight maxillary denture was used using the hollow tubing of salivary ejector apparatus to bring the uniform hollowness.

Mending aesthetics in anterior region - A case report

Lately esthetic rehabilitation has come to be a demanding treatment as a way to correct malposed as well as missing anterior dentition, the advent of creating an esthetic smile has become a part of routine dental practice. An attractive or appealing smile sincerely enhances the recognition of an individual in our society with the aid of enhancing the initial impact in interpersonal relationships. Any esthetic correction calls for right expertise and knowledge. Such rehabilitation can be achieved successfully with the aid of numerous treatment approaches. Orthodontic treatment is one of the most conservative approach for such cases but it is not an acceptable treatment option for most of the patients due to various reasons like long treatment time, financial constraints, appearance during the therapy, and relapse after the treatment. Alternatively, endodontic approach combined with prosthodontics offers a brief, reliable and economic treatment modality for such cases. Placement of implants has also become a treatment of choice for replacement of teeth in esthetic zone with advantages like preservation of unrestored adjacent teeth and halting the resorption of edentulous spaces to provide support for the prosthesis. This case report illustrates the multidisciplinary approach for rehabilitating aesthetics in anterior region.

Occlusion in implant- At a glance

Objectives: Occlusion is a critical and very important component for the clinical success and longevity of dental implants. This review article focuses on the various aspects of implant protective occlusion. Our scientific literature regarding implant occlusion, particularly in implant-supported fixed dental prostheses remains controversial. Materials and methods: A search strategy was performed in MEDLINE/PubMed, Scopus and Google Scholar with keywords ­ 'implants' and 'occlusion', 'implants' and 'fixed prosthesis, 'implants' and 'fixed dental prostheses', 'implants' and 'partial edentulism', 'implants' and 'complications', 'implants' and 'failures', 'implants' and 'cantilever', 'implants' and 'occlusal load'. Results: 135 articles were retrieved. After hand search a total of 290 articles were identified. Ultimately, 30 articles were selected and summarized and discussed as they met the selection criteria. Conclusion: Most of the available clinical data are controversial. Implant-protected occlusion can be accomplished by decreasing the width of the occlusal table and improving the direction of force. By doing these things, we can minimize overload on bone-implant interfaces and implant prostheses, to maintain an implant load within the physiological limits of individualized occlusion, and ultimately provide long-term stability of implants and implant prostheses. Current clinical practices rely heavily on principles extracted from the natural dentition or removable dental prostheses on complete edentulous patients and on expert opinions.

Ectopic pleomorphic adenoma.

We describe a case of pleomorphic adenoma of minor salivary glands occurring in the retromolar area. A 58-year-old male patient reported with complaint of a small mass in the left lower retromolar region of the mouth. It has grown slowly to the present size. Based on the history and clinical findings, differential diagnosis of fibroma, minor salivary gland tumor, and mucocele were considered. The microscopic findings revealed the presence of minor salivary gland tissue and the lesions showed the presence of myoepithelial and epithelial cell proliferation. The cells were arranged in ductal pattern. There were areas where the epithelial cells showed proliferation in sheets, cords, and strands. The patient was followed up for a period of 6 months and there was no evidence of recurrence. The retromolar area being affected as in the case presented is rare for this condition. Surgical excision along with surrounding normal tissue is the treatment of choice.

Diagnostic value of acetic acid comparing with conventional Pap smear in the detection of colposcopic biopsy-proved CIN.

AIM: To assess the role of visual inspection with acetic acid as an alternative to Pap smear and in screening program for cervical cancer in low resource settings. MATERIALS AND METHODS: A total of 225 women in the reproductive age group attending the Department of Gynecology were enrolled in the study. A Papanicolaou smear and visual inspection of the cervix with acetic acid was done. All patients who tested positive on screening then underwent a colposcopy-guided biopsy. The Pap smear of a low-grade squamous intraepithelial lesion (LSIL) and above was taken as abnormal. The statistical test used was the chi-square test and results were computed using Statistical Package for the Social Sciences (SPSS) version 12.0. RESULTS: Out of 225 patients, acetic acid (VIA) was positive in 27 (12%) patients and the Pap smear was abnormal in 26 (11.7%). There were 15 LSIL, 6 high grade squamous intraepithelial lesions (HSIL) and 5 were squamous cell carcinoma. On biopsy, there were 15 mild dysplasia, 2 moderate dysplasia, 4 severe dysplasia, and 3 squamous cancers. The Pap smear had a sensitivity of 83%, specificity of 98%, and positive predictive value of 80% and negative predictive value of 97.9%. VIA had a sensitivity of 70.8%, specificity of 95%, and positive predictive value of 62.9% and negative predictive value of 96.5%. CONCLUSION: Since diagnostic values of VIA is comparable to Pap smear, and it performs well in detecting a high grade lesion, we conclude that VIA can be used as a screening modality for cervical cancer in low resource settings.