Tuesday, 20 October 2020

Effects of Caffeine on Physical and Cognitive Performance: A Brief Review | Jaffe Daniel

Jaffe Daniel | Effects of Caffeine on Physical and Cognitive Performance: A Brief Review

 

Editorial

Caffeine is one of the most extensively studied and widely used ergogenic aid capable of improving many aspects of sport performance and cognitive abilities [1-12]. Some of the acute effects of caffeine supplementation are increases anaerobic power output and performance, increased muscular strength, endurance, and power, improvements to aerobic endurance, reduced fatigue, decreased RPE and pain, increased voluntary workload, and increased alertness [1-8]. Chronic caffeine consumption has also been shown to have a positive effect on long term memory, locomotor improvements, and overall mood state [9-11]. Some of the positive effects of athletic performance attributed to caffeine ingestion can be explained by its ability to moderate insulin sensitivity, increase plasma free fatty acids (FFAs), and increase plasma epinephrine [12]. These results demonstrated that caffeine consumption can allow more glucose and FFAs to be available in the blood for immediate energy. Furthermore, caffeine has been shown to increase calcium release from the sarcoplasmic reticulum of muscle fibers, which could result in increased actinmyosin binding and therefore increased force production [12]. Some of the acute physical effects of caffeine supplementation are increases anaerobic power output and performance, increased muscular strength, endurance and power, improvements to aerobic endurance, and reduced fatigue [1,3-6,8]. Additionally, acute caffeine consumption also enhances cognitive function during physical tasks as demonstrated through a reduction in self-reported rate of perceived exertion (RPE) and pain perception, increasing voluntary choice of work load, and increasing alertness [2,7,9]. As demonstrated in a multitude of studies, caffeine is used by athletes prior to competition because of the belief that it may improve performance. Beck et al. [1] performed an analysis of the immediate effects of caffeine supplementation on athletic performance [1]. During the study, 37 resistance-trained males (21+/-2 years) performed repeated Wingate Anaerobic Tests (WAnT) and multiple one repetition maximum (1RM) and additional submaximal assessments to evaluate the effects of caffeine on power, strength, and muscular endurance. Researchers noted a significant increase in the 1RM on bench press (2.1% increase; p <0.05) for the experimental group relative to the placebo. However, no significant differences in performance were noted between the groups in any other category [1].

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The results of this study demonstrated that ingesting a caffeine-containing supplement prior to performing an athletic event conferred a benefit to upper-body strength. According to the authors, future studies should examine the acute effects of various dosages of caffeine on strength, muscular endurance, and anaerobic capabilities in both trained and untrained subjects [1]. Chronic caffeine consumption has not been shown to effect physical performance and has actually been shown to decrease performance when caffeine ingestion ends after prolonged use [9]. Research has also shown that chronic supplementation may have a positive effect on long term memory, locomotor improvements, and overall mood state; however, has been shown to negatively impact sleep and cause headaches when caffeine consumption ends [9-12s]. James et al. [9] evaluated the acute and chronic effects of caffeine ingestion on mood, performance, headache, and sleep, and how these could change from caffeine withdrawal Utilizing a double-blind, placebo controlled, crossover experiment subjects were then tested on several objective indices of performance, and asked to self-report mood, headache, and sleep patterns. The results of the experiment demonstrated that there was no evidence of performance increase in either chronic or acute caffeine consumption [9]. However, performance was found to be impaired when caffeine consumption ceased following habitual use. Caffeine withdrawal was also associated with reported increases in headache frequency and severity, and with reports of sleeping longer and more soundly. Subjects reported feeling more alert after acute consumption of caffeine but feeling less alert overall with chronic use [9]. These findings demonstrated that the negative side-effects that correspond with caffeine withdrawal may outweigh and positive effects of alertness [9].

 

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Monday, 19 October 2020

Lupine Publishers | MDCT in Diagnosis of Anomalies of Coronary Artery Origin and Course a Coronary MDCT-Angiographic study of 9572 patients

     Lupine Publishers | Advancements in Cardiovascular Research 



Abstract

Background: Coronary anomalies are the causes of sudden cardiac deaths in young peoples, but usually asymptomatic. We perform this retrospective study to determine the types and prevalence of Coronary Anomalies of origin and course.

Method: The data of 9572 patients with Coronary CT-angiography by MDCT 640 Aquilion Toshiba machine were analyzed.

Results: Anomalous origin and course of coronary artery were detected in 47 (0.49%) of 9572 patients. The anomalous origins of Circumflex Artery from the RCA or the right sinus of Valsalva are most frequently visualized ( 15 pts [31.9%] ). High taking off of RCA observed in 11 pts ( 23.4% ).The RCA rising from the left sinus of Valsalva were seen in 8 pts ( 17% ).The Left Coronary Artery originates from the right sinus of Valsalva in 5 pts ( 10,6% ).The RCA arising from the LAD in 2pts (4,2% ).Absent RCA in 2 case (4.2%) and single coronary artery from LSV in one case (2.1%). The LCA rising from the Pulmonary Artery ( ALCAPA) in 2 cases and The RCA originating from the PA in one case ( RCAPA ).

Conclusion: Anomalies of coronary artery origin and course are rare but the diagnosis is very important to prevent SCD in young patients. MDCT with the Volume Rendered Images is the non-invasive modality that provides the valuable information to detect these anomalies.

Keywords: Multidetector Computed Tomography; Anomalies of coronary origin and course; sinus of Valsalva

Introduction

Coronary artery anomalies are a diverse group of congenital heart diseases with manifestations and pathological mechanisms are highly variable. Coronary anomalies include anomalies of origin and course, anomalies of intrinsic coronary arterial anatomy like myocardial bridge, anatomy of coronary termination as coronary artery fistula and anomalous anastomotic vessels. Anomalies of coronary origin and course may associated with arrhythmias, myocardial infarction and sudden cardiac deaths in young people, especially on effort like athletes. We study 9572 patients with coronary MDCT-angiography to evaluate the type and the incidence of coronary anomalies of origin and course[1,2].

Methods

All patients who underwent coronary CT-angiography by MDCT 64O Aquilion Toshiba equipment ( IV contrast medium, gantry rotation of 0.33 msec, slice thickness 0.5mm ) in MEDIC HCMC Viet Nam, from January 2016 to January 2019 were included. The main indications of CT-angiography were acute coronary syndrome, stable angina, coronary CT-angiography prior to surgery, congenital heart diseases involving coronary artery...

The CT-angiograms with coronary anomalies were selected and analyzed. The anomalies of coronary origin and course were assessed [3-5].

Results

We included 9572 pts with anomalies of coronary origin and course based on results of CT-angiograms that were interpreted by two cardiologists. Anomalous origin and course of coronary artery were detected in 47 ( 0,49 %) of 9572 patients. The mean age of these pts was 63± 8.4, M/F=1.8 . The anomalous origins of Circumflex Artery from the RCA or the right sinus of Valsalva are most frequently visualized ( 15 pts [31.9%] ).High taking off of RCA observed in 11 pts ( 23.4% ) The RCA rising from the left sinus of Valsalva were seen in 8 pts ( 17% ).The Left Coronary Artery originates from the right sinus of Valsalva in 5 pts ( 10.6% ), in this subgroup, a patient presented by myocardial infarction resulting cardiac arrest was notified, the surgical re-implantation of LCA was performed .The RCA arising from the LAD in 2pts (4,2% ). Absent RCA in 2 case (4.2%) and single coronary artery from LSV in one case ( 2.1% ) (Table1 ).The Left Coronary Artery arising from the Pulmonary Artery ( ALCAPA ) in 2 cases ( 4.2% ) and The RCA originating from the PA ( RCAPA ) in one case ( 2.1% ). sinus of Valsalva (Figures 1-10).

Table 1.

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RSV: Right sinus of Valsalva, LSV: Left sinus of Valsalva, ALCAPA: Anomalous Left Coronary Artery from The Pulmonary Artery, RCAPA: Anomalous Origin of the Right Coronary Artery off The Pulmonary Artery.

Figure 1: Single coronary artery rising from LSV.

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This patient is of 52 ages, presented by atypical chest pain, the single coronary artery originating from LSV. The other case report of Prashanth Panduranga revealed the single coronary artery arising from RSV with exertional angina

Figure 2: High taking off of RCA.

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Some time causes myocardial infarction due to excessive angulation between RCA and Aorta. We have in our study one young patient of 24 y.o that had been transferred to the hospital by cardiac arrest , related to this anomaly. Operative re-implanted had been indicated to save the patient

Figure 3: RCA originates from LSV with intra-arterial course resulting Angina

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Figure 4: Anomalous origin of LCA from RSV

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Figure 5: RCA rising from LSV and Intra-arterial course of RCA.

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Figure 6:LCx arising from the RVS and Retro Aortic Course of LCx.

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Figure 7: LCx arising from the RVS and Retro Aortic Course of LCx.

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Figure 8: Anomalous Left Coronary Artery from The Pulmonary Artery.

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Figure 9: Other case of ALCAPA.

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Figure 10: Anomalous Origin of the Right Coronary Artery off The Pulmonary Artery.

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Discussion & Conclusion

In our study, coronary anomalies of origin and course were detected in 47 of 9572 patients ( 0,49% ) that is consistent with the incidence of 0.27% to 1.66% reported in other series. The most frequent anomaly of origin and course was the Cx Artery arising from RCA/RSV ( 31.9% of anomaly prevalence and 0.16% among all patients ), this incidence is lower than previous published studies. The anomalies of origin and course of RCA were found in 17% and 4.2% respectively from LSV and LAD. This incidence is lower in comparison with previous study. Sudden deaths, myocardial infarction, arrhythmias related to the coronary anomalies were reported previously [6,7]. But these anomalies often asymptomatic, so early detection of coronary anomalies of origin and course is highly important. The former studies mainly based on the result of coronary angiography that is invasive modality. This study demonstrates MDCT is the noninvasive modality that provides important information related to coronary anatomy. Currently MDCT and MRI become fundamental to detection and diagnosis of coronary anomalies. Contrast enhanced ECG-gated 640-row MDCT coronary angiography is an accurate diagnostic method that can precisely detect the coronary anomalies of origin and course.

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Friday, 16 October 2020

Lupine Publishers | The American Academy of Pediatrics should Advise Parents to Put their Infants on their Right-Side Position Only When Sleeping. Summary of A Published Research

 Lupine Publishers | Journal of Otolaryngology


Introduction

For nearly 3000 years, it has been recognized that apparently healthy infants could die suddenly and unexpectedly usually during sleep [1]. During the last 60 years an intensive study were made by researchers for this dilemma. Studies showed that sudden infant death syndrome (SIDS) has association with sleeping positions. It affects about one out of every 500-600 live births [2]. SIDS is a common cause of infant’s deaths in developing countries, it is classified by Centre of disease control (CDC) as the third leading cause of overall infant mortality in USA [3]. A number of Studies showed that Apparent Life-Threatening Event (ALTE) linked to SIDS strictly while others consider ALTE as a separate entity, but they did not interpret this mystery. Up to date no study explained how they could prevent SIDS. The published research gains its importance because it gives -for the first time- a solution to preventing SIDS, which have been never suggested before. Numerous studies, flooding of theories, hypotheses, causes and risk factors were gushed but with no solution. Finally, the author postulates in his published research: hypothesis, suggesting new definition for SIDS and an explanation of ALTE, and opened doors for future studies.

What is known about SIDS and ALTE?

Definition of SIDS

In 1969, the Second International Conference on Sudden Infant Death gave the following definition for SIDS: every sudden, unexpected death of an infant where postmortem Investigations don’t explain death [4]. It was universally accepted. Despite slight changes suggested in 1989 (clinical history and scene of investigation), SIDS remains a diagnosis of exclusion [1,5].

The Clinical History and Manifestations of SIDS

 The history of any infant's death is repeated as follows: A child within the age of two years, in a good heath, without previous disease, put in a bed, and is either found dead in its sleeping place in the early morning, or is found dead some hours, after its early feed [2,6]. The infants (in both SIDS and ALTE) suffered before from: cyanosis, apnea, frightening, choking, frothy fluid, obstructive asphyxia and others. But in SIDS the infants die while in ALTE they escaped death.

Autopsy Findings

During autopsy, the pathologists found that the pathological features of SIDS as follows: intrathoracic petechiae (on thymus, heart, lungs, parietal pleura, pericardium, and diaphragmatic pleura), Pulmonary edema, frothy fluid, food in stomach. All these features are suggestive, but nor diagnostic of SIDS [1,2,5-7]. These features are found in natural and unnatural death, that is why, they diagnose SIDS by exclusion.

Theories

About more than 80 theory were proposed in the last 60 years , with no scientific explanation, some of these theories were as follows: Overlying, hypothermia, parathyroid insufficiency, CO2 toxicity, allergy to cow’s milk, heavy bed clothes, sleep apnea syndrome, arousal mechanisms, cardiac arrhythmias, chronic asphyxia, hypoxia, blocked air passages….etc. Until today no uniform explanation exists, some exclusively remark upon obstructive asphyxia [8], and refer to typical signs of asphyxiation which be found very often1. Other favor reflex mostly vagal inhibition of the heart but without explanation. Others restricted their theories to apnea without determining the specific cause. There were no diagnostic criteria for SIDS and there was no accurate method for prospective study too.

Risk Factors

Some of causes, risk factors Identified in the studies of SIDS infants were : age (more in the first year), sex (more in males), seasons (more in winter), race, social class, prematurity ,twins, time of death (more at night), all sleeping positions but mainly prone position, maternal smoking during pregnancy), bottle feeding, young maternal age , low birth weight , temperature and others [9,10]. Alexander et al stated: Much is known about risk factors for SIDS, however the true cause (or causes) of SIDS are still largely unexplained13.All these risk factors were of no significance as most studies determined.

Sleeping Position [1,2,11-13]

An infant's sleep position has been identified as a major risk factor for SIDS. Since 1985, investigators from around the world focused on sleep positions and no definite answer was found even after the sorrow recommendations of the American Academy of Pediatrics (AAP) to put infants on prone position which led to more deaths .After this , it was known that prone sleeping position has association to SIDS. That is why in 1992 the American Academy of Pediatrics changed their recommendation and recommended placing infants to sleep in the non-prone (back or side) position [14-16]. After this recommendation, there was a decline in statistical number of deaths. They found that there is a strong association between sleep positions (mainly prone,) and SIDS. But they could not determine which position is the cause of SIDS or which one is the safe position?

Apparent Life - Threatening Event (ALTE)

Another phenomenon associated with SIDS was ALTE , which the scientists could not interpreted its nature and its relation to SIDS.A link between ALTE and SIDS has been noted in much of the literature, but due to misinterpretation of the nature of these entities the researchers failed to answer its mystery. The researchers have not delineated the differences between SIDS and ALTE infants. ALTE is defined as an episode that is frightening to the observer and that is characterized by some combination of apnea, color changes (cyanotic), marked change in muscle tone (limpness) [14]. The researchers admitted that the Survivors of an ALTE share many risk factors for SIDS. The researchers declared their confusion in concern to ALTE. The author believes that this confusion is an extension of the SIDS misconception, misinterpretation raised from no standardization of its definitions.

The failure to link between ALTE and SIDS was due to impatience for observers or caregiver to stay beside the infant’s hours watching their changes. ALTE is a process of dying which might have or have not ended with SIDS. SIDS and ALTE are in the same line with two consequent stations. SIDS is the end result of some ALTE infants. Some infants are found agonizing and die before any help can be obtained. Vigorous stimulation is the only way which might revive the ALTE infant –in time- when the observer observed the infant in the process of asphyxia or dying process. An association between SIDS and ALTE was suggested because of prior ALTE events in 5% of SIDS victims18. The investigators declared their confusion in concern to ALTE. There are clinical similarities between SIDS and ALTE, the only difference is that in SIDS the death had occurred while in ALTE the infant escaped from death. From this information it is clear that SIDS is a continuity of ALTE till death and ALTE is interrupted SIDS. It is a transit either to death or to escaping from death.

Conclusion and Brief Explanation

The author believes that

a) All previous studies were unsatisfactory.

b) The previous studies have not reached to a definite answer about the nature of SIDS in order to prevent it.

It has been shown by study that

a) There is a lack of Criteria for both definition and diagnosis of SIDS.

b) There is consensus that sleep positions (mainly prone) are associated with SIDS [1,2].

c) There is increased resistance to airflow when an infant laid prone to sleep [17].

d) The prone/supine sleeping positions could be associated with lower arousal threshold [1].

e) It was proved that an arousal is a logical defense mechanism to protect breathing during sleep [1].

f) The right-side position can have a protective function by preventing the tongue from occluding the airway when the genioglossus muscle is hypnotic [17].

g) Obstruction of the upper airway-by the back of the large and muscular tongue falling posteriorly into the hollow of a soft yielding pharynx -in sleep- may obstruct the airway and even worsen as the baby inspires, thus enhancing negative pressure below the block [5,18].

h) Mechanical occlusion and upper airway obstruction are favored by prone positions and increased airflow resistance [17].

i) Negative esophageal pressure is higher in supine / prone positions [18].

j) It is well known that hypoxia, stimulates the vagal inhibition [18].

k) The right-side sleeping position never studied or tested before through the history of studies.

There Are Many Known Facts Regarding the Body Structures, And from Studies We Found That

a) Laying on Right side will ensure smooth breathing and lowering the resistance to breathing because the right bronchi remains in a good straight position and the short right lung will be in contact having a good right thoracic space. Hence the trachea will change its shape and length accordingly [1,17].

b) The liver in the right side of the body constitutes the base on which other organs lay down directly or indirectly in this position as it is the heaviest organ of the body.

c) Laying on right side position permits to establish a suitable direction to the stomach with its content of food that facilitates a smooth breathing.

d) The distention and pressure (mainly upward) by stomach - after ingesting food -upon the diaphragm well be decreased by this position.

e) The heart and left lung positioned in the upper side in the mediastinum gives the person an opportunity to breaths easily and gives the heart & lung an opportunity to beat and move freely.

f) The clinical similarities between SIDS and ALTE are suggestive for their having the same risk factors, common causes, and mechanisms. All these similarities give a clue to the nature of SIDS.

Conclusion

The Right-Side Sleeping Position Hypothesis

Based on the previous data, the author concludes that the current information, facts, and knowledge resulted in this study established the validity on which the hypothesis and suggested definition were based on: So in an effort to solve this controversial problems the author wishes to put forward his right side sleeping position hypothesis to prevent SIDS as follow: If an infant be placed for sleeping on right side position after having breastfeeding then SIDS would be prevented.

Recommendation

The revision recommended that healthy infants be positioned on their right-side position, rather than on other positions when being put-down a sleep. And the AAP American Academy of Pediatrics should review its opinion.

Acknowledgement

Finally, I would like to thank Edwin Mitchill, Professor of Child Health Research Department of Pediatrics, and University of Aukland, New Zealand, who sent me his scientific opinion about my study. He declared that no studies have reported on the difference between right and left side sleeping position and stated: this is a testable hypothesis. And I emphasize again, it is true that no study before had determined certainly that right side position is the safe position during sleeping.

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Lupine Publishers | Bilateral Dens in Dente in Maxillary Laterals: A Case Report

 Lupine Publishers | Journal of Pediatric Dentistry


Abstract

Dens invaginates is a defect categorized by a prominent lingual cusp and centrally located fossa. It occurs due to early invagination of the enamel epithelium into dental papilla of the underlying tooth germ. The affected teeth show a deep invagination of enamel as well as dentin initiating from foramen caecum or tip of the cusps and may extend even into the root. The teeth that are most frequently involved teeth are the maxillary lateral incisors, there might also occur a bilateral involvement. In this anomaly there can be seen several morphologic variations and it may lead to early pulpal involvement from the caries progressing into the pulp from lingual pit. The treatment varies from a preventive restoration to endodontic therapy, depending on the severity of the case. The present case report refers to one such case having a deep lingual pit bilaterally in both the maxillary permanent lateral incisors.

Introduction

Dens invaginatus is a rare malformation of teeth, showing various morphological variations. Radiographically the teeth show an invagination of enamel and dentin extending up to the pulp cavity or the roots. This malformation was described earliest by Ploquet [1], who discovered this anomaly in a whale’s tooth [2]. Dens invaginatus in a human tooth was first described by a dentist Socrates’ in 1856 [3]. ‘Anomalous cavities in human teeth were reported by M├╝hlreiter [4] in 1873, Baume [5] in 1874 and Busch [6] in 1897 reported about this anomaly as well. In 1887 Tomes [7] described the dens invaginatus as: The enamel of the coronal portion is generally well developed but we tend to find a small depression in its centre that appears to be a dark spot. On division of the tooth longitudinally, there occurs a dark centre of depression that is a blocked orifice within the tooth. If the section be a fortunate one, we shall be able to trace the enamel as it is continued from the exterior of the tooth through the opening into the cavity, the surface of which is lined completely with this tissue’ [7]. There are various reports on cases of dens invaginatus malformation in the dental literature [8-11]. Synonyms for this anomaly include:

a) Dens in dente,

b) Invaginated odontome,

c) Dilated gestant odontome,

d) Dilated composite odontome,

e) Tooth inclusion,

f) Dentoid in0 dente.

Case Report

A 12-year-old female patient referred to the Pedodontics department with the complaint of irregularly arranged teeth. General health of the patient was normal and medical history was not relevant. Clinical examination revealed teeth 12 and 22 with a lingual pit. The pre-operative photographs were taken for the same (Figure 1). An intraoral Periapical radiograph was also taken for both the teeth, which revealed deep lingual pits involving the coronal part of teeth (Figure 2). As the teeth showed only incisal invaginations, and no pulpal involvement preventive treatment was selected. Also, if the pits were left untreated, it would harbor irritants and microorganisms further leading to caries. And as these pits were deep enough, the caries would progress rapidly into the pulp and cause pulpal infection leading to the need for endodontic treatments.

Figure 1: Pre-operative photograph.

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Figure 2a: IOPA.

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Figure 2b: IOPA.

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Treatment Done

Following the oral prophylaxis, rubber dam placement was done for 12 and 22 (Figure 3). The teeth were initially washed, cleaned and dried. After that acid etching was performed using 37% phosphoric acid for 20 seconds. It was then washed and dried. Following that dentin bonding agent was applied with the applicator tip and cured for 20 seconds. The pits were then restored with flowable composite bilaterally (Figure 4). The teeth were then examined for any excess material and later finishing was done. The occlusion was also checked for any interference followed by post-operative photographs (Figure 5). Furthermore, the child was referred for orthodontic consultation.

Figure 3: IOPA.

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Figure 3: Rubberdam placement.

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Figure 4: Composite restoration.

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Figure 5: Post-operative view.

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Discussion

Dens Invaginatus has several variations of it. Oehlers gave a classification for various types of dens invaginatus [12]:

a) Type I: an enamel-lined minor form occurring within the confines of the crown not extending beyond the amelocemental junction.

b) Type II: an enamel-lined form which invades the root but remains confined as a blind sac. It may or may not communicate with the dental pulp.

c) Type III: a form which penetrates through the root perforating at the apical area showing a ‘second foramen’ in the apical or in the periodontal area. There is no immediate communication with the pulp. The invagination may be completely lined by enamel, but frequently cementum will be found lining the invagination.

Prevalence of Dens Invaginatus

The teeth mainly affected are maxillary lateral incisors and bilateral occurrence is not rare, they occur in almost 43% of all cases [13]. Swanson & McCarthy (1947) were the foremost to present bilateral dens invaginatus malformation, Conklin (1968) presented a patient with both maxillary central and lateral incisors affected bilaterally, and Burton et al. (1980) reported a case with six teeth involved, the maxillary incisors as well as the maxillary canines. Krolls (1969) also detected dental invaginations in maxillary central incisors and in many maxillary and mandibular premolars in a single patient. Conklin (1978) found the malformation in four mandibular incisors in one patient. There are many theories described in the literature to explain about the dental coronal invaginations some of them being:

a) The bulking of the enamel organ was thought to be caused due to the growth pressure of the arches [14,15].

b) Focal failure of the growth of the inner enamel epithelium leads to the invaginations; however, the surrounding epithelium continues to grow and engulfs the static area [11].

c) The invagination is due to the aggressive proliferation of a part of the inner enamel epithelium invading the dental papilla. It was thought as a ‘benign neoplasm of limited growth [16].

d) Protrusion and distortion of the enamel organ is thought to cause an enamel lined channel terminating at the cingulum or at the incisal tip. This might also lead to an irregular crown formation [17,18].

e) The ‘twin-theory’ [18] suggested a fusion of two toothgerms to be the causative factor.

f) Infection was also considered to be responsible for the anomaly [19].

g) Trauma was thought to be a reason, but they could not adequately explain why just maxillary lateral incisors were affected and not central incisors [20].

h) Most authors consider dens invaginatus as a deep folding of the foramen coecum during tooth development which may even result in a second apical foramen [3].

i) On the other hand, the invagination also may start from the incisal edge of the tooth. Genetic factors cannot be expelled (Grahnen 1962, Casamassimo et al. 1978, Ireland et al. 1987, Hosey & Bedi 1996).

Clinical Features

Due to the invagination there is just a thin layer of enamel and dentin left, which thus allows several microbes into the pulpal space easily. In some of the cases there is a complete enamel lining present. Also, channels may be present between the invagination and the pulp chamber. Pulp necrosis hence occurs in the earlier stages, within a few years of eruption and may be even before the root closure. The sequelae of untreated coronal invaginations can be as follows:

a) Abscess formation.

b) Retention of neighboring teeth.

c) Displacement of teeth.

d) Cysts, or Internal resorption.

Treatment Modalities

Preventive and restorative treatment should be opted for teeth with deep palatal or incisal invaginations and should be treated by fissure sealing [21]. Also, composite resin restoration followed by pit and fissure sealant can be done in the required cases [21]. Root canal treatment, surgical treatment and extraction of teeth should be done in severe cases wherein there is radicular invagination and pulpal involvement.

Conclusion

The clinician should be aware of occurrence of such tooth anomalies and should do a thorough clinical diagnosis as these anomalies are not rare. Earlier diagnosis and treatment of such cases can prevent further complications such as endodontic therapies and extractions. Hence the needed treatment should be done as early as possible and a periodic follow up should be maintained.

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Thursday, 15 October 2020

Lupine Publishers | Impact of Insomnia on Optimism-A Predictor Factor Among Young Adults in Indian Context

 Lupine Publishers | Journal of Otolaryngology


Abstract

Recent research studies have revealed that inadequate quantity of sleep cycle and deprived sleep quality, are one of the most common emerging issues which are affecting the personality and attitude traits of an individual. There are significant research studies conducted which indicates optimism and self-esteem are the core salient features for maintaining a good health.

Aim of the study: There is a dearth of knowledge regarding the possible determinants of positive optimism characteristics among young adults. Therefore, the present study was conducted to examine the relationship of optimism with insomnia symptoms among young adults.

Method: Sleep parameters and optimism were assessed by administering standardized questionnaire(s) among a sample of 92 young adults aged between 17 and 26 years studying in University.

Results: Statistical analysis shows significant correlation between optimism scale and sleep cycle, the participants exhibiting higher score of insomnia tend to show lower score on optimism scale.

Conclusion: The result provides preliminary input on risk factors for insomnia and effect on optimism, as adequate amount of sleep has a strong relationship with optimism leading to a more confident and improved quality of life.

Keywords: Insomnia Symptoms; Sleep Duration; Optimism

Introduction

Emerging research supports the findings that nocturnal sleep is one of the most important aspect of our life for maintaining a sound physical and mental health. This area is one of the emerging areas in the field of psychology which has been immensely studied. Various research studies indicate that sleeping less than 7 hours as well as sleeping more than 8 hours is closely linked to an increased susceptibility to a broad range of physical and psychological health problems, such as ranging from poor vigilance and memory to reduced mental and physical reaction times, reduced motivation, depression, insomnia, metabolic abnormalities, obesity, immune impairment, and even a greater risk of coronary heart disease and even cancer [1,2]. Longitudinal evidence suggests that, insomnia is most common co-morbid condition seen with mood, anxiety and predates the onset of low optimistic attitude within an individual [3]. Numerous research studies also reveal significant results which indicates that sleep deprivation among young adults tends to interfere with the mechanism, which is responsible for regulating personality characteristics including optimism, with increased risk for anxiety, negative mood, impulsivity, and inability to cope up with social stresses [4-8].

Neurobiology of Sleep

The circadian rhythm i.e. the sleep-wake cycle is controlled by the suprachiasmatic nucleus of hypothalamus [9]. The inhibitory projections of ventrolateral preoptic nucleus (VLPO) of the hypothalamus to the tuberomammillary nucleus (TMN), the dorsal and median raphe nucleus and the locus coeruleus, the cholinergic basal forebrain, the pedunculopontine thalamic nucleus (PPT) and lateral dorsal thalamic nucleus (LDT) functions as a switch promoting sleep [10]. The orexinergic neurons of lateral hypothalamic area (LHA) promote wakefulness and the inhibitory effect of VLPO promotes sleep [10].

Models of Insomnia

There are various models which define the foundation of insomnia explaining the various factors that are responsible for related sleep disturbances. One such model is The Diathesis Stress Model or the 3-P model (predisposing, precipitating and perpetuating) factors given by Spielman and colleagues (2011) mentioned the role of the three P’s in development and maintenance of insomnia. The insomnia symptoms worsen in an attempt to relieve it hence the model focuses on behavioral pattern [11]. For example, an attempt to compensate for reduced sleep by spending increased time in bed, may worsen insomnia unintentionally. The classical conditioning principles proposed by Bootzin (1972) is the basis of the stimulus control model which states that the person with insomnia becomes conditioned to sleep and bed environment as a stimulus for wakefulness instead of sleep. The therapy attempts to decondition to this stimulus by limiting activities like lying awake, watching TV in bed and ensuring bed is used for sleep only [12]. According to Cognitive Model of insomnia thoughts, (worry about poor sleep and its daytime effects) and associated feeling interferes with the sleep [13]. Study has suggested that scanning of the internal and environment threat signals, and the safety behaviours to increase sleep and minimize the outcome of insomnia ,worsens insomnia [13] whereas, the role of selective attention to sleep-related indicators in the development and maintenance of insomnia is as per the basis of the Psychobiological Inhibition Model [14]. As per Diagnostic Guidelines of Insomnia (ICD-10, 2004) the following are essential clinical features for a definite diagnosis [15].

a) The complaint is either of difficulty falling asleep or maintaining sleep or of poor quality of sleep.<

b) The sleep disturbance has occurred at least three times per week for at least 1 month.

c) There is preoccupation with the sleeplessness and excessive concern over its consequences at night and during the day.

d) The unsatisfactory quantity and/or quality of sleep either causes marked distress or interferes with ordinary activities in daily living.

e) The unsatisfactory quantity and /or quality of sleep is the patients only complain.

Compared to the research studies conducted on consequences of poor sleep, there is inadequate evidence regarding the association between sleep duration with positive individual characteristics. According to the data published by National Sleep Foundation (2002) revealed that individuals who had an average sleeping duration of 7 – 8 hours reported to have better mental satisfaction with life compared to the other group of individuals who had a sleeping duration of less than 6 hours a night [16]. Fredriksen (1994) conducted another similar kind of study in which the results obtained were evident indicating that longer the sleep duration higher is the self-esteem in adolescents [17]. Various other studies revealed a strong association between ample sleep duration and short sleep onset latency resulting in higher optimism in children [3]. Another experimental study was administered to examine the effect of insomnia and the results indicated that sleep deprivation leads to gradual degradation of self-reported optimism and poor social interaction in young adults, which suggested that sleep duration is a determinant factor for the initiation of positive personality characteristics in an individual [18]. Most of the research studies say that lack of sleep may lead to co-morbid condition which could be anxiety and depressive symptoms and also lack of optimism. In the present study, we therefore tested associations of sleep parameters with optimism among university students aged 17 to 26 years. In particular, the study was conducted to examine the relation between symptoms of insomnia and optimism. Simultaneously, also aimed to evaluate whether individuals with an average sleep duration (between 7 and 8 hours/day) are more optimistic compared to individuals who sleep less than 7 hours or, conversely, more than 8 hours per day [19].

Method

Participants

A total of 92 subjects were selected using purposive sampling based on their encouragement to participate in the present study from the university. The participants were divided into

a) Group 0: 63 (aged 17-21 years)

b) Group 1: 29 (aged 22-26 years)

Individuals who fulfilled the criteria of insomnia with the minimum age of 18 years were included in the study. On the other hand, individuals who were suffering from other psychiatric illness or co morbid conditions were excluded from the study. All the subjects were explained in detail regarding the purpose of the study. Primarily, the mother tongue of all the participants was Hindi simultaneously had a good knowledge of English. Informed consent and personal information were taken from the participant.

Materials Used

Two questionnaires were administered:

a) Pittsburgh Sleep quality Index (PSQI) which consisted of 19 individual items, creating 7 components. Higher the score on Pittsburgh quality index, the lower is the sleep quality and vice versa [19].

b) Optimism sleeping Index (OSI) to measure the five facets of Optimism. There are 60 items in the test which are in 5-point Likert system. All the questions were closed set task with 3-point rating scale i.e., yes or no and not sure [20].

The data collected was analyzed using SPSS (version 17, IBM Corporation, Bengaluru, India), along with percentages of the study subjects, with respect to a particular response. The percentages and proportions of different categories of questionnaires were used to analyze the data.

Results and Discussion

The aim of the study was to find out the relationship between insomnia and five facets of Optimism among University students. On statistical analysis, the correlation (Table 1) between Pittsburgh Sleep Quality Index and Optimism Index was found to be: (r = -.342, P < .01). Therefore, the findings reveal that there is a negative correlation between Sleeping Difficulties and Optimism which means higher level of optimism is related to better Sleep Quality and more sleeping difficulties relate to lower level of optimism. Further, the data analysed on optimism five facets Positive Emotions (P_E), Engagement (E_M), Meaningfulness(M_F), Relationships(R_S) and Accomplishment(A_C) also provides negative correlation is found again between Sleep Difficulties using PSIQ and each Optimism Facet using OSI (Table 1). Extensive research study on optimism; which is an major aspect of positive personality is important as it is considered one of core platform for the development subjective well-being and health [21].A prospective review study was conducted over a 9 year follow-up period which showed a protective effect of dispositional optimism against various cardiovascular mortality in old age controlling the initial health status [22].Considering the literature current study also revealed similar result findings among the university students. The detailed description are as follows:

Table 1: MRI of the parotid gland showing homogeneous mass on the superficial lobe of the left parotid gland on hyper signal T1 and T2 and a weak signal on fat suppressed sequences. The lesion is hypointense to parotid and uniformly non-enhancing.

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a) Positive Emotions and PSIQ: On statistical analysis, the correlation between Positive Emotions and Pittsburgh Sleep Quality Index was found to be: (r = -.304, P < .01) as shown in (Figure 1). This indicates that there is a negative correlation between Sleeping Difficulties & Positive Emotions. This implies the inference that good quality sleep is related to higher value of positive emotions and vice versa.

Figure 1: Graph representing relationship between Sleep Quality Index and Positive Emotions.

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Figure 2: Graph representing relationship between Sleep Quality Index and Engagement.

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b) Engagement and PSIQ: The relationship between Engagement and Pittsburgh sleep quality index is (r = -.241, P < .05) which implies a negative correlation between Sleeping Difficulties and Engagement also (Figure 2). A higher value of engagement is seen in students with lower Pittsburgh sleep quality index score as compared to those with higher Pittsburgh score. This implies the same inference as with above facet i.e. good quality sleep relates to good engagement score and Sleeping Difficulties relate to low engagement score/bad engagement skills.

c) Relationship and PSIQ: The correlation value between Relationship and sleep quality Index: (r = -.289, P < .01). A negative correlation value also indicates that this facet of optimism also relates to a higher value corresponding to lower values on Pittsburgh Sleep Quality Index (Figure 3). This again confirms our inference that more Sleeping Difficulties are related to lower inter-personal Relationship skills. A good quality sleep is related to a higher level of Relationship values in students. There are similar supporting studies which shows that people with lower social network and relationships tend to exhibit poor sleep. Researchers pointed out the importance of relationship support on health which indicated that higher level of non-reciprocity in social interaction, the higher level of sleep problems, depression and lower level of physical and mental health [23].

Figure 3: Graph representing relationship between Sleep Quality Index and Relationship.

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d) Meaningfulness and PSIQ: The fourth facet of optimism is meaningfulness which correlates as: (r = -.258, P < .05) with the Pittsburgh score. This value also suggests that a good meaningfulness score is seen in students with good quality sleep as compared to those with sleep difficulties (Figure 4). Haack And Mullington [24] demonstrated that sleep deprivation resulted in a gradual reduction of self-reported optimism and sociability in young adults, which suggests a causal relation between sleep and positive personality characteristics. There are rich literature studies conducted which shows the relationship between insomnia and physical health [25] wherein optimism on one side has a sleep-enhancing effect; whereas poor sleep constitutes pessimism on the other side [24,25]. Similarly, it’s interesting to study that depressive mood fully moderates the first pathway, from optimism to sleep quality, the effects of sleep on optimism are only partially explained by depressive mood [26].

Figure 4: Graph representing relationship between Sleep Quality Index and Meaningfulness.

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e) Accomplishment and PSIQ: The last facet which is accomplishment has a correlation value: (r = -.289, P < .01) with the Pittsburgh score. This facet is also related to Pittsburgh Sleep Quality Index similarly. Sleeping Difficulties relate to a lower value of accomplishment and good quality sleep relates to a higher value of accomplishment (Figure 5). Robert et al. [27] stated that chronic insomnia is one of the leading causes that can result in poor performances in various aspects, including the interpersonal, somatic and psychological functioning of an individual [27].

Figure 5: Graph representing relationship between Sleep Quality Index and Accomplishment.

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Further, analysis was done to compare the variation in Optimism Index and Pittsburgh Score of participants with variation across the age Group (Table 2). The mean Optimism Index for Age Group 0 & Age Group 1 (Table 2) were found to be M(SD) = 222.06(18.562) & M(SD) = 226.59(27.514). These mean optimism index scores of the students of the two age groups was compared and the variation was found to be just 2.04%, the mean Optimism Index increased by just 2.04% when moving from lower age group(Group 0) to higher age group(Group 1), which was considered as a marginal difference. This implies in turn reveals that Optimism level was comparatively better in Group 1: “22-26” age group. Thus, this present study also suggests age doesn’t have a significant impact on the optimism level of university students. Comparison was also done between the mean Pittsburgh scores of the two age groups. The Mean Pittsburgh Sleep Quality Index Scores for Age Group 0 and Age Group 1 found to be M(SD) = 6.05(3.333) & M(SD) = 5.86(3.710) which was suggestive marginal/negligible difference. However, there are longitudinal studies conducted on adolescence which revealed that sleep duration decreased with age. Longer sleep duration was concurrently associated with better subjective psychological wellbeing [28] whereas, there was contraindicatory findings which showed that both the age groups had a variation of just 3.14% in Mean Pittsburgh Index Scores. The Mean Pittsburgh Sleep Quality Index shows a decrease by 3.14% from lower age group (Group 0) to higher age group (Group1). This finding suggest that Sleep Quality was found marginally better in Group 1 i.e. “22-26” age group which indicates that age group variation among university students doesn’t significantly affect their sleep quality which can be related to limited sample size. A similar study was conducted on effect of Optimism and Self-Esteem related to sleep in a large community-Based Sample and results indicated that individuals with insomnia symptoms scored lower on optimism and selfesteem which was largely independent of age and sex, controlling for symptoms of depression and short duration. Thus, the current findings confirm the previous knowledge gained by studies that people with better sleep quality have higher optimism and people with poor sleep quality have lower optimism. Also, that high level of optimism also directly or indirectly results in better sleep quality

Table 2: Sociodemographic details and Clinical Characteristics of participants(N=92).

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Despite the success to find out the impact of insomnia on the five facets of optimism among young adults, there were certain limitations in the current study, which are as follows:

a) As the data collected was disproportionate in terms of sample size, gender therefore, standard generalization of the result is limited.

b) The optimism index scale questionnaire used in the study is under construction hence, superficial information regarding the facets of optimism was obtained which can be a factor that may affect the result analysis.

To overcome these shortcomings, further studies should be conducted so that a causal linkage between the variables can be drawn. Also, in order to give some more accurate result, different other aspects of the variable (e.g., stress and five facets of optimism; depression and optimism) should also be measured. Moreover, standardized objective instruments should be used to measure the variables, so that the reliability can be measured, and generalized results can be increased.

Conclusion and Implication

In summary, current study extends the knowledge towards the facets of optimism, elaborating that a better sleep quality is also related to higher level of positive facets viz. Positive Emotions, Engagement, Relationship, Meaningfulness & Accomplishment. It also the expands the knowledge towards expansion of the facets of optimism, elaborating that a better sleep quality is related to five positive facets of optimism index scale viz. Positive Emotions, Engagement, Relationship, Meaningfulness & Accomplishment. Future studies can make a greater effort in verifying the relationship among optimism, stress, depression, social support and how they interact with each other in order to predict insomnia or any sleep deprivation.

In a university setting, finding can be implemented to nurture optimism and guide sleep hygiene promotion and intervention among college students.

Acknowledgement

The authors would like to acknowledge all the participants of this study and also acknowledge all the participants who willingly participated in the study. Authors would also like to extend the gratitude toward Chancellor and Pro-vice chancellor of Amity University Haryana for their valuable support, motivation, and help during data collection and preparation of the manuscript.

Wednesday, 14 October 2020

Lupine Publishers | Msct In Diagnosis of Congenital Heart Diseases in Viet Nam

    Lupine Publishers | Advancements in Cardiovascular Research 

Abstract

Background: Congenital heart diseases associated with more malformations, complex aortopulmonary collaterals and anomalous coronary artery. Echocardiography is the initial diagnostic method but this method can be limited in complex congenital heart diseases.

Purpose: To assess the role of MDCT in congenital heart diseases (CHD) diagnosis compare with operative result and interventional angiography.

Methods: 910 patients with congenital heart diseases of 31.000 patients underwent cardiac angiography with 64 and 320 section CT at Medic Medical Center since 09/09/2006 to 30/12/2015.

Results: There are 658 operated cases, most of operated cases demonstrated the exact diagnosis of MDCT in congenital heart diseases.

Conclusions: MDCT is the fast and non-invasive diagnostic method with the high accuracy, overcomes the limit of echocardiography in complex congenital heart diseases diagnosis and provides the panorama and useful information’s prior to the operation.

Keywords: Congenital heart diseases; Cardiac multi-detector computed tomography, Multi-detector computed tomography in congenital heart diseases; Congenital heart diseases computed tomography

Introduction

Congenital heart diseases effect ~ 1% of all live births in the general population. Complex congenital heart diseases associated with more malformations, complex aortopulmonary collaterals and anomalous coronary artery. Over the past few decades, the diagnosis and treatment of congenital heart diseases have greatly improved [1-6]. Diagnostic tools: X-ray, ECG, echocardiography, MRI and MDCT. ECG and X-Ray suggest the diagnosis but are not specific. Echocardiography is the initial diagnostic method for patients with suspected CHD but this method can be limited in complex CHD. The great capabilities of MRI for anatomic and functional assessment of the heart but MRI is time-consuming and may require patient sedation. Now enable CT to be used as an accurate noninvasive clinical instrument that is fast replacing invasive cine-angiography in the evaluation of CHD [1,2,5].

I. Improves both spatial and temporal resolution.

II. Increases scanning speed.

III. Improves diagnostic image quality by reducing respiratory artifacts

Purpose

To assess the role of MDCT in congenital heart diseases (CHD) diagnosis compare with operative result and interventional angiography.

Material and Methods

Subject: 910 patients with congenital heart diseases of 31.000 patients underwent cardiac angiography with 64 and 640 section CT at Medic Medical Center since 09/09/2006 to 30/12/2015.

Means and scanning techniques

a) Medic Medical Center scanned cardiac CT by 64 MDCT Toshiba Aquilion machine and Toshiba Aquilion One (320 MDCT), 0.5mm slice thickness, 0.5mm imaging reconstruction.

b) Two phases scanning: Don’t inject phase and contrast media injection phase: +Phase doesn’t inject contrast which help locate and assess coronary artery calcification.

c) +Phase inject contrast media: Medicine chasing phase and water chasing phase.

d) Contrast pumping machine is double-barreled Stellant (Medrad).

e) To inject contrast by intravenous right hand.

f) Contrast dose used 1mL/ kg.

g) Drug pump speed depends on patient status and disease.

h) Vitrea software: Reconstructed images by MPR, MIP and VRT.

i) Effective radiation dose is low (320-MDCT is 3.69±061mSv; 64-MDCT is 12-14mSv) (Figures 1).

Figure 1.

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Data analysis

a. The prospective study and case series report compare with operative and interventional angiography.

b. Data collection at the HCM city Heart Institute, Tam Duc Heart Hospital and Medic medical center (Figures 2-17).

Figure 2: Atrial septal defects and Ventricular septal defects.

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Figure 3: Patent ductus arteriosus.

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Figure 4: Coarctation of aorta.

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Figure 5: Double aortic arch.

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Figure 6: Tetralogy of Fallot.

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Figure 7: Pulmonary atresia with ventricular septal defect.

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Figure 8: Transposition of great vessels.

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Figure 9: Double outlet right ventricle.

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Figure 10: Single ventricle.

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Figure 11: Aortopulmonary window:

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Figure 12: Truncus arteriosus.

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Figure 13: Anomalous systemic venous return.

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Figure 14: Anomalous pulmonary venous connection.

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Figure 15: Single pulmonary artery.

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Figure 16: Pulmonary artery trunk aneurysm:

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Figure 17: Congenital pulmonary arteriovenous malformation.

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Results

There are 658 operated cases, most of operated cases demonstrated the exact diagnosis of MDCT in congenital heart diseases.

Discussion

Congenital heart diseases associated with more malformations, complex aortopulmonary collaterals and anomalous coronary artery. Echocardiography is the initial evaluative method for preand post-operation congenital heart diseases but this method can be limited in complex cases. Multi-detector computed tomography overcomes the limit of Echocardiography by multiplanar reconstruction (MPR) and volume rendered techniques (VRT) reconstruction . Volume rendered techniques (VRT) reconstruction clearly demonstrates the relationship between the heart and great vessels.

Conclusion

Multi-detector computed tomography is the fast and noninvasive diagnostic method with the high accuracy. Overcomes the limit of Echocardiography in complex congenital heart diseases. Provides the panorama and useful information’s prior to the surgery.


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