Oral impacts on daily performance: Validity, reliability and prevalence estimates among Indian adolescents.

BACKGROUND: Dental diseases negatively influence people's oral health-related quality of life and thus their perceived need for dental care. OBJECTIVES: To test the validity and reliability of an Indian version of Oral Impacts on Daily Performance (OIDP) index for college students and to identify age and sex-specific OIDP prevalence estimates. METHODS: Cross-sectional descriptive survey was conducted among 800 professional and non-professional bachelor degree college students of Udaipur, India aged between 17 and 24 years. Oral health-related quality of life among the college students was assessed through OIDP, tested for validity and reliability and then prevalence rates were estimated. Chi square test was employed for statistical analysis. Cronbach's alpha was found to be 0.82. RESULTS: Sixty percent subjects reported at least one oral impact in last 6 months with overall mean OIDP score of 2.49±3.92. The most commonly affected performances were cleaning teeth (24%) and eating (12%). A significant association in oral impacts on daily performances among college students was observed with age (P=.001) but not with gender (P=.053). CONCLUSIONS: The validity and reliability of OIDP and also the prevalence of oral health-related impacts were found to be high. OIDP index showed acceptable psychometric properties in the context of an oral health survey among Indian college students.

Real vs simulated umbilical cords for emergency umbilical catheterization training: a randomized crossover study.

OBJECTIVE: To measure performance, fidelity and preference of two emergency umbilical vessel catheter (eUVC) simulation models. STUDY DESIGN: A randomized crossover trial of senior pediatric residents randomized to place an eUVC first using a real cord (RC) or simulated cord (SC), and then place an eUVC using the other model. The eUVC placement times were recorded and analyzed. Subjects rated physical and functional fidelity and preference for each model. RESULTS: The eUVC placement time (mean±s.d. s) was slower in RC vs SC (153 s ±71 vs 88 s ±35, P<0.001), however, there was no difference in eUVC placement time in the group that worked with SC first (115 s ±36 vs 97 s ±35, P=0.161). Physical and functional fidelity of RC were rated higher than SC (P<0.001), and RC were preferred. CONCLUSION: RC has higher physical and functional fidelity, and are preferred for training by pediatric residents, despite longer placement times.

Epidemiological and survival analysis of triple-negative breast cancer cases in a retrospective multicenter study.

INTRODUCTION: This is a retrospective study with data collected from breast cancer cases from five major Apollo Hospitals across India, as part of a biobanking process. One aspect of our study focused specifically on data from triple-negative breast cancer (TNBC) cases. The aim of this study was to analyze epidemiology, treatment options, and survival of the patients with TNBC. Our goal was to draw conclusions on the preponderance of the disease and also to understand the outcomes using the existing therapy options. MATERIALS AND METHODS: Data were collected after due ethical clearances and were coded with regard to patient identifiers to protect patient privacy. Data were not only from the various departments of the respective hospitals and the treating physicians but also from the follow-up made by hospital staff and social workers. RESULTS: About 20% of all cases of breast cancer comprised TNBC. Although the disease is generally thought to be an early onset disease, there was no major difference in the median age of diagnosis of TNBC compared to other breast cancer cases. More than 85% of the TNBC cases were of early stage disease with <4% of the cases of metastatic cancer. Data on follow-up were somewhat sporadic as a good number of cases were lost to follow-up, but from the available data, recurrence rate was about 11%. Death, when it occurred, was mostly in the early periods of treatment with 35% of the events occurring before 3 years. The overall survival rates beyond 3 years were more than 86%. CONCLUSIONS: Data and sample collection are an ongoing process, so we expect this data set to be enriched with more cases and longer duration of follow-up in a year. Preliminary analysis sheds light on the potential of such a collection both for understanding the epidemiology of the disease and also for conducting future studies with an eye toward improving treatment outcomes.

Familial Hypodontia: A Case Series.

The phenomenon of congenitally missing teeth has been described with different names: hypodontia, oligodontia, anodontia, congenitally missing teeth and dental agenesis. The present paper reports familial hypodontia, involving two siblings from a single family. Case I reported the absence of 18, 12, 22 and 31 teeth whereas case II reported the absence of 31 and 41. On the evaluation of the two reported cases that were offspring of same parents and absence of any clinical features associated with any syndrome the final diagnosis of non- syndromic familial hypodontia was made. Both the cases presented agenesis of the teeth leading to malocclusion and aesthetic disturbances. Cases were offered a treatment of interdisciplinary dental approach.

A randomised comparison of lidocaine 2% gel and proparacaine 0.5% eye drops in paediatric squint surgery.

We conducted a randomised trial comparing lidocaine 2% gel with proparacaine 0.5% eye drops in children having elective squint surgery. One hundred and forty children aged between 3 and 14 years were recruited. The requirement for intra-operative fentanyl and postoperative ibuprofen was significantly less in the lidocaine group compared with the proparacaine group (1 (1.7%) vs 12 (18.5%), p=0.002 and 16 (27.6%) 38 (58.5%), p=0.001, respectively). The incidence of postoperative nausea and vomiting was significantly less in the lidocaine group compared with the proparacaine group (6 (10.3%) vs 16 (24.6%), p=0.04). There were no differences between the groups in terms of incidence and severity of the oculocardiac reflex. We conclude that, compared with proparacaine 0.5% eye drops, a single application of lidocaine 2% gel improves peri-operative analgesia and reduces the incidence of postoperative nausea and vomiting in elective paediatric squint surgery.

Standardisation of neonatal clinical practice.

The International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ) is a large-scale, population-based, multicentre project involving health institutions from eight geographically diverse countries, which aims to assess fetal, newborn and preterm growth under optimal conditions. Given the multicentre nature of the project and the expected number of preterm births, it is vital that all centres follow the same standardised clinical care protocols to assess and manage preterm infants, so as to ensure maximum validity of the resulting standards as indicators of growth and nutrition with minimal confounding. Moreover, it is well known that evidence-based clinical practice guidelines can reduce the delivery of inappropriate care and support the introduction of new knowledge into clinical practice. The INTERGROWTH-21(st) Neonatal Group produced an operations manual, which reflects the consensus reached by members of the group regarding standardised definitions of neonatal morbidities and the minimum standards of care to be provided by all centres taking part in the project. The operational definitions and summary management protocols were developed by consensus through a Delphi process based on systematic reviews of relevant guidelines and management protocols by authoritative bodies. This paper describes the process of developing the Basic Neonatal Care Manual, as well as the morbidity definitions and standardised neonatal care protocols applied across all the INTERGROWTH-21(st) participating centres. Finally, thoughts about implementation strategies are presented.

[Meningiomas. Clinical case examples]. / Meningeome. Klinische Beispiele.

Using four case reports as examples the best treatment is discussed by considering the specific history and magnetic resonance imaging (MRI) findings. In many cases different therapeutic alternatives are possible for treatment of meningiomas.

Oral health promoting factors: a preliminary survey on knowledge, attitude and practise among caregivers in Udaipur, India.

AIM: To assess the level and determine the relationship between knowledge, attitudes and practices related to oral health promoting factors among secondary caregivers attending day-care centres. STUDY DESIGN: A cross-sectional descriptive survey. METHODS: A survey was conducted among 110 caregivers in Udaipur. Data were collected through self-administered questionnaire addressing aspects of knowledge, attitudes and practises of oral health promoting factors in children. RESULTS: Caregivers age, education and duration of employment were significantly associated with knowledge, attitude and practise scores (p ≤ 0.05). Primary job option and number of children under care were significantly associated with practise scores. A positive relationship was found between the average knowledge, attitude and practise scores of respondents, but this was not statistically significant (p ≥ 0.05). STATISTICS: General Linear Model (GLM) with Bonferroni post hoc was used for statistical analysis. CONCLUSION: Good understanding of caregiver knowledge and attitude is essential for oral health promotion efforts to be effective.

[Radiological diagnostics of meningiomas]. / Radiologische Diagnostik von Meningeomen.

Magnetic resonance imaging (MRI) is the method of choice for the diagnosis of sphenoid wing meningiomas. The close relationship situation to vascular and neural structures especially at the skull base can best be assessed with MRI. With a typical configuration and extent the diagnosis of meningiomas can be made on visual examination and MRI is also the standard imaging technique for follow-up of treated and asymptomatic meningiomas. In the preoperative evaluation, computed tomography is a complementary examination technique which can demonstrate the extent and type of bone involvement more precisely. This additional information is important to differentiate meningiomas from differential diagnoses, such as metastases, sarcomas, and primary osseous changes, such as fibrous dysplasia or Paget's disease. Positron emission tomography computed tomography (PET-CT) and PET-MRI are also supplemental examination procedures which can be used for determining tumor volume before a planned radiotherapy and can be helpful in the diagnosis of atypical meningiomas due to the selective binding of the tracer DOTATOC. Conventional angiography is only rarely used preoperatively.

Isolation and characterization of an atrazine-degrading Rhodococcus sp. strain MB-P1 from contaminated soil.

AIMS: The aim of this study is to isolate and characterize organisms capable of utilizing high concentration atrazine from the contaminated sites. METHODS AND RESULTS: A selective enrichment was used for isolating atrazine-degrading organisms from the contaminated sites resulting in isolation of an efficient atrazine-degrading organism designated as strain MB-P1. On the basis of 16S rRNA gene sequencing, total cellular fatty acid analysis and physiological and biochemical tests, strain MB-P1 was identified as a member of genus Rhodococcus. High performance liquid chromatography was performed to identify the atrazine degradation intermediates demonstrating that the degradation proceeds via formation of 'de-ethylatrazine' and 'de-isopropylatrazine'. Further, plasmid curing by SDS method showed atrazine-degrading gene(s) to be plasmid-encoded. CONCLUSIONS: We have successfully isolated a Rhodococcus sp. strain MB-P1 which is capable of utilizing atrazine as sole source of carbon and energy at very high concentrations of 1000 ppm. The pathway for degradation of atrazine has also been determined. The metabolic gene(s) responsible for atrazine degradation was found to be plasmid-encoded. SIGNIFICANCE AND IMPACT OF THE STUDY: Rhodococcus sp. strain MB-P1 could be used as an ideal model system for in-situ degradation and restoration of ecological niches which are heavily contaminated with atrazine.

Interferon-alpha--a new therapeutic option in refractory juvenile Behçet's disease with CNS involvement.

OBJECTIVE: To report the successful treatment with recombinant human IFN- alpha 2a (rhIFN-alpha2a) in two male adolescents suffering from severe treatment-resistant Behçet's disease (BD) with central nervous system (CNS) involvement. METHODS: The patients were 14- and 15-yrs old. Both met the International Study Group for Behçet's disease, O'Duffy and the Japanese criteria for the classification or diagnosis of BD. Signs of CNS involvement were impaired sensorimotor function of the left arm, hemiparesis of right arm and leg, dizziness and walking instability in Patient 1, weakness of both legs, impaired bladder-, bowel- and sexual function in Patient 2 and vasculitic lesions on cranial MRI in both patients. RhIFN-alpha2a was administered initially at 3 million IU/day for 4 weeks followed by 3 x 3 million IU/week. RESULTS: Complete remission was achieved in Patient 1 (reduction in BD activity score from 17 to 2). Patient 2 experienced remarkable improvement (reduction of BD activity score from 23 to 15). In both patients the MRI lesions improved. Patient 2 had mild flu-like symptoms as adverse effect. CONCLUSION: RhIFN-alpha2a was effective and well tolerated in these juvenile patients with severe neurological BD. Regarding the serious consequences following ocular and CNS affection and adverse effects of steroid dependency, administration of rhIFN-alpha2a at an earlier time point needs to be considered.

Distal radius fracture management in the emergency departments in UK: are we doing enough?

The objective of this study was to ascertain knowledge of the normal anatomy and appreciation of components of an 'adequate' or 'acceptable' reduction by the medical staff responsible for management of distal radius fractures in the emergency departments (A&E) in UK. A nationwide structured questionnaire survey based on literature review was performed on 138 doctors. Of the 100 (72%) respondents, only 40% could cite the correct values for volar tilt, radial inclination and ulnar variance, there being a significant difference between orthopaedic, n = 16 (64%) and A&E staff, n = 24 (32%); p = 0.031; chi(2) = 12.17. Only 18% respondents were aware of the acceptable ranges of adequate reduction; with orthopaedic staff, n = 12 (48%) being more aware than A&E staff, n = 6 (8%); p = 0.002; chi(2) = 6.38. Only 19% formally measure the key parameters before decision making (52% orthopaedic vs. 8% A&E staff; p = 0.018; chi(2) = 7.31). Only 14% of respondents from hospitals equipped with picture archive navigation system stated that they used the angle measurement function.A lack of knowledge of the normal anatomical values and implementation of generally accepted measurement criteria predictive of fractures unlikely to benefit from repeat manipulations is evident. It is important to emphasise the influence of factors reported to affect stability such as age, functional demands of the patient and extent of initial fracture displacement in decision making. The introduction of a set of guidelines and further education of the medical staff could reduce the number of inappropriately treated distal radial fractures in the A&E setting with significant economic implications.

A new in-vitro agglutination technique for potency estimation of antisnake venom serum (ASVS).

Traditionally the potency of ASVS is assayed quantitatively by in-vivo neutralization test for lethality in mice. A sensitive and simple in-vitro agglutination assay for the quantitative determination of Antisnake Venom Serum (ASVS) potency is reported. The method is rapid, cheap, simple, economical and above all does not require the use of experimental animals for potency assay of in process, unpurified and purified sera batches. Among in-vitro procedures, agglutination assay was favored in comparison to flocculation as the later was found to give variable results and also time consuming (high Kf value). Before application, the method was standardized and validated for choice and concentration of particulate material (latex vs. bentonite), temperature and optimum antiserum concentration. It is well known fact that venoms lose toxicity on dilution however this study demonstrated that the bentonite adsorbed venoms of the entire four snake species viz., Cobra, Krait, Russell's viper and Echis are stable even up to 30 days of storage. Among five lots each of unpurified serum, unprocessed plasma and purified sera tested, the results were found comparable with universally accepted in-vivo biological assay. The coefficient of correlation was found to be near 1.0 within 95% fiducial limits of acceptance and also significantly less variation was observed in the mean potency values and standard deviations. For all results p value was observed to be <0.01. Results indicate that in-vitro agglutination assay is suitable and can be used for potency estimation of in process as well as unpurified and purified ASVS batches.

Detection of acute thalamo-mesencephalic infarction: diffusion abnormality precedes T2 hyperintensity.

OBJECTIVE: To examine the time course of signal changes in diffusion-weighted magnetic resonance imaging (DW-MRI) and T2-weighted MRI in a case of cerebral infarction in the posterior circulation territory. MATERIALS AND METHODS: Diffusion- and T2-weighted MRI and comparison of signal changes in these sequences at 4 h, 1 day and 4 days after the onset of clinical symptoms caused by acute thalamo-mesencephalic infarction. RESULTS: Four hours after the onset of symptoms, signal changes in DW-MRI revealed an infarction in the territory of the posterior perforating thalamic artery, whereas no signal changes were detected in T2-weighted MRI. In follow-up MRI 1 and 4 days after infarction, however, a marked hyperintensity matching the location of the diffusion deficit could be identified in T2 images. CONCLUSION: Signal changes in DW-MRI precede T2 hyperintensity after infarction in the posterior circulation territory after hemispheric infarction.

MRI features of primary, secondary and metastatic medulloblastoma.

Medulloblastoma is the most frequent paediatric malignant brain tumour. The purpose of this study was to define imaging characteristics and contrast uptake patterns of primary and recurrent medulloblastoma using MRI. The MRI examinations of 17 histologically proven cases of medulloblastoma diagnosed in our institution (13 males and 4 females; mean age 13 years, 7 months) were reviewed in retrospect. Only patients with pre-treatment and follow-up examinations including T2-weighted images (fluid-attenuated inversion recovery or turbo spin echo) and T1-weighted images after contrast injection (0.1 mmol/kg Gd-DTPA) were included in this study. Whereas 6 of 7 tumours ( n=17) were hyperintense on T2-weighted images, contrast enhancement was detected in 13 patients. Fifteen tumours occurred in the cerebellar vermis, two were located in the cerebellar hemispheres. Mean size at the time of presentation was 30.1 mm. All patients presented with some extent of an occlusive hydrocephalus. Local recurrent tumour or metastases were seen in 6 patients (3 months to 7 years, mean age 2.5 years). Whereas the T2 signal intensity of recurrent tumour or subarachnoidal metastases resembled the primary neoplasms, the contrast uptake tended to be less pronounced ( n=3) or was completely absent ( n=2); thus, suggestive signs of primary medulloblastoma are location in the vermis, hyperintensity on T2-weighted images and hydrocephalus. The amount of contrast enhancement is variable and nonspecific. Secondary medulloblastoma manifestation is characterized by T2 hyperintensity but not by contrast uptake.

Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair.

BACKGROUND AND OBJECTIVES: Femoral nerve block is effective in reducing postoperative pain after inpatient knee surgery. We studied its efficacy compared with standard analgesia following outpatient anterior cruciate ligament repair, including the duration of analgesia and the effect of different concentrations of bupivacaine. METHODS: After Institutional Review Board approval and informed consent, we prospectively randomized patients to receive, in a blinded fashion, either a sham block, a femoral nerve block with 25 mL 0.25% bupivacaine, or with 25 mL 0.5% bupivacaine after anterior cruciate ligament repair under epidural anesthesia. Verbal analog pain scores were evaluated by a blinded observer at 20 and 40 minutes after injection. Patients with pain >4 (out of 10) were assessed for the presence of a block and offered a supplemental block if no anesthesia was present at either evaluation. By prospective agreement, any study group with 6 failures was excluded from further recruitment. After discharge, patients recorded pain scores and analgesic consumption in a diary, and estimated the time at which they perceived that analgesia and sensory block from the femoral nerve block resolved, based on an increase in pain, sensation, and strength in the leg. RESULTS: In the sham block group, 6 of 12 patients reported inadequate analgesia in the postanesthesia care unit (4 at 20 minutes, 2 at 40 minutes; greater than other groups, P <.003) and were excluded from further study. Patients with sham blocks had higher pain scores 20 minutes after the block, and requested intravenous analgesia more often. Bupivacaine 0.25% and 0.5% provided 23.2 +/- 7 and 25.7 +/- 11 hours of analgesia, respectively. CONCLUSIONS: Femoral nerve block with 0.25% bupivacaine contributes significantly to multimodal postoperative analgesia in the immediate postoperative period following outpatient anterior cruciate ligament repair. Both doses of bupivacaine studied provided analgesia for the first night after surgery.

HIV type 1 envelope subtype C sequences from recent seroconverters in Zimbabwe.

HIV-1 envelope sequence patterns have implications for virus cell tropism and for the development of an effective vaccine. To identify the sequence characteristics of recently transmitted HIV-1 isolates in southern Africa, we sequenced the V3-V5 envelope regions of 24 male seroconverters in Harare, Zimbabwe. Each of the sequences clustered with previously reported subtype C isolates and there was a mean 17% intersequence pairwise genetic distance between the Zimbabwean isolates. Three isolates were syncytium inducing (SI). One of the SI isolates had an unusual GIGK crown and a deletion at codon 23; one had the codon 23 deletion alone; and one had a high net positive charge in the V3 loop. The extensive genetic diversity within the envelope of subtype C HIV-1 isolates must be considered in vaccine development. Further analysis of subtype C SI isolates and site-directed mutagenesis experiments are required to determine the molecular basis of SI activity in global HIV-1 isolates.

Procaine compared with lidocaine for incidence of transient neurologic symptoms.

BACKGROUND AND OBJECTIVES: Transient neurologic symptoms (TNS) have been reported to occur after 16% to 40% of ambulatory lidocaine spinal anesthetics. Patient discomfort and the possibility of underlying lidocaine neurotoxicity have prompted a search for alternative local anesthetic agents. We compared the incidence of TNS with procaine or lidocaine spinal anesthesia in a 2:1 dose ratio. METHODS: Seventy outpatients undergoing knee arthroscopy were blindly randomized to receive either 100 mg hyperbaric procaine or 50 mg hyperbaric lidocaine. An interview by a blinded investigator established the presence or absence of TNS, defined as pain in the buttocks or lower extremities beginning within 24 hours of surgery. Onset of sensory and motor block, patient discomfort, supplemental anesthetics, and side effects were recorded by the unblinded managing anesthesia team. Anesthetic adequacy was determined from these data by a single blinded investigator. Hospital discharge time was recorded from the patient record. Groups were compared using appropriate statistics with a P < .05 considered significant. RESULTS: TNS occurred in 6% of procaine patients versus 31% of lidocaine patients (P = .007). Sensory block with procaine and lidocaine was similar, while motor block was decreased with procaine (P < .05). A trend toward a higher rate of block inadequacy (17% v 3%, P = .11) and intraoperative nausea (17% v 3%, P = .11) occurred with procaine. Average hospital discharge time with procaine was increased by 29 minutes (P < .05). CONCLUSIONS: The incidence of TNS was substantially lower with procaine than with lidocaine. However, procaine resulted in a lower overall quality of anesthesia and a prolonged average discharge time. If the shortfalls of procaine as studied can be overcome, it may provide a suitable alternative to lidocaine for outpatient spinal anesthesia to minimize the risk of TNS.

Small incision nonendoscopic browlift.

PURPOSE: To determine the efficacy of a nonendoscopic brow/forehead lift. METHODS: Case series of 12 patients. Small scalp and upper eyelid blepharoplasty incisions were used to elevate the brows/forehead and perform protractor myectomy. RESULTS: All patients achieved an aesthetically pleasing eyebrow and forehead lift with reduction of vertical and horizontal glabellar creases. Complications included one patient who experienced prolonged ecchymosis after corrugator muscle resection and one patient who had asymmetric lid folds after surgery. The length of follow-up ranged from 9 to 35 months. CONCLUSIONS: The small incision nonendoscopic browlift technique provides a useful alternative to the endoscopic approach.