Calcium hydroxide medication in primary molars using different preparations and placement techniques: an in vitro study.

AIM: This was to compare the effectiveness of different preparations and delivery techniques of calcium hydroxide paste as an intracanal medicament in primary molar root canals. METHODS: Extracted lower primary second molars roots (72) were randomly assigned to the four experimental groups. After complete root canal preparation with TF rotary nickel titanium up to .06/30 file, a mix of calcium hydroxide/ distilled water was delivered by lentulo spiral (group 1) or a syringe (group 2). UltraCal(®) XS was placed by lentulo spiral (group 3) and a syringe (group 4). Digital radiographs were taken in both buccal and proximal directions before and after calcium hydroxide placement to evaluate the quality of filling. The mean percentages of filled calcium hydroxide area by subtracted digital radiograph, and the quality assessments between four experimental groups, were compared by using Two-way ANOVA and Fisher's exact test respectively. A p value of less than 0.05 was considered statistical significance. RESULTS: There was no statistically significant difference in the mean percentages of the filled calcium hydroxide area among different preparations and delivery techniques (p ≥ 0.05). The syringe technique had statistically significant fewer of air inclusions than when using the lentulo spiral with the mix of calcium hydroxide group (p < 0.05). The completeness of obturation and the quality of filling at apical part were not different among groups (p ≥ 0.05). CONCLUSION: Syringe technique was a simpler handling method that presented similar filling quality but fewer porosities than lentulo spiral technique in primary molar root canals.

Risk factors of osteoporosis in institutionalized older Thai people.

INTRODUCTION: There are very few published studies on osteoporosis among the institutionalized elderly in Asian countries, where the incidence of osteoporosis is increasing rapidly. Our objectives were to determine both the prevalence and risk factors of osteoporosis, as assessed by calcaneal bone mineral density (BMD) measurements, in a Thai nursing home. METHODS: Activities of daily living, the Mini-Mental State Examination, blood chemistry, body composition analysis, calcaneal quantitative ultrasound (QUS) and serum C-terminal telopeptides of type I collagen (serum beta-CTx) were assessed in 108 older people living in the largest nursing home for the elderly in Bangkok. Calcaneal BMD was measured by dual-energy X-ray absorptiometry (DXA). RESULTS: The prevalence of osteoporosis, as defined by a calcaneal BMD T-score <1.6, was 79.6%. The prevalence of low bone mass, as defined by a T-score of broadband ultrasound attenuation <1.0, was 80.6%. The prevalence of osteoporosis detected by these two methods was not significantly different (p=1.00). The prevalence of increased bone turnover [with the cutoff point being the mean + 2 standard deviation (SD) of the serum beta-CTx level of a sex- and age-matched control group] was 13.9%. In multiple linear regression analysis, five risk factors -- serum beta-CTx, mental health, mobility index, height and lean body mass -- were able to predict calcaneal BMD at a coefficient of determination R(2)) of 0.54. CONCLUSIONS: These results indicate the importance of mental health and self-care ability as factors associated with osteoporosis. Increased bone turnover was also a significant risk factor of low bone mass. Calcaneal QUS was a useful screening tool for diagnosing osteoporosis in this population and was comparable to calcaneal DXA.

Laboratory assessment of the efficiency of encasing materials against house dust mites and their allergens.

BACKGROUND: The current recommendation to reduce mite allergen exposure for mite-sensitive individuals is to use allergen-impermeable bed coverings. As these covers are made of various kinds of materials, they vary in quality. The objective of this study was to investigate the efficiency of different covering materials against house dust mites and their allergens in vitro. METHODS: Four types of materials including (1) plastic cover, (2) polyurethane-coated cover, (3) non-woven covers, (4) tightly woven microfiber covers and a regular cotton bed sheet (as a control) were evaluated using three methods: (i) heat escape method, (ii) Siriraj chamber method and stereomicroscopy, scanning electron microscopy and (iii) enzyme-linked immunosorbent assay (ELISA). RESULTS: We found that there was a statistically significant difference in allergen permeability among four types of coverings (P < 0.001). In terms of the impermeability to mites and their allergens, plastic- and polyurethane-coated covers were observed to be the best, followed by non-woven, woven and cotton-based bed sheets. A regular cotton-based bed sheet allows a significant amount of leakage of mite allergens. Both woven and non-woven material are efficient barriers against mite allergen in terms of impermeability. However, with regard to mite colonization, non-woven covers have the drawback of mites being able to penetrate and colonize within the fabric fibers. Woven covers are therefore recommended because of their major advantages of not allowing the colonization of mites within the fabric, being easy to clean, and comfortable. CONCLUSION: The three assessment methods used in this study could be useful as a primary approach to evaluate the quality of covering materials in vitro using both pore size and ability to be colonized by mites on the materials as the key factors.

Lymphocyte activation after non-thermal trauma.

BACKGROUND: Severe injury causes immunological changes that may contribute to a poor outcome. Longitudinal characterization of lymphocyte response patterns may provide further insight into the basis of these immunological alterations. METHODS: Venous blood obtained seven times over 2 weeks from 61 patients with injury severity scores above 20 was assessed for lymphocyte phenotypic and activation markers together with serum levels of interleukin (IL) 2, IL-4, soluble IL-2 receptor (sIL-2R), soluble CD4 (sCD4), soluble CD8 (sCD8) and interferon gamma. RESULTS: Severe injury was associated with profound changes in the phenotypic and activation profile of circulating lymphocytes. Activation was indicated by increased numbers of T cells expressing CD25, CD69 and CD71, and raised serum levels of IL-2, sIL-2R, sCD4 and sCD8. Relatively higher levels of sIL-2R and sCD4 were found in patients with sepsis syndrome. CONCLUSION: Polytrauma is associated with dramatic alterations in the phenotypic and activation profile of circulating lymphocytes which are generally independent of clinical course. In contrast, several lymphocyte soluble factors, including sCD4 and sIL-2R, paralleled the clinical course. These data provide new insight into lymphocyte responses after injury and suggest that further assessment of soluble factors as clinical correlates, including those related to lymphocyte activation or generalized inflammation, may be warranted.

Factors associated with diabetic foot ulceration in Thailand: a case-control study.

A case-control study was conducted to determine factors involved in foot ulceration in Thai non-insulin-dependent (Type 2) diabetic patients. Fifty-five patients with foot ulcers (42 females and 13 males) and 110 patients without foot ulcers (83 females and 27 males) were evaluated for 26 factors possibly associated with foot ulceration. The results showed that diabetic patients with foot ulcers had significantly lower diabetic knowledge and foot-care practice scores; poorer glycaemic control, renal function, and visual function, and higher prevalence of retinopathy and peripheral neuropathy than diabetic patients without foot ulcers, whereas there were no differences in peripheral vascular status between both groups, each having a low prevalence. Multiple logistic regression analyses indicated that the risk of developing foot ulcers was associated with only three factors which were peripheral nerve status as determined by somatosensory evoked potentials (OR = 1.67; 95% CI 0.31 -8.97), visual acuity (OR = 0.223 per unit decrease in decimal visual acuity; 95% CI = 0.005, 0.39) and fasting plasma glucose level (OR = 1.01 per mmol l-1 increase; 95% CI = 1.00, 1.02). We conclude that peripheral neuropathy, visual impairment, and poor glycaemic control, but not peripheral vascular insufficiency, are the major independent risk factors associated with foot ulceration in Thai diabetic patients.

Iron status following trauma, excluding burns.

Serum concentration of iron, transferrin saturation and total iron binding capacity (TIBC) were measured on days 1, 2, 3, 5, 7, 10 and 13 in 36 Thai patients with trauma (burns excluded) to determine temporal changes in iron metabolism. Throughout the study profound hypoferraemia was observed in association with decreased transferrin saturation. TIBC, in contrast, did not differ significantly from that in controls. These findings confirm previous reports which describe altered iron metabolism in association with an adverse event, a response known as 'stress hypoferraemia', and extends these observations to non-burned patients with trauma. The degree of hypoferraemia in patients in this study was not related to sepsis, Injury Severity Score, volume of blood transfused or surgery, suggesting that hypoferraemia following trauma is an independent event. The recognition of rapid and prolonged iron sequestration provides insight into the clinical condition of patients with trauma.

Placebo-controlled double-blind cross-over study of botulinum A toxin in hemifacial spasm.

The evaluation of the efficacy of botulinum A toxin injection for hemifacial spasm has never previously been done in a double-blind study in spite of its use as a treatment. We thus conducted a double-blind cross-over study of botulinum A toxin use in hemifacial spasm in 55 patients at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Thirteen patients decided to withdraw from the study due to a lack of efficacy, all of them were subsequently found to be in the saline injection group. The remaining 42 patients, in the botulinum A toxin injection (30 mouse units) group, reported the responses as: excellent (34 patients; 80.95%), moderate patients; 2.38%). In contrast, when given the saline injection they reported no excellent outcome, 1 patient (2.38%) with moderate improvement, 5 patients (11.90%) with mild improvement and, 36 patients (85.71%) with no response. Side effects of botulinum toxin injections were found in 14.29% of patients compared with 9.5% of the saline injection group. The side effects of botulinum toxin injection were mild transient facial weakness (7.14%), local pain (4.76%) and excessive lacrimation (2.38%). We concluded that botulinum A toxin injection was a simple and effective out-patient treatment for the management of hemifacial spasm.

The failure of a preprinted order form to alter physicians' antimicrobial prescribing pattern.

Use of antimicrobial agents is highly effective in reduction of morbidity and mortality due to infectious disease. There is, however, evidence that the use of such agents is frequently inappropriate worldwide. Several methods were tried to rationalize the use, and, among these, the preprinted order form (P.O.F.) offered the simplest and most efficient way. We studied the use of the P.O.F. in Siriraj Hospital, Bangkok Thailand, where there was overuse of antimicrobial agents using a historical-controlled intervention study. In period I (no P.O.F.), the antimicrobial overuse was 35 per cent, and this was not reduced by using the P.O.F. in period II (32%), which was one year apart. There was no difference in overuse after adjustment for differences in base-line characteristics which were thought to affect antimicrobial prescriptions i.e. physicians' workload, physicians' knowledge and the method of diagnosis of infectious disease. Reasons for failure of the P.O.F. in unclear. Misdiagnosis was unlikely since the correct diagnosis as revised by attending physicians and specialists was as high as 83 per cent. The fear of malpractice suits was also not the reason because defensive medicine is not a problem in Thailand. The nature of the diseases, which lower the threshold to treat, the clinical immaturity and other unknown factors were thought to play a part in deviation from responsibility to perform according to written-justification.