Validation of the GRACE score for prognosis in Indian patients with acute coronary syndromes

AimTo validate the global registry of acute coronary events (GRACE) score in acute coronary syndromes (ACS) patients and study its angiographic correlation.Methods and resultsTwo-hundred and thirty-five ACS patients were studied for the combined endpoint of all-cause in-hospital mortality and non-fatal infarction/reinfarction. We tested the predictive accuracy of the composite GRACE score using the receiver operating characteristics (ROC) curve.Lower systolic blood pressure (SBP) (odds ratio [OR] 7.93, P=0.005), ST-segment deviation (OR 7.79, P=0.02) and cardiac biomarker positivity (OR > 6.52, P=0.01) were significantly associated with events. Serum creatinine > 1.4 mg/dL showed a trend towards statistical significance (OR 4.14, P=0.05), whereas age > 50 years (OR 3.62, P=not significant [NS]) and Killips class 4 (OR 2.71, P=NS) showed good association. The best value for predicting events was a GRACE score of > 217 and these patients were more likely to have double/triple vessel disease (P = 0.0009). The C statistic for the GRACE score was 0.75.ConclusionHigher GRACE score predicts in-hospital events and more severe angiographic coronary artery disease (CAD).     

The effects of daily consumption of grapefruit on body weight, lipids, and blood pressure in healthy, overweight adults

Folklore has suggested that consuming grapefruit may promote weight control. Sparse data exist to support this hypothesis, although there is some evidence of health promotion effects with regard to blood pressure control and modulation of circulating lipids. The aim of this randomized controlled trial was to prospectively evaluate the role of grapefruit in reducing body weight and blood pressure and in promoting improvements in the lipid profile in overweight adults (N = 74). Following a 3-week washout diet low in bioactive-rich fruits and vegetables, participants were randomized to either the control diet (n = 32) or daily grapefruit (n = 42) in the amount of one half of a fresh Rio-Red grapefruit with each meal (3× daily) for 6 weeks. No differences between group in weight, blood pressure, or lipids were demonstrated. Grapefruit consumption was associated with modest weight loss (-0.61 ± 2.23 kg, P = .097), a significant reduction in waist circumference (-2.45 ± 0.60 cm, P = .0002), and a significant reduction in systolic blood pressure (-3.21 ± 10.13 mm Hg, P = .03) compared with baseline values. Improvements were observed in circulating lipids of those consuming grapefruit, with total cholesterol and low-density lipoprotein significantly decreasing by -11.7 mg/dL (P = .002) and -18.7 mg/dL (P < .001), respectively, compared with baseline values. This study suggests that consumption of grapefruit daily for 6 weeks does not significantly decrease body weight, lipids, or blood pressure as compared with the control condition. However, the improvements in blood pressure and lipids demonstrated in the intervention group suggest that grapefruit should be further evaluated in the context of obesity and cardiovascular disease prevention.     

Comparative Evaluation of Bond Strengths of Different Core Materials with Various Luting Agents Used for Cast Crown Restorations

The coronal cast restoration continues to be used commonly to restore mutilated, endodontically treated teeth. The tensile bond strength of luting cements is of critical importance as many of failures are at the core and the crown interface. An invitro study with aim to evaluate and compare bond strengths of luting cements between different core materials and cast crowns. A total of 45 extracted identical mandibular second premolars were endodontically treated and divided into 3 groups of 15 each. Specimens in first group were restored with cast post and core (Group C), and specimens in second group were restored with stainless steel parapost and composite core material (Group B) and specimens in third group were restored with stainless steel parapost and glass ionomer core build (Group G). Standardized crown preparation was done for all the specimens to receive cast crowns. Each group was further divided into 3 subgroups and were cemented using 3 different luting cements namely, resin cement, polycarboxylate cement, glass ionomer cement (Type I). The samples of each subgroup (n = 5) were subjected to tensile testing using Universal Testing Machine at a crosshead speed of 2 mm/min till the dislodgement of crown from the core surface was observed. The bond strengths were significantly different according one way ANOVA (F-150.76 and p < 0.0000). The results of the study showed that the specimens cemented with resin cement in cast core, composite core and glass ionomer core exhibited significantly higher bond strengths as compared to specimens cemented with glass ionomer and polycarboxylate cement. Composite resin core and resin cement combinations were superior to all other cement and core combinations tested.     

Multidisciplinary treatment approach with one piece implants for congenitally missing maxillary lateral incisors: a case report

Congenitally missing lateral incisors are a common clinical occurrence. Dental Implants have become a primary treatment option for replacement of these teeth. Many times in prosthodontic treatment planning a multidisciplinary approach is needed for a comprehensive out come. Prosthodontic treatment planning is needed prior to the patient's consultation and following treatment acceptance; the prosthodontist may need to coordinate treatment needs with other specialists, including an orthodontist and an implant surgeon. This article describes multidisciplinary management of a case presenting with spaced maxillary anteriors due to the congenitally missing lateral incisors. Treatment consisted of initial orthodontic space management to obtain adequate space for missing lateral incisors. Single piece, narrow diameter implants were placed in edentulous spaces on both sides. Aesthetic crown lengthening procedure was performed with all anterior teeth along with tissues surrounding the implants. Metal-ceramic crowns were given as definitive restorations, resulting into an acceptable aesthetic outcome.     

Challenges Relating to the Interface Between Crisis Mental Health Clinicians and Police When Engaging with People with a Mental Illness

Symptoms of mental illness can increase the risk of disturbed behaviour. Joint intervention between police and mental health services is therefore sometimes needed to manage crisis events safely, and to divert people with a mental illness from further criminal justice system contact. This study explored how crisis mental health clinicians and police officers experience the service interface to identify perceived challenges tocollaboration and possible solutions. This was explored through circulation of a developed questionnaire to staff of the Crisis Assessment Team of Alfred Psychiatry and police officers from three Melbourne police stations. In addition to identifying the high frequency of contact between interfacing services, a number of challenges to effective interface were identified. These included: inefficient communication before or following a joint event; difficulty accessing support from the interfacing service and delays in handing over care in hospital emergency departments; and staff occasionally not respecting the professional abilities of staff from interfacing services.     

Presurgical Nasoalveolar Molding (PNAM) for a Unilateral Cleft Lip and Palate: A Clinical Report

Cleft lip and palate deformity is a congenital defect of the middle third of the face. Incidence varies from 1:500 to 1:2500 live births. Etiology depends upon hereditary and environmental factors. Restoration of these defects is important not only for functional and esthetic reasons, but also because there may be a positive psychological impact for the patient and parents. The goal of primary closure of the lip for unilateral cleft lip is to ensure a normal and symmetrical lip and nose. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. Presurgical nasoalveolar molding (PNAM) represents a paradigm shift from the traditional methods of presurgical infant orthopedics. PNAM consists of active molding of the alveolar segments as well as the surrounding soft tissues. This clinical report describes a new approach of PNAM therapy for an infant with complete unilateral cleft lip and palate showing significant reduction in cleft defect size and improved contour and topography of deformed surrounding soft tissues.     

Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

Background

We evaluated external ventricular drain placement for factors associated with placement accuracy. Data were acquired using an electronic health record data requisition tool.

Method

Medical records of all patients who underwent ventriculostomy from 2003 to 2010 were identified and evaluated. Patient demographics, diagnosis, type of guidance and number of catheter passes were searched for and recorded. Post-procedural hemorrhage and/or infection were identified. A grading scale was used to classify accuracy of catheter placements. A multiple logistic regression model was developed to assess features associated with accurate catheter placement.

Results

One hundred nine patients who underwent 111 ventriculostomies from 2003 to 2010 were identified. Patient diagnoses were classified into vascular (63 %), tumor (21 %), trauma (14 %), and cyst (2 %). Procedures were performed freehand in 90 (81 %), with the Ghajar guide in 17 (15 %), and with image guidance in 4 (4 %) patients. Eighty-eight (79 %) catheters were placed in the correct location. Trauma patients were more likely to have catheters misplaced (p?=?0.007) whereas patients in other diagnostic categories were not significantly associated with misplaced catheters. Post-procedural hemorrhage was noted in 2 (1.8 %) patients on post-procedural imaging studies. Five (4.5 %) definite and 6 (5.4 %) suspected infections were identified.

Conclusions

External ventricular drain placement can be performed accurately in most patients. Patients with trauma are more likely to have catheters misplaced. Further development is required to identify and evaluate procedure outcomes using an electronic health record repository.