Glucometrics in the first week of critical illness and its association with mortality / Glucometría en la primera semana de enfermedad crítica y su asociación con la mortalidad

Objective Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. Design Prospective observational study. Setting Mixed ICU of teaching hospital. Patients Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. Main variables of interest Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. Results A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162–178.75), SD 31mg/dL (26–38.75), CV 18.6% (17.1–22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5–1131.5) and TIR 57% (50–67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). Conclusions Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections (AU)

Objetivo Evaluación de la glucometría en la primera semana de estancia en la UCI y su asociación con los resultados. Diseño Estudio observacional prospectivo. Ámbito UCI mixta de hospital docente. Pacientes Adultos que iniciaron una infusión de insulina para dos lecturas consecutivas de glucosa en sangre (GS) ≥180mg/dl. Principales variables de interés Glucometría calculada a partir de la GS de la primera semana de ingreso: episodios de hiperglucemia (GS >180mg/dl) e hipoglucemia (GS <70mg/dl); mediana, desviación estándar (DE) y coeficiente de variación (CV) de GS, índice de labilidad glucémica (ILG), tiempo en el rango objetivo de GS (TIR). Resultados Se incluyeron un total de 5.762 GS en 100 pacientes con una mediana de edad de 55años. Glucometría: hiperglucemia: 2.253 (39%), hipoglucemia: 28 (0,48%), mediana GS: 169mg/dl, DE 31mg/dl, CV 18,6%, ILG: 718,5 [(mg/dl)2/h]/semana, TIR 57%. La diabetes y una puntuación APACHEII más alta se asociaron con una DE y un CV más altos y una TIR más baja. En la regresión multivariada, la diabetes (p=0,009) y la puntuación APACHEII (p=0,016) se asociaron de forma independiente con una DE más alta. La DE y el CV más altos se asociaron con menos días sin vasopresores; menor TIR, con más infecciones del torrente sanguíneo (ITS). En el análisis multivariado, el ILG solo se asoció con una mayor mortalidad (OR: 2,99, p=0,04). Conclusiones La labilidad glucémica en la primera semana en pacientes de UCI que reciben infusión de insulina se asocia con mayor mortalidad. Una TIR más baja se asocia con más ITS (AU)

Effect of magnetized water on blood indices and histomorphometric parameters of intestinal sections of Japanese quail.

A two-way experimental design was used to demonstrate the physiological effects of magnetized water and sex on blood indices and histomorphometric parameters of Japanese quail intestine sections. Red blood cell count (RBCs), packed cell volume (PCV), hemoglobin concentration (Hb), thrombocytes, white blood cell count (WBCs), and WBC differentiation were investigated. A total of 450 unsexed Japanese quail were randomized into three groups (45/replicate; 3 replicates; 135/group). As a monitoring group, the first group was given untreated tap water to drink. The two others were consumed magnetized water that were subjected to an electrical magnetic field with a power of 1 Tesla (10,000 Gauss) and 2 Tesla (20,000 Gauss), respectively. The treatments had a significant (p ≤ 0.05) effect on thrombocytes and Hb. Sex showed significant (p ≤ 0.05) differences for RBCs and PCV at 42 days of age. At different ages, significant effects were observed on histomorphometric parameters of the Japanese quail intestinal tract. It may be inferred that the influence of magnetized water, up to 1 Tesla, was positive on the haematological and histomorphometric parameters of the Japanese quail intestinal tract by augmenting the haematological measurements, which were within a normal range and increasing the surface area of the villus.

Glucometrics in the first week of critical illness and its association with mortality.

OBJECTIVE: Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. DESIGN: Prospective observational study. SETTING: Mixed ICU of teaching hospital. PATIENTS: Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. MAIN VARIABLES OF INTEREST: Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. RESULTS: A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162-178.75), SD 31mg/dL (26-38.75), CV 18.6% (17.1-22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5-1131.5) and TIR 57% (50-67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). CONCLUSIONS: Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections.

Anorectal Malformations and Associated Anomalies in Children.

Anorectal malformations (ARM) incorporate a broad spectrum of diseases, can affect both sexes, and involve the distal anus and rectum as well as the uro-genital tracts. Defects range from the minor which can be treated easily with an excellent outcome, to those are complex and often associated with other anomalies are difficult to manage with poor functional prognosis. This study was done to observe the hospital incidence of Anorectal malformations, frequency of types, sex distribution and spectrum of associations with ARM. The effects of presence of associated anomalies on morbidity and mortality also observed. Detailed history, clinical examinations and relevant investigations were performed for the primary and as well as the associated anomalies. A total of 80 patients were admitted in the department of pediatric surgery in Mymensingh Medical College Hospital during the period of June 2016 to May 2017. Age of the patients was ranging from 1-180 days with the mean age of 0.49±1.002 months. Male: Female ratio was 1.6: 1. Among them 48(60%) were high and 32(40%) were low variety of ARM. In male 37(46.2%) had high and 13(13.7%) were low variety whereas in female 11(13.7%) were high and 19(23.7%) had low ARM. Associated anomalies were seen in 25(31.2%) patient -18 in males and 7 in females; 20 in high and 5 in low ARM. Associated anomalies were uro-genital 11(13.8%), cardiovascular 10(12.5%), vertebral 4(5%), limb defects 3(3.5%) and others 2(2.5%). Four patients have more than one anomaly. Anorectal malformations occur more in boys than girls. Males were more likely to have high lesions and without fistula was the common defect. Low variety ARM were found more in females with Anovestibular fistula is the commonest defect. The most common associated anomalies were recto urinary fistula (13.8%). Associations were more in high than low ARM but not significant (p>0.05). Post operative complications were more in high ARM in both sexes with associated anomalies. The effects of types and associations on morbidity and mortality were significantly different (p<0.05).

The Buffalo study: Outcome and associated predictors in endodontic microsurgery- a cohort study.

AIM: To (i) evaluate and compare the outcome of endodontic microsurgery (EMS) using periapical radiographs (PAs) and cone-beam computed tomography (CBCT) scans; (ii) identify prognostic factors affecting the outcome; and (iii) correlate the effect of guided tissue regeneration (GTR) on the pattern of apical bone remodelling. METHODOLOGY: Eighty-two patients (101 teeth) who received EMS were included and followed-up using clinical and radiographic examinations (PAs and CBCT scans). Two calibrated endodontists evaluated the radiographic healing (favourable or unfavourable) by assessing PAs and CBCT. The success (favourable radiographic outcome with no clinical symptoms) and survival rates (tooth retention without clinical symptoms) were calculated, and the cause of failure (diseased or fractured) was identified. Pre-treatment (age, sex, tooth type, position, sequence of treatment, quality of root canal before surgery, presence/absence of through-and-through lesion, presence/absence apico-marginal defect) and treatment (presence/absence of errors during surgery, type of error (major or minor), retro-preparation depth, presence/absence of an isthmus, retro-filling material used, presence/absence bone graft material and/or resorbable membrane) factors were recorded. Data were analysed statistically to determine the inter-observer, intra-observer and inter-radiographic agreements. Univariate, bivariate and logistic regression analysis were used to determine prognostic factors affecting the outcome and the effect of GTR on the pattern of apical bone remodelling. The significance level was set at 5%. RESULTS: Sixty-eight patients (83 teeth) presented for outcome evaluation (recall rate: 84%). The survival rate was 93%. The success rate was 88% using PA and 86% using CBCT when vertical root fracture (VRF) cases were included and 94% using PAs, and 91% using CBCT when VRF cases were excluded. The intra- and inter-observer agreements were substantial using CBCT, slight to a fair agreement using PA (P < 0.001), and slight to moderate for inter-radiographic agreement. The occurence of a major procedural error during surgery was the only negative predictor for the outcome of EMS (P = 0.013). GTR did not affect the success rate or the type of healing when assessed using PA but it affected the type of healing on CBCT scans (complete vs incomplete healing) and the pattern of cortical plate remodelling (P < 0.001). CONCLUSION: The success and survival rate of endodontic microsurgery was very high, and the occurrence of a major procedural error during surgery was the only factor affecting the outcome. GTR did not improve the outcome, but did affect the quality of apical bone remodelling following EMS.

Clinical endodontic management during the COVID-19 pandemic: a literature review and clinical recommendations.

The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in millions of confirmed cases and hundreds of thousands of deaths. Despite all efforts to contain the spread of the disease, the number of infections and deaths continue to rise, particularly in some regions. Given its presence in the salivary secretions of affected patients, and the presence of many reported asymptomatic cases that have tested positive for COVID-19, dental professionals, including Endodontists, are at high risk of becoming infected if they do not take appropriate precautions. As of today, there are no predictable treatments or approved vaccines that can protect the public and healthcare professionals from the virus; however, there is speculation that a vaccine might be available sometime in 2021. Until then, general dentists and Endodontist will need to be able to treat emergency patients in order to relieve pressure on emergency clinics in hospitals or local community hubs. In addition, as the pandemic continues, strategies to manage patients will need to evolve from a palliative to a more permanent/definitive treatment approach. In this article, an update on the treatment considerations for dental care in general is provided, as well as a discussion on the available endodontic guidelines reported in the literature. Recommendations on clinical management of endodontic emergencies are proposed.

Surface and structural changes in root dentine by various chelating solutions used in regenerative endodontics.

AIM: To evaluate the effects of the prolonged use of various irrigant solutions used during regenerative endodontic procedures on the physical and chemical structure of root canal dentine in extracted human teeth. METHODOLOGY: Sixtyroot dentine samples from extracted, single-rooted, human teeth were assigned to 10 groups. Eight groups were irrigated with 1.5% NaOCl for 5 min, followed by 3%, 10%, 17% EDTA or 10% citric acid (CA) for 5 or 10 min. One group received only NaOCl irrigation, and samples with only distilled water irrigation were used as a control group. The changes in microhardness and flexural strength were determined using Vickers and 3-point flexural tester, respectively. Molecular and elemental compositions were recorded using FTIR and EDS spectroscopy. Data were analysed using one-way anova, Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The application of 1.5% NaOCl for 5 min did not affect the mineral content or microhardness of dentine (P > 0.05). However, it significantly decreased the dentine collagen peak values (P < 0.05), which was similar to the control group after the use of chelating agents (EDTA and 10% of CA) (P > 0.05). The effect of EDTA on the inorganic content was not concentration and time dependent (P > 0.05). CA resulted in a significantly greater reduction in the inorganic contents compared with the control and EDTA groups (P < 0.05). Regardless of the time, EDTA and CA significantly decreased dentine microhardness compared to the control (P < 0.05) with the greatest reduction in the CA groups (P < 0.05). NaOCl alone was associated with the lowest flexural strength, while none of the other irrigation regimens significantly decreased the flexural strength compared to the control group (P> 0.05). CONCLUSIONS: Use of 1.5% NaOCl for 5 min decreased the collagen content of samples of human dentine from extracted teeth while EDTA and 10% citric acid mostly affected the inorganic content and microhardness of dentine surfaces. None of the irrigant solutions significantly decreased the mechanical properties of the entire dentine specimen.

Knowledge and Practice of Nurses on Pediatric Pain Management in Bangladesh.

Among nurses due to inadequate pain management knowledge and practice skills, children's pain is often under treated. This study aimed to examine the level of knowledge and practice on pediatric pain management among nurses in Bangladesh. This was a descriptive survey study involving total 150 clinical pediatric nurses from two Medical College Hospital and a University hospital in Bangladesh. The data collection tool consisted of demographic data form, 32-items nurses' knowledge. There were 32 true and false questions related to nurses' knowledge on pediatric pain management in Bangladesh. The response formats to each item for correct answer was 1 and incorrect answer 0. The total scores were categorized into three levels including low (0-20), moderate (21-23) and high (24 and above). The data collection tool consisted of demographic data form, 19-item practice related questionnaire on pediatric pain management. Nurses' practice on pediatric pain management contained 19 items with 5-points Likert's scale ranging from 1=Never practice to 5=constantly practice. For each item, a score of 5 was accorded for constantly and 1 for never. The score ranged from 19-95. The total scores were categorized into three levels including low (19-38), moderate (39-76) and high (77-95). The results demonstrated that most of the nurses' knowledge score on pediatric pain management was at moderate level (mean=21.50, SD=2.35). Nurses' practice on pediatric pain management was also at moderate level (mean=75.45, SD=8.24). The relationship between nurses' knowledge and practice was not significant. In addition, nurses' knowledge and practice with demographic variables; there was significant relationship between nurse's knowledge and existence of pain management protocol, nurses' practice and their current position in unit and with reading nursing journal. This study showed moderate level of knowledge and practice indicating that they need to be enhanced the knowledge and practice skills in pediatric pain management.

An international survey on the use of calcium silicate-based sealers in non-surgical endodontic treatment.

OBJECTIVES: To gain insight on the current clinical usage of bioceramic root canal sealers (BRCS) by general dental practitioners (GDPs) and endodontic practitioners (EPs) and to determine if BRCS clinical application is in accordance with the best available evidence. MATERIAL AND METHODS: An online questionnaire of 18 questions addressing BRCS was proposed to 2335 dentists via a web-based educational forum. Participants were asked about socio-demographic data, clinical practice with BRCS, and their motivation for using BRCS. Statistical analysis (chi-squared test or Fisher's exact test) was applied, as appropriate, to assess the association between the variable categories (p value < 0.05). RESULTS: The response rate was 28.91%. Among respondents, 94.8% knew BRCS (EPs more than GDPs, p < 0.05) and 51.70% were using BRCS. The primary reason for using BRCS was their belief of its improved properties (87.7%). Among BRCS users, single-cone technique (SCT) was the most employed obturation method (63.3%) which was more applied by GDPs (p < 0.05); EPs utilized more of the thermoplasticized obturation techniques (p < 0.05). A proportion of 38.4% of BRCS users indicated the usage of SCT with BRCS regardless of the root canal anatomy (GDPs more than EPs p < 0.05) and 55.6% considered that BRCS may influence their ability to re-establish apical patency during retreatment (GDPs more than EPs p < 0.05). CONCLUSIONS: This study highlights wide variation in the clinical use of BRCS which is not in accordance with the current literature. CLINICAL RELEVANCE: This inconsistency among EPs and GDPs on BRCS clinical application requires further clarifications to better standardize their use and improve their future evaluation.

Miltefosine Induced Reduced Male Fertility Capacity after Treatment of Post Kala-azar Dermal Leishmaniasis, Bangladesh.

Post Kala-azar Dermal Leishmaniasis (PKDL) is the sequel of visceral leishmaniasis in Indian subcontinent and may appear among patients with or without previous history of visceral leishmaniasis (VL). The aim of the study is to understand the male reproductive safety profile of miltefosine used for the treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in Bangladesh. From January 2017 to March 2017, an exploratory study was carried out on male fertility capacity in Bangladesh among male patients above 14 years old with PKDL treated with miltefosine. Twenty nine male patients were included to observe the effect of miltefosine on reproductive health. All PKDL patients had history of visceral leishmaniasis (VL) in different time periods. Among them three (10.3%) patients were unable to ejaculate semen. In semen analysis, 3 patients (10.3%) were found azoospermia (sperm count & motility- 0, viscosity- good, pH- 7 to 8), microscopically there was presence of RBC (5-15/HPF), WBC (8-15/HPF). Another 3 patients (10.3%) were found oligospermia (sperm count- 4.2 to 15.3 million/ml, motility- 20 to 50%, viscosity- good, pH- 6 to 9, RBC- 4 to 15/HPF, WBC- 4 to 15/HPF). The study documented some important findings in evaluating male infertility and selection of drug regimens in treating PKDL patients with miltefosine for 12 weeks.

Prevalence of Intestinal Parasites in Raw Vegetables Consumed by Inhabitants of Mymensingh City.

Uncooked vegetables are an important part of a healthy diet in different parts of the world. The present descriptive cross sectional type of study was carried out to determine the parasitological contamination of vegetables sold at markets of Mymensingh city of Bangladesh. Parasitological examinations were performed in material derived from 200 specimens of 10 different vegetables to detect intestinal parasites in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2015 to July 2016. Each sample was washed with 5 liter distilled water, then washing fluid was centrifuged and resulting sediment was collected for iodine and normal saline wet mount slide preparation to detect human pathogenic intestinal parasites by microscopic examination. Out of 200 vegetable samples, 123(61.5%) were contaminated with different species of parasites. The vegetables red amaranth had the highest contamination rate of 18/20 (90%) followed by jute leaf 17/20 (85%), coriander leaf 15/20 (75%), onion 14/20 (70%), lady's finger 14/20 (70%), radish 13/20 (65%), green pepper 12/20 (60%), carrot 12/20 (60%), cucumber 5/20 (25%), tomato 3/20 (15%). Among the contaminating parasites Ascaris lumbricoides (egg) 36.5% was the most prevalent followed by Strongyloides stercoralis (larva) 35.5%, Entamoeba histolytica ( trophozoite and different cystic stages) 8.5%, Hook worm (egg and larva) 6.5% , Balantidium coli (trophozoite) 4.0%, Enterobius vermicularis (egg) 3.5%, Trichuris trichiura (egg) 1.5%, Giardia lamblia (cyst) 1.0%. To our knowledge, it was the first base line study pursued in Bangladesh. Contamination of raw vegetables from markets with pathogenic parasites would increase the risk of disease to the population that consumes or works with these products. So improperly washed raw eaten vegetables should be considered a potential risk for contracting parasites, particularly helminthes in Mymensingh city.

Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India.

OBJECTIVE: To evaluate the incidence, risk factors and associated mortality of central line-associated bloodstream infection (CLABSI) in an adult intensive care unit (ICU) in India. DESIGN: This prospective observational study was conducted over a period of 16 months at a tertiary care referral medical center. SETTING: We conducted this study over a period of 16 months at a tertiary care referral medical center. PARTICIPANTS: All patients with a central venous catheter (CVC) for >48 h admitted to the ICU were enrolled. INTERVENTION AND MAIN OUTCOME MEASURES: Patient characteristics included were underlying disease, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) scores and outcome. Statistical analysis of risk factors for their association with mortality was also done. RESULTS: There were 3235 inpatient-days and 2698 catheter-days. About 46 cases of CLABSI were diagnosed during the study period. The overall rate of CLABSI was 17.04 per 1000 catheter-days and 14.21 per 1000 inpatient-days. The median duration of hospitalization was 23.5 days while the median number of days that a CVC was in place was 17.5. The median APACHE II and SOFA scores were 17 and 10, respectively. Klebsiella pneumoniae was the most common organism (n = 22/55, 40%). Immunosuppressed state and duration of central line more than 10 days were significant factors for developing CLABSI. SOFA and APACHE II scores showed a tendency towards significance for mortality. CONCLUSIONS: Our results underscore the need for strict institutional infection control measures. Regular training module for doctors and nurses for catheter insertion and maintenance with a checklist on nurses' chart for site inspection and alerts in all shifts are some measures planned at our center.

PO-42 - A novel approach to a common problem: after-hours care of cancer patients diagnosed with VTE.

INTRODUCTION: Oncologists often receive phone calls from radiologists after regular working hours or while on call, informing them that a cancer patient has been diagnosed with a blood clot. In these situations, there may not be nursing staff available to contact the patient and provide teaching for Low Molecular Weight Heparin (LMWH) injections. As a result, patients are often sent to the emergency for injection and teaching, taxing an already overburdened emergency department. This problem constitutes an important care gap. AIM: In Alberta, Canada, pharmacists are able to prescribe medications including LMWH. We designed an after-hours program to provide care for cancer patients diagnosed with VTE. MATERIALS AND METHODS: Once the oncologist is made aware of the patient with a clot, a simple one page document is filled out and faxed to a 24-hour outpatient pharmacy outlining the following: patient demographics, clot location, systemic therapy, current anticoagulant and anti-platelet agents. The oncologist has the option to specify desired LMWH. The patient goes to the pharmacy where the pharmacist weighs the patient, reviews blood work electronically and prescribes the LMWH. Also provided are injection teaching and telephone follow-up. A specific algorithm is followed with the pharmacist able to contact the on call oncologist in specific situations where the patient's condition falls outside of the algorithm guideline. The pharmacist is able to order blood work, particularly to evaluate for Heparin Induced Thrombocytopenia. Patients must follow up with their oncologist within 7 days of diagnosis. RESULTS: This program has been run as a pilot and preliminary data will be presented at the ICTHIC meeting. Specifically, we will assess usage of the program, appropriateness of therapy chosen according to Canadian practice guidelines, as well as patient, pharmacist and physician satisfaction with the program. CONCLUSIONS: We believe that this outpatient pharmacy program is innovative, will decrease burden on emergency departments, and takes advantage of our pharmacists' ability to independently assess patients and write prescriptions. This program may serve as a model for other cancer centers looking for a novel way to provide after-hours care of patients diagnosed with VTE.

Socio-cultural and Knowledge-Based Barriers to Tuberculosis Diagnosis for Women in Bhopal, India.

BACKGROUND: In India, only one woman is diagnosed with tuberculosis (TB) for every 2.4 men. Previous studies have indicated gender disparities in care-seeking behavior and TB diagnosis; however, little is known about the specific barriers women face. OBJECTIVES: This study aimed to characterize socio-cultural and knowledge-based barriers that affected TB diagnosis for women in Bhopal, India. MATERIALS AND METHODS: In-depth interviews were conducted with 13 affected women and 6 health-care workers. The Bhopal Diagnostic Microscopy Laboratory Register (n = 121) and the Bhopal district report (n = 261) were examined for diagnostic and care-seeking trends. RESULTS: Women, especially younger women, faced socio-cultural barriers and stigma, causing many to hide their symptoms. Older women had little awareness about TB. Women often sought treatment from private practitioners, resulting in delayed diagnosis. CONCLUSIONS: Understanding these diagnostic and help-seeking behaviors barriers for women is critical for development of a gender-sensitive TB control program.

The Tennessee study: factors affecting treatment outcome and healing time following nonsurgical root canal treatment.

AIM: To determine factors that may influence treatment outcome and healing time following root canal treatment. METHODOLOGY: Root filled and restored teeth by pre-doctoral students were included in this study. Teeth/roots were followed-up regularly, and treatment outcome was evaluated at every follow-up appointment (healed, healing, uncertain or unsatisfactory). Host (age, immune condition, pulp/periapical diagnosis, tooth/root type, location and anatomy) and treatment factors (master apical file size, apical extension, voids and density of root filling) were recorded from patient dental records. Univariate, bivariate and multivariate analyses were performed to determine the impact of the factors on treatment outcomes and healing times. RESULTS: A total of 422 roots from 291 teeth met the inclusion criteria with a mean follow-up period of 2 years. The preoperative pulp condition, procedural errors during treatment, apical extension and density of root fillings significantly affected the treatment outcome. The average time required for a periapical lesion to heal was 11.78 months. The healing time increased in patients with compromised healing, patients older than 40 years, roots with Weine type II root canal systems, root canal systems prepared to a master apical file size <35, and roots with overextended fillings (P < 0.1). CONCLUSION: Multiple host and treatment factors affected the healing time and outcome of root canal treatment. Follow-up protocols should consider these factors before concluding the treatment outcome: patient's age, immune condition, as well as roots with overextended fillings, root canal systems with smaller apical preparations (size <35) or roots with complex canal systems. Intervention may be recommended if the treatment quality was inadequate or if patients became symptomatic.

Vitamin E attenuates neurotoxicity induced by deltamethrin in rats.

BACKGROUND: The safety of Deltamethrin (DM) has been raised as a point of concern. The current investigation was envisaged to explore the responsiveness of oxidative stress parameters, DNA fragmentation and expression levels of TP53, cycloxygenase 2 (COX2) and cytochrome p4502E1 (CYP2E1) as toxicological endpoint in rats treated with DM. as well as attention was provided to the neuroprotective effect of vitamin E (VE). METHODS: Four different groups of rats were used in this study, group I served as control, group II received DM (0.6 mg/kg BW), group III received both DM plus VE and finally group IV received VE only (200 mg/kg BW). The treatment regimen was extending for one month for all groups and the brain tissues were collected for further analysis. RESULTS: The obtained results showed a highly statistically significant increase in lipid peroxidation (LPO) content, nitric oxide concentration, and DNA fragmentation percentage and expression level of CYP2E1, TP53 and COX2 genes, in addition statistical significant reduction in total antioxidant capacity in DM treated group as compared to control were detected. Oral administration of VE attenuated the neurotoxic effects of DM through improvement of oxidative status, DNA fragmentation percentage and suppressing the expression level of CYP2E1, TP53 and COX2 genes. CONCLUSION: From this study we concluded that VE supplementation has beneficial impacts on DM neurotoxicity in rats through its antioxidant and antiapoptotic properties.

Improving manual vacuum aspiration service delivery, introducing misoprostol for cases of incomplete abortion, and strengthening postabortion contraception in Bangladesh.

The Obstetrical and Gynaecological Society of Bangladesh was an important advocate in mobilizing government authorities to adopt new techniques for postabortion care and provide long-acting contraceptives post abortion. With the support of the International Federation of Gynecology and Obstetrics (FIGO), the Society provided commodities and training to increase the use of these techniques in 7 private and public hospitals and clinics. Data from two of these institutes for the January 2012 to June 2013 period showed a rapid decrease in the use of dilation and curettage, an increase in the use of manual vacuum aspiration (MVA) and misoprostol, and the progressive adoption of long-acting reversible contraceptives, permanent contraception, and injectable contraceptives in one of these two hospitals. The Directorates General of Health and Family Planning incorporated training in the use of MVA and misoprostol in their national operation plans. The success in these hospitals shows that the proposed changes have been well accepted by providers and clients.