Comparison of Two Different Doses of Dexamethasone to Control Swelling and Trismus following Mandibular Third Molar Surgery

Introduction: Third molar surgery is one of the most common procedures performed by dental surgeons in clinical practice, where postoperative sequelae like pain, trismus, and swelling are often encountered. Thus, in this study, we compared medications employed to reduce such complications. Objective: To compare the effect of two different doses (4 and 8 mg) of dexamethasone in the control of swelling and trismus after the surgical extraction of mandibular impacted third molars. Methods: An experimental study consisted of twenty-seven (27) healthy adult patients of both genders with bilateral impacted lower third molars, where surgical extraction was indicated, 4 mg and 8 mg of dexamethasone were given orally to the patients 1 hour before the surgical procedure at both the surgeries. The swelling was recorded by measuring the length of 3 facial planes using a measuring tape. Trismus was evaluated by measuring the maximum interincisal distance. Recording of facial swelling and maximum interincisal distance was done preoperatively and on the 1st and 2nd days postoperatively. Results: Based on statistical analysis (Independent T-test), the results showed a difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4mg of dexamethasone though there was no statistically significant (p-value >0.05) difference between the two doses. Conclusions: 8 milligrams of the dexamethasone had better effectiveness than 4 milligrams of the dexamethasone in reducing the degree of swelling and trismus. Keywords: Dexamethasone; impacted third molars; swelling; trismus.

Outcome of Extracorporeal Shockwave Lithotripsy as Monotherapy in Upper Urinary Tract Lithiasis

Introduction: Due to its non-invasive nature, extracorporeal shockwave lithotripsy (ESWL) is the preferred treatment modality for uncomplicated renal and ureteral stone < 20 mm in diameter. The success rate of it ranges from 46% to 91% depending on various factors. Objective: To assess the outcome of ESWL as monotherapy in uncomplicated solitary renal and upper ureteric calculus ranging from 10mm to 20mm. Methods: In this retrospective study, the records of 34 patients who underwent Extracorporeal shockwave lithotripsy ESWL inBirat Medical College – Teaching Hospital over a period of one and a half years were reviewed to assess the outcome in terms of stone free rate and complication rate. Results: Mean age of the patients was 30.57±8.44 years and mean calculus size was 14.47±2.68 mm (range 10-20mm). The male and female ratio was 2:1. The success rate was higher for pelvic (83.33%) and upper calyceal (75%) and upper ureteric calculi (75%) compared to other calyces. Clinically significant residual fragment (CSRF) was the most common problem after ESWL (23.33%) at three months after the procedure. Conclusions: The outcome of ESWL as monotherapy for upper urinary tract calculi is acceptable in selected cases three months after the procedure. Keywords: Extracorporeal shockwave lithotripsy; outcome; upper urinary tract calculi.

Metabolic Pathways and Pathological Outcomes of Aflatoxins: A Review

Aflatoxin is a secondary fungal metabolite that contaminates foods, mostly staple diets like maize, peanuts, chillies, and even rice. These foods are also a major constituent of weaning food for infants in Asia and Sub-Saharan Africa. The fungal metabolite contaminates food during production, harvest, storage, and processing. The contamination is largely promoted by genotypes of crops, soil conditions, temperate regions, and insect activity. Once ingested into the body, aflatoxins get metabolized into different hydroxylated derivatives such as AFb1, AfM1, AFP1, aflatoxicol, and Aflatoxin B1. AFB1 is the most carcinogenic and potent of the known metabolites and they have been categorized as Group I carcinogenic agents by the International Agency for Research on Cancer. The toxic metabolites of aflatoxins have been found in blood samples, breast milk and also have been shown to traverse the placental route. Through various metabolic pathways aflatoxins are responsible for different types of pathological outcomes like gut enteropathy, anemia, stunting, and other immunological disorders. Moreover, socioeconomic determinants have indirectly shown to be strong predictors of aflatoxins exposure and thus its related pathological outcomes. Since we have a very limited number of researches about aflatoxins, this review altogether puts forward what is known about the toxin and its harmful metabolites. Keywords: Aflatoxins; aflatoxinB1; carcinogens; fungal toxins.

Serum Ferritin Concentration in Corona Virus Disease 19

Introduction: Coronavirus disease 19 (COVID-19) is a complex disease responsible for the development of exacerbated inflammatory response (cytokine storm) that ultimately leads to multiorgan failure and death. Serum ferritin has been recently identified as one of the inflammatory markers responsible for the pro-inflammatory effects. Small amount of ferritin is present in plasma (15-150 ng/mL) which might increase with the severity of COVID-19. Therefore, measurement of ferritin is essential in identifying disease severity and predict disease prognosis. Objective: This study aims to assess the ferritin level in COVID-19 patients. Methods: A cross-sectional study was carried out on 259 COVID-19 patients visiting KIST Medical College and Teaching Hospital (KISTMCTH), Lalitpur, Nepal from November 2020 to April 2021. Serum ferritin was estimated in the automated Siemens ADVIA Centaur CP Chemiluminescence Immunoassay system. All the patients visiting KISTMCTH referred by clinician for ferritin assessment were included in this study. Data collected using the proforma tool was tabulated in SPSS 21 and statistical analysis was done by inferential statistical test. Results: Out of total 259 COVID-19 patients, 58.7% were male and the majority of patients (82.6%) were below 70 years of age. The mean age for all participants was 52.11±16.59 years. Hyperferritinemia was seen in 218 (84.16%) COVID -19 patients. The mean value of serum ferritin was 767.1±789.86 (IQR: 12.8-4590) ng/mL and was significantly higher in males (p<0.001). Comparing the mean values of ferritin between the patients below and above 70 years, no statistical difference was observed (p=0.872). Conclusions: In our study, serum ferritin levels were greatly increased in patients with COVID-19 infection. Keywords: Coronavirus disease 19; cytokine storm; inflammatory marker; serum ferritin.

Improved Diagnosis of Pulmonary Tuberculosis using Bleach (Sodium hypochlorite) Concentration Technique at Tertiary Care Hospital

Introduction: In the Revised National Tuberculosis Control Program (RNTCP), microscopic examination of sputum for acid-fast bacilli (AFB) is currently the backbone for the diagnosis of pulmonary tuberculosis. Studies have shown liquefaction and concentration of sputum by 5% sodium hypochlorite is useful in providing increased sensitivity and safety for the handling of specimens. Objective: To assess the utility of the 5% Sodium hypochlorite concentration method in increasing the sensitivity of smear microscopy for detection of AFB for diagnosis of pulmonary tuberculosis. Methods: The study included a total of 1000 sputum samples from 500 patients with suspected pulmonary tuberculosis. Direct smears were prepared from the sputum samples as per RNTCP guidelines. The remaining sputum was used for bleach concentration and smears prepared from the concentrated material. Both smears were stained by Ziehl-Neelsen staining and screened for acid-fast bacilli and graded according to the RNTCP guidelines. Results: A total of 158 samples (15.8%) from 89 patients were positive by a routine direct method whereas by concentration method 236 samples (23.6%) from 143 patients were found positive diagnosing additional 54 patients. The gain in sputum smear positivity of 7.8% over the routine method is highly significant (p=0.0000, χ2= 270) with a 10.8% increase in case detection. Conclusions: Improvement in the sensitivity of smears microscopy will be useful in case detection of tuberculosis especially in resource-poor countries. The increased positivity of microscopy by bleach method indicates that would prove useful if included in the RNTCP to improve case detection. Keywords: Concentration; smear positivity; sodium hypochlorite; tuberculosis.

Pediatric Otological Disorders: An In-Hospital Study

Introduction: Social factors influencing the likelihood of developing pediatric Ear, Nose, and Throat (ENT) disorders include socioeconomic status, the type of family, overcrowding, and access to health care, which are prevalent in developing countries like Nepal. Nepalese populations are not well documented with regards to pediatric ENT disorders. Objective: The aim of the study was to determine the prevalence of ENT disorders in pediatric patients attending hospitals. Methods: This is a cross-sectional descriptive study that was conducted at Janaki Medical College, Janakpur between January and September of 2021. Consecutive children from Janaki Medical College between the ages of 6 months and 18 years with otological complaints participated in the study. Afterward, the diagnosis was derived from patients’ OPD cards or by contacting them by phone. Results: The mean ages of male and female participants were 3.2± 2.7 years old and 4.9 ± 2.6 years respectively. Out of the study participants who complained about otological complaints, the majority (37.45%) had ear wax on their ears, followed by foreign bodies (21.30%) and acute otitis externa (9.2%). Among foreign bodies encountered, rubber (35.48%) was most common, followed by seed (24.19%). Conclusions: Pediatric ear diseases are very common. In the majority of cases, ear wax and foreign bodies were found. By raising awareness about ear hygiene and disease, we can reduce the problems associated with them. Keywords: Ear, nose, and throat; otology; pediatric; prevalence.

Spectrum of Oral Cavity Lesions and its Clinico-Histopathological Correlation

Introduction: Oral cavity lesions comprise a wide spectrum of diseases that varies from non-neoplastic to neoplastic. The clinical evaluation alone is insufficient for proper diagnosis in most cases. So, histopathological examination is the gold standard method for diagnosis and management of patients accordingly. Objective: The present study was done to evaluate the histopathological spectrum of oral cavity lesions and compare them in relation to age, sex, site, clinical features, risk factors, and clinical diagnoses. Methods: This prospective cross-sectional study enrolled 127 cases of oral biopsies which were received at the Department of Pathology, Tribhuvan University and Teaching Hospital, Kathmandu Nepal, from May 2018 to April 2019 for histopathological examination. Specimens were fixed in 10% formalin and subjected for tissue processing and Hematoxylin and Eosin stained sections. Data entry and analysis were done by using SPSS 24 version where frequency and percentile were calculated. Results: Total cases were 127 with slight female predilection and the age group of 50-60 years (mean age of 44.24 years) were commonly affected. The tongue being the most common site, frequently lesions presented as swelling. Most of the lesions were non-neoplastic comprising 45% whereas malignant lesions comprised 23.6%. Smoking increased the risk of malignancy by 2 fold. The most common benign lesions were squamous papilloma & fibroepithelial polyp whereas the malignant lesion was squamous cell carcinoma. Sixty percent of clinical diagnoses didn’t show correlation. Conclusions: Oral cavity lesions have a wide spectrum of distribution in age, sex, site, and clinical presentation. Initially, oral lesions may present with subtle symptoms which may cause underdiagnosis. Thus, histopathological diagnosis is a must to rule out malignancy. Keywords: Clinical presentation; correlation; oral cavity; risk factors.

Comparison of Packed Cell Volume Changes after Erythropoietin Administration and Blood Transfusion in Patients with Anemia of Chronic Kidney Disease on Hemodialysis

Introduction: Anemia of chronic kidney disease (CKD) can be managed by regular administration of erythropoiesis stimulating agents (ESAs) and/or blood transfusion. The response to these therapies can be monitored by serial packed cell volume (PCV). Objective: This study was done to compare the temporal changes in PCV after ESA therapy and blood transfusion in patients with recently diagnosed anemia in CKD stage 5 on hemodialysis (CKD 5 HD). Methods: Medical records of patients undergoing hemodialysis at the National Kidney Center, Balaju, Kathmandu from July to September 2013 were examined retrospectively. The data collected were analyzed using Minitab 16. Results: A total of 44 patients were on ESA therapy while 48 patients were on blood transfusion. The mean PCV at the start of blood transfusion was significantly lower than the mean PCV at the start of ESA therapy (p = 0.000) but at four weeks, the mean PCV in blood transfusion group was significantly greater than that in ESA therapy group (p = 0.008). At eight weeks and twelve weeks, the mean PCVs in both groups were not significantly different from each other (p = 0.949 and p = 0.747). Conclusions: Blood transfusion increases PCV immediately and in sustained manner while with ESA therapy, the response takes a longer time to manifest. A large number of non-responders to ESA therapy may have influenced the findings of this study. It is recommended that adequate dosing of ESA and attention to comorbid conditions be followed during ESA therapy. Keywords: Anemia; chronic renal insufficiency; blood transfusion; hematinics.

Peri-implantitis: A Classification Update

The cases of peri-implantitis are soaring rapidly in the current scenario. It is very important to have adequate knowledge about the etiology, pathogenesis, clinical features, radiological features, and treatment of peri-implantitis. In this context, the classification of the disease is of utmost importance for planning and execution of the treatment. Various classifications have been proposed over the years and with each classification, more information is being added and there is a lack of universal acceptance of a single classification. Clinical errors may be anticipated due to miscommunication and misguidance. Thus, it is important to sensitize the clinicians about different classification systems. This review attempts to compile and critically analyze existing classification systems of peri-implant diseases. Keywords: Dental implants; diagnosis; peri-implantitis.

Detection of Extended Spectrum β-Lactamases (ESBL) Producing Bacteria in Sepsis Suspected Neonates

Introduction: Neonatal sepsis is a clinical syndrome that is caused when the bloodstream of an infant is invaded by bacteria in the first month after birth. Objective: The objective of the study was to identify bacteria involved in the infection and to determine “extended-spectrum beta-lactamase” (ESBL) producing bacteria from blood samples of sepsis suspected neonates in the Neonatal Intensive Care Unit and Special Care Baby Unit. Methods: This cross-sectional study was conducted from January to July 2019 at Microbiology laboratory of Paropakar Maternity and Women’s Hospital. A total of 380 venous blood specimens were included in the study. The blood culture was performed and organisms were identified with standard microbiological methods. The Antibiotic susceptibility test was performed using the modified Kirby Bauer disk diffusion method. Screening of the organisms was done using cefotaxime and ceftazidime antibiotic disc and confirmation of ESBL was done by combined disk test. The data were considered statistically significant if the p-value was < 0.05. Results: Out of a total of 380 blood specimens, the prevalence of neonatal sepsis was found to be 21.05% among which 57.5% were EOS type and 42.5% were LOS type. In EOS, E. coli (72.73%) was the predominant isolate while CoNS (100%) was the predominant isolate in LOS. Of the total 80 isolates, 65% isolates were found multidrug-resistant (MDR) whereas 58.75% of isolates were found to be ESBL producers. Conclusions: This study concludes that routine bacterial surveillance and study of their resistance patterns is an essential component of the neonatal care unit. Keywords: Extended-spectrum β-Lactamases; neonates; neonate intensive care unit; special care baby unit; sepsis.