Clinico-Epidemiological Profile and Predictors of Poor Outcome Among Children During a Diphtheria Outbreak in Haryana.

OBJECTIVE: To study the clinico-epidemiological profile and predictors of poor outcome in an outbreak of diphtheria. OUTCOME: Records of 390 children admitted with the diagnosis of clinical diphtheria in a tertiary care teaching hospital in Nuh, Haryana, from January, 2018 to December, 2020 were analysed with respect to demographic details, immunization status, clinical features, complications and mortality. Patients were divided into survivors and non-survivors, and various variables were compared between the two groups to identify the factors associated with poor outcome. RESULTS: Out of 390 cases, data of 318 (81.5%) was included. Young children (median age 5 year) were predominantly affected, and only 8 (2.5%) children were fully immunized. Pseudomembrane was present in 245 (77%) cases. Albert staining and culture were positive in 84.6% (269) and 12.9% (41) cases, respectively. Complications developed in 48.4% (n=154) cases and included: airway compromise 22.6% (n=72), diphtheritic cardiomyopathy 12.9% (n=41), acute kidney injury 3.7% (n=12), thrombocytopenia 8.5% (n=27) and hepatitis 0.6% (n=2) cases. Anti-diphtheritic serum (ADS) was administered to all admitted patients. Tracheostomy was done in (n=57) (17.9%) children. Case fatality rate was 17.9%. CONCLUSION: Diphtheria mostly affected young unvaccinated or partially vaccinated children. Mortality was high in unimmunized or partially immunized young children and those with bull neck, pseudomembrane, delayed (≥5 days) administration of ADS, acute kidney injury, thrombocytopenia and leukocytosis. Myocarditis was strongly associated with high mortality.

Comparison of fracture resistance of endodontically treated maxillary first premolar with mesio-occlusal-distal access restored with composite resin, fiber post, and prefabricated metal posts restored with/without full-coverage metal crowns.

Background: A myriad of materials and procedures have been recommended for restoring the root-filled teeth with significant loss of tooth structure and the most common method being the use of "posts." Material and Methods: A mesio-occluso-distal preparation was done on eighty intact maxillary first premolars, followed by access preparation and cleaning and shaping with rotary files. All samples were obturated and divided into four groups (n = 20). In Group 1, 3-mm gutta-percha was removed and restored using composite resin; Group 2 - Group 1 + crowns; Group 3 - prefabricated fiber post + crowns; and Group 4 - prefabricated metal post + crowns. All the groups were subdivided into eight groups (n = 10), fractured with 90° vertical and 45° oblique loading by a universal testing machine. Statistical Analysis: Fracture resistance was analyzed and compared by means of two-factorial two-way analysis of variance and Scheffe's post hoc test. Results: Under 90° loading, the fracture load of teeth restored with the Nayyar's composite resin core and crown was greatest. Under 45° loading, the fracture load of teeth restored with prefabricated metallic posts was significantly (P < 0.05) less than that in other groups. Under 45° load, group with fiber post exhibited significantly (P < 0.05) more number of favorable fractures than other groups. Conclusion: Under the conditions of vertical and oblique loadings, fiber post and composite resin core with a full-coverage crown is the most effective restorative modality for protecting the remaining tooth structure in pulpless teeth.

Comparison of Preoperative Oral Ketorolac on Anesthetic Efficacy of Inferior Alveolar Nerve Block and Buccal and Lingual Infiltration with Articaine and Lidocaine in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study.

INTRODUCTION: Irreversible pulpitis (IP) commonly results in decreased anesthetic efficacy of the inferior alveolar nerve block (IANB) for mandibular molar. It has been shown that supplementary buccal and/or lingual infiltration as well as premedication with ketorolac result in improved efficacy of the IANB. METHODS: One hundred fifty emergency patients who had their lower first or/and second molar diagnosed with IP participated in the study. All patients were randomly divided into 2 major IANB groups: 1 group received 4% articaine with 1:100,000 epinephrine, and the other group received 2% lidocaine with 1:80,000 epinephrine. Each group was further divided into 3 subgroups of 25 each: (1) buccal and lingual infiltration with articaine and lidocaine, respectively; (2) preoperative oral medication of ketorolac; and (3) preoperative oral medication of ketorolac followed by buccal and lingual infiltration with articaine and lidocaine, respectively. Endodontic access was initiated 15 minutes after solution deposition, and all patients were required to have profound lip numbness. Success of the anesthetic was defined as none or mild pain on endodontic access and initial instrumentation. RESULTS: Statistical analysis was performed using multiple-comparison analysis of variance (Kruskal-Wallis) and t tests. Articaine IANB with infiltrations plus oral ketorolac premedication significantly increased the success rate to 76%. The success rate after the administration of an articaine IANB with infiltration injections was 64%, whereas with lidocaine it was 32% (P < .05). CONCLUSIONS: Premedication with ketorolac significantly increases the anesthetic efficacy of articaine IANB plus infiltration in mandibular molars with IP.