Effect of Full Veneer Crown on Periodontal Health in Diabetic and Non-Diabetic Patients.

Both periodontal disease and diabetes mellitus (DM) are important public health issues. Compared to the non-diabetic counterparts, diabetic patients more often suffer from dental problems, sometimes requiring fixed-dental prosthesis. Gingival inflammation and other forms of periodontal disease are the common complications of the dental prosthesis. This prospective comparative experimental study was intended to compare the outcome of the periodontal health after placement of full veneer crown in diabetic and non-diabetic patients in the Department of Prosthodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from April 2018 to March 2019. This study involved consecutive 53 diabetic and 53 non-diabetic adult patients of either sex, undergoing treatment with full veneer crown in either maxillary or mandibular posterior teeth with healthy periodontal tissue. The outcome variables were: plaque index, gingival index, periodontal pocket depth, and bleeding on probing, at baseline, 3 months and 6 months post-procedure. Gingival index in the diabetic group reached from 0 at baseline to nearly 0.1 at 3 months which then steeply reached to 0.2 at 6 months interval, whereas the same index in the non-diabetic group reached from 0 at baseline to 0.009 at 3 months and 0.04 at 6 months interval. Plaque index of diabetic patients increased from 0 at baseline to 0.5 at 3- and 6-months interval, whereas the plaque index of non-diabetic patients increased to 0.4 at 3 months and then decreased again 0.3 at 6 months interval (p<0.001). Periodontal pocket depth of diabetic group increased from 1.0mm at baseline to 1.2 and 1.5mm at 3 and 6 months respectively, while the same measure in the non-diabetic group increased to 1.1 and 1.3mm at 3 and 6 months respectively (p<0.001). Bleeding on probing index in the diabetic group reached sharply to 1.5 at 3 months from 0 at baseline and then it reached 2.3 at 6 months, whereas the same index in non-diabetic group reached 1.1 and 1.6 at 3 and 6 months respectively (p<0.001). Periodontal health outcome of full veener crown in diabetic patients is adversely affected compared to that in non-diabetic patients.

Pancreatobiliary Diseases: Evaluation by Transabdominal and Endoscopic Ultrasound.

Pancreaticobiliary diseases are the important causes of morbidity and mortality worldwide. Among the imaging modalities, Transabdominal ultrasound (TUS) is cheap, available, and noninvasive but it has some limitations. Endoscopic ultrasound (EUS) is invasive but it has some diagnostic and therapeutic advantages over TUS. This study was aimed to see the diagnostic yields of EUS and TUS in the pancreatobiliary diseases. This cross sectional study was conducted in Sir Salimullah Medical College Mitford Hospital (SSMC&MH), Dhaka, Bangladesh from March 2017 to February 2019. All (n=222) patients were evaluated clinically and with relevant investigations. TUS and EUS were done in all patients. Endoscopic retrograde cholangiopancreatography (ERCP) was done in 60 patients. Among 222 patients 56.8% were males; mean age was 46±16 years; the main presenting symptoms were abdominal pain and jaundice. In diseases of biliary tree, EUS showed dilated CBD alone or in combination with stone in 50 and 67 cases and TUS showed 37, 63 patients respectively. The difference between the findings of EUS and TUS was statistically significant (p=0.00). In gall bladder, EUS found microlithiasis in 6(2.6%) and sludges in 24(10.8%) cases whereas TUS found microlithiasis in 1(0.5%) and sludges in 17(7.7%) cases respectively (p=0.00). Both EUS and TUS detected cholelithiasis in equal number of patients 46(20.3%). On pancreatic evaluation, EUS and TUS detected pancreatic parenchymal abnormalities in 24(10.8%) and 12(5.5%) patients respectively with significant p value (0.00). In cases of pancreatic and cholangiocarcinoma the difference between the findings of EUS and TUS were statistically significant (p<0.05). EUS detected 7 cases of ampullary/peri-ampullary neoplasms whereas TUS detected only 2 cases. The sensitivity of EUS for detecting CBD dilatation, CBD stones, CBD SOL and pancreatic SOL was 85%, 91%, 93%, and 92% respectively. The sensitivity of TUS for detecting CBD dilatation, CBD stones, CBD SOL and pancreatic SOL was 42%, 52%, 40%, and 37% respectively. EUS is more sensitive than TUS in diagnosing pancreaticobiliary disorders. It is of paramount importance in patients in diagnosing CBD dilatation, choledocholithiasis, biliary microlithiasis and pancreaticobiliary neoplasm. EUS has important role before proceeding to further management by more invasive techniques like ERCP or surgery.

Comparative Study of Alginate and Omeprazole in Symptomatic Treatment of Non-erosive Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease is widely reported most prevalent disease of the gastrointestinal tract. The burden of gastroesophageal reflux disease (GERD) is increasing in Asia and the majority of patients have non-erosive reflux disease. This prospective, open label, non random (consecutive), experimental study was performed due to compare the therapeutic efficacy of alginate and omeprazole in relieving symptoms of non erosive reflux disease (NERD) and was carried out in the Outpatient Department of Gastroenterology, Dhaka Medical College Hospital, Dhaka, Bangladesh from December 2013 to May 2014. Sixty patients were enrolled for this study and were divided into two groups. Among them, 30 subjects were assigned to the omeprazole group (Group I) and 30 subjects to the alginate group (Group II). Omeprazole 20mg enteric coated capsule daily and alginate 10ml three times daily were administered 14 days in this study. In ITT analysis, achieving complete symptom relief (heart burn) was 56.7% in alginate group & 60% in omeprazole group. Statistically which was not significant (p=0.793). In PP analysis, this was 65.4% and 66.7% respectively. In this study, the overall satisfaction of omeprazole & alginate was more than 86% and the mean duration of heart burn free was found 5.0±4.0 days in Group I and 3.65±2.8 days in Group II. The difference was not statistically (p>0.05) significant between two groups in this study. Therapeutic efficacy and safety profiles of alginate were comparable to omeprazole after two weeks treatment in NERD subjects. So alginate may be considered as a relevant and effective alternative medication in non-erosive reflux.

Initial Experience with Endoscopic Ultrasound.

Since its introduction in early 1990s, endoscopic ultrasound (EUS) has become integral to the diagnosis and staging of various luminal, extraluminal gastrointestinal (GI) and certain non-GI lesions. There is no data on EUS experience in Bangladesh. The aim of this paper is to evaluate the initial recent experience and clinical impact of EUS. All EUS procedures data were recorded prospectively from July 2013 to December 2014. These included patients' demographics, referral details, provisional diagnosis, management plan before and after EUS & indications of procedures. EUS-FNA data recorded included details regarding site, number of passes and histological diagnosis. Two hundred & four EUS procedures were carried out over one and half years. Male female ratio was 1.4:1, mean age was 46.4 ± 20 years. Of these procedures 148 (72.5%) were referrals from physicians and 56 (27.5%) were from surgeons. Most common indications were pancreatobiliary pathologies, esophageal & gastric pathologies. Pancreatobiliary lesions (n = 165, 80.9%) included patients with (A) Benign pathologies: Microliths in Gall baldder (n = 6), Gall stones (n = 12), Biliary ascarrisis (n = 22), Choledocholithiasis (n = 42), Acute Pancreatitis (n = 9), Chronic Pancreatitis (n = 15), Pancreatic pseudocysts(n = 4) (B) Malignant Pathologies : GB Carcinoma (n = 4), Cholangiocarcinoma (n = 29), Ca- pancreas (n = 9), Periampullary carcinoma (n = 12). Esophageal lesion was 9.3% (n = 19) of total procedures. Forty seven percent (n = 9) of EUS procedures on esophagus were for staging of esophageal malignancy, 10. 5% (n = 2) for restaging or recurrence after chemoradiation and 21% (n = 4) for submucosal lesions. Fifteen EUS procedures were carried out for gastric lesions, seven were for staging of gastric carcinoma, four were for assessment of submucosal lesions (e.g. GIST, lipoma or external compression), 02 for assessment of polyps and two for gastric ulcers.In clinical impact & outcome study, changes in diagnosis, management, avoidance of investigations and usefulness of EUS were evaluated. Diagnosis was changed in 34.4% (64/186) & management was changed in 45%(92/204). Additional investigation was avoided in 57.8% (118/204). This is the first report of Bangladesh experience of EUS to date. EUS is safe, accurate, cost effective & very useful tool for diagnosis and management of G.I. disorders.

Double balloon enteroscopy: Bangladesh experience.

Double balloon enteroscopy (DBE) is a newly developed endoscopic modality for diagnosis and treatment of small bowel disorders. The aim of this study was to evaluate the diagnostic and therapeutic impact of DBE in patient with suspected small bowel disease. This was a prospective study. Sixty one double balloon enteroscopy procedures (30 antegrade 31 retrograde) were done in thirty six patients (20M/16F, mean age 40 ± 12.5 range 16-65 years ) at gastroenterology department, Sir Salimullah Medical College, Dhaka between October 2011 and September 2012. Indications for DBE included chronic abdominal pain 14 (38.9%), obscure GI bleeding 11 (30.56%), Small bowel obstruction 05 (13.89%), and chronic diarrhea 06 (16.67%). The morphologic findings were ulcerations 13 (36.11%), growth 03 (8.33%), vascular ectasia 03 (8.33%) and polyp 01 (2.78%). Therapeutic interventions were performed in one patient only. No serious complications were observed. Diagnostic yields in case of chronic abdominal pain, chronic diarrhea, obscure GI bleeding and small bowel obstruction were 50%, 66%, 63% and 40% respectively. The findings were adenocarcinoma 04 (11%), lymphoma 03 (8.4%), tuberculosis 03 (8.4%), non specific findings 05 (13.9%), IPSID 01(2.8%), Crohn's disease 01 (2.8%), vascular ectasia 03 (8.33%) and normal 16 (44.44%). DBE is well tolerated, feasible and useful technique for the diagnosis as well as treatment of small intestinal disorders.

B2 receptor-mediated enhanced bradykinin sensitivity of rat cutaneous C-fiber nociceptors during persistent inflammation.

Bradykinin (BK), which has potent algesic and sensitizing effect on nociceptors, is of current interest in understanding the mechanisms of chronic pain. BK response is mediated by B2 receptor in normal conditions; however, findings that B1 receptor blockade alleviated hyperalgesia in inflammation have been highlighting the role of B1 receptor in pathological conditions. It has not yet been clear whether nociceptor activities are modified by B1 receptor agonists or antagonists during inflammation. In addition, previous studies reported the change in BK sensitivity of nociceptors during short-lasting inflammation, and data in persistent inflammation are lacking. Therefore we investigated whether an experimentally induced persistent inflammatory state modulates the BK sensitivity of nociceptors and which receptor subtype plays a more important role in this condition. Complete Freund's adjuvant was injected into the rat-tail and after 2-3 wk, persistent inflammation developed, which was prominent in the ankle joint. Using an in vitro skin-saphenous nerve preparation, single-fiber recordings were made from mechano-heat sensitive C-fiber nociceptors innervating rat hairy hindpaw skin, and their responses were compared with those obtained from C-fibers tested similarly in normal animals. BK at 10(-8) M excited none of the 10 C-fibers in normal animals while it excited 5 of 11 (45%) C-fibers of inflamed animals, and at 10(-6) M BK excited all of the 11 inflamed C-fibers (or 94% of 36 tested C-fibers) but only 4 of 10 (or 45% of 58 tested C-fibers) in normal animals. Thus the concentration-response curves based on the incidence of BK induced excitation, and the total number of impulses evoked in response to BK were significantly shifted to the left. Moreover, an increased percentage of the inflamed C-fibers responded to 10(-6) M BK with bursting or high-frequency discharges. Thirty-percent of inflamed C-fibers had spontaneous activity, and these fibers showed comparatively less tachyphylaxis to consecutive second and third 10(-6) M BK stimulation. A B2 receptor antagonist (D-Arg-[Hyp3, Thi5,8,D-phe7]-BK) completely eliminated BK responses in inflamed rats, while B1 receptor antagonists (B 9958 and Des-Arg9-[Leu8]-BK) had no effect. Selective B1 receptor agonist (Des-Arg10-Kallidin) excited 46% (n = 13) of inflamed C-fibers at 10(-5) M concentration, which is 1,000 times higher than that of BK needed to excite the same percentage of inflamed C-fibers. We conclude that in chronically inflamed tissue, sensitivity of C-fiber nociceptors to BK, which is B2 receptor mediated, is strongly increased and that B1 receptor may not be important to a persistent inflammatory state, at least at the primary afferent level.

Differences between the Lewis and Sprague-Dawley rats in chronic inflammation induced norepinephrine sensitivity of cutaneous C-fiber nociceptors.

We investigated whether there are any differences between the Lewis and Sprague-Dawley (SD) rats in chronic inflammation-induced norepinephrine (NE) sensitivity of nociceptors. Activities of C-fiber nociceptors innervating rat hairy hindpaw skin were recorded in an in vitro skin-nerve preparation. Sixty-five percent of C-fibers from inflamed Lewis rats were excited by NE (10 microM), against only 38% of C-fibers from inflamed SD rats. The average of the total impulses evoked in response to NE was also significantly higher in Lewis rats. The alpha2-adrenoceptor antagonist CH 38083 (10 microM) and yohimbine (10 microM) consistently blocked the NE-excitation of both strains. These results show that after chronic inflammation, C-fiber nociceptors of Lewis strain rats have a stronger sensitivity to NE, and that alpha2-adrenoceptors are predominately involved in the NE-sensitivity of inflamed rats in both strains.