Prosthodontic Rehabilitation of Maxillary Defect in a Patient with Mucormycosis

Maxillofacial rehabilitation after accidents, surgical removal due to malignancy or congenital deformity is challenging, since it not only affects the patient function and aesthetics but also impairs the patient confidence in the society. Prosthodontic rehabilitation restores patient confidence, comfort along with function and aesthetics. Various prosthodontic treatment options are available. Selection of adequate prosthesis that suits the patient is of utmost importance. Fixed or removable prosthesis are selected based on the supporting structures. If the teeth or underlying bone are of poor quality or quantity, removable prosthesis is advised. Conventional complete denture therapy results in inadequate denture retention, stability & patient satisfaction.1 The patient’s confidence & comfort in such cases would be compromised. However, the hybrid dentures could overcome the shortcomings of conventional complete dentures. Problems like loose dentures, loss of proprioception & bone resorption can be resolved with hybrid dentures & hence it is the last line of defence that successfully keeps patients from becoming edentulous. Studies indicate that there is inevitable resorption of residual ridge, following the loss of teeth. Ridges treated with hybrid dentures showed significant less vertical alveolar bone resorption than ridges with conventional complete maxillary and mandibular dentures.2 The rate of resorption depends on three factors; the character of bone, health of the individual and the amount and type of forces on the bone. Ten years of clinical investigation showed that weak teeth used as support for denture prosthesis not only remained in position but a few have regained a healthier status.3 Neil’s Brill (1955) classified the dentures supported by the existing natural teeth that had characteristics of both a removable partial denture and a complete denture, were termed as Hybrid Prosthesis.4 This case report describes the prosthodontic rehabilitation of a patient after undergoing partial maxillectomy due to mucormycosis.Rehabilitation of maxillofacial defect to an acceptable manner is challenging as it is related with psychological factors apart from function and aesthetics. A proper selection of prosthesis is utmost important to achieve this goal. The basic principles of any prosthetic design include preservation of the remaining natural tissues along with retention, stability, support, and aesthetics. Prosthodontic rehabilitation can be done either fixed or removable based on the supporting structures. If the hard tissue support is not adequate to withstand forces for fixed restoration, removable prosthesis are recommended. This clinical report describes maxillary rehabilitation with removable prosthesis in a compromised hard tissue support.

Role of pre-operative serum albumin level in predicting the post-operative outcomes in gastrointestinal surgery

Background: The prevalence of protein-energy malnutrition in surgical patients is seen in 30-50% of surgical patients with gastrointestinal disease. Malnutrition and hypalbuminaemia contribute to increased morbidity and mortality. Serum albumin level is a low-cost key element in nutritional assessment. Clavien-Dindo classification of post-operative complications enables stratification of post-operative complication.Methods: We retrospectively analysed the prospectively maintained data of 136 patients who underwent major gastro intestinal procedures from October 2019 to March 2020. We assessed the pre-operative; intra operative parameters, outcome variables and the postoperative complications were graded according to Clavien-Dindo severity, length of ICU stay, length of hospitalization and mortality.Results: Out of the 136 patients (M: F=3:2), the procedures were hepatopancreaticobiliary (n=40), colorectal (n=39), small bowel (n=36) and esophago-gastric (n=19). Pre-operative serum albumin was identified to be single most statistically significant pre-operative variable predicting post-operative complication of Clavien-Dindo severity grade III and above. The ROC curve of the serum albumin level predicting the severe post-operative complication suggested optimal cut off value of 3.1 gm/dl (AUC=0.76; 5% CI=0.64-0.87; p<0.001). Linear regression analysis of serum albumin level predicting the severe post-operative complication suggested good correlation with (r2=0.133; b=0.689; p<0.001). Further analysis of serum albumin level in predicting the length of ICU and the hospital stays suggested a significant negative correlation with both of these dependent outcome variables. The serum albumin level correlated inversely with the length of ICU stay and hospitalization.Conclusions: Low pre-operative albumin (serum level <3.1 gm/dl) in patients undergoing major gastrointestinal surgery predicts severe post-operative complications, prolonged ICU and hospital stays.

Full Mouth Rehabilitation in Dental Fluorosis Patient - A Time Restrained Scenario.

Dental Fluorosis which is endemic in nature is considered to be a serious problem in nearly 15 states of India.1 It is defined as hypo-mineralization of enamel resulting from excessive ingestion of fluoride (more than 1 ppm) during tooth development. Excessive fluoride basically disturbs mineralization in the developing tooth by decreasing free calcium ion concentrations in the mineralizing matrix. In turn, it indirectly interferes with the proteinases which degrade matrix proteins during the maturation phase of amelogenesis,2 resulting in delayed enzymatic degradation of enamel matrix proteins.3The fluoride-induced retention of enamel matrix proteins is responsible for impaired and incomplete crystal growth resulting in the increased porosity of enamel, and the subsequent optical and physical changes.4

Seroprevalence of hepatitis B virus and hepatitis C virus co-infection in human immunodeficiency virus infected patients at a tertiary care hospital in South India.

Background: About one third of human immunodeficiency virus (HIV) infected patients are co infected with either hepatitis B virus (HBV) or hepatitis C virus (HCV) as the three viruses have similar routes of transmission that is through transfusion of blood and blood products, sharing of needles to inject drugs and unprotected sexual activity. The survival of HIV infected patients has been markedly improved with highly active antiretroviral therapy (HAART). However several studies showed that the liver diseases caused by HBV or HCV have emerged as one of the leading causes of non AIDS related deaths in HIV patients. The objective of this work was to study the prevalence of HBV & HCV co-infection in HIV infected patients at a Tertiary care centre in South India. Methods: The study group includes 100 HIV seropositive individuals confirmed by three rapid tests as per NACO (National AIDS Control Organization) guidelines in ICTC (Integrated Counseling and Testing Centre), Department of Microbiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. Age and sex matched 100 HIV seronegative individuals were also included in the study as controls. Both the groups were screened for detection of HBV and HCV markers by one rapid test and a solid phase enzyme linked immunosorbent assay (sandwich ELISA). Results: Out of 100 HIV positive patients in the study group 12(12%) were co infected with HBV and 2(2%) were co infected with HCV. Out of 12 HIV and HBV co infected patients 7(58.3%) were females and 5(41.7%) were males. The HIV &HCV co infected patients were both females. Co infection of HBV & HCV with HIV was found to be 0(0%). Co infection was most commonly seen in the age group 31-40 years followed by 21 – 39 years. In the control group out of 100 HIV negative individuals, 1(1%) was infected with HBV infection. Conclusions: The routine screening of HBV and HCV should be mandatory for HIV infected patients, as there is more chance of co infection with these Hepatitis viruses due to enhanced immunodeficiency by HIV and similar routes of transmission. Clear National policies should be established which should include clear economic and health care strategies to improve quality of living conditions, education and easy access to health care facilities.

Impact on prevalence of intestinal helminth infection in school children administered with seven annual rounds of diethyl carbamazine (DEC) with albendazole.

Background & objectives: One third of the world’s population is infected with one or more of the most common soil-transmitted helminths (STH). Albendazole (ALB) is being administered with diethyl carbamazine (DEC) in filariasis endemic areas to eliminate lymphatic filariasis (LF) and helminth infections. In this study, the cumulative impact of seven annual rounds of mass drug administrations (MDA) of DEC and ALB on STH infection in school children in selected villages in southern India was determined. Methods: During 2001-2010, seven MDAs were implemented by the Tamil Nadu state health department, India. LF and STH infections were monitored in school children from 18 villages of the two treatment arms (viz, DEC alone and DEC+ALB). Kato-Katz cellophane quantitative thick smear technique was employed to estimate STH infections at three weeks, six months and one year post MDA. Results: Prior to treatment, an overall STH prevalence was 60 per cent. After each MDA, infection markedly reduced at three weeks post-treatment in both the arms. The prevalence increased at six months period, which was maintained up to one year. After seven rounds of MDA, the infection reduced from 60.44 to 12.48 per cent in DEC+ALB arm; while the reduction was negligible in DEC alone arm (58.77 to 52.70%). Interpretation & conclusions: Seven rounds of MDA with DEC+ALB reduced the infection load significantly, and further sustained low level of infection for 10 years. However, complete parasite elimination could not be achieved. To curtail STH infection in the community, MDA should be regularized and environmental sanitation measures need to be improved by effective community-based campaigns.

Phytoplankton diversity in the Parangipettai coastal waters, southeast coast of India.

An investigation was carried out during June 2005 to May 2007 on hydrography, composition and community structure of phytoplankton including chlorophyll a in Parangipettai coastal waters (southeast coast of India). Air and surface water temperatures varied from 25.5 to 31.2 °C and from 25 to 29.3°C, respectively. Salinity values varied from 5 to 33.1‰ and the pH ranged between 7.2 and 8.3. Dissolved oxygen content varied from 3.1 to 7.9 mg l-1 while the light extinction coefficient values (LEC) ranged between 1.8 and 11.0 cm. The range of inorganic nutrients viz., nitrate, nitrite, phosphate and silicate were: 6.5 - 27.0 µM; 1.0 - 8.9 µM; 0.1 - 3.0 µM and 15.0 - 140 µM, respectively. The range of chlorophyll a was: 2.0 - 7.5 µg l-1. Presently, 117 phytoplankton species representing different classes viz: Bacillariophyceae (66); Dinophyceae (22); Cyanophyceae (19); Chlorophyceae (7) and Chrysophyceae (3) were recorded. The phytoplankton cell abundance varied from 0.14 to 132 cells ml-1, with peak diversity (3.52 bits ind.-1) during summer season. The maximum abundance was found during summer season coinciding with the stable hydrographical conditions. Canonical Correspondence Analysis was applied in this study for discriminating environmental factors effecting on phytoplankton community at species level.

Phytoplankton diversity in Pichavaram mangrove waters from south-east coast of India.

The results of an investigation carried out during September 2002 to August 2003 on hydrography, composition and community structure of phytoplankton including chlorophyll ‘a’ (Chl-a) content and primary productivity (PP) of the Pichavaram mangrove (South-east coast of India) are reported. Atmospheric and surface water temperatures varied from 30.0 to 34.8oC and from 29.7 to 34.2oC respectively while the light extinction coefficient values (LEC) (K) ranged between 3.2 and 14.9. Salinity values varied from 9.6 to 35.4‰ and the pH ranged between 7.2 and 8.6. Variation in dissolved oxygen content was from 3.2 to 6.5 ml l-1. The ranges of inorganic nutrients viz., nitrate, nitrite, phosphate and silicate were: 7-36.23, 0.31-5.46, 0.28-3.70 and 12.26-56.64 μM respectively. Chlorophyll ‘a’ content ranged between 0.20 and 105.60 ;g l-1 and the ranges of gross and net primary productivities (PP) were: 16.54-826.8 and 11.52-610.2 mg C m-3 hr -1respectively. Presently a total of 94 species of phytoplankton were identified. Among these, the diatoms formed predominant group. Population density of phytoplankton varied from 400 to 3,21,000 cells-1. While the peak diversity (5.23 bits / ind.) of the phytoplankton was observed during summer season, the maximum population density was found during summer season coinciding with the stable hydrographical conditions.

Seasonal variations in physico-chemical characteristics of Pichavaram mangroves, southeast coast of India.

All the physico-chemical parameters such as temperature, salinity pH, dissolved oxygen and nutrients like nitrate, nitrite, inorganic phosphate and reactive silicate were studied in Pichavaram mangroves, southeast coast of India, for a period of two years (April 2000-March 2002). Air and surface water temperatures varied from 27 degrees C to 38 degrees C and from 26 degrees C to 37 degrees C. Salinity varied from 3.0 per thousand to 33.0 per thousand and the pH ranged between 7.2 and 8.2. Variation in dissolved oxygen content was from 2.4 to 5.0 ml l(-1). Concentrations of nutrients viz nitrates (9.50 to 32.12 microM), nitrites (1.07 to 5.99 microM), phosphates (0.73 to 2.36 microM) and reactive silicates (22.1 to 89.8 microM) also varied independently.