Evaluation of Antimicrobial Efficacy and Clinical Outcomes of Triphala and 2.5% Sodium Hypochlorite as Intraradicular Irrigants in Pulpectomy of Primary Teeth.

A natural irrigation solution with a broad spectrum of antimicrobial coverage, triphala was selected for the pulpectomy procedure. Because of its natural ingredients, it is well-known for promoting tissue healing. It also supposedly has certain additional qualities as compared to usual irrigation solutions that are made chemically. Although 2.5% NaOCl is thought to be perfect since it meets most of the requirements for an irrigation solution but it cannot be optimized for pulpectomy procedure. Primary teeth that were recommended for pulpectomy underwent this randomized controlled experiment. Two groups of eighty-four primary teeth were randomly assigned to receive irrigations: triphala in Group A; 2.5% Sodium hypochlorite in Group B. Sample were taken from infected primary root canals. A sterile test tube with bhi broth as the transport media was used to collect pre- and post-irrigation samples using sterile absorbent paper tips. On agar media, microorganisms were cultivated and their mean colony count was assessed. Following the procedure, the patient's follow-up visits at one, two and three months were used to evaluate the clinical result. The post-microbial colony count was dramatically reduced (p<0.001) by both irrigation treatments. Triphala in Group A is demonstrating desirable efficacy. Clinical success was found satisfactory in both the groups studied (p<0.001). But statistically significant difference was not found (p=0.175). Considering undesirable properties of sodium hypochlorite triphala can be a better alternative as a root canal irrigants in pulpectomy of primary teeth.

Evaluation of efficiency of nested multiplex allele-specific PCR assay for detection of multidrug resistant tuberculosis directly from sputum samples.

UNLABELLED: For an effective control of tuberculosis, rapid detection of multidrug resistant tuberculosis (MDR-TB) is necessary. Therefore, we developed a modified nested multiplex allele-specific polymerase chain reaction (MAS-PCR) method that enables rapid MDR-TB detection directly from sputum samples. The efficacy of this method was evaluated using 79 sputum samples collected from suspected tuberculosis patients. The performance of nested MAS-PCR method was compared with other MDR-TB detection methods like drug susceptibility testing (DST) and DNA sequencing. As rifampicin (RIF) resistance conforms to MDR-TB in greater than 90% cases, only the presence of RIF-associated mutations in rpoB gene was determined by DNA sequencing and nested MAS-PCR to detect MDR-TB. The concordance between nested MAS-PCR and DNA sequencing results was found to be 96·3%. When compared with DST, the sensitivity and specificity of nested MAS-PCR for RIF-resistance detection were determined to be 92·9 and 100% respectively. SIGNIFICANCE AND IMPACT OF THE STUDY: For developing- and high-TB burden countries, molecular-based tests have been recommended by the World Health Organization for rapid detection of MDR-TB. The results of this study indicate that, nested MAS-PCR assay might be a practical and relatively cost effective molecular method for rapid detection of MDR-TB from suspected sputum samples in developing countries with resource poor settings.

A feeding aid prosthesis for a preterm baby with cleft lip and palate.

Cleft lip and palate is a common congenital defect of human being. If a child is born with congenital cleft palate defect, it is very painful to their parents. They are very much worried about the feeding of their baby. In this situation feeding aid prosthesis is the only treatment of choice. The feeding aid prosthesis helps not only feeding the baby but also help to develop proper articulation of speech. The article describes an advanced clinical and laboratory technique for the fabrication of a feeding aid prosthesis for new born baby. 9 infants who were suffering from congenital cleft lip and palate defect and a 9 month old baby with acquired palatal defect (acid-victim) were included in this study. All of them had treated with feeding aid prosthesis for feeding till palatoplasty was done. The feeding aid prosthesis was fabricated with acrylic resin and finally relined with soft lining materials. The impression of the palate was taken with heavy body silicon putty with the help of modeling wax custom tray. Data were collected before and after prosthesis on the basis of feeding time, amount of consumption of milk and growth pattern of the infants with their height and weight. Out of ten babies, 30% rejected the prostheses and 70% had accepted and used the prostheses until they were fit for palatoplasty. Growth of the babies was significantly improved who accepted the prosthesis than who rejected the prosthesis.

"Two per cent isn't a lot, but when it comes to death it seems quite a lot anyway": patients' perception of risk and willingness to accept risks associated with thrombolytic drug treatment for acute stroke.

BACKGROUND: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. OBJECTIVE: To explore acute stroke patients' perception of risk and willingness to accept risks associated with thrombolytic drug treatment. DESIGN: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. RESULTS: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients' willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients' reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. CONCLUSION: Acute stroke patients' difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved.

I don't like that, it's tricking people too much...: acute informed consent to participation in a trial of thrombolysis for stroke.

BACKGROUND: Informed consent is regarded as a contract between autonomous and equal parties and requires the elements of information disclosure, understanding, voluntariness and consent. The validity of informed consent for critically ill patients has been questioned. Little is known about how these patients experience the process of consent. OBJECTIVE: The aim of this study was to explore critically ill patients' experience with the principle of informed consent in a clinical trial and their ability to give valid informed consent. DESIGN: 11 stroke patients who had been informed about thrombolytic treatment and had been through the process of deciding whether or not to participate in a thrombolysis trial went through repeated qualitative semistructured interviews. RESULTS: None of the patients had any clear understanding of the purpose of the trial. Neither did they understand the principles of randomisation and voluntariness. Reasons for giving or not giving consent were trust, conceptions of benefits and risks and altruism. Several patients found it immoral to involve patients in the consent procedure and argued that this was the doctors' responsibility. Others argued that it is a duty to question patients and perceived it as a sign of being treated with respect and dignity. A majority of the patients found the consent process vague and ambiguous. CONCLUSIONS: The results indicate that the principle of informed consent from critically ill patients cannot be seen as a contract between equal and autonomous parties. Further studies are needed to explore critically ill patients' experiences with the process of informed consent.

Human serum antibody response to Helicobacter pylori whole cell antigen in an institutionalized Bangladeshi population.

AIMS: To use a commercial ELISA kit and an immunoblot assay to investigate the antibody levels of selected members of the Bangladeshi population to Helicobacter pylori protein antigens. METHODS AND RESULTS: Using immunoblotting, high seroprevalence rates were observed in all age groups, although the subjects within the 1-9 years age group had the highest seroprevalence of antibodies to H. pylori antigens. By ELISA, the highest level of seroprevalence was observed in those over the age of 20 years. CONCLUSION: On the basis of these results the overall prevalence rate of H. pylori infection for the whole population was 77.4%; 77.9% for orphan boys and 76% for carers. CagA antibodies were detected in 86% of those with high levels of antibodies to H. pylori antigens. SIGNIFICANCE AND IMPACT OF THE STUDY: A combination of immunoblotting and ELISA was the most efficient means of detecting serum antibodies to H. pylori antigens and could be applied to the screening of human sera for H. pylori-specific antibodies.

[Have you met Mao?]. / Har du møtt Mao?

What is a clinical discourse, and what elements of the patient-doctor encounter are most important for the outcome in medical practice? I approach these questions by using the notion of narratology and some key concepts from discourse analysis: interaction, transaction and context. Traditionally, clinical discourse is either consultative or psychotherapeutic. I argue for a third approach to the patient-doctor discourse, a "narrative dialogue". In the narrative dialogue, the patient-doctor-interchange is supposed to be less structural, more flexible, more individualistic than what has traditionally been the case. The doctor is supposed to be visible as a person more than as a professional persona, and the patient is encouraged to participate in the dialogue with his or her own personal narrative as a substantial contribution to the consultation.

[Defending pluralism]. / Til forsvar for mangfaldet.

The 20th century is the century of modernity. Medical science and technology have basically and positively changed the health of the population. The serious infectious diseases are under control and the health services and their institutions have expanded extensively, in Norway as throughout the western world. Nevertheless, there is an impression of general frustration and discontentment. The authors reflect over this paradox by reminding the reader of some of the main developments in primary care in this century. They call attention to former Director General of the Norwegian Board of Health, Karl Evang, and his role as initiator and leader, and see him in contrast to former Minister of Health, Werner Christie and his criticism of the system. The authors suggest that the crisis within the health care system emerging over the last decades, should be understood as a crisis of modernity. There is a need to adjust some of the ideals which have dominated our century. In order to face the challenges of post-modern society, they recommend restoring the art of medicine. Above all, there is a need to incorporate pluralism as an essential value in the planning of our future health care system.

Effect of Nelumbo nucifera rhizome extract on the gastrointestinal tract of rat.

Extract of Nelumbo nucifera rhizome (RNN) was used as anti-diarrheal agent to combat the diarrhea in experimental rats. The RNN extract in graded doses (100, 200, 400 and 600 mg/kg body wt.) reduced not only the frequency of defecation, wetness of fecal dropping and PGE2 induced enteropooling but also the propulsive movements of charcoal meal significantly.

Tell me what's wrong with me: a discourse analysis approach to the concept of patient autonomy.

BACKGROUND: Patient autonomy has gradually replaced physician paternalism as an ethical ideal. However, in a medical context, the principle of individual autonomy has different meanings. More knowledge is needed about what is and should be an appropriate understanding of the concept of patient autonomy in clinical practice. AIM: To challenge the traditional concept of patient autonomy by applying a discourse analysis to the issue. METHOD: A qualitative case study approach with material from one consultation. The discourse is interpreted according to pragmatic and text-linguistic principles and provides the basis of a theoretical discussion of different concepts of patient autonomy. RESULTS: The consultation transcript illustrates how the patient's wishes can be respected in real life. The patient, her husband and the doctor are all involved in the discourse dynamics, governed by the subject matter, namely her mental illness. CONCLUSION: We suggest a dynamic and dialogue-based conception of autonomy as adequate for clinical purposes. These perspectives, based on mutual understanding, take communication between patient and doctor as their starting point. According to this approach, autonomy requires a genuine dialogue, an interpersonal mode of being which we choose to call "authentic interaction".

"Feeling your large intestines a bit bound": clinical interaction--talk and gaze.

OBJECTIVE: To explore the relationship between observation and talk in the clinical encounter, using the medical gaze as a key metaphor. DESIGN: A qualitative case study approach based on data from one consultation. Two sequences of patient-doctor interaction are the basis of a theoretical discussion of the medical gaze. SETTING: Audiotape recording from a Norwegian general practice. RESULTS: The doctor balances observation and talk to produce an appropriate, but not necessarily the only correct diagnosis. Verbal utterances illustrate how the doctor's structuring of the diagnosis works as an interactional means both to take care of the patient and to explain his sufferings. CONCLUSION: Clinical medicine is talk and gaze as an integral whole. Doctors not only make a diagnosis, but also structure a clinical reality.

About signs and symptoms: can semiotics expand the view of clinical medicine?

Semiotics, the theory of sign and meaning, may help physicians complement the project of interpreting signs and symptoms into diagnoses. A sign stands for something. We communicate indirectly through signs, and make sense of our world by interpreting signs into meaning. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and chest pain into heart attack. Medical semiotics is part of general semiotics, which means the study of life of signs within society. With special reference to a case story, elements from general semiotics, together with two theoreticians of equal importance, the Swiss linguist Ferdinand de Saussure and the American logician Charles Sanders Peirce, are presented. Two different modes of understanding clinical medicine are contrasted to illustrate the external link between what we believe or suggest, on the one hand, and the external reality on the other hand.

[Guardians of the welfare state?]. / Vaktbikkje for velferdsstaten?

The welfare state in post-war Norwegian society is a result of the dominating social democratic ideology now adapted to far-reaching technological development. Increased spending on health has provoked the question of whether doctors should be the guardians of the welfare state against inappropriate demands from patients. This paper argues against this view. What is really a problem for the whole society cannot be solved on the individual level. In many ways, to be sick is to fall outside the community, with a real risk of loosing rights and duties essential to all of us. The doctor has to find-and redefine-his ancient role of spokesman and champion, and of serving as a friendly and emphatic corrective to the individual patient. This is particularly important in modern health services where having to face interpersonal problems is a key element of everyday practice.