Objectives: We investigated the association of fluid overload and oxygenation in critically sick children, and their correlation with various outcomes (duration of ventilation, ICU stay, and mortality). We also assessed whether renal angina index (RAI) at admission can predict mortality or acute kidney injury (AKI) on day 3 after admission.Design and setting: Prospective study, pediatric intensive care in a tertiary hospital.Duration: June 2013-June 2014.Patients: Patients were included if they needed invasive mechanical ventilation for >24 h and had an indwelling arterial catheter. Patients with congenital heart disease or those who received renal replacement therapy (RRT) were excluded.Methods: Oxygenation index, fluid overload percent (daily, cumulative), RAI at admission and pediatric logistic organ dysfunction (PELOD) score were obtained in all critically ill children. KDIGO classification was used to define AKI, using both creatinine and urine output criteria. Admission data for determination of RAI included the use of vasopressors, invasive mechanical ventilation, percent fluid overload, and change in kidney function (estimated creatinine clearance). Univariable and multivariable approaches were used to assess the relations between fluid overload, oxygenation index and clinical outcomes. An RAI cutoff >8 was used to predict AKI on day 3 of admission and mortality.Results: One hundred and two patients were recruited. Fluid overload predicted oxygenation index in all patients, independent of age, gender and PELOD score (p < 0.05). Fluid overload was associated with longer duration of ventilation (p < 0.05), controlled for age, gender, and PELOD score. Day-3 AKI rates were higher in patients with a RAI of 8 or more, and higher areas under the RAI curve had better prediction rates for Day-3 AKI. An RAI <8 had high negative predictive values (80–95%) for Day-3 AKI. RAI was better than traditional markers of pediatric severity of illness (PELOD) score for prediction of AKI on day 3.Conclusions: This study emphasizes that positive fluid balance adversely affects intensive care in critically ill children. Further, the RAI prediction model may help optimize treatment and improve clinical prediction of AKI.
Renal cell carcinoma (RCC) is an aggressive and lethal tumor that has a high frequency of metastatic spread to unpredictable sites. One quarter of patients have either distant metastases or significant local-regional disease with atypical symptoms on presentation. We present a 41-year-old patient with symptoms of right heart failure and was found to have metastatic renal cell carcinoma with enhancing tumor from left renal vein up to right atrium.
“Gummy smile” is a major concern for a large number of patients visiting the dentist. Esthetics has now become an integral part of periodontal treatment plan. This article presents a case of a gummy smile in which esthetic correction was achieved through periodontal plastic surgical procedure wherein a 10-12 mm of partial-thickness flap was dissected apical to mucogingival junction followed by approximation of the flaps. This novel technique gave excellent post-operative results with enormous patient satisfaction. This surgical chair-side procedure being one of its kinds with outstanding results is very rarely performed by Periodontists. Thus, a lot of clinical work and literature review with this surgical technique is required. To make it a routine surgical procedure this technique can be incorporated as a part of periodontal plastic surgery in the text. Hence, we have put forward experience of a case with critical analysis of the surgical technique including the limitations of the technique.
In patients with higher risk of local recurrence, surveillance with MRI may represent an effective surveillance strategy though subgroups benefiting have not been identified nor has the impact on quality of life and cost been evaluated.
Gingival enlargement is one of the adverse drug reactions associated with the administration of several drugs. Progression of gingival enlargement affects the normal oral hygiene practice and may interfere with mastication, speech, etc. It gradually becomes a source of pain and disfigurement. There is a wide variation in the presentation of clinical and histological features of such gingival enlargements. Nifedipine is one such drug of the family of calcium channel blockers that has the potential to cause gingival overgrowth in patients taking the same, although in a limited number of cases. The management of such cases requires a multi-pronged approach including thorough scaling and root planning, drug substitution, and surgical approach. This case report highlights the management of one such case of a patient taking nifedipine for the management of hypertension.
Dentistry is truly a great profession and recently it is coming to the terms of use of technology and tech-savvy dentists, who nowadays use smart devices to make their life easier. Researchers are constantly innovating to integrate technology into dentistry. Of all the latest technological innovations in dentistry, the most talked about innovations are threedimensional (3D) printing and cone beam computed tomography (CBCT), which have made the treatment planning and execution a whole lot easier. Three-dimensional printing like CBCT has been gaining much popularity in the masses. Three-dimensional printing technologies are evolving rapidly in the recent years and can be used with a wide array of different materials. In addition to rapid prototyping, the dominant use in the past, they are now being used in all manner of manufacturing applications in a diversity of industries such as sports goods, fashion items such as jewelry and necklaces to aerospace components, tools for automobile industry, and medical implants also in dentistry for producing models, making scaffolds, etc. In future, 3D printing has ability to change the way many products are manufactured and produced and bring an era of 'personal manufacturing'. This article introduces 3D printing and gives little information about the technology behind the working of 3D printers. It also gives information about the applications of 3D printers and materials most often used for 3D printed scaffolds for periodontal regeneration.
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