विवरण
Endodontics is a specialized field within dentistry dedicated to diagnosing and treating diseases affecting the dental pulp and tissues surrounding the roots of teeth. Central to this discipline is the root canal procedure, an intervention aimed at salvaging teeth with infected or damaged pulp, which, if left untreated, could lead to severe pain and potential tooth loss. Endodontists employ advanced techniques, including digital imaging and precision instrumentation, to meticulously clean, disinfect, and shape the root canals before sealing them with biocompatible materials. This process not only alleviates pain but also preserves the natural tooth, promoting long-term oral health. Endodontics plays a crucial role in preventing unnecessary tooth extractions, offering patients a pathway to retain their natural dentition.
सारांश
- Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women, characterized by complexities in diagnosis, pathology, and management. The global prevalence is around 10-13%, but may be higher in South Asian populations due to ethnic predispositions. Historical treatments included invasive wedge resections which led to complications. More recent advancements include medical treatments like clomiphene citrate and minimally invasive procedures like laparoscopic ovarian drilling.
- The etiology of PCOS is complex, with genetic, exogenous, and prenatal factors hypothesized to contribute. Genetic factors may play a role as it affects 50% of first-degree relatives, resembling autosomal dominant inheritance. Environmental factors like smoking and prenatal androgen exposure also have potential influences.
- PCOS pathophysiology is complex and involves aberrant LH secretion, insulin resistance, and hyperandrogenism, which create a vicious cycle. This can lead to increased glucose levels, hyperinsulinemia, increased free androgen levels, and decreased SHBG production, ultimately affecting follicular development and ovulation.
- Diagnosis of PCOS involves meeting two out of three Rotterdam criteria: oligo or anovulation, clinical or biochemical signs of hyperandrogenism, and polycystic ovaries. A diagnosis can be made based on clinical features such as hirsutism, acne, and female-pattern balding, or by confirming biochemical evidence of hyperandrogenism through lab tests.
- Clinical features of PCOS span reproductive, metabolic, psychological, cosmetic and social concerns. Cardiometabolic complications include type 2 diabetes, hypertension, dyslipidemia, and sleep apnea. Pregnancy complications include increased risk of miscarriage, gestational diabetes, pre-term labor, and postpartum hemorrhage. The risk of endometrial cancer is also increased.
- Treatment for PCOS should address various aspects, including mental health, cardiometabolic risks, cosmetic issues, and menstrual problems. Lifestyle modifications, including weight reduction through dietary changes and exercise, are crucial first steps. Weight loss of 10% can improve fertility rates by up to 80% in obese patients.
- For fertility issues, first-line treatment involves letrozole due to its high pregnancy rate and reduced risk of multiple pregnancies. Second-line treatments include parenteral gonadotropins and laparoscopic ovarian drilling. In vitro fertilization (IVF) is considered when first and second-line treatments fail.
- Laparoscopic ovarian drilling (LOD) is a second-line treatment that can be considered when the first-line agents are not successful and when there is the need to asses pelvic tubal patency. The technique involves making four holes, diathermizing for four seconds, with a 4mm dip, using 40 volts. It carries risks of ovarian reserve reduction, adhesions, and surgery-related complications.
- Additional treatments include Inositol and weight loss medication. Gonadotropin-releasing hormone (GnRH) antagonist protocols, in vitro maturation (IVM), and freeze-all strategies can be used to reduce the risk of ovarian hyperstimulation syndrome (OHSS) during IVF.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
डॉ. वी.एस. मोहन
Former President of IDA, Endodontist at Dr.Mohan’s Dente Dental Clinic, Mumbai
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