Aim:To compare the difference in microleakage values using conventional and new low-shrink Silorane composites using the dye penetration method.Background:With improvement in adhesive technology, problems associated with composites have been largely overcome. However, microleakage due to polymerization shrinkage still remains a challenge. New Silorane-based composites are alleged to have less than 1% polymerization shrinkage, which would potentially decrease the microleakage, and hence, resolve this longstanding issue.Materials and Methods:The teeth were randomly divided into three groups (A,B, and C). Group A was restored with conventional composite (Valux™ Plus), with a total-etch protocol, Group B was restored with conventional composite, with a self-etch protocol, and group C were restored with a silorane-based composite (Filtek TMP90). Thermocycling at 200 cycles between 5 and 55°C ± 2°C with a dwell time of 60 seconds was conducted. The teeth were stained with methylene blue dye and then sectioned and viewed under a dissection microscope, afer which the microleakage was evaluated.Results:The interexaminer reliability was evaluated using the kappa score, which was acceptable (61 – 78%). The total-etch group performed statistically and significantly better (P < 0.001) at the occlusal margin and was marginally and statistically significant (P = 0.05) at the gingival margin compared to the self-etch conventional and Silorane groups.Conclusions:The Silorane composite did not perform better than the conventional composites, however, it may have its uses and requires further research.
Background: Nosocomial infections in the neonatal intensive care unit (NICU) are a cause of increased mortality, length of stay and cost of management. There is limited data on strategies for reducing these infections from developing countries. Therefore we evaluated the effectiveness of implementation of six strategies in reducing the rate of nosocomial bloodstream infections (BSI) due to multidrug resistant organisms (MDRO) in the NICU.Methods: Using a pre and post design, the study was carried out (from June 2010-August 2011) at the NICU of the Aga Khan University, a tertiary care hospital with a 12-bed, level III NICU. The intervention comprised of hand washing certification for all NICU staff, use of chlorhexidine instead of povidone iodine for skin preparation, use of non-sterile gloves for diaper change, implementation of barrier nursing for clinically suspected and culture proven infections, provision of separate intubation & central line trolley for each room and limiting the use of umbilical catheters to7 days. Within unit transmission of multidrug resistant acinetobacter, pseudomonas, vancomycin resistant enterococcus (VRE), extended spectrum  lactamase producer (ESBL) and methicillin resistant staphylococcus aureus (MRSA), were used as markers for nosocomial BSI. Average rates of BSI due to within unit transmission of MDRO are reported (3months pre-intervention period, 3 months implementation phase and 3months post intervention). Average number of admissions within the unit was used as denominator.Results: The average pre intervention rates of BSI due to ESBL, Acinetobacter, Pseudomonas and MRSA were 4.7, 3.3, 1.2 and zero respectively. In the implementation phase the BSI rates for all organisms dropped except for ESBL. A significant reduction in rates was observed in the post implementation period (ESBL 1.3, Acinetobacter 1.0, no case due to Pseudomonas and MRSA). No case of BSI due to VRE was reported during the entire study period. The average number of admissions during the 3 phases was almost similar (64, 49 and 51 respectively). There was sustained reduction in rates for all organisms, six months after the post intervention period.Conclusion: Nosocomial transmission of MDRO within the NICU can be effectively reduced by adoption of simple strategies.
IntroductionWe attempted to find the sensitivity and specificity of various pediatric brain masses in the Pakistani population while keeping histopathology or clinical diagnosis as the gold standard. MethodsThis was a retrospective study that was conducted from January 2007 to January 2016. We reviewed the records of 204 patients that presented to the radiology department of Aga Khan University Hospital (AKUH). Out of the 204, 135 pediatric patients in the 0–18 age group with focal brain lesions who underwent magnetic resonance spectroscopy (MRS) and a biopsy or clinical diagnosis were included. If histopathology was available, it was taken as the gold standard test; otherwise, clinical diagnosis was considered the gold standard. ResultsWe had a total of 135 patients, of which 71 (52.6%) were male and 64 (47.4%) were female. The mean age represented was 7.2 ± 4.5 years with a range of 1–18 years. We found radiology (magnetic resonance imaging (MRI) and MRS) to have a 91.7% sensitivity and a 94.3% specificity for tumors. For leukodystrophy, there was a 64.3% sensitivity and a 97.3% specificity. On the other hand, infection and mitochondrial disorders had sensitivities of 35.7% and 21.7%, respectively, and specificities of 98.9% and 97.1%, respectively. The category labeled “others” had a sensitivity of 27.4% and a specificity of 86.0%. ConclusionA combination of MRI and MRS was highly sensitive and specific for tumors. For infections, leukodystrophy, mitochondrial disorders, and the category of “others,” it was highly specific but poorly sensitive.
BACKGROUND: The most commonly used technique to anesthetize maxillary teeth is the infiltration anesthesia that currently is the gold standard. However, infiltration uses a dental needle that is associated with its de merits also. This led to the discovery of novel methods to anesthetize teeth. We in our study have used lidocaine with xylometazoline in the form of an intranasal spray to achieve local anesthesia of maxillary teeth for restorative procedures. The most commonly used technique to anesthetize maxillary teeth is the infiltration anesthesia that currently is the gold standard. However, infiltration uses a dental needle that is associated with its de merits also. This led to the discovery of novel methods to anesthetize teeth. We in our study have used lidocaine with xylometazoline in the form of an intranasal spray to achieve local anesthesia of maxillary teeth for restorative procedures. A total of 60 patients were enrolled in the study. Thirty patients were randomized each to lidocaine/Xylometazoline or to control local anesthesia group. Group A participants received 4% Lidocaine and 0.1% Xylometazoline solution as intranasal spray while Group B participants received injectable local anesthesia. Local anesthesia was then assessed and reading was taken on the Visual Analog Scale. If the reading was ‘0’ the cavity preparation was performed. If the VAS reading was more than ‘0’ a third dose of intranasal spray anesthesia was delivered. If profound local anesthesia was still not achieved the case was labeled as failure of intranasal spray anesthesia and local anesthesia was achieved by conventional infiltration anesthesia. For Group B participants, local anesthesia was achieved by means of conventional infiltration anesthesia. SPSS v.16 was used to analyze the data with level of significance set at p<0.05. Demographic data were analyzed upon the basis of frequency and percentages. Chi-square test and Fischer exact test were applied to see the difference of efficacy among the two groups and any influence of variables on the efficacy. RESULTS: 21 out of 30 (70%) patients from Group A were anesthetized by intranasal spray anesthesia while all 30 (100%) patients from Group B had successful anesthesia by conventional infiltration. The p value computed is <0.05. No statistically significant effects of age group, gender, tooth location or the number of sprays was observed on the efficacy of intranasal spray anesthesia (p>0.05). There was a statistically significant effect of ICDAS score on the efficacy of intranasal spray anesthesia (p<0.05). CONCLUSION: Lidocaine xylometazoline intranasal spray solution was fairly efficacious in anesthetizing maxillary teeth with smaller carious lesions for restorative procedures in patients with a stable medical history. Intranasal spray solution can be used for patients with needle phobia.TRIAL REGISTRATION: The study is registered on clinical trials website via NCT04732104 on 26/01/2021.
Objective: To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers. Methods: The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined for clinical signs of iron deficiency anaemia. Results: Of the 100 women, 20(20%) were malnourished, 42(42%) were of normal weight, and 38(38%) were either overweight, pre-obese or obese. The caloric intake of 26(26%) mothers was less than 1500 kcal per day, while 42(42%) were taking between 2000-2500 kcal per day and 32(32%) were taking >2500 kcal daily. Also, 67(67%) women were suffering from anaemia and 80(80%) women had some myths related with dietary restrictions during pregnancy, lactation and complimentary feeding of children. Overall, 23(23%) women breastfed their babies.
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