Assessment of Flexural and Compressive Strengths of EQUIA, GC Gold Hybrid, and Conventional GIC Restorative Materials.

Objectives: This in vitro research was performed to assess the flexural and compressive strengths of EQUIA, GC Gold Hybrid (GH), and conventional glass ionomer cement (GIC) restorative materials. Materials and methods: This study compares three restorative. Materials: group I-EQUIA Forte GIC, group II-GC GH, and group III-conventional GIC for compressive and flexural strength evaluation. With a specially made Teflon mold, thirty-six cylindrical test specimens measuring 4 mm × 5 mm in dimension were created. They were then placed in 20 mL of deionized water and kept at 37°C for 3 hours every day for 30 days. Later, they were subjected to compressive strength and flexural strength using the universal testing machine. Statistics were used to examine each and every result. Result and Conclusion: EQUIA had the highest average compressive strength and flexural strength, whereas traditional GIC restorative material had the lowest.

Perioperative Variation in Optic Nerve Sheath Diameter - A Prospective Observational Study of Traumatic Brain Injury Patients Undergoing Decompressive Craniectomy.

Background: Measuring optic nerve sheath diameter (ONSD) by transbulbar ultrasonography (TBUS) can suffice non-invasive ICP measurement with considerable accuracy. Objective: The primary objective of this study was to evaluate the perioperative variation in ONSD by TBUS in Traumatic Brain Injury (TBI) patients undergoing emergency craniectomy. Methods: We prospectively compared bilateral ONSD measurements in 45 consecutive TBI cases undergoing decompressive craniectomy under general anesthesia; before and after surgery. A total of 180 ONSD images were obtained and measurements were done by the same investigator blinded to the pre/postoperative nature of the image. Results: Based on preoperative Glasgow Coma Scores, 34 cases (75.5%) had severe TBI; 10 cases (22.2%) moderate TBI; and 1 case (2.2%) mild TBI. Preoperative ONSD in the study population were as 6.625 ± 0.414mm. Average ONSD reduced significantly by 0.249 ± 0.148 mm (P < 0.001) after craniectomy. On pooled analysis of cases undergoing right versus left sided craniectomy average ONSD reduced significantly by 0.252 ± 0.173 mm (P < 0.001) and 0.259 ± 0.139 mm (P < 0.001), respectively. ONSD of right eye with left eye and vice-versa were strongly correlated both pre/postoperatively with Pearson correlation coefficients (r)=0.879 (P < 0.001) and r = 0.827 (P < 0.001), respectively. Conclusions: In TBI cases undergoing decompressive craniectomy ONSD is bilaterally increased preoperatively. ONSD reduces significantly immediately after craniectomy; however, the diameters did not near the normal range. There hold a strong correlation between right/left ONSD measurements irrespective of the laterality of injury or side of surgery. Variable elastic properties of ONS in an injured brain can possibly explain our findings.

Evaluation of Use of RPMI Medium to Preserve Cell Morphology for Pleural/Peritoneal Fluid Cytology.

Introduction: Cytologic evaluation is the best way to detect the presence of malignancy in body cavity fluids. Roswell Park Memorial Institute (RPMI) medium or RPMI 1640 is used in cell culture, tissue culture, and also to improve the cellularity and morphology of CSF cytology specimens. Objectives: To determine whether RPMI medium can be used to preserve cell morphology in pleural/peritoneal effusion samples. Method and Material: The study was conducted on 30 pleural/peritoneal fluid samples received routinely during 2 months for diagnostic purposes in our department. The samples were divided into four parts. One-fourth of the sample was directly refrigerated and the other fourth was at room temperature. In the other two parts, an equal volume of RPMI media was added, and one was kept at room temperature and the other refrigerated. These cytospin-prepared Giemsa-stained smears were examined for cell morphology, cellularity, and occurrence of bacterial colonies at 24 h, 48 h, 72 h, and 1 week, respectively. Result: Refrigerated RPMI medium is the best preservative for pleural/peritoneal samples; however, samples with RPMI at room temperature were equivalent/even worse than the simple refrigerated sample.

Post-herpetic Neuralgia: A Systematic Review of Current Interventional Pain Management Strategies.

BACKGROUND: Post-herpetic neuralgia (PHN) is usually a constant or intermittent burning, stabbing, or sharp shooting pain with hyperalgesia or allodynia, persisting beyond the healing of herpetic skin lesions. This review was carried out in concordance to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We used PICOS (Population, Intervention, Control, and Outcome Study) design for inclusion of potential studies into this review. Online literature available in PubMed, Cochrane, and Embase was searched for studies from January 1995 till March 2020, which evaluated interventional treatments in PHN by an independent reviewer, using the relevant medical subject heading (MeSH) terms. We analyzed the following outcome parameters with regard to each intervention-pain status at predefined fixed intervals after the intervention, quality of sleep using any of the reported questionnaires, analgesic consumption, functional evaluation, and quality of life assessment after the intervention. CONCLUSION: Interventional pain management options provide effective and long-lasting pain relief to patients not responding to medical management. The choice of intervention will depend on the region involved, cost, and invasiveness. Simple procedures such as intercostal nerve blocks/neurolysis, stellate ganglion blocks, paravertebral neurolysis, epidural steroid injections, and dorsal root ganglion-radiofrequency ablation are effective interventions, and if they fail, spinal cord stimulators could be effective in the hands of experienced pain physicians.

Effect of Distinctive Moisture Conditions on Push-out Bond Strength of Three Root Canal Sealers-An In-Vitro Study.

OBJECTIVE: Endodontic sealer should adhere to both dentin and the core filling material but the moisture conditions of the canals affect the adhesive properties of the sealer. An ideal sealer with perfect moisture conditions will lead to greater strength of the restored tooth, which may provide greater resistance to tooth fracture and clinical longevity of an endodontically treated tooth. The aim of this study was to evaluate the effect of moisture conditions on the push-out bond strength of three root canal sealers: AH Plus® (Dentsply-Tulsa Dental, Tulsa, OK), Epiphany (Pentron Clinical Technologies, Wallingford, CT), and GuttaFlow (Coltene/Whaledent, Altstatten, Switzerland). MATERIALS AND METHODS: A total of 120 single-rooted, non-carious teeth were collected for the study and were stored in normal saline. The root canals were prepared using step-back technique. Teeth were divided into four groups based on type of drying procedure used and further subdivided into three subgroups based on the type of sealer used. The samples were cut horizontally to produce slices and then tested for push-out bond strength using Universal Testing Machine (Servo Series 50 kN; P S I Sales Private Limited, New Delhi, India). The specimens were examined for mode of fracture under magnification and the results were analyzed statistically. RESULTS: Distinctive moisture conditions for all sealers were observed and the highest strength of AH Plus® was evaluated under moist condition, Epiphany under dry condition, and GuttaFlow under normal condition, respectively. CONCLUSION: Distinctive moisture conditions affect the push-out bond strength of the sealers.

A Clinical Study of Prevalence of Microalbuminuria in Patients of Primary Hypertension and its Correlation with Left Ventricular Mass Index.

INTRODUCTION: Hypertension is one of the most challenging health problems in the world. Hypertension is closely related to kidney diseases. Microalbuminuria is a reflection of early kidney dysfunction and a marker of asymptomatic preclinical disease which precedes and predicts the occurrence of major morbid events. AIMS AND OBJECTIVES: To investigate the relationship between microalbuminuria and LVH in patients with primary hypertension. To establish microalbuminuria as an independent risk factor for increased Left Ventricular Mass Index in patients with Primary Hypertension. METHODS: This was a cross-sectional prevalence, analytical study conducted for a period of two years in a tertiary care teaching hospital in Western India. 126 patients diagnosed as primary hypertension, according to JNC 7 criteria were included in the study. Left ventricular Mass Index was measured using 2 D Echo Machine using the formula of Left ventricular mass. Multiple logistic regression was conducted to find out independent correlation of Left Ventricular Hypertrophy. RESULTS: Mean age was 64.32 years in patients without LVH while it was 63.85 years in patients with LVH. Serum creatinine, albumin-creatinine ration and Microalbuminuria were independently correlated with the Left Ventricular hyper trophy. Multiple logistic regression concluded that presence of microalbuminuria increases risk of LVH 2.04 times more as compared to absence of microalbuminuria. Serum creatinine level was higher in patients with LVH compare to patients without LVH. patients with Microalbuminuria were higher in LVH group compare to non LVH group and this difference was statistically significant. CONCLUSION: This study demonstrates that microalbuminuria has an independent correlation with Left Ventricular Mass Index and hence an independent risk factor for increased cardiovascular morbidity and mortality.

Implementation of a Mini-Clinical Evaluation Exercise (Mini-CEX) Program to Assess the Clinical Competence of Postgraduate Trainees in Pediatrics.

OBJECTIVE: To implement Mini-CEX, a Workplace-based assessment tool, for formative assessment of clinical skills of final year pediatric post-graduate residents. METHODS: All final-year postgraduate residents at the Department of Pediatrics of a public medical college in India underwent mini-CEX assessment by rotation among six faculty members. Outcome was assessed by an anonymous questionnaire-based feedback from the participating students and faculty members, collected after the completion of all the mini-CEX encounters. RESULTS: 20 final year postgraduate students (12 males, 15 MD and 5 DCH) were assessed. Data gathering (68.7%) and counseling (63.3%) were the most common areas assessed. 84% and 58% of the students and faculty, respectively were satisfied with their Mini-CEX encounter (score > 8 on a 10-point Likert scale). 90% of the participating students felt that Mini-CEX should be included as a routine in postgraduate teaching. All six faculty thought they had a good experience, but 50% were unsure whether it was a valid method of assessment. CONCLUSION: The involved faculty and residents had high satisfaction levels with mini-CEX evaluation. Mini-CEX has a potential to be incorporated in the formative evaluation of postgraduate pediatric students as part of the workplace-based assessment.

Case series on anesthesia for video-assisted thoracoscopic surgery for congenital diaphragmatic hernia in children.

Video-assisted thoracoscopic surgery (VATS) in the pediatric population is a challenging task for any anesthesiologist, moreover considering the high incidence of associated congenital anomalies which are individual predictors of poor prognosis. A thorough preoperative evaluation, knowledge of the physiology of one lung ventilation - pertaining to various methods of lung isolation, individualized meticulous planning, and continuous vigilance to detect any untoward event at the earliest with good communication between the anesthesiology and surgical teams contributes to a safe and successful surgery. We present a case series of anesthetic management of congenital diaphragmatic hernia with VATS.

Scapular dislocation from trivial trauma: a rare case.

Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event. Scapulothoracic dissociation though has been reported, usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury, etc. Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition. Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature. It is a distinct clinical entity and needs to be differentiated from other similar conditions. Here, we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a 10 years old girl. The patient had a recurrence of the dislocation before presenting to us. But she did not have any pre-existing condition for scapular dislocation.