Conservative management of diabetic foot osteomyelitis

In this retrospective study, 130 patients with diabetic foot osteomyelitis were analysed. 66.9% of these healed with antibiotic treatment alone and 13.9% needed amputation, of which 1.5% were major. Presence of MRSA was associated with adverse outcome (53.3% vs 21.1%, p=0.04) which was defined as death, amputation and failure to heal.

Efficacy of extrinsic stain removal by novel dentifrice containing papain and bromelain extracts

To evaluate the stain removal efficacy of a novel dentifrice containing papain and bromelain extracts (Glodent) in comparison with a control dentifrice (Colgate regular). This was a randomized, positive-controlled, double-blinded, clinical study. Subjects were randomly divided into one of the two study groups. Pre-treatment and post treatment photographs of the 4 anterior teeth were recorded under standardized conditions and analyzed for lightness or luminosity values using Adobe Photoshop. The difference between the mean pre-treatment luminosity of test and control groups was not statistically significant. In both test and control groups, the post-treatment luminosity was significantly higher than pre- treatment luminosity (P < 0.001 and P = 0.003 respectively). The mean post-treatment luminosity for test group was found to be significantly higher than control group. The mean percentage removal of stains for test group was significantly higher than control group. The test dentifrice showed significant stain removal when compared to control which could be attributed to the role of proteolytic enzymes in the test dentifrice.

Change in Nox4 expression is accompanied by changes in myogenic marker expression in differentiating C2C12 myoblasts

Myoblast differentiation is mediated by a cascade of changes in gene expression including transcription factors such as myogenin. Subsequent to myoblast differentiation, there is an increase in expression of the transmembrane protein NADPH oxidase (Nox). Nox is one of the primary factors for the generation of reactive oxygen species (ROS) in myogenic (C2C12) cells. Recently, ROS have been shown to be important regulators of several intracellular signaling pathways, and the full extent of their regulatory roles is yet to be discovered. In the present study, qRT PCR analysis demonstrated that Nox4 isoform is primarily expressed in differentiating C2C12 cells and contributes to the generation of ROS in C2C12 myoblast during differentiation. Over-expression and silencing of Nox4 expression during myoblast differentiation was accompanied by a reduction in intracellular ROS concentrations and an alteration in the expression patterns of Myf5, Pax7, MyoD1, and myogenin. This modulation was found to be associated with ERK1/2 phosphorylation. In both over-expression and reduced expression of Nox4, we found significant reductions in ERK1/2 phosphorylation. This indicates that cellular differentiation may be affected by Nox4-mediated endogenous ROS generation. These data suggest a new opportunity to study the temporal expression of Nox4 in the generation of ROS accompanying changes in myogenic differentiation.

Cesarean section without urethral catheterization: a randomized control trial

BACKGROUND

Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay.

OBJECTIVE

To determine the feasibility and safety of cesarean section without urethral catheterization.

METHODS

A prospective, randomized controlled trial was carried out from April 2008 to March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences. Among 150 patients who had undergone cesarean section 75 were catheterized and 75 were uncatheterized.

RESULTS

First void discomfort was significantly associated with the use of indwelling catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P less than 0.001).Significant number of patients with indwelling catheter had signs and symptoms of urinary tract infection (OR 6,CI 95%, 2.59 to 13. 86; P less than 0.001). Positive urinalysis for urinary tract infection was high in catheterized group (P less than 0.001). Hospital stay was shorter in patients without catheter (p less than 0.05). None of the patients had bladder injury. There were no significant differences in duration of surgery and ambulation time between two groups of patients.

CONCLUSIONS

Cesarean section can be done safely without urethral catheterization with reduced morbidities.

Dental neglect and adverse birth outcomes: a validation and observational study

OBJECTIVES

The objectives of this study were to validate the Indian translation of the Dental Neglect Scale (DNS) among a sample of parturient Indian women and to investigate dental neglect as a possible risk indicator in adverse birth outcomes.

SUBJECTS AND METHODS

Three hundred and sixteen parturient women were administered the DNS and the Modified Dental Beliefs Scale (MDBS) and were also clinically examined for oral health status. Information regarding socio-economic status, weeks of gestation and birth weight was also collected. A gestation period of less than 37 weeks was considered as preterm and a birth weight of less than 2500 gm as 'low birth weight'.

RESULTS

The Indian version of the DNS was found to be reliable (Cronbach's Alpha = 0.72) and valid for assessing dental neglect among the women. Factor analysis of the DNS revealed a two-factor structure accounting for 56% variance. Dental neglect was higher among those with poorer oral health status, lower socio-economic and educational status. Multinomial logistic regression showed high dental neglect and negative dental beliefs and not poor oral health, as significant risk indicators for occurrence of adverse birth outcomes.

CONCLUSION

The finding of an association of adverse birth outcomes with dental neglect and beliefs, but not with poor oral health could be due to the influence of other more important general factors which had a direct bearing on birth outcomes. There is a need for further research to assess the role of behavioural factors like dental neglect as risk indicators for adverse birth outcomes.

Assessment and validation of the oral impact on daily performance (OIDP) instrument among adults in Karnataka, South India

OBJECTIVES

The objective of the study was to test the applicability of abbreviated version of the oral impact on daily performance (OIDP) inventory among the adults visiting dental outreach centre in Karnataka, South India.

BASIC RESEARCH DESIGN

Cross sectional study.

CLINICAL SETTING

Dental outreach centre in Udupi District, Karnataka.

PARTICIPANTS

312 adults aged 35-44 years attending the centre.

INTERVENTIONS

Face-to-face interview followed by oral health examination. The questionnaire in Kannada version of OIDP, perceived general and oral health and satisfaction with dental appearance were used.

MAIN OUTCOME MEASURES

Reliability and Validity of OIDP instrument, Prevalence of oral impacts in study population.

RESULTS

Majority of the participants (71.2%) reported oral health problems affecting at least one daily performance in the 6 months preceding the survey. The performance most affected was 'eating' (52.2%) followed by 'cleaning teeth' (32.4%). Cronbach's alpha for the OIDP frequency items was 0.70. Construct validity was proved by significant association of OIDP scores and self-rated oral, general health status and perceived satisfaction with appearance of teeth; with those more satisfied having fewer oral impacts (p < 0.001). Criterion validity was demonstrated in that the OIDP scores increased significantly as the number of decayed and missing teeth increased (p < 0.001).

CONCLUSION

The Kannada version of OIDP had excellent psychometric properties for applicability among the adults in Karnataka. Thus, the study highlighted the limits of focusing exclusively on normative needs and suggested the incorporation of oral quality of life measures into the oral healthcare services.

Future specialization interests among medical students in southern India

BACKGROUND

A consideration of the future specialization interests of undergraduate medical students might help to understand the needs of higher medical education and future manpower availability for healthcare.

METHODS

A cross-sectional study was conducted among 373 undergraduate students of a medical college in southern India using a self-administered questionnaire.

RESULTS

Of the 373 students, 188 (50.4%) were men. Almost all of them (370 [99.2%]) wanted to pursue postgraduation. Of these, 267 (72.4%) wanted to pursue postgraduation in India. Overall, the first choice subject was surgery (120 [32.2%]) followed by internal medicine (85 [22.8%]) and paediatrics (43 [11.5%]). The third preference for men and women differed, with men choosing orthopaedics and women choosing obstetrics and gynaecology. The factors that influenced the choice of specialization were interest in the speciality (Likert scale score 4.7), job satisfaction (4.6), employment opportunities (4.0), job security (4) and high income potential (3.9).

CONCLUSION

It was evident from the proportion of students desiring to do postgraduation and their choice of specialties that most of them will end up working at hospitals instead of at primary healthcare centres. The deficiencies of certain specialists such as ophthalmologists are likely to persist. This is a cause for concern as the majority of our population lives in rural areas and there is already a maldistribution of doctors.

Carcinoma of Vagina in Utero-Vaginal Prolapse: A Rare Presentation

Primary vaginal carcinoma in uterovaginal prolapse is a rare entity. We report a case of an 84-years-old lady, who presented with long standing vaginal ulcer in association with third degree uterovaginal prolapse. Incisional biopsy was taken from the ulcer. Histopathological examination showed a large cell keratinizing squamous cell carcinoma. Keywords: Squamous cell carcinoma, uterovaginal prolapse, vaginal carcinoma.

Variation in effects of four OP insecticides on photosynthetic pigment fluorescence of Chlorella vulgaris Beij

Effects of the insecticides quinalphos, chlorfenvinphos, dimethoate and phorate on photosystem activity of Chlorella vulgaris were investigated by different chlorophyll fluorescence measurements. Exposure to each of the insecticides increased the proportion of inactivated PS II reaction center. Quinalphos and chlorfenvinphos caused OJIP fluorescence reduction at all levels by decreasing the proportion of Q(A)-reducing PS II reaction centers (RCs). The other two insecticides affected OJIP fluorescence rise by hindering the electron transport beyond Q(A). Insecticide treatment resulted in decrease of the density of active RC and performance indices (PI) by enhanced dissipated energy flux per active RC. Antenna size was severely minimized by quinalphos and chlorfenvinphos treatment whereas other two insecticides had no such effect. Each insecticide treatment caused increase of photosystem antenna/core and PS II/PS I fluorescence ratios. Quinalphos and chlorfenvinphos affected the donor sides of photosystems whereas dimethoate and phorate inhibited electron transfer beyond Q(A) (acceptor side).

Carcinoma of vagina in utero-vaginal prolapse: a rare presentation

Primary vaginal carcinoma in uterovaginal prolapse is a rare entity. We report a case of an 84-years-old lady, who presented with long standing vaginal ulcer in association with third degree uterovaginal prolapse. Incisional biopsy was taken from the ulcer. Histopathological examination showed a large cell keratinizing squamous cell carcinoma.

Fictitious pseudo Meig’s syndrome: A medical emergency

The present case scenario deals with an acute on chronic symptomatology, and collapsed state of the patient with poor vitals on admission in casualty. Clinical work up pointing to an elevated serum CA 125 levels and USG pelvis suggesting peritoneal adhesions with cystic to firm mass in left ovary and minimal free fluid in abdomen and cul de sac, X Ray chest suggesting right sided Pleural effusion. It was after careful evaluation of the case, with past and present history along with signs, symptommatology and intraoperative findings that differentials like Chronic granulomatous lesions, endometriosis, Neoplastic lesions with metastasis and Meig’s syndrome or Pseudo Meig’s were evaluated. Finally, a diagnosis of genital tuberculosis with enodmetriosis was confirmed on histopathological evaluation. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5975 JCMSN 2011; 7(1): 57-64

Malocclusion and orthodontic treatment need measured by the dental aesthetic index and its association with dental caries in Indian schoolchildren

OBJECTIVE

To assess prevalence of malocclusion and orthodontic treatment needs among 12 year old Indians using the Dental Aesthetic Index, and to find its association with dental caries.

METHOD

927 schoolchildren were randomly selected and their DAI and dentition status scores were recorded as per 1997 World Health Organization criteria. Clinical exams were carried out by one trained and calibrated examiner. The Chi-square test, Z-test and Spearman's correlation test were carried out.

RESULTS

Mean DAI score was 19.2 (sd 6.8). Differences were found between male and female DAI scores (Z < or = 0.05). 82% of children had DAI scores < 26 with no or minor malocclusion requiring no or little treatment, 3.2% had DAI scores 31-35 with severe malocclusion requiring highly desirable treatment and 1.8% DAI scores > 35 with handicapping malocclusion requiring mandatory treatment. A mean DMFT of 1.15 (sd 1.62) was recorded. Severe and handicapping malocclusions were associated with dental caries.

CONCLUSIONS

The distribution of DAI scores among Indian schoolchildren differs from that reported in other populations. Positive correlation was found between severe and handicapping malocclusion with dental caries.

Relationship between body mass index and dental caries among adolescent children in South India

OBJECTIVE

To evaluate the relationship between body mass index (BMI) and dental caries and to study the role of sweet consumption in predicting this relationship among adolescent children in Udupi district, India.

METHODS

The study population consisted of 463 school children in the 13-15-year age group. Anthropometric (height in metres and weight in kilograms) and caries measurements and decayed missing filled teeth (DMFT) index, were carried out by a trained recorder according to standard criteria.

RESULTS

The majority of the children were having low normal weight (BMI < 25) with 18.6% classified as overweight (BMI 25-29.9) and 3.5% as obese (BMI > 30). The frequency of sweet consumption significantly increased from low normal weight children to overweight and obese children. Analysis showed that the obese group of children had more caries than the overweight and low normal weight children. Correlation analysis showed significant positive relation with BMI, decayed teeth (DT) [r = 0.254, p < 0.001] and DMFT (r = 0.242, p < 0.001). Binomial logistic regression showed that males (OR = 2.09, CI = 1.01, 4.33), obese/overweight children (OR = 3.68, CI = 1.79, 7.56) and those who consumed sweets more than once a day (OR = 3.13, CI = 1.25, 7.85) were more likely to have high caries experience.

CONCLUSION

There was a significant association between overweight/obesity and caries experience among school children of the Udupi district. Obesity and dental caries have common risk determinants and require a comprehensive multidisciplinary approach by both medical and dental healthcare professionals.

Efficacy of IV Iron Compared to Oral Iron for Increment of Haemoglobin Level in Anemic Chronic Kidney Disease Patients

Introduction: Anemia is the most common finding in chronic kidney disease patients. Iron supplements are commonly prescribed for these patients with or without erythropoietin therapy by means of oral and intravenous iron. Both oral and intravenous irons have their own advantage and disadvantage, and the efficacy is also different. The objective of the study is to analyze the efficacy of oral and intravenous iron in chronic kidney disease patients on erythropoietin therapy, an erythropoiesis stimulating agents for increment of haemoglobin. Methods: This is a prospective study comparing intravenous iron to oral iron in chronic kidney disease patients who underwent maintenance hemodialysis at different centers and visited Kathmandu Medical College Teaching Hospital from April 2010 to April 2011. Patients having a haemoglobin level of < 11 g/dl, transferrin saturation (TSAT) < 25%, ferritin < 300ng/ml and who were on erythropoietin therapy were allocated alternately into two groups to receive oral iron (iron fumarate) or IV iron (iv sucrose). Haemoglobin was measured after 30 days of therapy. Results: A significant increase in haemoglobin levels was observed in both groups. But the mean haemoglobin increment was more in the IV iron group than in the oral iron group. Sixty percent 60% of patients in the IV iron group had an increase in the haemoglobin level of more than 1gm/dl while only 20% of the oral iron group had this increase. Conclusions: Intravenous iron therapy is more effective in raising the hemoglobin level in hemodialysis dependent chronic kidney disease patients. Keywords: anemia; chronic kidney disease; iron.

Subcutaneous Emphysema in Pregnancy

Spontaneous pneumomediastinum and subcutaneous emphysema are rare complications of labor, especially in the late pregnancy period, but they are usually self-limiting. Management includes avoidance of exacerbative factors and close observation with supportive treatment. A 19-year-old primi gravida at 36 weeks pregnancy presented with swelling over the right side of the face, neck and chest. Her general examination was normal. Systemic examination revealed swelling with palpatory crepitation over the right side of chest, neck and face, and other examination findings were normal. Chest X-ray revealed subcutaneous emphysema without pneumothorax. The patient left hospital against medical advice. Keywords: Pregnancy; subcutaneous emphysema; pneumomediastinum.

Subcutaneous emphysema in pregnancy

Spontaneous pneumomediastinum and subcutaneous emphysema are rare complications of labor, especially in the late pregnancy period, but they are usually self-limiting. Management includes avoidance of exacerbative factors and close observation with supportive treatment. A 19-year-old primi gravida at 36 weeks pregnancy presented with swelling over the right side of the face, neck and chest. Her general examination was normal. Systemic examination revealed swelling with palpatory crepitation over the right side of chest, neck and face, and other examination findings were normal. Chest X-ray revealed subcutaneous emphysema without pneumothorax. The patient left hospital against medical advice.

Efficacy of IV iron compared to oral iron for increment of haemoglobin level in anemic chronic kidney disease patients on erythropoietin therapy

INTRODUCTION

Anemia is the most common finding in chronic kidney disease patients. Iron supplements are commonly prescribed for these patients with or without erythropoietin therapy by means of oral and intravenous iron. Both oral and intravenous irons have their own advantage and disadvantage, and the efficacy is also different. The objective of the study is to analyze the efficacy of oral and intravenous iron in chronic kidney disease patients on erythropoietin therapy, an erythropoiesis stimulating agents for increment of haemoglobin.

METHODS

This is a prospective study comparing intravenous iron to oral iron in chronic kidney disease patients who underwent maintenance hemodialysis at different centers and visited Kathmandu Medical College Teaching Hospital from April 2010 to April 2011. Patients having a haemoglobin level of < 11 g/dl, transferrin saturation (TSAT) < 25%, ferritin < 300ng/ml and who were on erythropoietin therapy were allocated alternately into two groups to receive oral iron (iron fumarate) or IV iron (iv sucrose). Haemoglobin was measured after 30 days of therapy.

RESULTS

A significant increase in haemoglobin levels was observed in both groups. But the mean haemoglobin increment was more in the IV iron group than in the oral iron group. Sixty percent 60% of patients in the IV iron group had an increase in the haemoglobin level of more than 1gm/dl while only 20% of the oral iron group had this increase.

CONCLUSIONS

Intravenous iron therapy is more effective in raising the hemoglobin level in hemodialysis dependent chronic kidney disease patients.

Aliskiren-based stepped-care treatment algorithm provides effective blood pressure control

AIMS

Recent guidelines for the management of hypertension recommend an individualised stepped-care treatment approach in mild-to-moderate hypertensive patients, to achieve blood pressure (BP) goals. This study evaluated the probability of patients achieving BP targets with an aliskiren-based stepped-care treatment regimen.

METHODS

This was a 24-week, open-label, non-comparator study design that included six sequential 4-week treatment periods in patients with mild-to-moderate hypertension. Over the potential 24 weeks of active treatment, incremental therapy included the following add-on therapies at 4-week intervals: aliskiren 150-300 mg once daily, hydrochlorothiazide (HCTZ) 12.5-25 mg once daily, and finally amlodipine 5-10 mg once daily, as needed to achieve target BP. Subjects achieving BP targets following any given 4 weeks of therapy were considered study completers, while subjects not achieving their clinical BP target entered into the next step of incremental therapy. The primary efficacy end-point was the estimated cumulative probability of patients achieving BP target.

RESULTS

Of 256 patients treated, 232 (90.6%) completed the study. Baseline mean sitting BP was 155.7/91.7 mmHg. At study end-point, the estimated cumulative probability of reaching BP target was 86.12%. The stepped-care treatment regimen was well tolerated at the maximal recommended doses of all the individual complimentary therapies.

CONCLUSION

An aliskiren-based stepped-care treatment regimen that subsequently included both HCTZ and amlodipine is effective in achieving BP goals in approximately 90% of patients with mild-to-moderate hypertension.

Role of CaCO3 alone and CaCO3 plus vitamin D3 in terms of calcium phosphorus product in chronic kidney diseases

BACKGROUND

CaCO3 alone and CaCO3 plus vitamin D3 metabolites are commonly prescribed in CKD patients. The objective of this study is to analyze the changes in Ca x P product, calcium level and phosphorus level in CKD patients receiving calcium carbonate alone and calcium carbonate with vitamin D3 in combination.

METHODS

A prospective, cross sectional study among CKD patients under maintenance hemodialysis two times a week were studied over a period of one year. The patients were divided into two groups receiving oral CaCO3 alone and CaCO3 plus vitamin D3 once a day. The patients were followed for 1 month and result of Ca x P product was analyzed accordingly.

RESULTS

Mean decrease of Ca x P product in CaCO3 group is (50.42+/-8.85 to 47 +/-6.63) in one month, p value =0.001(0.6-5) and CI- 95%. There is also significant reduction of phosphorus level in CaCO3 group than CaCO3 plus vitamin D3 group. Mean decrease in phosphorus in CaCO3 group is (5.51+/-0.76 to 5.17+/- 0.05) in one month. P value =0.01(0.14-0.53) and CI 95%.

CONCLUSIONS

There is a significant decrease in Ca x P product and phosphorus level was observed in CKD patients taking CaCO3 alone.

A comparative clinical trial of Chincha kshara and Kadali kshara on Amlapitta

A clinical trial was carried out on 30 patients of Amlapitta aged between 20 to 35 years with complaints of Avipaka, hrit-kanthadaha, tikta-amlodgara, utklesa, udarasula, adhmana and aruchi, who were registered from OPD and IPD of Gopabandhu Ayurveda Mahavidyalaya, Puri. They were equally divided into three groups Chincha kshara, Kadali kshara and placebo (who were administered with fresh wheat powder) for 30 days in a dose of 500 mg thrice daily with water. Investigations was done in order to exclude upper gastrointestinal tract ulcer, carcinoma in stomach, cholecystitis, carcinoma gall bladder, and heart diseases. The clinical assessments were carried out on the 30^th day by subjective and objective parameters and it was inferred that both Chincha kshara and Kadali kshara were effective and reduced the symptoms of amlapitta. Chincha kshara was found to be more effective than Kadali kshara. The study shows the effect of Chincha and Kadali kshara which led to cure in 4(40%) and 3(30%) patients respectively, and maximum improvement in 4(40%) and 5(50%) patients affected with amlapitta disease, respectively. No untoward effect was noticed due to administration of ksharas during the clinical trial period.

Nanocrystalline NiFe2O4 and nanocomposites of (NiFe2O4)(1-x)(Al2O3)x (x = 0.25, 0.40): superparamagnetic behavior and Mössbauer spectroscopy

Nanocrystalline NiFe2O4 with different particle sizes and nanocomposites of (NiFe2O4)(1-x)(Al2O3)x (x = 0.25, 0.40) were prepared by using co-precipitation method. In this method two techniques viz., 'ultrasonication' and 'magnetic stirring' during co-precipitation were used. The as prepared samples were annealed at different temperatures to obtain samples with different particle sizes. The formation of the nanocrystalline spinel phases of all the samples were confirmed by X-ray diffraction (XRD) patterns. The sizes of the nanoparticles of all the samples were calculated from the broadening of the (311) line in the XRD pattern. The distribution of sizes are remarkably less in samples obtained from 'ultrasonication' technique compared to those obtained in 'magnetic stirring' technique. The different soft magnetic quantities viz., coercive field, magnetization, remanance, hysteresis losses etc. were extracted from the ac hysteresis loops observed at different frequencies. The variations of coercive field and hysteresis loss as functions of frequency and particle sizes have been studied. Mössbauer spectra of the samples along with the hysteresis loops recorded at room temperature indicate the presence of superparamagnetic (SPM) relaxations of the nanoparticles. Also, SPM relaxations have been introduced in the samples annealed at higher temperature by encapsulating the nanoparticles in non-magnetic matrix of Al2O3 with 40% coating.

Multiple odontogenic keratocysts associated with Gorlin-Goltz syndrome

Gorlin-Goltz syndrome or Nevoid basal cell carcinoma syndrome is an autosomal dominant disorder with a predisposition to cancer. Features like basal cell carcinoma, odontogenic keratocysts, calcification of falx cerebri, bifid ribs, pits on palms and soles and hypertelorism are evident. A case of this rare disease seen on a 13 year old female patient is presented here, where multiple odontogenic keratocysts were causing disfigurement of the lower jaw as well as displacement and malocclusion of the lower teeth.

Development of tolerance of egg plant (Solanum melangena L.) to field application of dimethoate

Dimethoate, at field concentration (1.419 mg g(-1) fr wt), caused inhibition of photosynthesis, transpiration and stomatal conductance of Solanum melangena L. on first treatment but subsequent treatments caused adaptation and recovery of these parameters. The variable fluorescence (F(v)), dissipation (DI(0)/RC), 2 ms relative variable fluorescence (V(j)), net rate of PS II closure (M(0)), and maximum trapping rate of active PS II (TR(0)/RC) increased initially but reduced to the control value with repetition of treatment. However, fluorescence yield (TR(0)/Abs), electron transport probability (ET(0)/TR(0)) and activity of RC (ET(0)/RC) increased with each treatment. With each subsequent treatment there was enhancement of activities of esterases and decrease of insecticide content of leaves.

Atomic positional versus electronic order in semiconducting ZnSe nanoparticles

Size-controlled ZnSe nanoparticles with high extents of atomic positional order are shown to exhibit large size-dependent variations in their local electronic environments. Solid-state ;{77}Se and ;{67}Zn NMR spectra reveal increasingly broad distributions of ;{77}Se and ;{67}Zn environments with decreasing nanoparticle sizes, in contrast with high degrees of atomic positional order established by transmission electron microscopy and x-ray diffraction. First-principles calculations of NMR parameters distinguish between atomic positional and electronic disorder that propagate from the nanoparticle surfaces and yield insights on the order and disorder present.

Value of targeting at-risk populations at outreach venues: findings from a local sauna

An assessment of the need to increase access to an outreach venue, the local sauna in Walsall, UK, frequented only by men who have sex with men, was undertaken. A case-notes review of the clients who attended the monthly outreach sessions at the sauna in the year 2007 was performed. Among the 287 men seen at the 12 outreach sessions, 37% had a sexually transmitted infection (STI). Of those tested positive, 88% had never had a previous STI. Twenty-one men had syphilis and a further six tested positive for HIV. Hepatitis B vaccination was completed for 41% of the clients seen. Those who tested positive for an STI said they would not have attended a conventional setting but accepted screening at the sauna. This confirmed the need to increase access at this outreach venue, and further funding has now been provided to have outreach sessions twice a month.

Vaginal prostaglandin E2 gelversustablet in the induction of labour at term—a retrospective analysis

Our aim in this retrospective analysis was to compare labour outcomes between 145 consecutive women with unfavourable cervices, who received prostaglandin E2 vaginal gel (1-2 mg) for labour induction over a 3-month period, and 149 women receiving a prostaglandin E2 vaginal tablet (3 mg) over the following 3 months. Our results showed that cervical dilatation in the gel group was significantly more than in the tablet group at transfer to labour ward [4 cm (SD 2.5 cm) versus 3.3 cm (SD 2 cm), mean difference -0.7, 95% CI -1.2 to -0.2, P=0.01), with fewer women requiring oxytocin augmentation, but this was not statistically significant (41.4% versus 50%, RR 0.8, 95% CI 0.7-1.1). There were no significant differences in the mode of delivery in the number delivering vaginally within 24 hours of the induction (60.4% in the gel group versus 56.2% in the tablet group, RR1.1, 95% CI 0.9-1.4), in the number of doses of PGE2 administered, or in the neonatal outcomes between the two groups. In conclusion, there were no significant differences in labour or neonatal outcomes between prostaglandin E2 gel or tablet use in the induction of labour in this retrospective analysis.

Role of foley's catheter in removing foreign body of oesophagus

Oesophageal foreign bodies are commonly removed with rigid oesophagoscopy under general anaesthesia, but spherical foreign bodies can also be removed using a foley's catheter under fluoroscopic control without anaesthesia. We present a case of successful removal of a spherical marble from the oesophagus in a four years old girl by a foley's catheter under general anaesthesia.

Role of Foley’s Catheter in Removing Foreign Body of Oesophagus

Oesophageal foreign bodies are commonly removed with rigid oesophagoscopy under general anaesthesia, but spherical foreign bodies can also be removed using a foley's catheter under fluoroscopic control without anaesthesia. We present a case of successful removal of a spherical marble from the oesophagus in a four years old girl by a foley's catheter under general anaesthesiaKeywords:Keywords:Foreign body, oesophagus, foley’s catheter

Oral health-related quality of life and its relationship with health locus of control among Indian dental university students

OBJECTIVES

The objectives of this study were to assess the relationship between Oral Health-Related Quality of Life (OHRQoL) and Health Locus of Control (HLC) among students in an Indian dental school.

MATERIALS AND METHODS

A cross sectional study design was used. Three hundred and twenty-five dental students returned completed forms containing the 14 item Oral Health Impact Profile (OHIP-14) and the 18 item Multidimensional Health Locus of Control Scale (MHLC).

RESULTS

The results showed that the perceived OHRQoL differed among students studying in different stages of the dental course. The OHRQoL dimensions of 'Social Handicap' and 'Handicap' were significantly (P < 0.01) lower among the later years of the course than the freshman year students. There was a sharp increase in Self-reported dental problems, in particular, Malocclusion, Tooth decay, Calculus among the third year and final year students respectively. The OHIP-14 scores were significantly higher among those with self-reported oral problems. Correlation analysis between the OHIP-14 and the MHLC scores also showed a statistically significant (P < 0.01) correlation between the 'Chance' dimension of the MHLC and OHIP-14 scores.

CONCLUSIONS

The results of this study underscored the relationship between the OHRQoL and HLC and of importance of assessing health attitudes and their impact on OHRQoL among the dental student community.

Bax and Bid act in synergy to bring about T11TS-mediated glioma apoptosis via the release of mitochondrial cytochrome c and subsequent caspase activation

The specific apoptotic role of T11TS has been well established in glioma animal models. T11TS specifically induces the glioma cells to die an apoptotic death via immune cross-talk with the two intracranial immune competent cells-microglia and the brain-infiltrating lymphocytes. To unearth the molecular cascades operative within the glioma cells and to some extent in the two interacting immunocytes, we had initiated studies where preliminary findings not only had indicated the involvement of death receptors but had also hinted to the involvement of other apoptotic regulators. Hence, to identify the molecular pathway of apoptosis involving other apoptotic regulators in the three cell types, the cells were studied for the intrinsic apoptotic death regulators that were engaged to maintain the mitochondrial membrane integrity. The proteins that were selected could be divided into three broad classes-the Bcl-2 family of proteins-Bid, Bax and Bcl-2; the guardian of the genome p53 and the proteins downstream of mitochondria-Apaf-1, cytochrome c, caspase-9 and caspase-3. Activated Bid as well as maximal p53 expression was observed in the first dose of T11TS thus dually activating the pro-apoptotic Bax in the first and second dose in the glioma cells. Concurrently, the pro-survival protein Bcl-2's expression level was very much down-regulated in the same two doses favoring the internal microenvironment to proceed for apoptosis. High expression of cytochrome c and Apaf-1 and the presence of active caspase-9 and active caspase-3 in all the T11TS-treated tumor-bearing groups further adjudicated apoptosis of the glioma cells with clear involvement of mitochondrial death pathway in the T11TS-treated animals. Even though expression of the apoptotic regulators remained more or less the same indicating the involvement of mitochondria in the two interacting immunocytes, the intensity of expression of these proteins was much lower than the tumor cells. The present work focuses on the mechanistic approach of how T11TS mediates apoptosis and hence is the first approach of its kind in the field of immunology where the immunotherapeutic molecule's mode of action has been worked out.

Chemoradiation in locally advanced cervical cancer : A randomized trial

Background: Radiation with concurrent chemotherapy (weekly cisplatin) is currently standard of care for locally advanced cervical cancer. Gemcitabine, a pyrimidine analogue is a potentially radio-sensitizing drug. We compared cisplatin and gemcitabine in the treatment of locally advanced cervical cancer. Methods: 90 patients with locally advanced squamous cell cancer of the cervix (stage IIB-IVA) were randomized to receive either cisplatin 40mg/m2 weekly or gemcitabine 150 mg/m2 weekly (45 patients in each arm) along with external beam radiation (50Gy in 25# over 5 weeks). This was followed by three insertions of high dose radiation (HDR) intracavitary brachytherapy one week apart. Results: At a median follow up of 13months, 25 (55.56%) patients were in complete response (CR) in the cisplatin arm compared to 22 patients (48.89%) [p=0.67] in gemcitabine arm. 10 patients (22.22%) in cisplatin arm had either died or lost to follow up compared to 11 patients in gemcitabine (24.44%) arm. Nausea/vomiting was higher in cisplatin arm. Diarrhea, skin reaction and hematological toxicity were more in gemcitabine arm. Conclusion: Cisplatin seems to be a better option than gemcitabine when used concurrently with radiation for locally advanced cervical cancer both in terms of response and toxicity.

Factors affecting dental anxiety and beliefs in an Indian population

The purpose of this study was to describe the possible factors that may affect dental anxiety and beliefs and to validate and test the psychometric properties of the Modified Dental Anxiety Scale (MDAS) and a Modified Dental Beliefs Scale (MDBS) among the patients attending a university dental clinic in India. A cross-sectional study design was used. A total of 482 general dental patients attending a university dental clinic returned completed forms of the Indian translations of the MDAS and MDBS. General information about the age, sex, occupation and educational qualifications of the respondents as well as information about past dental experiences was also collected. All the statistical analysis was carried out by the spss (version 10) statistical software package. The Indian translations of the MDAS and the MDBS were found to be internally reliable with a Cronbach's alpha of 0.78 and 0.85, respectively. Validity was demonstrated by a statistically significant correlation between the MDAS and the MDBS scores with the correlation coefficient of 0.47. Age was also inversely related to dental anxiety. Anxiety scores were higher among the less educated patients. Those who had a prior unpleasant dental experience showed higher dental anxiety and more negative dental beliefs. The data obtained in this study provided strong evidence for the psychometric properties of the Indian version of the MDAS and the MDBS.

64-slice CT scan in Kathmandu Medical College Teaching Hospital

64-slice CT scan is a versatile newly introduced imaging technology, which is capable of diagnosing various diseases from head to toe. The 64-slice CT coronary angiography has a negative predictive value of 100%. Virtual images of bronchi, stomach and colon can provide definite diagnosis. Coronary artery calcification score which predicts coronary artery disease can be calculated by 64-slice CT scan.

Ventricular tachycardia in acute fulminant myocarditis: medical management and follow-up

The combination of ventricular tachycardia (VT) and severe left ventricular dysfunction presents a serious challenge in management of acute fulminant myocarditis (AFM). We report a case of a 17-month-old girl with AFM, presented with hypotension and VT, successfully treated with respiratory and inotropic support, high-dose intravenous immunoglobulin, and amiodarone. The myocardial function improved significantly within 2 weeks of treatment. The clinical course was complicated by significant amiodarone-induced hepatotoxicity, disseminated intravascular coagulation, and deep-vein thrombosis. She was later diagnosed with congenital dysfibrinogenemia and treated with chronic Lovenox therapy.