Assessment of pressure injury knowledge using PZ-PUKT questionnaire among Indian nurses and the evaluation of impact of an educational intervention on the knowledge scores: A quasi-experimental study.

AIM: To determine the knowledge of pressure injury among Indian nurses using PZ-PUKT questionnaire and to evaluate the effect of an educational intervention on knowledge scores. MATERIALS AND METHODS: A Quasi-experimental study design was used to test the Pressure injury knowledge of 273 nurses in a tertiary care teaching hospital. The Pieper Zulkowski Pressure Ulcer Knowledge Test questionnaire was given as a pre-test prior to education session and re-administered after the activity was completed. RESULTS: The mean score of the pre-test was 48.58 ± 6.75 (C·I 47.8-49.4) and post-test 54.14 ± 7.69 (C·I 53.3-55.1), which showed a statistically significant improvement. In the pre-test, nurses had highest score in the prevention subset while wound subset had the greatest improvement in the post-test. Female participants had a better understanding about Pressure injuries when compared to males. Also, the Assistant Nursing Superintendents and ward in Charge nurses had better knowledge as compared with other nurses. CONCLUSIONS: The knowledge of pressure injury among nurses is limited. Knowledge deficits should be identified and targeted educational interventions should be administered to all the nurses irrespective of their educational level and work experience. Wound certification courses should be instituted so that it gives the nurses a better opportunity to learn about pressure injuries at a certified level. All nurses should undergo periodic training in this ever-evolving field so as to provide the best care to their patients.

A Simple and Cost-effective Approach to Make a Modified Suture Anchor in Orthopaedics.

The purpose of this study is to describe a technique of using an affordable suture anchor for various soft tissue repairs of both upper and lower limb surgeries in our series of patients. Eighteen patients with minimum 1-year follow-up after various upper limb surgeries using modified suture anchor were assessed both clinically and radiographically. In all 18 cases, the purpose of the suture anchor was served in terms of attachment of ligament or the tendon. There was no incidence of breakage of suture material or loosening of the implant seen during the insertion. There were no complications related to the implant noted. This novel technique turns a simple screw and suture material into an efficient suture anchor while saving time, being quick, easy, affordable and repeatable. Level of Evidence: Level V (Therapeutic).

Analysis of the carbide precipitation and microstructural evolution in HCCI as a function of the heating rate and destabilization temperature.

Microstructural modification of high chromium cast irons (HCCI) through the precipitation of secondary carbides (SC) during destabilization treatments is essential for improving their tribological response. However, there is not a clear consensus about the first stages of the SC precipitation and how both the heating rate (HR) and destabilization temperature can affect the nucleation and growth of SC. The present work shows the microstructural evolution, with a special focus on the SC precipitation, in a HCCI (26 wt% Cr) during heating up to 800, 900, and 980 °C. It was seen that the HR is the most dominant factor influencing the SC precipitation as well as the matrix transformation in the studied experimental conditions. Finally, this work reports for first time in a systematic manner, the precipitation of SC during heating of the HCCI, providing a further understanding on the early stages of the SC precipitation and the associated microstructural modifications.

Safe sites for buccal shelf bone screw placement in various skeletal malocclusions: A CBCT study.

INTRODUCTION: The mandibular buccal shelf area is an extra-alveolar anchorage site that has high quality and quantity of bone, provides biomechanical benefits and has low failure rates. It is essential to place the implant in the region of bone with optimal thickness. The aim of this study was to determine the suitable site of the mandibular buccal shelf for bone screw insertion at 90 degrees and 30 degrees angles of insertion and various heights, angulations, areas of the buccal shelf in prognathic and retrognathic mandibles, and vertical and horizontal growth patterns. METHODS: In this retrospective study, we evaluated the cone-beam computed tomography (CBCT) images of 48 patients in the age range of 18-30 years, divided into four groups. Seven sectional sites were examined at 3, 5, and 7 mm from the alveolar crest at 90 degrees and 30 degrees. The angulation and area of the buccal shelf were examined. RESULTS: Cortical bone thickness increased distally from the first to the second molar in all four groups. CONCLUSIONS: The preferred site for buccal shelf implant placement was distal to the mandibular second molar. The maximum amount of cortical bone was observed distal to the second molar, 7 mm vertically from the alveolar crest, when the buccal shelf implant was placed at 30 degrees angulation to the long axis of the tooth.

Comparative evaluation of dermatoglyphic patterns between skeletal class I and skeletal class III malocclusion.

Background: Dermatoglyphics is the study of various dermal configurations on the fingers, palms, and soles. These appear during the 12th week of intrauterine life and develop completely by the 24th week. It is said that they remain constant thereafter. The aim of the present study was to compare and assess the association of dermatoglyphic patterns between skeletal class I and skeletal class III malocclusion. Methods: Finger and palm prints were collected using the ink and roller method from 604 subjects who were divided into skeletal class I, class III with maxillary retrognathism and class III with mandibular prognathism based on lateral cephalogram assessment. Results: Loop pattern was more predominant in skeletal class I malocclusion subjects and whorl pattern was more frequent in the other two groups. Total finger ridge count and atd angle also showed significant difference between the study groups. Conclusions: The present study attempted in assessing the association between dermatoglyphic patterns and skeletal malocclusion. Analysing dermal configurations may aid in indicating the type of developing malocclusion and thus help in interceptive and preventive orthodontics.

Association between dermatoglyphic patterns and growth patterns of subjects with skeletal class I relation: A cross sectional study.

Background: To assess the relationship between dermatoglyphic patterns and various growth patterns of the mandible. Methods: Patients with Class I Skeletal relation were selected after clinical diagnosis followed by digitally tracing the cephalogram. The patients were subdivided into three groups of mandibular divergence patterns ie Average, Horizontal and Vertical. 90 samples ie 30 in each group were selected for the study. The fingerprints of all the selected subjects were then extracted digitally and analysed for the most dominant pattern in each hand. Results: For the left hand, there was a statistically significant (P<0.05) association between fingerprint pattern and growth pattern when Horizontal growers were compared to Average and Vertical Growers. For the right hand, there was a statistically significant (P<0.05) association between fingerprint pattern and growth pattern when Horizontal growers were compared to Average Growers. A significant association (P<0.05) between fingerprint pattern and growth pattern was also found when average growers were compared to vertical growers. Conclusions: Horizontal growers had 80% frequency of appearance of whorls in their left hand and 67% in their right hand. Horizontal growers could easily be differentiated from the average and vertical growers because of the dominance of whorl pattern in their hands. Composite and arch pattern were more frequent in vertical growers when compared to horizontal and average growers.

'Comparison and correlation of the maxillary sinus dimensions in various craniofacial patterns: A CBCT Study'.

Background: To compare and correlate the maxillary sinus dimensions and basal bone height among various facial patterns using CBCT for advanced diagnosis and treatment planning in Orthodontics. Methods: 66 CBCT images within age group of 18-30 years were divided into horizontal (Group 1), average (Group 2) and vertical (Group 3) facial growth patterns. Maxillary sinus dimensions were compared and correlated in all three groups. The sinus height and basal bone height were recorded at 3 locations-between 1 st premolar and 2 nd premolar (PM1-PM2), between 2 nd premolar and 1 st Molar (PM2-M1) and between 1 st and 2 nd molar (M1-M2). Results: Overall reduction in sinus height and significantly reduced sinus volume was seen in Group-1. Longest maxillary sinus height in M1-M2 region and shortest in PM1-PM2 region was seen in Group-3. The basal bone height in PM1-PM2 region was significantly longer in Group-3 than in Group-1(p<.05).Shortest basal bone height in M1-M2 region was seen in Group-3. A significant negative correlation was seen between the maxillary sinus height and the basal bone height in Group-1 and Group-3(p<.05). Conclusion: There is a correlation between the maxillary sinus height and basal bone height with that of facial pattern which needs to be considered during orthodontic treatment planning and while carrying out facial growth modification procedures in younger patients.

A Multicultural Demographic Study to Analyze Antibiotic Prescription Practices and the Need for Continuing Education in Dentistry.

OBJECTIVES: The objective of the study was to understand and analyze the prescription patterns of dentists across various demographic locations for managing oral infections and pain with antibiotics and explore the evidence-based practices by clinicians as well as the need for further education. Materials and methods. This cross-sectional study was carried out using an online questionnaire framed to explore the knowledge, attitude, and practices among dentists with varying levels of experience and qualifications, regarding antimicrobial prescription. The questions were validated from previous published studies that explored the knowledge, attitude, and practice (KAP) with respect to antimicrobial prescription. In total, N = 300 of dentists from four different countries responded to the online questionnaire out of which 53% were specialists while 47% were general dentists. After data collection, descriptive analysis was carried out along with a one-sided hypothesis test to depict the power of the sample. RESULTS: It was seen from the results of the study that the first-choice antibiotics for 67.8% of dentists were found to be the ß-lactam group while sulfonamides and tetracyclines at 20% were the second most prescribed group. Another important finding was that 45.6% of dentists ignored hypersensitivity testing before prescription of antibiotics even though 83.3% of the total dentists interviewed were aware of the increase in antibiotic resistance. CONCLUSION: In conclusion, the dentists are partially aware of the guidelines but need further training and education on antimicrobial prescription that enables evidence-based decision-making for better practices and outcomes.

The morphology of sella turcica in cleft and non-cleft individuals.

AIMS AND OBJECTIVES: The aim of the study was to analyze the morphology and expedient the linear dimensions of Sella Turcica among cleft and non-cleft Indian individuals, and then to determine whether differences exist between different study groups. MATERIALS AND METHODS: The lateral cephalogram of 300 patients (150 cleft and 150 non-cleft), aged 18 to 30 years who reported for various treatments of malocclusions were studied. RESULT: The normal morphology of the sella turcica were seen in 85 of the 150 non-cleft individuals which was highest (56.66%) in the non-cleft group, however in the cleft group it was seen in only 16 of the 150 individuals (10.6%). Sella turcica bridge were seen in 10% of the non-cleft subjects, whereas in the cleft group it was seen in 38% of the individuals. A significant difference was seen in the linear measurements of the sella turcica of cleft and no-cleft individuals. CONCLUSION: The normal morphology of the sella turcica was seen in the majority of the non-cleft individuals. The cleft individuals showed an increased incidence of sella turcica bridging with reduced linear measurements of the sella as compared to the non-cleft individuals.

In vivo study on the release of nickel, chromium, and zinc in saliva and serum from patients treated with fixed orthodontic appliances.

BACKGROUND: Fixed orthodontic appliances can release metal ions such as nickel, chromium, and zinc into saliva and blood, which can cause contact dermatitis, hypersensitivity, and cytotoxicity. This study was undertaken to assess the release of nickel, chromium, and zinc in saliva and serum of patients undergoing fixed orthodontic treatment. MATERIALS AND METHODS: This in vivo study was conducted on 80 participants with an age range of 15-40 years. Thirty were included as controls and 50 participants were treated with fixed orthodontic appliances. Saliva and blood samples were collected at five different periods, before insertion of fixed orthodontic appliance and at 1 week, 3 months, 1 year, and 1.5 years after insertion of appliance, respectively. The metal ion content in the samples were analyzed by atomic absorption spectrophotometry. Mean levels of nickel, chromium, and zinc in saliva and serum were compared between groups using independent sample t-test and before and after results using paired t-test. P < 0.05 was considered as statistically significant. RESULTS: At the end of 1.5 years, the mean salivary levels of nickel, chromium, and zinc in controls were 5.02 ppb, 1.27 ppb, and 10.24 ppb, respectively, as compared to 67 ppb, 30.8 ppb, and 164.7 ppb at the end of 1.5 years. This was statistically significant with P < 0.001. A significant increase in the metal ion levels were seen in participants with before and after insertion of appliance (P < 0.001). CONCLUSION: Orthodontic appliances do release considerable amounts of metal ions such as nickel, chromium, and zinc in saliva and serum. However, it was within permissible levels and did not reach toxic levels.

Effect of increasing the vertical intrusive force to obtain torque control in lingual orthodontics: A three-dimensional finite element method study.

CONTEXT: Biomechanical differences between lingual and labial orthodontics (LiO and LaO). AIMS: To investigate the effects of intrusive forces in lingual technique during retraction treatment mechanics. SETTINGS AND DESIGN: Intrusive forces act differently in both techniques because of the different location of force vectors in relation to the center of resistance. Increasing the vertical intrusive force is one of the methods routinely used to prevent the uncontrolled tipping and obtain bodily tooth movement in LaO. However, its effects in lingual technique need to be investigated to derive at an optimal treatment mechanics. SUBJECTS AND METHODS: Finite element method which has been successfully used to simulate tooth movement and optimize orthodontic mechanics effectively was used in this study. An accurate model of the upper central and lateral incisors with the surrounding structures was developed, and the "ANSYS" version 7.0 software was used for analysis. RESULTS: Intrusive forces as high as 3.6N was required to obtain translation in LiO that too in an undesirable direction. Efforts to obtain torque control by increasing the intrusive force only would not be successful. CONCLUSION: Forces that produce a translation in LaO tends to produce uncontrolled tipping in lingual technique. To obtain adequate torque control in lingual technique, a combination of the reduction in horizontal retraction forces, increased lingual root torque application, and increase in vertical intrusive forces is desirable.

A Rare Case of Pregnancy with Restrictive Cardiomyopathy.

Restrictive cardiomyopathy (RCM) is a relatively rare form of cardiomyopathy with high mortality which is characterized by impaired filling of the ventricles in the presence of normal wall thickness and systolic function. RCM is generally seen in association with infiltrative, storage, or systemic diseases. We present a rare case of familial RCM with pregnancy which was successfully managed.

Comparison of the dental arch changes in patients with different malocclusions.

AIMS AND OBJECTIVES: To evaluate the pre-treatment and post-treatment dental arch changes in both upper and lower arches in orthodontic patients treated with extraction of first premolar teeth. SUBJECTS AND METHODS: Measurements were made on casts of 50 post treated cases in the age group of 12-30 years for individual tooth measurements, width of the arches (inter-incisal, inter-canine, inter-premolar and inter-molar) arch length (both right and left sides, anterior segment, posterior segment and total arch length for both for the maxillary and mandibular dental casts. STATISTICAL ANALYSIS USED: Kolmogorov-Smirnov test for Normality, Regression Analysis was done as variables were tested and proved to follow normality. Statistical software  Statistical Package for the Social Sciences version 18 (SPSS Inc.; Chicago, Illinois, USA) was used for data analysis. Descriptive statistics and paired t-tests were used to compare the changes in the Class I and Class II div 1 groups. RESULTS: There was a significant increase in the inter-incisor and inter-canine width post-treatment in the Class I and Class II div 1 subjects in the upper arch but no significant change in inter-incisor width in the lower arch in class I subjects. A significant decline in the inter-molar arch width in both the groups were seen. The inter-premolar arch width declined significantly in Class I cases while it increased significantly in Class II div 1 subjects. There was a significant increase in anterior arch length and a significant decrease in posterior arch length in all subjects. CONCLUSIONS: The findings of this original clinical research should significantly help the orthodontists in orthodontic treatment planning in patients requiring extractions of premolars.

Evaluation of the effects of manuka honey on salivary levels of mutans streptococci in children: a pilot study.

BACKGROUND: There has been much debate in the past about whether honey is harmful to the teeth, mostly as part of the debate about raw sugar versus refined sugar and the results have been equivocal. However, what has not been taken into account is that honey varies markedly in the potency of its antibacterial activity. Manuka (Leptospermum scoparium) honey from New Zealand has been found to have substantial levels of non-peroxide antibacterial activity associated with an unidentified phytochemical component, denoted as Unique Manuka Factor (UMF). AIMS: Considering the potential antimicrobial effects of manuka honey, the present study attempted to investigate effects of twice daily use of manuka honey with UMF 19.5 on salivary levels of Mutans streptococci in children. STUDY DESIGN: The investigation was a stratified comparison of two parallel groups of children who either used manuka honey with regular tooth brushing regimen or continued only with regular tooth brushing regimen twice daily under professional supervision for a 21-day period. A total of three salivary samples were taken from each individual at baseline, day 10, and day 21; colony counts of Streptococcus mutans (S. mutans) were determined. All data was subjected to paired T-test and Wilcoxon's signed ranks sum for intra- and intergroup comparisons respectively. RESULTS: Children using manuka honey showed statistically significant reductions in salivary S. mutans after 10 and 21 days. CONCLUSION: Manuka honey with UMF 19.5 may be considered as an effective adjunctive oral hygiene measure for reducing colony counts in children.

Atypical Manifestations of Dengue Fever (DF) - Where Do We Stand Today?

BACKGROUND AND OBJECTIVES: Dengue fever (DF) is transmitted by Aedes aegypti mosquitoes. With growing population, rapid urbanization and lack of appropriate sanitary measures, proliferation of mosquitoes and subsequent dengue infections have increased rampantly with an estimated 30-fold increase in incidence over last five decades. With rising disease burden, atypical manifestations have increased as well, which are missed most often due to lack of awareness. Our aim was to look for the atypical manifestations of dengue fever. MATERIALS AND METHODS: A prospective hospital based observational study was conducted at hospitals of Kasturba Medical College in Mangalore over a period of two years (June-2010 to May-2012). One-hundred fifty ELISA confirmed IgM-dengue sero-positive cases satisfying WHO criteria were examined clinically and laboratory data assessed till they got discharged from hospital after ruling out other causes of fever. Atypical manifestations in dengue fever were noted and analyzed. RESULTS: Most common symptoms noticed were myalgia, headache, rash, arthralgia, pain in abdomen and nausea. More than half of the study group had one or the other atypical manifestation. Liver function test derangement was most often seen. Most common atypical manifestation was hepatitis found in 40.6% patients. Febrile diarrhea, renal failure, Acalculous cholecystitis and conduction abnormalities of heart were among other common manifestations. Three patients died of multi-organ dysfunction, disseminated intravascular coagulation and shock. Platelet count did not correlate well with severity of bleeding. Overall recovery rate was good. CONCLUSION: Some of the atypical manifestations of dengue fever are no more a rare entity. Clinical vigilance for these manifestations is important for timely detection and management as some of them could be fatal.

Hansen's disease associated with erythromelalgia mimicking Lupus erythematosus.

Hansen's disease, though considered to be at the verge of elimination in many countries including India, still continues to surprise patients and dermatologists alike. This is mainly due to its varying and unconventional presentations which may lead to initial misdiagnosis and prolongation of treatment. Here we describe an unusual case presenting with erythematous photosensitive facial lesions associated with erythromelalgia of the finger tips, provisionally diagnosed as SLE. A subsequent histopathology examination proved it to be Hansens' disease Borderline Tuberculoid variety. Hansen's disease can be termed as the modern great imitator, displacing the traditional great imitator, syphilis.