Haematological indices and haematinic levels after mini gastric bypass: a matched comparison with Roux-en-Y gastric bypass

Many surgeons believe mini gastric bypass (MGB) is more likely to cause micronutrient malabsorption compared to Roux-en-Y gastric bypass (RYGB). Till date, there is no published study evaluating haematological indices and haematinic levels in patients undergoing MGB and comparing these with a matched cohort of RYGB. Two hundred patients who underwent MGB between October 2012 and October 2015 were matched to 200 patients who underwent RYGB for age, sex, body mass index and time of surgery. We then compared haemoglobin, mean corpuscular volume, iron, ferritin, vitamin B12 and folic acid levels preoperatively and at 6 monthly intervals after surgery until 2 years. The percentage total weight loss was significantly higher in the MGB group compared to the RYGB group at all time points. At 2 years, MGB and RYGB both led to an increase in anaemia rates but the difference was only significant for MGB group. Compared to RYGB, MGB patients were more likely to be anaemic at 2 years, although the difference was not significant statistically (16.6% vs. 12.7%; P value = 0.55). There was a trend for lower iron and folate levels in MGB group compared to RYGB group but the difference was statistically significant at some of the time periods only (significantly lower folate at 6 and 12 months and lower iron at 6 months in the MGB group). MGB leads to a significant increase in anaemia rates in a supplemented cohort. There is a trend towards lower iron and folate levels and higher anaemia rates in MGB group in comparison with RYGB. Larger studies with longer follow-up should evaluate results of MGB with a shorter biliopancreatic limb.

Economic Evaluation of a Pilot School–Based Dental Checkup Program

The objectives of this study were to perform an economic evaluation of a targeted school-based dental checkup program in northern metropolitan Melbourne, Victoria. A 12-mo retrospective case-control cohort analysis using the decision tree method evaluated the incremental cost-utility and cost-effectiveness ratio (ICUR/ICER) for passive standard care dental services and an outreach pilot intervention completed in 2013. A societal perspective was adopted. A total of 273 children ( n = 273) aged between 3 and 12 y met the inclusion/exclusion criteria: 128 in the standard care group and 145 in the intervention group. The total society costs included health sector costs, patient/family costs, and productivity losses in 2014 Australian dollars. Outcome measures were evaluated using quality-adjusted tooth years (QATY) and the combined deciduous and permanent decayed, missing, and filled teeth prevented (DMFT-prevented). A generic outcome variable was created to determine the impact of the intervention to reach underserved populations based on government concession eligibility (cardholder status). Uncertainties were incorporated using 95% confidence intervals. The mean total society cost per child is $463 and $291 ( P = 0.002), QATY utility difference is 0.283 and 0.293 ( P = 0.937), effectiveness difference is 0.16 and 0.10 ( P = 0.756), and cardholder status is 50.0% and 66.2% ( P = 0.007), respectively, for the standard care and intervention groups. On average per child, there was a cost saving of $172 and improvement of 0.01 QATY, with an additional proportion of 16.2% of cardholder children reached. The calculated ICER was $3,252 per DMFT-prevented. The intervention dominates standard care for QATY and per 1% cardholder reached outcome measures. Our study found the pilot checkup program was largely less costly and more effective compared with the current standard care. Further research is needed to quantify the value of outreach interventions to prevent dental caries development and progression in populations from low socioeconomic status.

Knowledge Transfer Statement: The findings of this research demonstrated that an outreach dental program can be less costly and more effective than standard models of dental care. It showed that a school-based dental checkup program is beneficial despite other opinions that dental screening is ineffective as a method to improve public dental health. There is fiscal economic evidence to support broader expansion of similar programs locally and internationally to reduce dental caries for children from low-income families.

Single-center prospective study of Plummer-Vinson syndrome

Post-cricoid web is an uncommon cause for dysphagia and is most frequently reported in middle-aged women. Triad of web, iron deficiency anemia (IDA), and dysphagia is known as Plummer-Vinson syndrome (PVS). Literature on PVS is very limited. Here we report the first prospective study of PVS with predefined diagnostic criteria and management plan. Adults with dysphagia or those incidentally found to have esophageal web were prospectively enrolled between July 2011 and June 2013. Participants were evaluated with hemogram, barium swallow, and esophagogastroduodenoscopy. PVS was diagnosed if a person had IDA and a post-cricoid web in barium swallow and/or endoscopy. Patients were managed with dilation using through-the-scope controlled radial expansion balloon followed by oral iron and folic acid supplementation. Thirty-seven patients (age, median [range] 40 [19-65] years; 32 [86%] women) were enrolled. Thirty-one symptomatic patients had dysphagia grade 1 (n = 12, 39%), 2 (n = 13, 42%), and 3 (n = 6, 19%) for a median (range) duration of 24 (4-324) months. Barium swallow, done in 29, showed web in 25 which were either circumferential or anterior in position. Twenty-nine (29/31, 94%) patients had complete and two had partial response after the first session of endoscopic dilatation without any complication. Dysphagia recurred in three (10%) of the 30 patients who were followed for a median (range) of 10 (1-24) months. Esophageal-web related dysphagia in patients with PVS responds favorably after single session of endoscopic dilation.

Qualitative and quantitative OCT response of diffuse diabetic macular oedema to macular laser photocoagulation

PURPOSE

To assess the quantitative and morphological changes of the macula in response to macular grid laser for diabetic macular oedema (DMO) using optical coherence tomography (OCT).

PATIENTS AND METHODS

Cirrus OCT macular cube scans of 30 eyes of 25 patients were retrospectively analysed before and 4 months after macular grid laser for diffuse DMO. The oedema was quantified and response evaluated in the nine early-treatment diabetic retinopathy study (ETDRS) zones of the macula. Post-laser OCT changes were compared with the baseline features, including morphology patterns, changes in both logarithmic transformed (logOCT) and standardised average macular thickness (AMT), total macular volume, number of parafoveal quadrants involved, and the presence of intact 3rd hyper-reflective band (HRB).

RESULTS

The rate of change of retinal thickness in response to laser was maximum in the central (8.17%) and perifoveal inferior quadrants (0.04%). Diffuse retinal thickening on OCT responded best to treatment. The AMT of 300-350 μm had the worst response (+0.94%). Eyes with less than four quadrants of oedema showed good response. Disrupted HRB was associated with poor visual gain (-0.33 ETDRS letters).

CONCLUSION

The topographic location of oedema on the retinal map and the morphological patterns of the oedema on OCT are useful predictors of treatment response in diffuse DMO.

Power and Wavelength Dependence of Photoenhancement in (CdSe)ZnS-Dopamine in Aqueous Solution and Live Cells

CdSe(ZnS) quantum dots conjugated to the electron donor dopamine show enhancement of photoluminescence over a time course of seconds to minutes when exposed to ultraviolet or blue irradiation. This phenomenon is observed when the dots are in aqueous solution as well as after endocytosis by living cells. The rate of enhancement is directly related to the number of dopamine conjugates per quantum dot, and can be semi-quantitatively adjusted over a wide range. Uptake of the particles by cells is also dependent upon surface coverage, with moderate coverages proving ideal for both uptake and relative signal enhancement. The enhancement is strongly power-dependent and may also show dependence upon wavelength; however, direct excitation of the dopamine molecule is not necessary for the enhancement effect.

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort

AIM

To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India.

METHODS

Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied.

RESULTS

Orbicularis oculi weakness (4.62%), lagophthalmos (4.20%), ectropion (0.42%), trichiasis (0.84%), blocked nasolacrimal ducts (1.68%), pterygium (11.34%), impaired corneal sensation (53%), corneal opacity (10.5%), corneal nerve beading (1.68%), punctate keratitis (1.26%), keratic precipitates (4.62%), iris atrophy (1.68%), and cataract (12.6%) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6% had blind eyes. Increasing age was associated with ocular complications. 80% of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71% had some limb deformity. 44% had only leprosy related ocular complications (LROC), 28% had only general ocular complications (GOC) while 14% had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100%) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions.

CONCLUSIONS

Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.

The changing role of the apicectomy operation in dentistry

Enormous progress has been made in the last quarter of a century in understanding the nature of root canal infection and periapical disease. New techniques and materials may be expected to increase the already high success of conventional root canal treatment. Surgical intervention is required for cases where retreatment has failed or is not an option, and the tooth is to be retained rather than extracted. This article reviews the operation of apicectomy and how this minor oral surgical procedure has evolved. Recent modifications to techniques and materials are likely to improve its success, allowing conservation of previously unsaveable teeth.

Radiographic practices of dentists undertaking endodontics in New Zealand

OBJECTIVES

To determine the radiographic practices of New Zealand dentists undertaking root canal treatment, and to investigate the relationship between radiographic practices and educational and clinical factors.

METHODS

A questionnaire was sent to all 1200 general dental practitioners and five specialist endodontists in New Zealand. Data were subjected to descriptive and analytical statistics.

RESULTS

The response rate was 79%. The mean number of root canal treatments done by general dentists in the previous 12 months was 103, and for the specialists 938. Pre-operative views were taken by 57.1% of respondents all the time and by 34.8% in most cases. The long cone paralleling and bisecting angle techniques were in regular use by similar numbers of respondents, and over one half of the practitioners regularly used film holders and electronic apex locators. Working length films were taken by 67% of practitioners all the time and by 18% in most cases. One-quarter of practitioners took a master point view all the time, and 15% did this for most cases. Almost 65% always took a film of the completed root filling and 21% did for most cases. Twenty-three per cent of practitioners did not follow up their work.

CONCLUSIONS

The majority of respondents used radiographs pre-operatively, for working length assessment and to assess the final root filling. There was a general improvement in radiographic practices compared with data from a previous national survey held in 1980.

Pathogenesis of dry eye in leprosy and tear functions

Seventy-five leprosy patients and an equal number of age- and sex-matched controls were examined for tear functions, using Schirmer's test and tear break up time (BUT). There was no statistically significant difference in the Schirmer's test, but the tear BUT showed a statistically significant lower value of < 10 seconds in multibacillary patients compared to paucibacillary patients. Leprosy patients with lagophthalmos and decreased corneal sensation showed a lower value of tear BUT which was also statistically significant. This study shows that even though the quantity of tears is not affected, proper and prolonged wetting of the cornea is deficient in many leprosy patients.

Therapeutic approaches to achieve desired blood pressure goals: focus on calcium channel blockers

The new guidelines for blood pressure control recommended by the World Health Organisation, the International Society of Hypertension, and the JNC VI require that blood pressure be lowered to levels of < 130/85 mmHg in persons with either diabetes or renal insufficiency. A review of over 20 clinical trials performed over the last two decades indicates that an average of 62% of the participants required more than two medications to achieve a goal of < 140/90 mmHg. Thus, with the new guidelines it is clear that an even higher proportion of people will require at least two different medications to achieve this lower goal. Certain classes of antihypertensive medications are relatively more efficacious for lowering blood pressure in certain ethnic and racial groups, thus reducing the probability that two or more agents will be needed to achieve a stated blood pressure goal. This is exemplified by the effects of calcium channel blockers in African-Americans. However, even in these groups many require at least two different antihypertensive agents to achieve the blood pressure goal. The fixed-dose combinations of a calcium channel blocker and ACE inhibitor offer the advantages of complementary physiologic action, improved tolerability, lower side-effect profile, enhanced salutary effects on target organs, better compliance, and lower cost. Varieties of fixed-dose combination regimens for blood pressure lowering are available for clinical use. This article focuses on the subclasses of calcium channel blockers and their role in altering the natural history of both cardiovascular and renal disease. The article further discusses the role of fixed-dose agents with regard to their place in the antihypertensive armamentarium.

Hypopigmented face patches; their distribution and relevance to ocular complications in leprosy

Eighty-two leprosy patients with hypopigmented patches over the face (cases) and an equal number of age-, sex-, and classification-matched leprosy patients without any hypopigmented patches over the face (controls) were examined for the distribution of hypopigmented facial patches, areas of anesthesia over the face, and eye complications. The hypopigmented patches did not follow any pattern and overlapped in the areas of sensation supplied by the three branches of the trigeminal nerve. Anesthesia over the face, evaluated by a Semmes-Weinstein monofilament which exerted a force of 0.05 grams, was present in 19.5% of the cases and 15.9% of the controls. Patients with hypopigmented facial patches were found to have more corneal hypoesthesia than patients who did not have hypopigmented facial patches. The risk of having impaired corneal sensation was three to four times higher in patients with hypopigmented facial patches. This feature can be used to identify decreased corneal sensation among leprosy patients under field conditions where direct estimation of corneal sensation is not advocated.

Dental age assessment: the applicability of Demirjian's method in south Indian children

The paper concerns the testing of Demirjian's method of age assessment in South Indian children. Since previous studies have shown the inapplicability of Demirjian's method on other populations, an attempt to compile a maturity standard for South Indian children was made. An additional independent indicator of age was employed, namely the skeletal age. The material was 184 South Indian children aged 5 to 15 years and an additional 34 children as the test sample. It was found that Demirjian's method gave an overestimation of 3.04 and 2.82 years in males and females, respectively. The skeletal age was found to differ from the dental and chronologic age. It may be concluded that the accuracy of age estimation based on Demirjian's method is not applicable for the South Indian children. For the population to be tested, it is imperative that individual assessment parameters need to be put forward because of wide ethnic differences.

Dental age assessment: the applicability of Demirjian's method in south Indian children

The paper concerns the testing of Demirjian's method of age assessment in South Indian children. Since previous studies have shown the inapplicability of Demirjian's method on other populations, an attempt to compile a maturity standard for South Indian children was made. An additional independent indicator of age was employed, namely the skeletal age. The material was 184 South Indian children aged 5 to 15 years and an additional 34 children as the test sample. It was found that Demirjian's method gave an overestimation of 3.04 and 2.82 years in males and females, respectively. The skeletal age was found to differ from the dental and chronologic age. It may be concluded that the accuracy of age estimation based on Demirjian's method is not applicable for the South Indian children. For the population to be tested, it is imperative that individual assessment parameters need to be put forward because of wide ethnic differences.

A precaution when preparing very large plasmids by alkaline lysis procedure

The extractabilities of plasmids of different sizes by the sodium lauryl sulfate (SDS)-alkali procedure were compared using either sodium acetate or potassium acetate buffer as the neutralizing agent. There was a selective loss of large plasmids (above 100 kb) when the potassium salt was used. When N-lauryl sarcosine instead of SDS was used as the detergent, no loss of large plasmids occurred in the presence of potassium salt. A comparison of the kinetics of precipitate formation with sodium acetate and potassium acetate indicated that the rate and the amount of lauryl sulfate precipitated were lower with the sodium salt. It is suggested that faster precipitation of lauryl sulfate with potassium acetate leads to trapping of large denatured plasmids that cannot renature as fast as the small ones.