Journal Of Clinical And Diagnostic Research[JOURNAL]
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200 papers
To Evaluate the Correlation Between Skeletal and Dental Parameters to the Amount of Crowding in Class II Div. 1 Malocclusions.
Singh S, Shivaprakash G
J Clin Diagn Res · 2017 Sep · PMID 29207827 · Full text
INTRODUCTION: Crowding of teeth is one of the most common problem that motivates the patient to seek orthodontic treatment. Determination of etiology of crowding could have a significant effect on treatment planning and...
INTRODUCTION: Crowding of teeth is one of the most common problem that motivates the patient to seek orthodontic treatment. Determination of etiology of crowding could have a significant effect on treatment planning and prognosis of Class II malocclusion. AIM: Aim of this study was to evaluate the relationship of skeletal and dental parameters to amount of dental crowding in patients with Class II Divison 1 (div.1) malocclusion. MATERIALS AND METHODS: Pretreatment lateral cephalograms and dental casts of 60 patients with skeletal Class II malocclusion were collected for the study. The sample was divided into two groups according to severity of pretreatment mandibular crowding. Group I consisted of cases with crowding ≥3 mm and Group II with crowding <3 mm. Lateral cephalograms for each patient was manually traced and skeletal parameters (effective maxillary and mandibular length, mandibular plane angle, Y Axis, lower anterior face height) and dental parameters (axial inclination of lower incisor, inclination of lower incisor to mandibular plane, interincisal angle) were measured. Unpaired t-test was used for intergroup comparison and relationship between different measurements was investigated using Pearson correlation coefficient. RESULTS: Among the skeletal parameters measured, only effective mandibular length exhibited statistically significant difference between the two groups. No statistically significant difference was found between the two groups for any of the dental parameters. Significant inverse correlation was found between mandibular crowding and effective mandibular length. CONCLUSION: Subjects with Class II div.1 malocclusion and moderate to severe mandibular crowding have significantly smaller effective mandibular base length than subjects with the same malocclusion and slight mandibular crowding.
The Association between Periodontal Status, Serum Lipid Levels, Lipoprotein Associated Phosholipase A2 (Lp-PLA2) in Chronic Periodontitis Subjects and Healthy Controls.
Koshy BS, Mahendra J
J Clin Diagn Res · 2017 Sep · PMID 29207826 · Full text
INTRODUCTION: Lipoprotein associated phospholipase A2 (Lp-PLA2) has been explored as a potential biomarker for Cardiovascular Disease (CVD). The human Lp-PLA2 is a serine-dependent, Ca2+- independent enzyme. It gives way...
INTRODUCTION: Lipoprotein associated phospholipase A2 (Lp-PLA2) has been explored as a potential biomarker for Cardiovascular Disease (CVD). The human Lp-PLA2 is a serine-dependent, Ca2+- independent enzyme. It gives way to oxidised free fatty acids and lysophosphatidyl choline by hydrolysing oxidised phospholipids, that leads to smooth muscle cell apoptosis, inflammatory cell chemotaxis and endothelial cell dysfunction in CVD. Owing to its role in inflammation, it may influence the development and progression of periodontitis as well. AIM: To compare the demographic variables, Gingival Index(GI), Bleeding On Probing (BOP), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) with serum lipid profile and Lp-PLA2 level in Chronic Periodontitis (CP) subjects. MATERIALS AND METHODS: A total of 75 subjects were selected and divided into three groups; based on the inclusion and exclusion criteria: Group I - 25 subjects with severe generalized CP with CAL ≥ 5 mm in more than 30% of sites. Group II -25 subjects with moderate generalized CD with clinical CAL 3 mm-4 mm in more than 30% of sites. Group III- 25 systemically and periodontally healthy volunteers who served as control. Clinical parameters such as Plaque Index (PI), BOP, Probing Depth (PD) and CAL, lipid profile such as Total Cholesterol (TC), Triglyceride (TG), High density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Very Low Density Lipoprotein (VLDL) as well as Lp-PLA2 were assessed. One-way ANOVA and Tukey's Post-hoc test were used for data analysis. RESULTS: Age was higher in Group I and II when compared to Group III. Group II showed a significant correlation between PI and LDL. In Group III, lower PI was significantly correlated with high HDL and low LDL and BOP was positively correlated with TG and HDL. A significant association of Lp-PLA2 was found to be higher with increase in the TG and VLDL level in Group I and Group II when compared to Group III. CONCLUSION: The study concluded that Lp-PLA2, TG and VLDL already being a predictor biomarker for atherosclerotic disease can be an inflammatory marker for periodontitis.
Global Search Trends of Oral Problems using Google Trends from 2004 to 2016: An Exploratory Analysis.
Patthi B, Kumar JK, Singla A … +5 more , Gupta R, Prasad M, Ali I, Dhama K, Niraj LK
J Clin Diagn Res · 2017 Sep · PMID 29207825 · Full text
INTRODUCTION: Oral diseases are pandemic cause of morbidity with widespread geographic distribution. This technology based era has brought about easy knowledge transfer than traditional dependency on information obtained...
INTRODUCTION: Oral diseases are pandemic cause of morbidity with widespread geographic distribution. This technology based era has brought about easy knowledge transfer than traditional dependency on information obtained from family doctors. Hence, harvesting this system of trends can aid in oral disease quantification. AIM: To conduct an exploratory analysis of the changes in internet search volumes of oral diseases by using Google Trends (GT). MATERIALS AND METHODS: GT were utilized to provide real world facts based on search terms related to categories, interest by region and interest over time. Time period chosen was from January 2004 to December 2016. Five different search terms were explored and compared based on the highest relative search volumes along with comma separated value files to obtain an insight into highest search traffic. RESULTS: The search volume measured over the time span noted the term "Dental caries" to be the most searched in Japan, "Gingivitis" in Jordan, "Oral Cancer" in Taiwan, "No Teeth" in Australia, "HIV symptoms" in Zimbabwe, "Broken Teeth" in United Kingdom, "Cleft palate" in Philippines, "Toothache" in Indonesia and the comparison of top five searched terms provided the "Gingivitis" with highest search volume. CONCLUSION: The results from the present study offers an insight into a competent tool that can analyse and compare oral diseases over time. The trend research platform can be used on emerging diseases and their drift in geographic population with great acumen. This tool can be utilized in forecasting, modulating marketing strategies and planning disability limitation techniques.
Comparative Evaluation of Antiplaque Efficacy of Coconut Oil Pulling and a Placebo, Among Dental College Students: A Randomized Controlled Trial.
Nagilla J, Kulkarni S, Madupu PR … +3 more , Doshi D, Bandari SR, Srilatha A
J Clin Diagn Res · 2017 Sep · PMID 29207824 · Full text
INTRODUCTION: Oil pulling, has been extensively used as traditional Indian folk remedy since many years to prevent dental diseases and for strengthening teeth and gums. AIM: To compare and evaluate antiplaque efficacy of...
INTRODUCTION: Oil pulling, has been extensively used as traditional Indian folk remedy since many years to prevent dental diseases and for strengthening teeth and gums. AIM: To compare and evaluate antiplaque efficacy of coconut oil pulling with a placebo among dental students, in Hyderabad city of India. MATERIALS AND METHODS: A randomized controlled study was carried out among 40 dental students. Out of 40, 20 subjects were randomly assigned to study group and other 20 to control group. Subjects in the study group were given the coconut oil and control group a placebo, and advised to rinse for 10 minutes, once daily in the morning for a period of seven days. Plaque levels were assessed on day zero, third and seventh day using Turesky-Gilmore-Glickman Modification of the Quigley-Hein Plaque Index (1970) for both the groups. RESULTS: The mean plaque scores showed a significant difference at baseline, third day and seventh day among both study (p<0.001) and control groups (p<0.001). Group wise comparison revealed, though the mean plaque scores were low among study group on third day and seventh day on comparison with the control group, significant difference was noticed only on the seventh day. Furthermore, the mean percentage reduction of plaque scores were also significant only on the seventh day with a high mean plaque reduction among study groups (p<0.001). CONCLUSION: Oil pulling is effective in controlling plaque levels.
An In vitro Study to Compare the Effect of Different Types of Tea with Chlorhexidine on .
George DE, Shetty R, Shetty PJ … +1 more , Gomes LA
J Clin Diagn Res · 2017 Sep · PMID 29207823 · Full text
INTRODUCTION: Tea is the second most commonly consumed beverage in the world after water. The leaf and bud of the plant produces tea. The different forms of tea are 'non-fermented' green tea, 'semi-fermented' oolong tea...
INTRODUCTION: Tea is the second most commonly consumed beverage in the world after water. The leaf and bud of the plant produces tea. The different forms of tea are 'non-fermented' green tea, 'semi-fermented' oolong tea and 'fermented' black tea according to the manufacturing process. is the main causative organism in dental caries and plaque formation. AIM: The present study was undertaken to determine the antibacterial effectiveness of aqueous and ethanol extracts of green tea, black tea and oolong tea against in comparison with 0.2% chlorhexidine. MATERIALS AND METHODS: An in vitro study was conducted to compare the effectiveness of aqueous and ethanol extracts of green tea, black tea and oolong tea with 0.2% chlorhexidine against . Chlorhexidine 0.2% commercially available as mouthwash was used as such for comparison. The antimicrobial activity was determined using agar well diffusion method. About 50 µl of the aqueous and ethanol extracts of tea and 0.2% chlorhexidine were inoculated into the wells prepared on blood agar plates smeared with . The agar plates were incubated for 24 hours after which the diameter of the zone of inhibition was measured. Analysis of Variance (ANOVA) followed by Tukey's post hoc test were used for statistical analysis. RESULTS: The mean zone of inhibition of the aqueous extracts of green tea, black tea, oolong tea and chlorhexidine was found to be 16.33 mm, 10.33 mm, 19.66 mm and 22 mm respectively. The mean zone of inhibition of the ethanol extracts of green tea, black tea, oolong tea and chlorhexidine was found to be 14 mm, 9 mm, 20.66 mm and 22 mm respectively. The study result state that the inhibitory effect of chlorhexidine is almost similar to that of oolong tea followed by green tea and black tea. CONCLUSION: From the present study, it can be concluded that the aqueous and ethanol extracts of oolong tea showed highest antimicrobial activity compared to green tea and black tea.
Estimation of Correlation between Chronological Age, Skeletal Age and Dental Age in Children- A Cross-sectional Study.
Macha M, Lamba B, Avula JSS … +3 more , Muthineni S, Margana PGJS, Chitoori P
J Clin Diagn Res · 2017 Sep · PMID 29207822 · Full text
INTRODUCTION: In the modern era, identification and determination of age is imperative for diversity of reasons that include disputed birth records, premature delivery, legal issues and for validation of birth certificat...
INTRODUCTION: In the modern era, identification and determination of age is imperative for diversity of reasons that include disputed birth records, premature delivery, legal issues and for validation of birth certificate for school admissions, adoption, marriage, job and immigration. Several growth assessment parameters like bone age, dental age and the combination of both have been applied for different population with variable outcomes. It has been well documented that the chronological age does not necessarily correlate with the maturational status of a child. Hence, efforts were made to determine a child's developmental age by using dental age (calcification of teeth) and skeletal age (skeletal maturation). AIM: The present study was aimed to correlate the chronological age, dental age and skeletal age in children from Southeastern region of Andhra Pradesh, India. MATERIALS AND METHODS: Out of the total 900 screened children, only 100 subjects between age groups of 6-14 years with a mean age of 11.3±2.63 for males and 10.77±2.24 for females were selected for the study. Dental age was calculated by Demirjian method and skeletal age by modified Middle Phalanx of left hand third finger (MP3) method. Pearson's and Spearman's correlation tests were done to estimate the correlation between chronological, dental and skeletal ages among study population. RESULTS: There was a significant positive correlation between chronological age, dental age and all stages of MP3 among males. Similar results were observed in females, except for a non-significant moderate correlation between chronological age and dental age in the H stage of the MP3 region. CONCLUSION: The results of the present study revealed correlation with statistical significance (p<0.05) between chronological, dental and skeletal ages among all the subjects (48 males and 52 females) and females attained maturity earlier than males in the present study population.
Hand-Held Dynamometer is a Reliable Tool to Measure Trunk Muscle Strength in Chronic Stroke.
Karthikbabu S, Chakrapani M
J Clin Diagn Res · 2017 Sep · PMID 29207821 · Full text
INTRODUCTION: Patients with chronic stroke show atypical coordination of trunk movement and they find difficulty during bed mobility and transfer skills due to weakness of trunk muscles. Routine bedside clinical examinat...
INTRODUCTION: Patients with chronic stroke show atypical coordination of trunk movement and they find difficulty during bed mobility and transfer skills due to weakness of trunk muscles. Routine bedside clinical examination fails to quantify the trunk muscle strength in patients with stroke. Handheld dynamometer is widely administered to quantify the strength of extremities, but its reliability on testing the trunk muscles strength is limited. AIM: This study aimed at examining the reliability of hand-held dynamometer to quantify the strength of trunk muscle groups in chronic stroke. MATERIALS AND METHODS: This reliability study was conducted in outpatient clinical settings. Patients with chronic stroke aged between 30 and 80 years and an ambulatory capacity of 10-meter distance volunteered in the study. The strength of trunk flexors, extensors, rotators towards most and least affected sides and bilateral lateral flexors was examined by break test using hand-held dynamometer and the isometric strength was reported in pounds (lb.). These tests were carried out by two physical therapists independently at two time points and the assessment procedure was standardized. Pearson's correlation test was conducted to observe the reliability of dynamometer strength testing i.e., internal consistency of the measure and intra-class correlation coefficient (r). RESULTS: Of the 85 study participants, 51 of them had most trunk involvement on the left side and 34 had it on the right side. This study showed an excellent intra-rater (0.88-0.98) and inter-rater (0.84-0.96) reliability of trunk muscle strength testing using hand-held dynamometer. CONCLUSION: Hand-held dynamometer showed excellent intra and inter tester reliability to quantify the trunk muscle strength in patients with chronic stroke. So this tool can easily be administered in clinical and rehabilitation settings for diagnostic and prognostic purposes.
Relationship Between Trunk Control and Balance in Children with Spastic Cerebral Palsy: A Cross-Sectional Study.
Panibatla S, Kumar V, Narayan A
J Clin Diagn Res · 2017 Sep · PMID 29207820 · Full text
INTRODUCTION: Trunk control is impaired in children with Cerebral Palsy (CP) thus influencing their functional balance. However, there is a paucity of literature determining the relationship between trunk control and bal...
INTRODUCTION: Trunk control is impaired in children with Cerebral Palsy (CP) thus influencing their functional balance. However, there is a paucity of literature determining the relationship between trunk control and balance in children with CP. AIM: To find the relationship between trunk control and balance by means of Trunk Control Measurement Scale (TCMS) and Paediatric Balance Scale (PBS). MATERIALS AND METHODS: Twenty four children {age range 8-14 years, Gross Motor Function Classification System (GMFCS) Level I-III} with spastic CP were recruited and evaluated using TCMS and PBS. The results were expressed as summary measures median (M) and Inter-Quartile Range (IQR). The correlation of TCMS and PBS were done using Spearman's correlation coefficient. A p-value <0.05 was considered statistically significant. RESULTS: The children obtained a median score of 52 out of 58 on the TCMS and 50 out of 56 on PBS. There was a significantly strong correlation with r=0.77 and p<0.01. A strong correlation (p<0.01) was seen between static, dynamic and total components of TCMS and PBS. The median scores of TCMS and PBS had a strong correlation for boys with r=0.74 and very strong correlation for girls with r=0.84. Based on the type of spastic CP, diplegics had a very strong correlation with r=0.85. While based on GMFCS levels, Level II and Level III had a very strong correlation (For level II rs=0.81 and level III rs=0.86) and weak correlation for level I (rs=0.27). CONCLUSION: Based on gender, topography and severity of the motor impairment both trunk control and balance are impaired to a different degree in children with CP. The findings of this study showed a high positive correlation between trunk control and balance in children with spastic CP.
Effect of Rocker Soled Shoe Design on Walking Economy in Females with Pes Planus.
Dhyani M, Singla D, Ahmad I … +3 more , Hussain ME, Ali K, Verma S
J Clin Diagn Res · 2017 Sep · PMID 29207819 · Full text
INTRODUCTION: The energy cost is increased during walking in pes planus condition whereas, energy cost during walking using rocker bottom shoes is debatable. AIM: To determine the walking economy with rocker soled shoes,...
INTRODUCTION: The energy cost is increased during walking in pes planus condition whereas, energy cost during walking using rocker bottom shoes is debatable. AIM: To determine the walking economy with rocker soled shoes, when compared with bare feet walking in females with pes planus over treadmill. MATERIALS AND METHODS: Seventeen collegiate flat footed females aged 18-25 years were recruited in accordance with inclusion and exclusion criteria. Subjects were asked to walk barefooted and with rocker soled shoes on treadmill for four minutes at a speed of 3.8 km/hour. Oxygen consumption (VO) was measured directly using PowerLab 8/35 data acquisition system with Lab Chart Pro (AD Instruments, Australia) one minute before walking, four minutes during walking and one minute after walking. Rating of Perceived Exertion (RPE) was taken after termination of walking. RESULTS: VO during barefoot walking was significantly lower than rocker soled shoe walking during four-five minutes (p<0.001) and during recovery (p=0.04). RPE is significantly lower during barefoot walking than rocker soled shoe walking (p<0.001) over treadmill. CONCLUSION: Oxygen consumption and RPE were increased during walking with rocker soled shoe design in comparison to bare feet walking over treadmill at same speed.
Clinical Efficacy and Safety on Combining 20% Trichloroacetic Acid Peel with Topical 5% Ascorbic Acid for Melasma.
Dayal S, Sahu P, Yadav M … +1 more , Jain VK
J Clin Diagn Res · 2017 Sep · PMID 29207818 · Full text
INTRODUCTION: Trichloroacetic Acid (TCA) is a versatile peeling agent for treatment of melasma. However, Post-Inflammatory Hyperpigmentation (PIH) is reported to be the most common side-effect associated with TCA peel. T...
INTRODUCTION: Trichloroacetic Acid (TCA) is a versatile peeling agent for treatment of melasma. However, Post-Inflammatory Hyperpigmentation (PIH) is reported to be the most common side-effect associated with TCA peel. Topical Ascorbic Acid (AA) due to its effect as antioxidant and tyrosinase inhibitor helps to prevent PIH and maintains the response. AIM: To assess the clinical efficacy, safety and reduction in Melasma Quality of Life (MELASQOL) on combining 20% TCA peel with 5% ascorbic acid cream in epidermal melasma. MATERIALS AND METHODS: This study was conducted in the Department of Dermatology, Pt. Bhagwat Dayal Sharma University of Health Sciences, Rohtak. This was an open labelled prospective randomized study in which 60 patients of epidermal melasma were enrolled for 12 weeks. Patients were divided into two groups: Combination group received 20% TCA peel every two weeks with once daily 5% ascorbic acid cream and Control group received only 20% TCA peel. Melasma Area Severity Index (MASI) was used for evaluating clinical improvement of melasma. Improvement in Quality Of Life (QoL) was assessed by MELASQOL scale in both groups. Adverse effects were evaluated at each visit. All statistical analysis was carried out with SPSS 20 version. The difference in change in mean MASI scoring and MELASQOL scores between the two groups were analysed using Mann-Whitney test. The side effects between the two groups were compared using Chi-square test. RESULTS: The combination group demonstrated a statistically significant improvement in MASI, percentage decrease in MASI and quality of life as compared to control group after treatment. At the baseline there was no statistically significant difference in MASI between the two groups (i.e., MASI in combination group and control group were 23.55±4.61 and 23.613±4.088 respectively). However, it was statistically significant at the end of therapy (i.e., MASI in combination group was 9.50±5.31 and in control group was 15.10±4.44). When the results were analysed in terms of percentage decrease in MASI from baseline, there was statistically significant difference in combination group (i.e., 10.87±4.11) as compared to control group (i.e., 6.3±1.97) after 2 week of therapy. When the mean MELASQOL scores were compared between the two groups at the end of therapy (i.e., 12 weeks), it was found to be statistically significantly lower in combination group (16.60±8.03) as compared to control group (25.90±8.17). Minor adverse effects like post peel erythema, pruritus, burning and stinging sensation were observed in some of the patients, which didn't necessitate termination of the therapy. CONCLUSION: Combination of 20% TCA peel with topical 5% ascorbic acid is a highly effective, safe and promising therapeutic option in treatment of melasma which significantly improves the QoL.
Immunohistochemical Expression of Cyclo-oxygenase 2 and Liver X Receptor-α in Acne Vulgaris.
Bakry OA, El Farargy SM, El Kady NNED … +1 more , Dawy HFA
J Clin Diagn Res · 2017 Sep · PMID 29207817 · Full text
INTRODUCTION: Acne Vulgaris (AV) is a common inflammatory disease of pilosebaceous units. Liver X Receptor-α (LXR-α) is a ligand activated transcription factor. It controls transcription of genes involved in lipid and fa...
INTRODUCTION: Acne Vulgaris (AV) is a common inflammatory disease of pilosebaceous units. Liver X Receptor-α (LXR-α) is a ligand activated transcription factor. It controls transcription of genes involved in lipid and fatty acid synthesis. Cyclo-oxygenase 2 (COX2) is a rate limiting enzyme in prostaglandin synthesis. It plays important role in inflammation. AIM: To evaluate the immunohistochemical expression of LXR-α and COX2 in acne vulgaris skin biopsies to explore their possible pathogenic role in this disease. MATERIALS AND METHODS: Sixty five subjects were included (45 cases with AV and 20 age and gender-matched healthy controls). Skin biopsies were taken from lesional and perilesional skin of cases and from site-matched areas of control subjects. The evaluation of LXR-α and COX2 was done using immunohistochemical technique. Data were collected, tabulated and statistically analysed using a personal computer with "(SPSS) version 11" program. Chi-square test was used to study the association between qualitative variables. Mann-Whitney test was used for comparison between quantitative variables. Student's t-test was used for comparison between two groups having quantitative variables. Spearman's coefficient was used to study the correlation between two different variables. Differences were considered statistically significant with p<0.05. RESULTS: COX2 was upregulated in lesional skin compared with peilesional and control skin both in epidermis and pilosebaceous units (p<0.001 for all). Higher epidermal COX2% was significantly associated with papulopustular acne (p=0.009) and higher acne score (p=0.018). Higher pilosebaceous units COX2% was significantly associated with papulopustular acne (p=0.04). LXR-α was upregulated in lesional skin compared with peilesional and control skin both in epidermis and pilosebaceous units (p<0.001 for all). Higher LXR-α % in epidermis and pilosebaceous units was significantly associated with papulopustular acne (p=0.01 for both) and higher acne score (p=0.03 for both). Significant positive correlation was detected between COX2% and LXR-α % in epidermis (p=0.001, r=0.87) and pilosebaceous units (p=0.001, r=0.65). CONCLUSION: Both LXR-α and COX-2 play a role in the pathogenesis of acne vulgaris through their effects on cellular proliferation, inflammation and lipid synthesis. Research for new therapeutic modalities based on their inhibition is needed. More understanding of the interaction between LXR-α, COX2 and acne lesions may lead to effective interference, possibly directed toward specific cell types or steps within inflammatory pathways.
Non-Catheter Related Perioperative Superior Vena Cava Syndrome Following Surgical VSD Closure-Role of Transesophageal Echocardiography.
Kundra TS, Gopal D, Dhananjaya M
J Clin Diagn Res · 2017 Sep · PMID 29207816 · Full text
Unintentional iatrogenic surgical complications can complicate the operative and postoperative courses of paediatric cardiac surgery patients. Unless recognized and treated early, it's possible, these complications may l...
Unintentional iatrogenic surgical complications can complicate the operative and postoperative courses of paediatric cardiac surgery patients. Unless recognized and treated early, it's possible, these complications may lead to a prolonged hospital stay, increased treatment cost, morbidity, and even death. Ventricular Septal Defect (VSD) is the most common congenital heart defect in children, occurring in 50% of all children with congenital heart disease and in 20% as an isolated lesion. Herein, we discuss the development of Superior Vena Cava (SVC) syndrome following surgical repair of VSD in a nine-month-old child. Early clinical diagnosis, immediate confirmation with Transthoracic Echocardiography (TTE) and surgical re-exploration led to a good outcome in this patient. If, however, we could have performed an intraoperative Trans Esophageal Echocardiography (TEE), this complication could have been recognized, even before shifting from the operating room.
Anaesthetic Management in Transoral Endoscopic Thyroidectomy.
Patel RD, Gowani N, Nadkarni M … +2 more , Rege S, Devalkar P
J Clin Diagn Res · 2017 Sep · PMID 29207815 · Full text
Young females undergoing thyroid surgery are apprehensive about the surgical scar. This leads to the introduction of Transoral Endoscopic Thyroidectomy (TOET). TOET is gaining popularity for its minimally invasive and co...
Young females undergoing thyroid surgery are apprehensive about the surgical scar. This leads to the introduction of Transoral Endoscopic Thyroidectomy (TOET). TOET is gaining popularity for its minimally invasive and cosmetically sound approach to perform thyroidectomies in young patients. The surgical site being the mouth orifice poses a challenge to the anaesthesiologist to secure a definitive airway. The case report is that of a young female undergoing TOET for whom we have successfully performed nasal intubation with a North Pole ivory endotracheal tube (ET).
Congenital Lobar Emphysema: Anaesthetic Challenges and Review of Literature.
Saini S, Prakash S, Rajeev M … +1 more , Girdhar KK
J Clin Diagn Res · 2017 Sep · PMID 29207814 · Full text
Congenital Lobar Emphysema (CLE) is a developmental anomaly, characterized by hyperinflation of one or more pulmonary lobes. It presents in infancy with variable degree of respiratory distress due to compression atelecta...
Congenital Lobar Emphysema (CLE) is a developmental anomaly, characterized by hyperinflation of one or more pulmonary lobes. It presents in infancy with variable degree of respiratory distress due to compression atelectasis. It is most often associated with mediastinal shift with subsequent hypoxia. CLE poses a diagnostic and therapeutic dilemma. We report a case of five-month-old infant of CLE requiring left lobectomy, who was previously being treated for pneumonia which was unresponsive to medical therapy. Anaesthetic challenges experienced during the case and a brief review of literature is presented.
Anaesthetic Considerations for Balloon Mitral Valvuloplasty in Pregnant Patient with Severe Mitral Stenosis: A Case Report and Review of Literature.
Hemlata, Goyal P, Tewari S … +1 more , Chatterjee A
J Clin Diagn Res · 2017 Sep · PMID 29207813 · Full text
Even though, the incidence of Mitral Stenosis (MS) has reduced grossly, it still remains a health problem in developing countries and is the most common rheumatic valvular lesion encountered in pregnant patients. The alr...
Even though, the incidence of Mitral Stenosis (MS) has reduced grossly, it still remains a health problem in developing countries and is the most common rheumatic valvular lesion encountered in pregnant patients. The already compromised cardiac status of a pregnant female deteriorates further by the presence of MS. So, pregnancy is a common situation during which untreated and frequently poorly tolerated MS are first diagnosed. Percutaneous Balloon Mitral Valvuloplasty (BMV) may be life saving in such a setting and a multidisciplinary approach in the management reduces the mortality and morbidity during the procedure. Anaesthetic management of such a procedure has hardly ever been reported. We report a case of a 23-year-old woman presenting at 28 weeks gestation with severe MS and severe pulmonary hypertension (52 mmHg) who underwent successful percutaneous BMV under monitored anaesthesia Care. The anaesthetic considerations in such situations are being discussed.
Prediction of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) after Thoracic Surgery- The Role of Estimated GFR.
Padhy S, Kar P, Ramachandran G
J Clin Diagn Res · 2017 Sep · PMID 29207812 · Full text
INTRODUCTON: Little is known about the prognostic utility of preoperative estimated GFR (eGFR) on perioperative Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in apparently lower risk patients undergoing...
INTRODUCTON: Little is known about the prognostic utility of preoperative estimated GFR (eGFR) on perioperative Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in apparently lower risk patients undergoing moderate risk surgeries like thoracotomy. AIM: The current study sought to identify a clinically relevant cut-off value of eGFR for identifying thoracotomy patients at higher risk for MACCE. MATERIALS AND METHODS: Between July 2012 and July 2016, 436 consecutive patients were retrospectively studied after elective thoracotomy in a single institution. Patients were classified into six groups according to the calculated Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI) eGFR (ml min 1.73 m ): Stage 1, eGFR >90; Stage 2, eGFR=60-89.9; Stage 3a, eGFR=45-59.9; Stage 3b, eGFR=30-44.9; Stage 4, eGFR=15-29.9; Stage 5, eGFR <15. All the eGFR groups were analysed for perioperative MACCE, length of hospital stay, and mortality. RESULTS: The incidence of perioperative MACCE in our study was 4.24%. The mean eGFR in our study as calculated by the CKD-EPI equation was 83 ml min1.73 m. With the exception of nonfatal cardiac arrest which was not seen in any patient, the incidence of all MACCE increased with progressively worsening preoperative eGFR.It was seen by logistic regression analysis that the occurrence of any perioperative MACCE increased significantly with worsening eGFR (p<0.001). The increase in MACCE was particularly marked from Stage 3b onwards to the later stages (OR 1.9 in 3a vs. 3.6 in 3b). The two mortalities observed in the study were in Stages 4 and 5 with no deaths seen in the better eGFR subgroups. There was also an increased length of hospital stay with declining eGFR. CONCLUSION: Preoperative eGFR is a predictor of perioperative MACCE in homogenous moderate risk elective surgical population like thoracic surgeries. There is an inverse relationship between eGFR and MACCE, particularly manifested at eGFR values <45 ml/min/1.73. Routine use of preoperative eGFR for cardiovascular and cerebrovascular risk assessment in patients undergoing moderate risk surgeries like thoracotomy would be beneficial.
Comparative Evaluation of Ropivacaine and Fentanyl Versus Ropivacaine and Fentanyl with Clonidine for Postoperative Epidural Analgesia in Total Knee Replacement Surgery.
Panwar S, Govind PS, Duarah PJ … +2 more , Mahajan HK, Korde SA
J Clin Diagn Res · 2017 Sep · PMID 29207811 · Full text
INTRODUCTION: Clonidine an alpha 2 adrenoceptor agonist possesses analgesic properties and has been used as an adjuvant in epidural analgesia. The addition of clonidine to other analgesics may result in enhanced analgesi...
INTRODUCTION: Clonidine an alpha 2 adrenoceptor agonist possesses analgesic properties and has been used as an adjuvant in epidural analgesia. The addition of clonidine to other analgesics may result in enhanced analgesia through additive mechanisms or synergistic mechanisms. The enhanced analgesia may lead to a decrease in the dosage of analgesic drugs along with reduction of side effects. AIM: The purpose of this study was to evaluate the effect of adding clonidine to epidural ropivacaine and fentanyl mixture in terms of quality of analgesia and side effects in patients of total knee replacement surgery. MATERIALS AND METHODS: A prospective randomised double blind study was conducted on 60 patients of ASA physical status I, II and III who underwent unilateral total knee replacement surgery under combined spinal epidural anaesthesia. Patients were divided into two Groups A and B randomly. Postoperatively Group A received continuous epidural infusion of ropivacaine 2 mg.ml and fentanyl 2 μg.ml along with clonidine 2 μg.ml in the range of 3-7 ml.hr while Group B received the ropivacaine and fentanyl epidural solution. The postoperative VAS scores, haemodynamic parameters, motor block, sedation, nausea, vomiting and any other significant side effects were noted. The two groups were compared with student's t-test, Pearson's Chi square test and t-test using SPSS statistical software. RESULTS: Visual analog scale scores were lower in Group A (3.38) than in Group B (3.72). The average infusion rate was lower in Group A (4.7 ± 0.7 ml.hr ) than in Group B (5.5 ± 0.7 ml.hr). Patients in Group A required less dosage of rescue pain medication Paracetamol (1g i.v.), diastolic pressure and heart rate were lower in Group A. The groups were comparable in terms of sedation, motor block and nausea vomiting. CONCLUSION: Clonidine added to a ropivacaine and fentanyl mixture augmented the postoperative epidural analgesia without significant side effects.
Comparative Study of the Effect of Dexmedetomidine Vs. Fentanyl on Haemodynamic Response in Patients Undergoing Elective Laparoscopic Surgery.
Vaswani JP, Debata D, Vyas V … +1 more , Pattil S
J Clin Diagn Res · 2017 Sep · PMID 29207810 · Full text
INTRODUCTION: Dexmedetomidine and fentanyl, both have sedative and analgesic effects. They are often used as adjunct during anaesthesia to attenuate pressor response during tracheal intubation. Limited study has been don...
INTRODUCTION: Dexmedetomidine and fentanyl, both have sedative and analgesic effects. They are often used as adjunct during anaesthesia to attenuate pressor response during tracheal intubation. Limited study has been done comparing the effect of both drugs on haemodynamic response in patients undergoing laparoscopic surgery. AIM: The study was designed to compare the effect of dexmedetomidine Vs fentanyl on haemodynamic response to tracheal intubation, following pneumoperitoneum and intraoperative period in patients undergoing laparoscopic surgery. MATERIALS AND METHODS: Sixty patients of age group 18-60 years of either sex, classified as American Society of Anaesthesiologist (ASA) Grade I and II undergoing elective laparoscopy surgery were randomly allocated to one of the two groups (Group-D) and (Group F) of 30 each. Group D received dexmedetomidine and Group F received fentanyl. Patients received intravenous 0.5 μg/kg of the study drug as loading dose over 10 minutes prior to intubation followed by 0.2-0.7 μg/kg/hr as infusion till surgery was over. In operating room parameters like Heart Rate (HR), Respiratory Rate (RR), Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP), SpO, EtCO were recorded 10 minutes after infusion of drug i.e., dexmedetomidine or fentanyl. The said parameters were again recorded after injection of induction drugs, after intubation, five minutes after intubation, just after pneumoperitoneum, and 5,10,15,30,45 and 60 minutes after pneumoperitoneum, five minutes after release of pneumoperitoneum, five and 10 minutes after extubation. RESULTS: Dexmedetomidine significantly attenuates stress response at intubation with lesser increase in HR (5% Vs 18%), SBP (9% Vs 19%) and DBP (3% Vs 15%), MAP (2% Vs 15%) as compared to fentanyl (p<0.05). Throughout intraoperative period of pneumoperitoneum Group D showed significant fall in HR, SBP, DBP, MAP from baseline value at all points of time intervals whereas it remained constantly high above baseline value in Group F (p-value <0.05). CONCLUSION: Dexmedetomidine when compared to fentanyl causes greater attenuation of stress response to tracheal intubation, following pneumoperitoneum and in intraoperative period resulting in greater reduction of HR, SBP, DBP, MAP than that of fentanyl, thus causing better haemodynamic stability in patients undergoing elective laparoscopic surgery.
Therapeutic Efficacy of Ozone Injection into the Knee for the Osteoarthritis Patient along with Oral Celecoxib and Glucosamine.
Feng X, Beiping L
J Clin Diagn Res · 2017 Sep · PMID 29207809 · Full text
INTRODUCTION: Suffering from osteoarthritis is prevalent among elderly patients so the use of intra-articular injection of medical ozone may well be the effective way to relieve their pain. AIM: To evaluate the effect of...
INTRODUCTION: Suffering from osteoarthritis is prevalent among elderly patients so the use of intra-articular injection of medical ozone may well be the effective way to relieve their pain. AIM: To evaluate the effect of intra-articular injection of medical ozone given into the knee of the osteoarthritis patients, and to compare it with taking celecoxib and glucosamine orally. MATERIALS AND METHODS: In the present study, 76 patients suffering from osteoarthritis were randomly assigned into two groups. In the ozone group, 20 ml ozone-oxygen mixture gas concentration of 20 μg/ml was injected into knee articular cavity and each patient took oral celecoxib and glucosamine hydrochloride. Patients in control group only took the celecoxib and glucosamine hydrochloride orally.Pain score and Lysholm knee score were measured prior to the injection (pretreatment) and at one, three, six weeks after the beginning of the treatment (posttreatment). RESULTS: After the treatment, the pain intensity and function significantly improved in the two groups compared with the pretreatment (p<0.05). In the ozone group, three weeks after intervention, the pain score improved significantly when compared with the control group (p<0.05).After the treatment, the lysholm scores increased significantly (p<0.05), but in the ozone group, it improved faster. CONCLUSION: Intra-articular injection of ozone plus oral celecoxib and glucosamine could significantly decrease pain intensity in patients with mild to moderate Knee Osteoarthritis (KOA), and improve their functional status early than oral celecoxib and glucosamine only.
Chilli Sign: Pathognomonic Sign for Ruling Out Sacral Agenesis on Foetal MRI.
Yadav VK, Nori M
J Clin Diagn Res · 2017 Sep · PMID 29207808 · Full text
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