Poly methyl methacrylate (PMMA) resin is the most widely used material for fabrication of dentures since 1937 as it exhibits adequate physical, mechanical and esthetic properties. But one of the major problems faced using this material is that, it is highly prone to plaque accumulation due to surface porosities and its food retentive properties. This in turn increases the bacterial activity causing denture stomatitis. In efforts to impart antimicrobial property to these resins, various nanoparticles (NP) have been incorporated viz. Silver, Zirconia oxide, Titanium dioxide (TiO2), Silica dioxide (SiO2) etc. However, as additives they can affect the mechanical properties of the final product. Therefore, the aim of the present study was to evaluate and compare the effect of different concentration of TiO2 NP on the flexural strength of PMMA resins. Specimens made from heat polymerizing resin (DPI) without NP were used as a control group (Group A). The two experimental groups, (Group B and Group C) had 0.5 and 1 % concentration of TiO2 NP respectively. The specimens were stored in 37 °C distilled water for 50 ± 2 h. A three-point bending test for flexural strength measurement was conducted following ADA specification no. 12. The maximum mean flexural strength (90.65 MPa) belonged to the control group; and acrylic resin with 1 % TiO2 NP demonstrated the minimum mean flexural strength (76.38 MPa). But, the values of all the three groups exceeded the ADA Specification level of 65 MPa. Conclusion may be drawn from the present study that addition of TiO2 NP into acrylic resin can adversely affect the flexural strength of the final product and is directly proportional to the concentration of NP.

Summary Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution, and duration of pain in these children have not been studied as extensively as in adults. Currently, there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response while minimizing their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimize opioid‐related side effects, but this may not obtund the stress response in all children. The development of chronic pain although rare when compared to adults is still a risk that needs further investigation. Regional anesthetic techniques, by blocking the afferent impulses, have been shown to be advantageous in reducing the stress response to surgery as well as pain and opioid requirements in children up to 24 hours after cardiac surgery. Central neuraxial blockades have not gained wide spread acceptance in these procedures due to the worry of hematoma, although rare, leading to catastrophic neurological outcomes. This review focuses on blocks outside the vertebral column, ie, peripheral nerve blocks, performed either in the front or the back of the chest wall to target the thoracic intercostal nerves. Techniques of ultrasound‐guided bilateral single shot paravertebral block and erector spinae block posteriorly and transversus thoracic plane block anteriorly are discussed. In addition, parasternal block and wound infiltration by surgeon as well as continuous local anesthetic infusion via catheters placed at end of procedures are summarized. Current evidence available for use of these techniques in children undergoing cardiac surgery are reviewed. These are based on small studies and case series and further studies are required to evaluate the risks and benefits of local anesthetic blocks in children undergoing cardiac surgery.

Introduction Characterized by the development of hundreds to thousands of colonic adenomas, classic familial adenomatous polyposis (FAP) is one of the most common hereditary syndromes associated with an increased risk of colorectal cancer. Several studies have attempted to correlate specific APC mutations with clinical phenotype.6 However, there is considerable variability in the expression of specific phenotypes within families and among individuals with identical mutations.7 Case presentation A 30 year-old Hispanic female presented to the emergency department with a 2-week history of persistent, worsening, left lower quadrant abdominal pain. She had no family history of malignancy. Sigmoidoscopy revealed innumerable polyps in the rectum and sigmoid colon and a large mass in the sigmoid colon. Biopsy of the mass revealed a moderately differentiated adenocarcinoma invading the subserosa. Endoscopy revealed innumerable polyps. Genetic testing of the patient via southern blot revealed a germline APC mutation 3927del5, resulting in a premature truncation of the APC protein at amino acid position 1312. Conclusion Genetic information has only recently started being incorporated into clinical care. More research and randomized clinical trials need to be conducted to definitively characterize random mutations. Once these mutations are further understood, FAP patients may be able to be risk stratified and this may ultimately improve the screening, diagnosis, and treatment of this rare condition.

This prospective, randomised double-blinded study was designed to assess the analgesic efficacy and occurrence of nausea when tramadol is added to a nonsteroidal anti-inflammatory drug to provide analgesia following day-case third molar teeth extraction. All patients received oral diclofenac pre-operatively and one of four treatments intra-operatively: fentanyl and metoclopramide, tramadol and metoclopramide, fentanyl and ondansetron, or tramadol and ondansetron. There were no significant differences between groups in scores for pain in the early postoperative period. However, there were significant differences in nausea scores at this time, with the fentanyl-ondansetron group having the lowest and the tramadol-ondansetron group having the highest scores. There were no significant differences in the incidence of pain or nausea in the following 24 h. We conclude that the addition of tramadol to diclofenac results in no useful improvement in analgesic effect, and that the use of ondansetron fails to reduce the nausea associated with tramadol.

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