Aim: To ascertain the adoption of new endodontic technology in general dental practice in India in 2011.
Methodology: A postal questionnaire survey comprising 26 questions was sent to 700 general dental practitioners. The questions covered professional activity, root canal preparation and instrumentation, choice of irrigants and intracanal medicaments, choice of obturation techniques and other aspects of endodontics. The data were analyzed using descriptive statistics and the Chi-square (χ2) test at 0.05 level of significance.
Results: The overall response rate was 88%. The results showed that rubber dams were used by 27% of dental practitioners in India. The most widely used irrigant was sodium hypochlorite, which was used by 33% of the respondents. Thirty nine percent of the practitioners were still incorporating only hand files during the cleaning and shaping phase of treatment. The technique of choice was both step back and crown down (35%). Calcium hydroxide was found to be the most frequently used (62%) intracanal medicament. Lateral condensation with guttapercha (61%) was the most common method used for obturation. Majority used zinc oxide eugenol as a sealer (55%). The post obturation restoration was done mostly by composite material (46%). Most of the respondents placed crowns after root canal treatment. Digital radiography was reported as being used by 17% of the respondents. There was no difference between males and females with respect to the incorporation of new technologies in dentistry. They had been incorporated significantly more by respondents who held postgraduate qualifications and had professional activities of <5 years.
Conclusion: The results indicated that new endodontic technology and materials are slowly being incorporated in clinical practice of endodontics in India. This survey shows the importance of continuing dental education for practitioners to update their knowledge.
Survey; Endodontics; General dental practitioner; Root canal treatment; Ni-Ti instruments; Obturation
Closed circuit suction system (CCSS) has become a standard of care for the tracheal suctioning of mechanically ventilated patients. The advantages of CCSS over the open suction system include decreased environmental, personnel and patient contamination, preservation of lung volumes and oxygenation especially in the severely hypoxemic patients. On the other hand, CCSS has lower efficacy in removal of secretions and it may have certain other disadvantages due to the invisibility of its tip. We report an unusual case of an airway foreign body causing blockage of the CCSS leading to retained secretions and deterioration of patient. Timely changing over to open suction system helped in its detection and improvement of patient.
Catheter; closed circuit suction system; foreign body; suction
Multiple intra–oral sinus tracts of dental origin are an uncommon condition. Patients with this condition may undergo surgical extraction, biopsies and antibiotic regimens, but all of them fail with the recurrence of the sinus tract. A proper diagnosis and management are important, to avoid any complications. This case report has described the conventional root canal treatment of a patient who had three distant intra–oral sinuses which had occurred due to an intact tooth with pulp necrosis, who had a history of accidentally biting on a hard food object and having a periapical radiolucency which indicated a chronic periradicular abscess. At follow up examination, the tooth was found to be asymptomatic and radiographically, it showed repair of the lesion.
Sinus tract; Periapical abscess; Root canal treatment; Mandibular molar
To determine the surface roughness of esthetic restorative materials after finishing and polishing.
Materials and Methods:
All 60 specimens were divided into four groups. Group I: Nanocomposite, Z 350 XT (3M ESPE, USA); Group II: Microhybrid composite, Z 250 (3M ESPE, USA); Group III: Compomer, Dyract XP (LD Caulk/Dentsply, USA); and Group IV: Resin modified glass ionomer cement (GIC), Fuji II LC (GC, Japan). Each group was again divided into three subgroups. Subgroup A: Sof-Lex (3M ESPE); Subgroup B: Super-Snap Rainbow finishing and polishing kit (Shofu INC, Japan); and Subgroup C: Control Mylar strip. Surface roughness was determined by Perthen Perthometer S6P profilometer.
Filtek Z350 XT showed minimum surface roughness followed by Filtek Z250, Dyract XT and Fuji II LC. Super-Snap exhibited less surface roughness than Sof-Lex polishing systems.
One-way analysis of variance (ANOVA) followed by multiple post hoc comparisons using least square difference method and unpaired t-test was used.
Filtek Z350 XT with Mylar strip exhibited least surface roughness.
Composite; finishing; glass ionomer cement; polishing; surface roughness
Many human diseases are associated with amyloid fibril deposition, including type 2 diabetes mellitus (DM) where human Islet Amyloid Polypeptide (hIAPP) forms fibrils in the pancreas. We report here that engineered, soluble forms of the human Ca2+-binding protein Nucleobindin 1 (NUCB1), prevent hIAPP fibril formation and disaggregate pre-existing hIAPP fibrils. Scanning transmission electron microscopy (STEM) and atomic force microscopy (AFM) indicate that NUCB1 binds to and stabilizes heterogeneous prefibrillar hIAPP species. The NUCB1-stabilized prefibrillar species were isolated by size-exclusion chromatography and analyzed by STEM, dynamic light scattering (DLS) and multi-angle light scattering (MALS). The stabilized prefibrillar species show a size-range of 2–6 million Da and have other similarities to hIAPP protofibrils, but they do not progress to become mature fibrils. The effects of NUCB1 are absent in the presence of Ca2+. We postulate that the engineered forms of NUCB1 prevent hIAPP fibril formation by a mechanism where protofibril-like species are “capped” to prevent further fibril assembly and maturation. This mode of action appears to be different from other protein based inhibitors, suggesting that NUCB1 may offer a new approach to inhibiting amyloid formation and disaggregating amyloid fibrils.
amylin; islet amyloid polypeptide; Type-2 diabetes mellitus; amyloid; Nucleobindin 1; NUCB1; protofibril; fibril
Illness-related absences have been shown to lead to negative educational and economic outcomes. Both hand washing and hand sanitizer interventions have been shown to be effective in reducing illness-related absences. However, while the importance of hand hygiene in schools is clear, the role of instruction in use is less obvious. The purpose of this study was to compare absenteeism rates among elementary students given access to hand hygiene facilities versus students given both access and short repetitive instruction in use, particularly during influenza season when illness-related absences are at a peak.
A hand hygiene intervention was implemented from October to May during the 2009/2010 academic year, including peak flu season, in two Chicago Public Elementary Schools among students grades pre-kindergarten to eighth grade (ages 4–14). Classrooms were systematically assigned to an intervention or control group by grade (cluster design). Hand hygiene facilities (sanitizer and soap) were made available to all students. Students in the intervention group also received short repetitive instruction in hand hygiene every 2 months. Only absences as a result of respiratory or gastrointestinal illness were used to establish illness-related absenteeism rates. Percent absent days were calculated and bivariate analyses were performed to compare percent absent days among students given access to hand hygiene facilities versus students given both access and instruction. Prior to the intervention, teachers’ perceptions of students’ hand hygiene were also evaluated. Teacher perceptions were analysed to describe attitudes and beliefs.
Data were collected and analysed for 773 students reporting 1,886 absences during the study period (1.73% of total school days). Both the percent total absent days and percent illness-related absent days were significantly lower in the group receiving short instruction during flu season (P = 0.002, P < 0.001, respectively). This difference peaked during the influenza season (when intervention began) and declined in the following months. Teachers (n = 23) agreed that hand hygiene is not performed properly among students and reported time constraints as a barrier to frequent hand washing.
Adding hand hygiene instruction to existing hand hygiene practices improved attendance at public elementary schools during the flu season. Standardized and brief repetitive instruction in hand hygiene holds potential to significantly reduce absenteeism.
Hand hygiene; Education; Elementary school; Illness
To evaluate sealing properties of different obturation systems placed over apically fractured rotary NiTi files.
Materials and Methods:
Forty freshly extracted human mandibular premolars were prepared by using Protaper (Dentsply-Maillefer, Ballaigues, Switzerland) or the RaCe (FKG Dentaire, La Chaux-de-Fonds, Switzerland) systems (n=20 for each), after which half of the specimens were subjected to instrument separation at the apical level. Roots with and without apically separated instruments (n=5) were filled with the two obturation systems i.e. Thermafil and lateral compaction technique. The modified glucose penetration setup was used to assess the microleakage. The leakage data was statistically analyzed.
The amount of leakage was significantly lower in specimens containing fractured instruments, regardless of the obturation method used. Roots obturated with Thermafil displayed significantly less leakage than cold lateral compaction technique, both, in the presence and absence of separated instruments. There was no significant difference among specimens prepared with ProTaper and RaCe when Thermafil obturation was done. But with cold lateral compaction technique, RaCe system showed less leakage as compared to ProTaper system.
The type of obturation may play more important role than the type of instrument or retained/non-retained instrument factor.
File separation; fracture; microleakage; NiTi instrument; obturation
Minisatellites are an integral part of eukaryotic genomes and show variation in the complexity of their organization. Besides their presence in non-coding regions, a small fraction of them are part of the transcriptome, possibly participating in gene regulation, expression and silencing. We studied the minisatellite (TGG)n tagged transcriptome in the water buffalo Bubalus bubalis across various tissues and the spermatozoa, and characterized the genes TSPY1 and COL6A1 discovered in the process.
Minisatellite associated sequence amplification (MASA) conducted using cDNA and oligonucleotide primer (TGG)5 uncovered 38 different mRNA transcripts from somatic tissues and gonads and 15 from spermatozoa. These mRNA transcripts corresponded to several known and novel genes. The majority of the transcripts showed the highest level of expression either in the testes or spermatozoa with exception of a few showing higher expression levels in the lungs and liver. Transcript SR1, which is expressed in all the somatic tissues and gonads, was found to be similar to the Bos taurus collagen type VI alpha 1 gene (COL6A1). Similarly, SR29, a testis-specific transcript, was found to be similar to the Bos taurus testis-specific Y-encoded protein-1 representing cancer/testis antigen 78 (CT78). Subsequently, full length coding sequences (cds) of these two transcripts were obtained. Quantitative PCR (q-PCR) revealed 182-202 copies of theTSPY1 gene in water buffalo, which localized to the Y chromosome.
The MASA approach enabled us to identify several genes, including two of clinical significance, without screening an entire cDNA library. Genes identified with TGG repeats are not part of a specific family of proteins and instead are distributed randomly throughout the genome. Genes showing elevated expression in the testes and spermatozoa may prove to be potential candidates for in-depth characterization. Furthermore, their possible involvement in fertility or lack thereof would augment animal biotechnology.
Post operative analgesia in patients undergoing lower limb surgery is very essential for immediate postoperative pain relief which can be provided by oral or parentral medication, epidural analgesia, local blocks etc.The study was designed to evaluate the efficacy of epidural butorphanol and tramadol for postoperative pain relief.
Patients & Methods:
This was randomized, prospective, double blind study was conducted on 60 patients, ASA grade I&II, age 18-60 undergoing lower limb surgeries after approval from hospital ethics committee. Group allocation - Group I I (n=30) received 2 mg butorphanol as bolus epidurally, 1 mg for top up dose. Group II (n=30) received 100mg tramadol as bolus, 50 mg for top up. All the drugs were diluted to 10 ml normal saline & the observer was blinded to the drugs given. Postoperatively VAS, sedation score, vitals & side effects were observed. Top ups were given on achieving VAS>4. Diclofenac 75mg was given as rescue analgesia.
Duration of analgesia was 5.35±0.29 hr and 6.25±1.58 hrs in Butorphanol and Tramadol groups respectively and the difference was found to be statistically significant. Pain scores were also significantly lower statistically in Group I as compared to Group II. Sedation scores were significantly higher in butorphanol group, whereas nausea vomiting was seen in tramadol group only (4 patients).No other side effects were observed.
Both butorphanol and tramadol were effective for relieving postoperative pain, however quality of analgesia & patient satisfaction was more with butorphanol.
Epidural; Tramadol; Butorphanol; Post-operative Pain
Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants’ airways.
To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing.
The Boston Birth Cohort (n=1096) were followed prospectively from birth to a mean age of 2.2±2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (≥2 physician documented episodes). Secondary outcomes included physician diagnosed asthma, food allergy and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (<33 weeks) with and without chorioamnionitis, and compared to term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were preformed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis.
Prematurity was associated with recurrent wheezing (OR:1.7, 95%CI:1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR:4.0, 95%CI:2.0-8.0) and physician diagnosed asthma (OR:4.4 95%CI:2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR:5.4, 95%CI:2.4-12.0) and asthma (OR:5.2, 95%CI:2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis were associated with food allergy or eczema.
We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African Americans.
Chorioamnionitis may increase the risk of recurrent wheezing in very low birth weight infants.
Chorioamnionitis; prematurity; recurrent wheezing
The 37-residue human islet amyloid polypeptide (hIAPP or amylin) self-assembles into fibers, the assembly of which has been associated with the disease mechanism of type II diabetes. Infrared spectroscopy in conjunction with isotope labeling is proving to be a powerful tool for studying the aggregation process of hIAPP and other amyloid forming proteins with residue specific structure and kinetic information, but the relationship between the spectroscopic observables and the structure is not fully established. We report a detailed analysis of the linear and 2D IR spectra of hIAPP fibers isotope labeled at seven different residue positions. The features of the 2D IR spectra, including the frequencies, linewidths, intensities, and polarization dependence of the diagonal and cross-peaks, rely heavily on the position of the isotope labeled residue. In order to understand how these measured parameters depend on fiber secondary and tertiary structure, we have simulated 1D and 2D IR spectra utilizing idealized structural models in addition to a recently published solid-state NMR based model of the amyloid fibril. The analysis provides a more rigorous foundation for interpreting the infrared spectra of amyloids. In addition, we demonstrate that 2D IR spectra can be employed to distinguish between residues in β-sheets versus those in turn regions, and that transitional residues between secondary structures can be identified by the suppression of their cross-peaks in 2D IR spectra. This latter approach is not limited to amyloid fibrils and will be generally useful in identifying regions of secondary structure in proteins using 2D IR spectroscopy and isotope labeling.
Pediatric asthma is a serious public health problem in Chicago and has been designated a high priority concern by residents of Chicago's Humboldt Park, a diverse community area with a large number of Puerto Rican, African American, and Mexican American families.
In May 2009, following the principles of community-based participatory research, a cross-sectional asthma screening survey was administered to adult caregivers of children attending two Humboldt Park elementary schools. Data were analyzed to determine the prevalence of diagnosed and probable asthma as well as the degree of asthma control among affected children; associations between asthma outcomes and mutable triggers were evaluated.
Surveys from 494 children were evaluated. Physician-diagnosed asthma was reported for 24.9% of children and probable asthma identified in an additional 16.2% of children. Asthma was poorly or moderately controlled in 60.0% of diagnosed children. Smoking occurred inside 25.0% of households and 75.0% of caregivers reported idling of vehicles in their community. Report of general stress among caregivers, stress due to community crime, and/or an inability to cope with everyday life were significantly and positively associated with poor asthma morbidity and control among affected children.
Despite high prevalence rates and poor asthma morbidity and control in Humboldt Park, the association of these measures with mutable variables is promising. A community-based asthma intervention to address the issues identified in this study is needed to affect positive change.
Asthma burden in the US is not evenly distributed. Although asthma prevalence varies widely across urban neighborhoods, little attention has been paid to the community as a key contributor.
To determine the effect of positive socio-environmental community factors on childhood asthma prevalence in Chicago.
From 2003–2005, an asthma screening survey was conducted among children attending Chicago Public/Catholic K-8 schools. One hundred five schools participated, yielding a stratified representation of 4 race-income groups. Positive community factors, such as social capital, economic potential and community amenities, were assessed using the Metro Chicago Information Center’s Community Vitality Index.
Of the surveys returned, 45,177 (92%) were geocoded into 287 neighborhoods. Neighborhoods were divided into quartile groups by asthma prevalence (mean: 8%, 12%, 17%, 25%). Community vitality (54% vs. 44%, p<0.0001) and economic potential (64% vs. 38%, p<0.0001) were significantly higher in neighborhoods with low asthma prevalence. Neighborhood interaction (36% vs. 73%, p<0.0001) and stability (40% vs. 53%, p<0.0001) were significantly higher in neighborhoods with high asthma prevalence.
Overall, positive factors explained 21% of asthma variation. Childhood asthma increased as the Black population increased in a community (p<0.0001). Accordingly, race/ethnicity was controlled. In Black neighborhoods, these factors remained significantly higher in neighborhoods with low asthma prevalence. When considered alongside socio-demographic/individual characteristics, overall community vitality as well as social capital continued to contribute significantly to asthma variation.
Asthma prevalence in Chicago is strongly associated with socio-environmental factors thought to enrich a community. A deeper understanding of this impact may lend insight into interventions to reduce childhood asthma.
asthma; prevalence; community; neighborhood; childhood; environment; social capital; disparity
Polymorphous low-grade adenocarcinoma is a distinct neoplasm of the salivary gland composed of luminal and non-luminal tumor cells admixed in varying proportions. Its resemblance to lobular carcinoma of the breast had led to its earlier nomenclature of 'terminal duct carcinoma'. Most patients present with an asymptomatic mass in the hard palate. In rare cases, the mass can also occur in the tongue. We report an unusual case of polymorphous low-grade adenocarcinoma at the base of tongue.
A 47-year-old Asian Caucasian woman presented with a painless swelling at the right lateral border of the tongue with an intact overlying mucosa. There were no other associated complaints. The lesion was excised and subjected to histopathological examination that revealed an interesting and unusual morphology of polymorphous low-grade adenocarcinoma.
Polymorphous low-grade adenocarcinoma is a well-defined entity in the minor salivary glands. Its occurrence in the tongue is rare with very few cases reported in the literature. It is a malignant neoplasm with low aggressiveness and it is thus important to identify and treat it accordingly.
Today in the era of minimally invasive surgery, paediatric laparoscopy has become widely popular.The anaesthetic management in these cases poses special problems due to pneumoperitoneum created and extremes of position adopted in addition to the fact that paediatric anaesthesia itself is a challenge. Mostly the physiological as well as anaesthetic consideration are same except that child is not a small adult. The pressure of pnemoperitoneum needs to be kept between 6-12cm H2O, flow of gas about 0.9l, ventilation to be controlled, temperature monitoring being essential, use of atropine as premedicant, intravenous fluid management to be meticulous, induction with sevoflurane preferred as children may not allow i.v.puncture, intraoperative surgical complications being more, one needs to be very vigilant to diagnose and treat it. Using periumbilical area in paediatric age group should be avoided because the umbilical vessels have not involuted and can get punctured.Thus careful management in paediatric laparoscopic surgery will assume an important place in paediatric surgery.
Paediatric Laparoscopy; Anaesthetic challenges
Parents of children with food allergy, primary care physicians, and members of the general public play a critical role in the health and well-being of food-allergic children, though little is known about their knowledge and perceptions of food allergy. The purpose of this paper is to detail the development of the Chicago Food Allergy Research Surveys to assess food allergy knowledge, attitudes, and beliefs among these three populations.
From 2006–2008, parents of food-allergic children, pediatricians, family physicians, and adult members of the general public were recruited to assist in survey development. Preliminary analysis included literature review, creation of initial content domains, expert panel review, and focus groups. Survey validation included creation of initial survey items, expert panel ratings, cognitive interviews, reliability testing, item reduction, and final validation. National administration of the surveys is ongoing.
Nine experts were assembled to oversee survey development. Six focus groups were held: 2/survey population, 4–9 participants/group; transcripts were reviewed via constant comparative methods to identify emerging themes and inform item creation. At least 220 participants per population were recruited to assess the relevance, reliability, and utility of each survey item as follows: cognitive interviews, 10 participants; reliability testing ≥ 10; item reduction ≥ 50; and final validation, 150 respondents.
The Chicago Food Allergy Research surveys offer validated tools to assess food allergy knowledge and perceptions among three distinct populations: a 42 item parent tool, a 50 item physician tool, and a 35 item general public tool. No such tools were previously available.
Food allergy prevalence is increasing in US children. Presently, the primary means of preventing potentially fatal reactions are avoidance of allergens, prompt recognition of food allergy reactions, and knowledge about food allergy reaction treatments. Focus groups were held as a preliminary step in the development of validated survey instruments to assess food allergy knowledge, attitudes, and beliefs of parents, physicians, and the general public.
Eight focus groups were conducted between January and July of 2006 in the Chicago area with parents of children with food allergy (3 groups), physicians (3 groups), and the general public (2 groups). A constant comparative method was used to identify the emerging themes which were then grouped into key domains of food allergy knowledge, attitudes, and beliefs.
Parents of children with food allergy had solid fundamental knowledge but had concerns about primary care physicians' knowledge of food allergy, diagnostic approaches, and treatment practices. The considerable impact of children's food allergies on familial quality of life was articulated. Physicians had good basic knowledge of food allergy but differed in their approach to diagnosis and advice about starting solids and breastfeeding. The general public had wide variation in knowledge about food allergy with many misconceptions of key concepts related to prevalence, definition, and triggers of food allergy.
Appreciable food allergy knowledge gaps exist, especially among physicians and the general public. The quality of life for children with food allergy and their families is significantly affected.