Parenteral medication use in hospital at home: Challenges and opportunities.

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Healing After Horizontal Root Fracture of Maxillary Central Incisor: A Case Report With 24-Month Follow-Up.

Facial traumatic injuries are quite common, resulting in the fracture and displacement of tooth and/or bone fragments. Loss of tooth structure may have lifetime consequences for the patient. Horizontal root fractures (HRFs) may occur in the maxillary anterior teeth at different locations, showing varied patterns of healing. The treatment options range from simple observation and follow-ups to conservative management or even complex surgical procedures. Correct and timely intervention can help preserve the tooth structure, leading to the long-term survival of the tooth. The present case report showcases endodontic treatment and favourable healing of a horizontal root fracture at the apical third of a permanent maxillary central incisor. At the 24-month follow-up, the tooth is clinically healthy, and radiographic images show a successful outcome.

Comparative evaluation of eighth-generation bonding agent modified with 7% arginine and 0.12% chitosan for antibacterial property and microtensile bond strength.

Aim: The aim of this study was to evaluate and compare eighth-generation bonding agent (G-Premio BOND) modified with 7% arginine and 0.12% chitosan for antibacterial property and microtensile bond strength. Methods: To evaluate antibacterial property, the sterile 96-microtiter plate was taken. The sidewalls of nine wells were coated with 15 µl of adhesive from each group. Suspension of Streptococcus mutans bacteria was placed on each group of adhesive and antibacterial property was checked using Spectrophotometer. Thirty-three healthy extracted premolars were taken and adhesive from each group was applied on the exposed surface of dentin, and the specimens were tested using a universal testing machine at crosshead speed of 1 mm/min. Results: The least antibacterial efficacy was seen with unmodified eighth-generation bonding agent. This result was statistically significant when all study groups were compared. Microtensile bond strength was evaluated and the highest mean value (5.07) was seen with adhesive modified with 7% arginine, followed by adhesive modified with 0.12% chitosan (mean value: 4.14), and unmodified adhesive had the lowest mean bond strength value (4.07). Conclusions: The eighth-generation bonding agent modified with 7% arginine and 0.12% chitosan showed antibacterial efficacy against S. mutans. In addition to this, they also had higher tensile bond strength values as compared to unmodified adhesive.

Effect of fibre-reinforced composite as a post-obturation restorative material on fracture resistance of endodontically treated teeth: A systematic review.

BACKGROUND: Fracture resistance of endodontically treated tooth is affected due to large cavity designs and access cavities and an appropriate material capable to resist fracture plays an important role. This review aims to evaluate the effect of fibre-reinforced composite (FRC) as a post-obturation material on fracture resistance of endodontically treated teeth. OBJECTIVES: To systematically gather and evaluate the fracture resistance of fibre-reinforced composite as a post-obturation restorative material in endodontically treated teeth. DATA SOURCES: A systematic search was conducted using PubMed, Ebsco Host, Scopus, Google Scholar, Hinari and manual search library resources from 1st Jan 2000 to 30th November 2019 to identify appropriate studies. RESULT: A total of 157 articles were examined out of which 55 articles were selected after reading the title. After removing the duplicates, 27 articles were screened for abstract and 1 article was eliminated as it did not meet the eligibility criteria. A thorough reading of the full text of the remaining 26 selected articles was assessed for eligibility. Amongst these, 1 article was then excluded from the study as the full text was not accessible. Lastly, 25 articles were included in the study. CONCLUSION: FRC as a core material increases fracture resistance of endodontically treated teeth but they do not have the fracture resistance similar to the intact tooth. Both polyethylene and short fibre-reinforced composites showed greater fracture resistance when compared to glass FRC and restoration without reinforcement. Also, the fracture resistance increases if restored with FRC along with retention slots and are placed on the occlusal third surfaces of cavities. Also, favourable fractures were most commonly seen and it usually occurred at the level of enamel and dentin and adhesive fractures were seen.

A study to evaluate the prevalence of hypogonadism in Indian males with Type-2 diabetes mellitus.

BACKGROUND: A high prevalence of hypogonadism in men with Type-2 diabetes mellitus (T2DM) has been reported worldwide. OBJECTIVES: To evaluate the prevalence of hypogonadism in Indian males with T2DM and assess the primary and secondary hypogonadism along with androgen deficiency. MATERIALS AND METHODS: In this cross-sectional study, 900 men with T2DM were evaluated using androgen deficiency in aging male questionnaire. They were screened for demographic characteristics, gonadal hormone levels, lipid profile, and glycosylated hemoglobin. RESULTS: The prevalence of hypogonadism in T2DM patients was found to be 20.7% (186 out of 900). Hypogonadism was of testicular origin (primary) in 48/186 (25.8%) patients, of pituitary or hypothalamic origin (secondary) in 14/186 (7.53%), and remaining 124/186 (66.67%) patients were found to have low testosterone with the inappropriate normal level of luteinizing hormone and Follicle-stimulating hormone. 451/900 (50.1%) patients were only symptomatic but had normal testosterone levels. Further 263 patients out 900 were asymptomatic, of which 51/900 (5.7%) patients had low levels of testosterone and 212/900 (23.5%) patients had normal testosterone level without symptoms. There were no deaths or other serious adverse events except mild pyrexia which was not related to the study. CONCLUSION: Hypogonadism diagnosis, at times, might not be validated with the help of androgen deficiency questionnaire or symptoms only. Given the large number of patients of T2DM in India, the incidence of hypogonadism is more in diabetic patients as compared to the general population. Hence, implementation of screening programs in diabetic patients is necessary to understand and detect individuals with low serum total testosterone at any early stage and to supplement testosterone accordingly.

The burden of segregated respiratory diseases in India and the quality of care in these patients: Results from the Asia-Pacific Burden of Respiratory Diseases study.

BACKGROUND: Chronic respiratory diseases such as asthma, allergic rhinitis (AR), chronic obstructive pulmonary disease (COPD), and rhinosinusitis are becoming increasingly prevalent in the Asia-Pacific region. The Asia-Pacific Burden of Respiratory Diseases study examined the disease and economic burden of AR, asthma, COPD, and rhinosinusitis across the Asia-Pacific and more specifically India. OBJECTIVES: To estimate the proportion of adults receiving care for asthma, AR, COPD, and rhinosinusitis and assess the economic burden, both direct and indirect of these chronic respiratory disease. SUBJECTS AND METHODS: Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Surveys comprising questions about respiratory disease symptoms, healthcare resource utilization, work productivity, and activity impairment were completed by treating physicians and participants during one study visit. Costs, indirect and direct, that contributed to treatment for each of the four respiratory diseases were calculated. RESULTS: A total of 1000 patients were enrolled. Asthma was the most frequent primary diagnosis followed by AR, COPD, and rhinosinusitis. A total of 335 (33.5%) patients were diagnosed with combinations of the four respiratory diseases; the most frequently diagnosed combinations were asthma/AR and rhinosinusitis/AR. Cough or coughing up sputum was the primary reason for the current visit by patients diagnosed with asthma and COPD while AR patients reported a watery, runny nose, and sneezing; patients with rhinosinusitis primarily reported a colored nasal discharge. The mean annual cost per patient was US$637 (SD 806). The most significant driver of direct costs was medications. The biggest cost component was productivity loss. CONCLUSIONS: Given the ongoing rapid urbanization of India, the frequency of respiratory diseases and their economic burden will continue to rise. Efforts are required to better understand the impact and devise strategies to appropriately allocate resources.

Unusual complication of coronary angiogram: Spinal epidural hematoma.

Coronary angiogram is considered a relatively safe procedure but unusual complications do occur. Such an unusual case was happened post radial artery approach angiogram leading to severe co-morbidity to patient. We are reporting this case of a female patient who developed acute spinal epidural hematoma two hours after coronary angiogram.

Antiadherent and antibacterial properties of stainless steel and NiTi orthodontic wires coated with silver against Lactobacillus acidophilus--an in vitro study.

BACKGROUND: The purpose of the study is to assess the antiadherent and antibacterial properties of surface-modified stainless steel and NiTi orthodontic wires with silver against Lactobacillus acidophilus. METHODS: This study was done on 80 specimens of stainless steel and NiTi orthodontic wires. The specimens were divided into eight test groups. Each group consisted of 10 specimens. Groups containing uncoated wires acted as a control group for their respective experimental group containing coated wires. Surface modification of wires was carried out by the thermal vacuum evaporation method with silver. Wires were then subjected to microbiological tests for assessment of the antiadherent and antibacterial properties of silver coating against L. acidophilus. Mann-Whitney U test was used to analyze the colony-forming units (CFUs) in control and test groups; and Student's t test (two-tailed, dependent) was used to find the significance of study parameters on a continuous scale within each group. RESULTS: Orthodontic wires coated with silver showed an antiadherent effect against L. acidophilus compared with uncoated wires. Uncoated stainless steel and NiTi wires respectively showed 35.4 and 20.5 % increase in weight which was statistically significant (P < 0.001), whereas surface-modified wires showed only 4.08 and 4.4 % increase in weight (statistically insignificant P > 0.001). The groups containing surface-modified wires showed statistically significant decrease in the survival rate of L. acidophilus expressed as CFU and as log of colony count when compared to groups containing uncoated wires. It was 836.60 ± 48.97 CFU in the case of uncoated stainless steel whereas it was 220.90 ± 30.73 CFU for silver-modified stainless steel, 748.90 ± 35.64 CFU for uncoated NiTi, and 203.20 ± 41.94 CFU for surface-modified NiTi. CONCLUSIONS: Surface modification of orthodontic wires with silver can be used to prevent the accumulation of dental plaque and the development of dental caries during orthodontic treatment.

Asthma Insights and Management in India: Lessons Learnt from the Asia Pacific - Asthma Insights and Management (AP-AIM) Study.

BACKGROUND: Despite a better understanding of the pathophysiology of asthma, presence of reliable diagnostic tools, availability of a wide array of effective and affordable inhaled drugs and simplified national and international asthma management guidelines, asthma remains poorly managed in India. OBJECTIVE: The Asia-Pacific Asthma Insight and Management (AP-AIM) study was aimed at understanding the characteristics of asthma, current management, level of asthma control and its impact on quality of life across Australia, China, Hong Kong, India, Malaysia, Singapore, South Korea, Taiwan and Thailand. This paper describes the results of asthma management issues in India in detail and provides a unique insight into asthma in India. METHODOLOGY: The AP-AIM India study was conducted in eight urban cities in India, viz: Ajmer, Delhi, Kolkata, Rourkela, Chennai, Mangalore, Mumbai and Rajkot from February to July 2011. Face-to-face interviews were conducted in adult asthmatics and parents of asthmatic children between the ages of 12 and 17 years with a confirmed diagnosis or a treatment history of 1 year for asthma. RESULTS: Four hundred asthmatics (M:F::1:1.273), with a mean age of 50 ± 17.8 years, from across India were studied. 91% of the asthmatics in India perceived their asthma to be under control, however, none of the asthmatics had controlled asthma by objective measures. Asthmatics in India believed that their asthma was under control if they have up to 2 emergency doctor visits a year. The quality of life of these patients was significantly affected with 93% school/work absenteeism and a loss of 50% productivity. Seventy-five percent of the asthmatics have never had a lung function test. The common triggers for asthmatics in India were dust (49%) and air pollution (49%), while only 5% reported of pollen as triggers. Eighty-nine percent of Indian asthmatics reported an average use of oral steroids 10.5 times a year. Only 36% and 50% of Indian asthmatics used controller and rescue inhalers with a majority preferring the oral route of asthma medication. CONCLUSIONS: This study has clearly highlighted the fact that asthma management in India remains very poor, with a significant proportion of patients experiencing bothersome symptoms and worsened quality of life. There is a need for an urgent review of this situation and initiate active measures at local as well as national levels to improve asthma care in India.

Comparison of shear bond strength of metal brackets bonded to porcelain surface using different surface conditioning methods: an in vitro study.

AIM: To evaluate and compare the shear bond strength of metal brackets bonded to ceramic surfaces using different conditioning methods and to assess the site of bond failure after debonding. MATERIALS AND METHODS: A total of 70 ceramic surfaces were produced with uniform shape, size and composition. The samples were divided into 7 groups (each of 10 samples). Group 1 was the control group (untreated surface); in group 2 the surface were roughened with a diamond bur; in group 3 the surface were etched with hydrofluoric acid; in group 4 the surfaces were sandblasted; in group 5 the surfaces roughened with bur and silane applied; in group 6 the surfaces were etched with hydrofluoric acid and silane applied and in group 7 the surfaces were sandblasted and silane applied. To all the above groups, metal orthodontic brackets were bonded with light cure adhesive. The brackets were later stored in artificial saliva and incubated at 37°C (24 hours). The samples were then subjected to shear bond strength test using an Instron universal testing machine. The debonded porcelain surfaces were then studied under stereomicroscope to assess site of bond failure. RESULTS: Sandblasting the ceramic surface and silane application showed the highest bond strength. Stereomicroscope examination after debonding showed that the bond failure is at bracket-adhesive interface in four groups namely hydrofluoric acid, sandblasting, hydrofluoric acid with silane and sandblasting with silane. CONCLUSION: Sandblasting with silane combination produced the highest shear bond strength, so it is a clinically suitable method for bonding orthodontic metal brackets onto ceramic surface. CLINICAL RELEVANCE: Bonding orthodontic brackets to ceramic crowns of patients has been a tough task. In this study, different conditioning methods were used to treat the ceramic surfaces before bonding. The results showed that sandblasting the ceramic surface prior to application of silane produced the highest shear bond strength which is clinically suitable to reduce bond failures.

In vitro assessment of photocatalytic titanium oxide surface modified stainless steel orthodontic brackets for antiadherent and antibacterial properties against Lactobacillus acidophilus.

OBJECTIVE: To assess the antiadherent and antibacterial properties of surface modified stainless steel orthodontic brackets with photocatalytic titanium oxide (TiO(2)) against Lactobacillus acidophilus. MATERIALS AND METHODS: This study was done on 120 specimens of stainless steel preadjusted edgewise appliance (PEA) orthodontic brackets. The specimens were divided into four test groups. Each group consisted of 30 specimens. Groups containing uncoated brackets acted as a control group for their respective experimental group containing coated brackets. Surface modification of brackets was carried out by the radiofrequency (RF) magnetron sputtering method with photocatalytic TiO(2). Brackets then were subjected to microbiological tests for assessment of the antiadherent and antibacterial properties of photocatalytic TiO(2) coating against L acidophilus. RESULTS: Orthodontic brackets coated with photocatalytic TiO(2) showed an antiadherent effect against L acidophilus compared with uncoated brackets. The bacterial mass that was bound to the TiO(2)-coated brackets was less when compared with the uncoated brackets. Furthermore, TiO(2)-coated brackets had a bactericidal effect on L acidophilus, which causes dental caries. CONCLUSION: Surface modification of orthodontic brackets with photocatalytic TiO(2) can be used to prevent the accumulation of dental plaque and the development of dental caries during orthodontic treatment.

Ortho-perio integrated approach in periodontally compromised patients.

It is an undisputed fact that sound and strong periodontal health is a must in patients seeking orthodontic treatment. Does this mean that we are going to deny orthodontic treatment for those adults whose number is rising, more often secondary to periodontal deterioration and pathological migration of teeth resulting in aesthetic and functional problems? Need of the hour is to have an integrated approach where in periodontal treatment precedes orthodontic treatment to restore periodontal health. Orthodontic treatment should be performed under strict plaque control measures to place the teeth in a structurally balanced and functionally efficient position. Aim of this article is to familiarize the practicing clinicians both in the field of orthodontics and periodontics with current thoughts and successful clinical techniques used in the field of periodontology to regenerate lost periodontal structures. Furthermore, it aims to integrate such techniques into the orthodontic treatment of patients with severe bone loss.

Impact of left ventricular function on early outcomes after arterial switch for D-transposition of great arteries with intact ventricular septum.

OBJECTIVE: The aim of this study was to assess the utility of tissue Doppler echocardiography in evaluating the pre-operative left ventricular systolic function and in turn its impact on early post-operative outcomes following arterial switch operation for transposition of great arteries with intact ventricular septum. BACKGROUND: Pre-operative left ventricular function is an important determinant of outcomes following arterial switch. METHODS: We studied 19 patients with transposition and intact septum who had undergone one stage arterial switch operation. All had a pre-operative echocardiogram. RESULTS: The left ventricle was adequate in 15 infants as per the dimensions and shape for age. The early outcomes of surgery were assessed on the basis of their pre operative tissue Doppler. There were 7 (40%) patients with reduced S wave velocities (2.62 +/- 0.84 cm/sec) and lower isovolumetric myocardial acceleration (1.2 +/- 0.5 m/sec(2)) reflecting systolic dysfunction. Those patients with reduced S wave velocities and isovolumetric acceleration correlated with poor early surgical outcomes in terms of longer duration of ventilation ( p< 0.001), longer duration of inotropes ( p< 0.00001) and higher mortality ( p < 0.001). CONCLUSION: The tissue Doppler echocardiography is a more sensitive modality to evaluate ventricular performance than the 2D-echo. It can be used as a sensitive predictor of outcomes following arterial switch.

Echocardiographic evaluation of the morphology and function of the right ventricle in Eisenmenger's syndrome and idiopathic pulmonary hypertension.

AIM: The aim of this study was to investigate the reasons for better prognosis in adults with Eisenmenger's syndrome than those suffering from idiopathic pulmonary hypertension. Our hypothesis was that right ventricular function is better preserved in the former case than in the latter. METHODS: We used two-dimensional echocardiography and tissue Doppler imaging to compare right ventricular morphology and function in 24 subjects with Eisenmenger's syndrome and 23 age- and sex-matched subjects with idiopathic pulmonary hypertension. RESULTS: The mean age was 27.4+/-12.2 years for both groups. There were more patients from the idiopathic pulmonary hypertension group in the New York Heart Association Class III than those from the Eisenmenger's syndrome group (48.4% vs 36.3%; p<0.01). Measurements of the right and left ventricular free wall thickness, as well as the internal diameter of the right ventricle were taken, and tissue Doppler imaging was used to assess the function of both ventricles. In the Eisenmenger's group, the mean right ventricular and left ventricular free wall thickness was 10.4+/-2.78 mm and 9.7+/-1.98 mm, respectively. The mean right ventricular internal diameter in diastole and in systole were 20+/-8.64 mm and 18.1+/-9.24 mm, respectively. The mean right ventricular S1 was 10.4+/-3.4 cm/sec and S2, 10.3+/-2.6 cm/sec, while the left ventricular S1 was 7.4+/-1.87 cm/s and S2, 7.5+/-1.05 cm/sec, with a normal biventricular function. In the idiopathic pulmonary hypertension group, the mean right ventricular and left ventricular free wall thickness was 11.3+/-3.24 mm and 9.8+/-1.94 mm, respectively. The mean right ventricular internal diameter in diastole and systole was 36+/-8.9 mm and 30.1+/-9.8 mm, respectively. The mean right ventricular S1 was 6.9+/-3.4 cm/sec and S2, 6.8+/-2.8 cm/sec, while the left ventricular S1 was 7.4+/-1.8 cm/sec and S2, 7.5+/-1.05 cm/sec, reflecting right ventricular systolic dysfunction. CONCLUSIONS: Right ventricular function was better preserved among subjects with Eisenmenger's syndrome than those with idiopathic pulmonary hypertension in a study in which the two groups were matched for age and sex.