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Biomedical subjects

R Nanda

Publications and source records attributed to R Nanda.

At least 19 recordsLinked to original sources
PubMed2002

Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols.

We compared two protocols of early mobilisation for minimally displaced radial head fractures through a single-blinded, prospective randomised trial. Sixty patients were randomly allocated to either immediate active mobilisation or 5-day delay before active mobilisation was commenced. Patients were reviewed at 7 days, 4 weeks and 3 months after injuries. A blinded observer assessed each patient. All fractures united by the third month. At the end of 7 days, the mobilisation group had less pain (visual analogue scale (VAS) 6 versus 7.6, P=0.002); greater flexion (mean 112 versus 98 degrees, P=0.0004); greater strength in supination (P<0.001) and better elbow function (Morrey Score: 54 versus 43, P=0.005). By the fourth week, both groups were comparable in all parameters and improvement continued into the third month. Mean limit of extension at the third month were 2.3 degrees in the immediate mobilisation group and 1.8 degrees in the delayed group (NS). All had excellent function on the basis of the Morrey Score. Immediate mobilisation did not adversely affect the outcome; the patients had less pain and better elbow function at 1-week post-injury. Pain, ranges of movement and function were similar by the fourth week post-injury.

Adolescent↗
PubMed2001

Role of lateral cephalograms in assessing severity and difficulty of orthodontic cases.

To assess the role of lateral cephalometric films in the evaluation of orthodontic patients, 16 certified orthodontists examined 80 sets of dental casts and lateral cephalograms. The patients included 5 subgroups: Class I with mild crowding, Class II Division 2, Class III, open bites, and bimaxillary protrusion. A 5-point Visual Analogue Scale was used to assess the degree of severity and difficulty of each case. Severity was defined as the degree of deviation from ideal occlusion, while difficulty was defined as the probability of attaining an ideal occlusion when all treatment options were available. The examiner then chose one or more of the following treatment options: growth modification, extraction, nonextraction, and surgery. All examiners scored the degree of severity and difficulty of each case with casts only at Time 1 (T1), then with casts and cephalograms at Time 2 (T2). The observed ratings from the Visual Analogue Scale were scored by using the Rasch model, which transforms the nonlinear ordinal ratings to a linear interval scale. Intersubgroup differences and differences between T1 and T2 difficulty and severity were assessed by using a 5 x 2 repeated measures analysis of variance. A paired t test examined the amount and direction of the differences between T1 and T2 of each subgroup. Multiple contingency tables were used to compare treatment option changes between all subgroups at each time. Severity and difficulty scores highly correlated. Analysis of variance showed significant differences among subgroups for both severity and difficulty; however, there were significant time differences for severity only. Paired t tests revealed a small increase in severity for the bimaxillary protrusive group and small but significant decreases for the subgroups Class II Division 2 and Class III when cephalograms were added. The multicontingency table analysis demonstrated that a significant number of examiners did change their treatment options at T2 for bimaxillary protrusive, nonextraction, and Class II Division 2 patients. It was concluded that lateral cephalometric films showed a significant influence on a clinician's determination on severity of some types of orthodontic malocclusions.

Adolescent↗
PubMed2000

Evaluation of dimethylaminosulfonates of alkane diols as a novel group of anticancer agents.

A series of title compounds has been synthesized and evaluated by the cytotoxicity assays conducted in vitro in seven human tumor cell lines, initially in MT-4 and H-9, followed by U-937, PM-1, MCF-7, Hep-3B, and K-562. These compounds were simultaneously compared with the existing clinical drug, busulfan and also with an experimental drug, hepsulfam. IC(50) values of these agents in T-cell lymphoma and leukemic cell lines indicate that two of these agents hexsulfamyl and octsulfamyl (compounds 3 and 4) were significantly more potent than busulfan and were comparable in antileukemic activity with hepsulfam. In order to determine the effect of these agents on normal proliferating cells, the toxicity of 3 and 4 was also determined in vitro against human peripheral blood mononuclear cells (PBMC) and against murine bone marrow progenitor cells. PBMC assay data indicate that these agents were generally less toxic than hepsulfam. The results of the colony forming unit-erythroid (CFU-E) and granulocyte-macrophage colony forming unit (CFU-GM) assays, however, indicate that these agents were more toxic than hepsulfam to erythroid progenitor cells than to granulocyte-macrophage progenitors. The toxicity of octsulfamyl was further assessed in vivo in normal Swiss mice by measuring drug-induced changes in hematological parameters, femoral bone marrow cellularity and splenic cellularity as well as hepatotoxicity and nephrotoxicity on day 7 and 14 following drug treatment at the dose of 1.0 mg/kg body weight from days 1 to 5. The results indicate that the compound did not adversely affect hematopoiesis. Marginal bone marrow suppression was observed on day 7, which gradually tends to reach normalcy on day 14. The other parameters were within normal limit.

Alkanes↗
PubMed2000

Fatal tetanus in a drug abuser with "protective" antitetanus antibodies.

Tetanus is a rare disease in the United States. From 1995-1997, the average annual incidence of tetanus was 0.15/1,000,000 population. Injecting-drug users, particularly those who use heroin, are among the highest risk population for acquiring tetanus. We present a case of an injecting-drug user who was seen in the emergency department with worsening diffuse midthoracic back pain and spasms. He subsequently developed acute respiratory failure and central nervous system hypoxic injury. Serum obtained before administration of tetanus immune globulin showed a tetanus antibody titer greater than 16 times the level considered protective. Because of limited human data on the minimum protective level of neutralizing antibody, as well as reports of tetanus among individuals with "protective" antibody titers, the diagnosis of tetanus should not be excluded solely on the basis of antitetanus titers.

Antibodies, Bacterial↗
PubMed1997

Surgical complication outcome (SCOUT) score: a new method to evaluate quality of care in vascular surgery.

PURPOSE: Surgical outcome data are generally reported as raw morbidity and mortality rates, which do not necessarily reflect quality of surgical care. The Society for Vascular Surgery has led this area with recommendations by the Ad Hoc Committee on Reporting Standards to establish standardized methods of outcome assessment in vascular surgery. The purpose of this study was to evaluate a new method for evaluating the overall quality of surgical care, which includes surgeon, nursing, and hospital system performance. The goal of the method is to identify problem areas in surgical practice that can be targeted for focused improvement to improve outcome. METHODS: A database of more than 9000 general and vascular surgical cases was compiled over a 3-year period. Every postoperative complication was tabulated prospectively by a surgical nurse on a daily basis. Fifty clinically significant complication types specific for vascular surgery patients were identified from a list of 151 postoperative events by a panel of vascular surgeons and were grouped into nine broad categories (vascular, cardiac, pulmonary, etc.). These complications reflect the entire continuum of postoperative care, including surgeon, nursing, and hospital system performance. Each complication type was further stratified into four grades (mild, moderate, severe, death) and assigned a SCOUT severity score from 0 to 100 (0, no complication; 100, death) by the panel of surgeons. For case of data collection and monitoring of outcome, a software program was developed to run on a laptop computer and includes medical history, risk factors, pertinent laboratory data, and the preassigned SCOUT severity scores for measuring outcome. In this study, 170 major vascular procedures performed over the previous 12-month period were prospectively evaluated usig the SCOUT method in an attempt to more easily identify problem areas of practice. In-hospital morbidity and 30-day mortality results were examined. RESULTS: One hundred sixteen postoperative complications were identified in the 170 patients, with an overall morbidity rate of 51% and a 30-day mortality rate of 1.8%. Fifty-three percent of the complications were "mild" and required minimal intervention or observation only. Abdominal aortic aneurysm repair was associated with the highest morbidity rate (mean SCOUT score, 384.35), whereas distal extremity bypass grafting had the lowest morbidity rate (mean SCOUT score, 114.4). However, subgroup analysis demonstrated that cardiac events accounted for 52% of the morbidity associated with distal extremity bypass but only 34.7% of the morbidity associated with abdominal aortic aneurysm repair (p < 0.05). CONCLUSIONS: The SCOUT score is a new technical quality of care measure that can objectively quantify surgeon and other hospital system-related performance. The SCOUT score allows the surgeon to identify problem areas that can then be targeted for improvement to positively affect outcome.

Aged↗
PubMed1997

Role of pharyngeal length in patients with a lack of overbite.

Anterior open bites may be localized dental manifestations, which are caused by habits or skeletal disharmony, with or without functional aberration. Previous studies suggest various associations between open bites and underlying etiologic factors. We hypothesize that respiratory efficiency may be associated with anterior open bites. Under the assumption that breathing efficiency of the oropharynx and hypopharynx may be related to pharyngeal airway length, a cephalometric variable, vertical airway length (VAL), was measured on lateral cephalograms obtained from a total of 58 subjects with, so called, "open bite tendencies" (hereafter, open bite tendency). By means of the variable VAL, the association between pharyngeal length and open bite was investigated. In addition, the difference between actual open bite and open bite tendencies was also examined. The samples were randomly collected under stringent selection criteria from an existing database. A series of statistical analyses, such as unpaired t test, multiple regression, and discriminant analysis, was used to test the proposed hypothesis. The study found that none of the open bite tendency indicators used can segregate open bite subjects from nonopen bite subjects. The obtained discriminant function clearly divides the samples into two groups, i.e., open bite group and nonopen bite group, which were based on VAL and lower facial height. The study concludes that, first, an open bite tendency may be a different entity from an actual open bite or may be a misconceptualized term. Second, pharyngeal length may be a convenient indicator to diagnose open bite. We speculate that open bite may be different from an open bite tendency in pharyngeal length.

Adolescent↗
PubMed1997

Correction of deep overbite in adults.

Deep overbite is one of the most common features of adult malocclusions. Treatment of deep overbites involves a careful diagnosis, treatment plan, and mechanics plan. Pure intrusion of upper or lower incisors alone or in combination with flaring and extrusion of posterior teeth are common methods to correct deep overbites. This article describes appliance systems and biomechanical considerations necessary for intrusion of incisors.

Adult↗
PubMed1997

The importance of the Doppler angle.

We examined 118 infrainguinal grafts (103 patients) to determine the effect changes in the angle of theta or Doppler angle had on the accuracy of velocity measurements made with a duplex scanner. Four separate measurements of peak velocity were made on each graft. Three measurements were made with the flow toward the probe at 60 degrees, 50 degrees, 120 degrees (60 degrees the other way). The probe was then turned 180 degrees so the flow was away from the probe and measurements were made at 60 degrees. When the primary cursor was aligned with the vessel wall (Technologist A), the mean velocity at 60 degrees was 69.4 cm/sec and 57.3 cm/sec at 50 degrees, a difference of 12 cm/sec. The same measurements done by Technologist B (primary cursor non aligned with the wall), showed a 10 cm/sec difference (60.7 and 50.5). We saw a consistent difference with even this small difference in the angle of theta throughout the study. The mean velocity obtained by Technologist A when the flow was toward the probe was 61.7. When the probe was turned 180 degrees (flow away from the probe), the mean velocity was 60.5. The same measurements by Technologist B were 51.8 and 50.5. This indicates that the direction of the flow of blood towards or away from the probe does not effect the velocity measurements. Using the vessel wall to line up the primary cursor provides a consistent and easily reproducible reference point to compare measurements made on different days but is less important for single measurements.

Arterial Occlusive Diseases↗
PubMed1996

Presurgical satisfaction with facial appearance in orthognathic surgery patients.

Orthognathic surgery and orthodontic therapy are most often performed to improve the patient's appearance. However, not all patients are satisfied with the result though the procedure may be considered successful by the orthodontist and the maxillofacial surgeon. It has been suggested that the patient's satisfaction with his or her facial appearance before the surgery can predict later satisfaction with orthognathic procedures. The present study examined the role of several potential predictor variables in satisfaction with facial appearance before orthognathic treatment. The variables, identified in previous research, included severity of facial disharmony, self-concept, psychological distress, gender, age, and socioeconomic status. Questionnaires were gathered from 54 patients in 10 orthodontic practices in Connecticut and New York. Contrary to expectations, gender, age and socioeconomic status failed to predict patients' presurgical satisfaction with appearance. Self-concept, psychological distress, and orthodontists' ratings of total facial appearance (from a lateral view) were bivariate predictors of satisfaction. When all variables were analyzed with a multiple regression analysis, however, only self-concept emerged as a significant independent predictor of satisfaction with appearance. This accounted for 15% of the variance in satisfaction. Orthodontists' ratings of facial views, considered here objective measures of disharmony, were predictive neither of satisfaction with appearance nor of self-concept. It is suggested that self-concept may be a predictor of postsurgical as well as presurgical satisfaction with appearance and that self-concept itself may be unaffected by severity of facial disharmony, at least in young adults. Orthodontists may need to pay special attention to those patients with poor self-concept, because these patients may be more likely to report unsatisfactory surgical outcomes.

Adolescent↗
PubMed1996

An evaluation of root resorption incident to orthodontic intrusion.

A new radiographic method was developed for measuring changes in root length. With this technique, orthodontic intrusion was investigated as a potential cause of apical root resorption of maxillary incisors. The experimental group consisted of 17 patients with excessive overbite who were treated with a Burstone-type intrusion arch, which delivered a low level of force (about 15 gm per tooth). A control group was made up of 17 patients in full-arch fixed appliances who were randomly selected. After a period of approximately 4 months, the intrusion group had only slightly more root resorption than the controls, 0.6 mm versus 0.2 mm (statistically significant difference). Intrusion measured at the center of resistance of the central incisor averaged 1.9 mm. The amount of resorption was not correlated with the amount of intrusion. A weak correlation, r = 0.45, was found between resorption and movement of the apex (i.e., in addition to intrusion, there was often palatal root movement). Results of this study seem to indicate that intrusion with low forces can be effective in reducing overbite while causing only a negligible amount of apical root resorption.

Adolescent↗
PubMed1996

Treatment strategies for midline discrepancies.

Midline discrepancies are among the most complex and commonly seen problems in clinical orthodontics. Skeletal, soft tissue, and dentoavleolar asymmetries may be present alone or in combination in a patient who has noncoincident midlines. Due to the multifactorial etiology of midline discrepancies, a thorough understanding of the components that may contribute to the problem is essential for a correct diagnosis. The treatment mechanics that are derived from the treatment plan must be biomechanically oriented in order to achieve the desired results without the introduction of adverse side effects. This article discusses strategies to correctly diagnose and treat patients with significant midline asymmetries.

Activator Appliances↗
PubMed1995

Biomechanics of orthodontic correction of dental asymmetries.

Correction of dental asymmetries requires special attention in orthodontic treatment. Several types of asymmetries are described, along with the biomechanics needed for correction. Treatment with different appliance designs that correct these asymmetries with the lowest level of negative contribution from side effects will be compared with conventional treatment.

Biomechanical Phenomena↗
PubMed1995

Adolescent growth changes in soft tissue profile.

Growth of the lips, nose and chin was studied in a mixed longitudinal sample of 82 subjects from the "Nijmegen Growth Study". The age range was between 9 and 14 years with a single measurement at the age of 22 years. Differences in growth pattern between boys and girls are illustrated by mean cumulative growth curves and mean growth velocity curves as well as by contour plots.

Adolescent↗