The Need of Endodontic Therapy among Patients Attending Tertiary Care Center in Central Nepal.

Background Dental caries is considered as the most prevalent oral disease in Nepalese population that frequently needs endodontic therapy or root canal treatment (RCT). Pulp infection is one of the most common sequels of dental caries which when left untreated leads to pulpal necrosis and peri-radicular diseases. Patients usually reports to the dental hospital after there is pain, sensitivity, swelling or fracture of the tooth structure which usually impedes their normal routine of daily life. RCT is one of the efficacious therapeutic procedures that can save the teeth retaining its aesthetics and function. Objective To determine the need of RCT among patients attending Tertiary Care Hospital. Method A cross-sectional epidemiological study was conducted in the Department of Conservative Dentistry and Endodontics over the period of one year from April 2019 to April 2020. Ethical approval was taken from the Institutional Review Committee Kathmandu University School of Medical Sciences. In total, 7566 records of the patients that needed endodontic therapy and other treatments were collected and the need of endodontic therapy versus other treatments were assessed. The data obtained were analyzed using the SPSS version 20. The association between various patient-related variables were calculated by chi square test and mean, standard deviation, frequency and percentage were calculated using descriptive statistics. P value was set at < 0.05 for statistical significance. Result Among the total study population, (n=7566), the mean age was 34.97±14.34 years among which 4387 (58%) were females and 3179 (42%) were males. The type of treatment required by the study participants were significantly associated with age and sex (p < 0.001) and p < 0.001, respectively). Conclusion The findings of this study concluded that there was an increased need for endodontic therapy among patients visiting the department compared to other treatments. There was a significant association between gender and age showing females and elderly patients in greater need for endodontic therapy.

Radiographic Assessment of Occurrence of Pulp Stones in Molars of Selected Adult Nepalese Populations at Tertiary Care Center.

Background Pulp stones or "denticles" are a frequent finding in coronal and radicular pulp of primary and permanent dentition. These discrete calcified bodies can be seen in a healthy, diseased and sometimes even in an unerupted tooth. These calcifications are mostly present in molars as free, attached or embedded to dentine of pulp chamber or root canals. Objective To determine the occurrence of pulp stones in molars of selected adult Nepalese population using radiographs and assess the association of its occurrence gender and arch wise. Method A descriptive cross-sectional study was performed using orthopantomogram of total 380 patients (190 male and 190 females) of age group ranging from 16-30 years by convenience sampling. Data were collected through the examination of both hard and soft copies of radiographs under magnification. Pulp stones were scored as present or absent and their association with gender and dental arch were recorded. Descriptive statistics and chi square test was performed to see the prevalence and to compare the occurrence of pulp stone respectively. Result Out of 380 radiographic samples, pulp stones were present in 41.05% of the samples. The occurrence of pulp stones were found to be higher in females than in males, although the difference was not statistically significant (p=0.060).The total number of teeth with pulp stones was 238 and 61 in maxillary and mandibular arches respectively, with statistically significant difference (p<0.001). Conclusion The overall occurrence of pulp stone was found to be 41.05%. It was observed more in females (45.78%) than in males (37%) and more frequently located in maxillary molars (29.2%) than in mandibular molars (8.2%).

Non Traumatic Coma in the Intensive Care Unit: Etiology and Prognosis.

Background Impaired consciousness and coma is common reason for admission into the intensive care unit .It results from many etiological factors with varying outcome. Causes may vary in different parts of the world as is the outcome depending on the availability of appropriate care to deal with those patients. Objective To identify the etiological factors responsible for non traumatic coma and also evaluate if those factors influence the prognosis. Method This is a hospital based cross sectional study carried out at Nobel Medical College, Biratnagar between December 2019 and December 2020. All the patients who were admitted into the intensive care unit with coma due to non traumatic causes were included in the study. Result One hundred seven patients were enrolled in the study with mean age of the patient 54.5±19 years. There were 61(57%) male. Forty seven (43.9%) patients died while 60(56.1%) patients survived. Common etiological factors identified were impaired renal function 32(29.9%), anoxia 30 (28%), sepsis 28(26.2%), stroke 26(24.3%), metabolic derangement 21(19.6%). Coma due to sepsis was significantly associated with mortality (p=0.001) as was impaired renal function (p =0.035), cardiac disease (p=0.016) and low Glasgow Coma Scale (p=0.046). We did not find any association between age (p=0.53), gender (p=0.94) duration of coma (p=0.75) and mortality. Conclusion Impaired consciousness is a common problem encountered in the intensive care unit with very high mortality. Low Glasgow Coma Scale, Sepsis, impaired renal function and cardiac disease were associated with higher mortality.

Correlation of Pelvic Parameters with Isthmic Spondylolisthesis.

Background Spondylolisthesis is one of the major causes of low back pain. The anterior shift of the vertebra is mostly at L4 and L5 levels. Several types have been described, most common being the isthmic type. Pelvic parameters are said to be associated with development and progression of listhesis, and should be evaluated while treating it. Objective To study the correlation of Pelvic parameters with isthmic spondylolisthesis. Method It was a cross sectional case control study. In 68 cases with Isthmic Spondylolisthesis and of 34 cases with low back pain without listhesis (control), the spinopelvic parameters like lumbar lordosis, pelvic incidence, pelvic tilt and sacral slopes were measured together with degree of slip with lateral radiographs. Findings were analyzed and compared with control group. Result In control group, the pelvic incidence was 50.44±4.78o , the sacral slope was 34.38±6.79o , the pelvic tilt was 15.97±5.31o , and the lumbar lordosis was 46.76±6.78o . In Isthmic Spondylolisthesis group, the pelvic incidence was 60.85±6.79o , the sacral slope was 40.40±6.91o , the pelvic tilt was 20.63±7.51o , and the lumbar lordosis was 57.31±7.11o . The difference in spinopelvic parameters amongst control and Isthmic Spondylolisthesis group was statistically significant (p < 0.001). The degree of slip was directly proportional to the pelvic incidence angle (grade I=52o , II =62o and III 72.5o ). Conclusion Spino-pelvic parameters are higher in isthmic spondylolisthesis group and is significantly associated with severity of the slip.

Saliva as a Biological Sample for COVID-19 Diagnosis?

The COVID-19 pandemic, caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), has become a severe global health problem affecting almost every country in the world. Compared to other coronaviruses, SARS-CoV-2 is considered to be more infectious thereby leading to a rapid spread of this disease across the world. The effective control of this disease relies on timely diagnosis, proper isolation, contact tracing of the infected people and segregation of vulnerable group from potential contamination. Currently, the gold standard diagnostic test for COVID-19 is real-time reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swab (NPS). However, NPS collection has several shortcomings. Besides requiring an active involvement of healthcare personnel and personal protective equipment (PPE), NPS collection is uncomfortable for the patient as it can induce coughing, gagging, vomiting and even bleeding. Evidence from current studies indicates that saliva has a potential to be useful as an alternative biological sample for COVID-19 diagnosis. Indeed, saliva as a biological sample offers several advantages over NPS. Saliva collection is better accepted by patients, it can be self-collected and does not require PPE and active involvement of healthcare personnel. Moreover, preliminary results indicate that the sensitivity and specificity of saliva for COVID-19 diagnosis is similar to that of NPS. This summarizes recent observations in the field and discusses the potential use of saliva for COVID-19 diagnosis.

Outcome of Patients with Meningitis and Encephalitis at Tertiary Care Hospital in Eastern Nepal.

Background There are several etiologies of meningitis and encephalitis which must be considered in any patient presenting with fever, headache, neck stiffness and vomiting. Bacterial meningitis and viral encephalitis are medical emergencies and need urgent attention and treatment. Any delay in diagnosis and treatment has been shown to increase morbidity and mortality. Some of the survivors also have neurological sequel with a need for long term physical and occupational rehabilitation. Objective To find out common causes of meningitis, encephalitis, predictors of outcome, early and late complications of meningitis and encephalitis at Tertiary Care Hospital in Eastern Nepal. Method It is a prospective study which was conducted at Nobel Medical College Teaching Hospital from April 2015 to March 2016. Result A total of 52 patients participated in the study. Bacterial meningitis was the most common type of neuroinfection (40.4%) followed by tubercular meningitis (27%), viral encephalitis (17.3%) and viral meningitis (15.4%). Pneumococcus was the most common identified cause of meningitis accounting for 28.9% of bacterial meningitis. Japanese encephalitis was the most common identifiable cause of encephalitis accounting for 33% of cases. Low Glasgow Coma Scale at admission was significantly associated with worse neurological outcome (P<0.001). Similarly, high white blood cell count in blood was associated with worse neurological outcome (P=0.001). Conclusion Meningitis and encephalitis are neurological emergency. Prompt diagnosis and treatment is needed to improve survival. Neurological sequel is common after those infections which require long term rehabilitation.

Gender Based Comparison of Gingival Zenith Esthetics.

Background The size, proportion and gingival zenith position of maxillary anterior teeth plays in the anterior teeth esthetics. Objective To compare the gingival zenith positions and levels between male and female in right and left side as an esthetic parameter. Method Impression of the maxillary arch was made in each participant with irreversible hydrocolloid, and dental cast was made with dental stone type IV. Two clinical parameters were evaluated: (1) the gingival zenith position (GZP) from the vertical bisected midline along the long axis of each individual maxillary anterior tooth; and (2) the gingival zenith level (GZL) of the lateral incisors in an apical-coronal direction relative to the gingival line joining the tangents of the GZP of the adjacent central incisor and canine teeth under healthy conditions. Statistical analyses were conducted using SPSS with the level of significance (α) = 0.05. Descriptive statistics was done and Independent t-test was used to compare the GZP and GZL between male and female. Result In male, the gingival zenith position for right side central, lateral and canine were 1.05 mm, 0.57 mm and 0.14 mm, and in left side were 1.02 mm, 0.53 mm, 0.15 mm. In female, the gingival zenith position for right side central, lateral and canine were 0.99 mm, 0.48 mm and 0.15 mm, and in left side were 0.94 mm, 0.44 mm and 0.14 mm. The gingival zenith position was significantly different between male and female for both lateral incisors. In addition, significantly different was found for the lateral incisor between right and left side. In male, the gingival zenith level of right and left lateral incisors 0.74 mm and 0.71 mm. In female, the gingival zenith level of right and left lateral incisors 0.76 mm and 0.72 mm. No significant difference was found between male and female for the gingival zenith level of right and left lateral incisors. Conclusion The GZP and GZL obtained from this study can be clinically applied to reestablish the GZP of the maxillary anterior teeth during periodontal surgery; crown lengthening or root coverage procedures.

Retrospective Study to Determine Stability of Mandibular Setback Surgery using Bilateral Sagittal Split Osteotomy Technique.

Background Bilateral sagittal split osteototomy of mandible is one of the most commonly performed orthognathic surgical procedure performed in the mandible. According to hierarchy of stability, mandibular setback procedure is considered to be relatively unstable procedure and chances of relapse are higher. Objective We conducted this study to determine the skeletal stability of mandibular setback procedure using bilateral sagittal split osteotomy technique in Nepalese population. Method Lateral cephalograms of 14 patients who underwent mandibular setback using bilateral saggital split osteotomy were taken pre-operatively (P1), immediate postoperatively (P2) and eight months to one year post-operatively (P3). Cephalometric tracing was done for all the cephalograms. Various parameters of Burstone's hard and soft tissue, Steiner's and McNamara analysis were used in the study to determine angular and linear changes following surgery. After tracing the cephalograms, changes between P1- P2, P1-P3 and P2-P3 were calculated. Mean difference in changes between P1-P2, P1-P3 and P2-P3 were compared using paired t test. P value less than 0.05 was considered to be significant. Data analysis was done using SPSS software version 20. Result Mean setback at Pogonion was 3.03 mm whereas at point B were 4.64 mm. Relapse at Pogonion was 0.03 mm and relapse at point B were 0.02 mm. Mean change in point A-Nasion-point B angle was 5.1 degrees whereas mean changes in NA-Pogonion angle were 4.69 degrees. Conclusion There were significant changes in angular as well as horizontal parameters at P2 but there were no significant changes in those parameters at P3. This is a preliminary study that we have carried out at our institution with smaller sample size thus we recommend a study with larger sample size and long term follow up.

Orthognathic Surgery for the Correction of Severe Skeletal Class III Malocclusion.

Skeletal Malocclusions results from the abnormal position of maxilla and mandible in relation with cranial base. These types of malocclusion are commonly treated by orthodontic teeth movement known as camouflage orthodontics. However severe skeletal malocclusions cannot be treated by orthodontics alone. Such cases need surgical intervention to align the position of the jaw along with orthodontic correction. This procedure is commonly known as Orthognathic Surgery. Orthognathic Surgery dates back to early eighteenth century but became popular on mid twentieth century. Though the prevalence of skeletal malocclusion is more than 1% the treatment facility was not available in Nepal till 2012. Here we present a case of Skeletal Class III malocclusion treated at Dhulikhel Hospital, Kathmandu University Hospital. For this case, double jaw surgery was performed by le-Fort I osteotomy and Bilateral Sagital Split Osteotomy. Orthognathic surgery has been routinely performed at this centre since then.

Clinical profile of patients with recurrent seizure in tertiary care hospital in Nepal.

BACKGROUND: Epilepsy is a common and diverse disorder with many different causes. Outcomes are varied with 60-70% of newly diagnosed people rapidly entering remission after starting treatment and 20-30% developing a drug-resistant epilepsy with consequent clinical and psychosocial distress. About one third of patients with a first unprovoked seizure will have further seizures within five years, and about three quarters of those with two or three unprovoked seizures have further seizures within four years. OBJECTIVE: The aim of the study was to find out those factors which were associated with recurrence of seizure in Nepalese population. METHOD: It is a Descriptive Cross-sectional study which was conducted in Tribhuvan University Teaching Hospital from January 2013 to January 2014. RESULT: A total of 150 patients participated in the study. Neuroimaging was normal in 65(43.3%) patients. 48(32%) patients had neurocystercosis in their brain imaging, neuroinfection in 12(8%) of cases, cerebral infarction in 12(8%), Cerebral atrophy in 5(3.3%) patients, brain tumor in 4(2.7%), Mesial temporal sclerosis in 2(1.3%), tuberous sclerosis in 1(0.7%) and hypoxic brain injury in 1 (0.7%) patient. 14(9.3%) patients reported having a family history of epilepsy in first degree relative. There was statistically significant association between higher number of seizures before starting medication and increased frequency of seizure after starting medication (p<0.001). CONCLUSION: Most of the patients with recurrent seizure had identifiable cause. Neurocysticercosis was the most common cause. Higher number of seizure before starting medication was associated with increased frequency of seizure after starting medication.

Adjunctive orthodontic treatment with lingual orthodontic system.

The lingual orthodontic therapy though started in 1972, could not be popular till the beginning of 1990. In Nepal it does not have a history of more than a year. It is started in Dhulikhel Hospital for the first time in Nepal. Usually orthodontic therapy is meant for putting braces on the labial surface of the teeth which is called labial orthodontic system. Lingual orthodontic system is a purely invisible kind of orthodontic therapy in which braces are placed behind the teeth. The advantages of lingual orthodontic therapy are: invisibility, better biomechanics and improved patient compliance. On the other hand it is difficult to master and costlier than labial orthodontics. We have presented six adjunctive orthodontic cases treated by lingual system with the same end result comparable to labial orthodontic system.

Study of fibrinogen in patients with diabetes mellitus.

Patients with diabetes mellitus have 2 to 4 times increased risk for cardiovascular disease than non-diabetic patients. However this excess risk is not fully explained by the traditional cardiovascular risk factors (Hypertension, Hypercholesterolaemia, Smoking and Obesity) which are also associated with diabetes. Fibrinogen has been identified as an independent risk factor for cardiovascular disease and it is associated with traditional cardiovascular risk factors. This is a descriptive analytical cross-sectional study carried out in Tribhuvan University Teaching Hospital (TUTH) medical outpatient department and Medical ward from June 2005 to June 2006. A total of 120 consecutive patients were enrolled; 30 patients having Diabetes. Next 30 patients having both diabetes and coronary artery disease. Thirty patients having only coronary artery disease but no diabetes. And 30 patients (control) not having both diabetes and coronary artery disease. Fibrinogen was found to be significantly higher in patients with diabetes than control. Fibrinogen was significantly higher in diabetic patients with coronary artery disease than those patients who had only diabetes or coronary artery disease (p value<0.01).

Antimony-121 Mössbauer spectral study of the Eu14MnSb11 and Yb14MnSb11 Zintl compounds.

The antimony-121 Mössbauer spectra of the Yb14MnSb11 and Eu14MnSb11 Zintl compounds have been measured between 2 or 5 and 300 K. The resulting three-dimensional arrays of the spectral counts, velocity, and temperature have been simultaneously fit with a minimum number of free parameters. These fits yield a 0 Kelvin transferred hyperfine field of 2.9(2) T, a Curie temperature of 57(3) K, and a Mössbauer temperature of 182(2) K for Yb14MnSb11; in this case the transferred field arises solely from the ordering of Mn2+. Because Eu14MnSb11 has both Eu2+ and Mn2+ ions that are magnetically ordered, its antimony-121 Mössbauer spectra are more complex and reveal two magnetic transitions, the first at 92(1) K resulting from the ordering of the Mn2+ ions and the second at 9.5(1.0) K resulting from the ordering of the Eu2+ ions; the corresponding 0 Kelvin transferred hyperfine fields are 1.3(1) and 3.7(1) T. The antimony-121 isomer shifts yield electronic configurations of 5s1.745p4.28 and 5s1.745p4.19 for the average antimony anion in Yb14MnSb11 and Eu14MnSb11, respectively.