The normal range of maximal incisal opening in pediatric population and its association with physical variables

Background: Restricted mouth opening is a common complaint in patients suffering from temporomandibular joint disorders, ankylosis, impaired masticatory muscle function, rheumatic disease, infection, or malignancy. As with any disease, the aim of treatment of disorders affecting mouth opening is to restore the mouth opening to its normal value. It is thus of paramount importance to determine the normal value. Objective: To establish the normal range of maximal incisal opening (MIO) in children aged 4 to 15 years and to investigate the correlation between MIO and age, gender, height, and body weight. Materials and Methods: Six hundred and two children from various schools in Bengaluru, India, participated in the study. The children were divided into the following age groups: 4­5, 6­7, 8­9, 10­11, 12­13, and 14­15 years. MIO for the children was recorded using Therabite® scale. The measurements of MIO were then correlated with gender, body weight, and height of the children in different age groups. Results: It was observed that MIO gradually increased with age with a mean MIO of 41.34 mm at 4­5 years to a mean MIO of 51.73 mm at 14­15 years. The mean MIO value for males (48.90 ± 6.49 mm) was found to be higher when compared to that of females (46.17 ± 5.58 mm). The results indicated a strong positive correlation of MIO with height and weight. Conclusion: MIO gradually increased with age in both the genders, and a strong positive correlation of MIO with height and weight was observed

Bone level measurements around platform switched and platform matched implants: a comparative study

Background: The overall success of dental implants depends on the crestal bone support around the implants. During the initial years, the bone loss around the implants determines the success rate of treatment. Platform switching (PLS) preserves the crestal bone loss, and this approach must be applied clinically. Aim: The purpose of this study was to determine the changes in vertical and horizontal marginal bone levels in platform-switched and platform-matched dental implants. Materials and Methods: One fifty patients received one fifty dental implants in the present study over a 1-year period. Measurement was performed between the implant shoulder and the most apical and horizontal marginal defect by periapical radiographs to examine the changes of peri-implant alveolar bone before and 12 months after prosthodontic restoration delivery. Results: These marginal bone measurements showed a bone gain of 1.56 ± 2.4 mm in the vertical gap and 1.49 ± 2.24 mm in the horizontal gap of the platform matching, while in the PLS, a bone gain of 2.67 ± 2.0 mm in the vertical gap (P < 0.05) and 2.89 ± 1.67 mm in the horizontal gap was found. Only a statistically significant difference was found comparing bone gains in the vertical gap between the two groups (P < 0.05). Conclusion: PLS helps preserve crestal bone around the implants, and this concept should be followed when clinical situations in implant placement permit

Comparison of vacuum-assisted closure therapy and conventional dressing on wound healing in patients with diabetic foot ulcer:a randomized controlled trial

Background: Vacuum-assisted closure (VAC) therapy has been shown to be beneficial in a variety of wounds. However, evidence of its benefit in diabetic foot ulcers (DFUs), especially with respect to Indian population, is sparse. Methodology: This randomized controlled trial included DFUs of Wagner's Grades 1 and 2. Patients were further stratified with respect to DFU size <10 cm and ≥10 cm. Patients with vascular disease, osteomyelitis, and bilateral DFUs were excluded from the study. The enrolled patients were randomized to receive VAC therapy or conventional dressing. The time to wound healing, granulation tissue formation, and complications such as pain, infection, and bleeding were compared between the two groups. Results: A total of sixty patients were randomized, of which 27 in each group were analyzed. The mean time to healing in days was significantly less in VAC group (22.52 vs. 3.85; P < 0.0001). Mean time to achieve 75%­100% granulation tissue cover was significantly less in VAC group (23.33 vs. 32.15; P < 0.0001). Rate of granulation tissue formation was also found to be significantly better in VAC group (2.91 cm2/day vs. 2.16 cm2/day; P = 0.0306). There was no difference between the two groups with respect to wound infection and bleeding which are commonly attributed to VAC therapy. VAC therapy group had significantly lesser pain at week 3 (Visual Analog Scale score 3 vs. 4; P = 0.004). Conclusion: VAC therapy significantly decreases the time to complete wound healing, hastens granulation tissue formation, and reduces the ulcer area compared to conventional dressing. The study did not find any significant increase in the bleeding and infection in the VAC therapy group

Fast-track protocol versus conventional protocol on patient outcome:a randomized clinical trial

Background: The aim of this study is to compare fast-track methodology with traditional methods of surgical care in achieving better patient outcome, and ensuring a timely discharge from the hospital, and also note the factors that are responsible for a delayed discharge from the hospital. Materials and Methods: One hundred patients undergoing elective surgeries were randomly allocated into fast-track and traditional protocol of perioperative care. Patients who underwent fast-track protocol (FTP) were started on early oral feeding and were encouraged for early discharge, while the others were made to follow the traditional method of recovery. The gastrointestinal functions, postoperative complications and hospital stay time were recorded. The results were tabulated and analyzed. Results: Early feeding was well tolerated by all the patients in the "fast track" group, while the patients in the control group had increased number of "nil by mouth" days, and this result was statistically significant. Ambulation was started earlier in the case group as compared to the controls, and the mean period of starting of ambulation was statistically significant, in the cases as compared to the controls. The patients in the case group had an earlier discharge from the hospital, as compared to the control group. The most common reason for a delay in discharge from the hospital, in either group, was seen to be inadequate pain relief postoperatively. Conclusion: The FTP can significantly shorten the postoperative hospital stay after elective surgery, as compared to the traditional protocol

Micronuclei in exfoliated cells : a biomarker of genotoxicity in tobacco users

Aims: The aim of this study was to analyze the tobacco-related genotoxic effects in individual with habit of smoking and chewing tobacco. Materials and Methods: The present study sample consisted of 120 individuals attending the outpatient department of D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh (UP). The sample was divided into four groups as follows: Group I (individuals with habit of smoking tobacco), Group II (individuals with habit of chewing tobacco), Group III (individuals with habit of smoking and chewing tobacco), and Group IV control group (nontobacco-exposed individuals). Patients were asked to rinse their mouth gently with water. The exfoliated cells were obtained by scraping the buccal mucosa of individuals with a wooden spatula. The scraped cells were placed on the precleaned slides. The smears were then stained with RAPID-PAP™ and analyzed under the microscope. Data were analyzed using SPSS statistical software. Results: In the present study, an arbitrary unit was obtained using frequency/day multiplied by the duration of years (risk multiplication factor [RMF], a positive and significant correlation were observed between the RMF and the mean percentage of micronucleated cell count in smokers, chewers, and in individuals with both smoking and chewing habit, respectively. A weak positive and nonsignificant correlation were observed between age and mean percentage of micronucleated cells in smokers and smokers + chewers, respectively, while it was weak negative and nonsignificant in chewers. In control group, correlation between age and percentage of micronucleated cells was weak positive and nonsignificant at 5% level of significance. Conclusion: The micronuclei in exfoliated mucosal cells from buccal mucosa can be used as a biomarker of genotoxicity in predicting the effects of carcinogens

Rare breast malignancy subtypes: A cytological, histological, and immunohistochemical correlation

Background: Breast malignancies encompass various subtypes which differ in their clinical presentations, outcomes, and response to the treatment regimens. Thus, a proper histological diagnosis and a special mention of the rare histologic subtypes are required to formulate clear recommendations of their treatment protocols. Materials and Methods: This is a 1-year retrospective study highlighting the rarely encountered subtypes on the mastectomy specimens received. Results: We encountered only 11 rare cases out of the total 153 mastectomy specimens received. The rare subtypes were as follows mucinous cystadenocarcinoma (0.6%), mucinous carcinoma (0.6%), dermatofibrosarcoma protuberans (0.6%), Squamous cell carcinoma (0.6%), papillary carcinoma (2.6%), medullary carcinoma (0.6%), and malignant mesenchymal tumor (1.3%). Conclusion: Our data suggest that these variants are distinct clinicopathological entities with a unique hormonal receptor status. Scant information is available on the rare breast tumor subtypes

Management of major postcholecystectomy biliary injuries: An analysis of surgical results in 62 patients

Background: Management of injuries sustained during cholecystectomy requires expertise and involves a patient who is troubled, usually drained of personal resources. There has been an increase in incidence with laparoscopic cholecystectomy. The standard surgical management done for major biliary injuries is Roux-en-Y Hepaticojejunostomy (R-en-Y HJ). Materials and Methods: Patients managed surgically for definitive management of biliary injuries in the form of R-en-Y HJ were included. Data were collected from prospectively maintained records and through outpatient follow-up. Demographic data, early and late surgical complications, long-term outcomes, and follow-up results were analyzed. Results: Among the 62 patients, 26 were males, with a mean age of 37.4 ± 13.5 years. A total of 24 patients presented with ongoing biliary fistula. The Strasberg­Bismuth type of injury included types E1 in 8 (13%), E2 in 31 (50%), E3 in 19 (30.6%), and E4 in four patients (6.4%). There were no postoperative mortality and morbidity in 27.4% of patients. Atrophy­hypertrophy complex was seen in four patients, vascular injury in six patients, and an internal fistulisation with duodenum in two patients. Presence of comorbidities (P = 0.05), male gender (P = 0.03), tobacco use (P = 0.04), low albumin (P = 0.016), and more proximal (E4-E1) type of injury (P = 0.008) were independent predictors of postoperative morbidity (P < 0.05). The mean duration of patient follow-up was 26.2 ± 21.1 months. Conclusion: Optimization of preoperative nutrition, avoidance of intraoperative blood transfusion, proper timing of repair, and tension-free R-en-Y HJ draining all the ducts which is done at an experienced hepatobiliary center provide the best outcome

The prevalence pattern of locomotor disability and its impact on mobility, self-care, and interpersonal skills in rural areas of Jodhpur district

Context: Impact of disability is deleterious, affecting an individual's every aspect. Majority of disabled reside in rural areas of developing countries. Moreover, different types of disability add to its wide spectrum. All these make it a major health issue. Aims: The aim of this study was to note the prevalence rate and pattern of locomotor disability in a rural population of Jodhpur District and to observe its impact on mobility, self-care, and interpersonal skills of disabled. Settings: This study was carried out in rural field practice area of the Community and Family Medicine Department of tertiary care setup. Design: This was a cross-sectional study. Materials and Methods: House-to-house survey for a sample size of 1656 was conducted by a team of trained doctors, therapists, and anganwadi workers for identification of locomotor disability applying a pretested survey questionnaire. Statistical Analysis: SPSS version 22 was used for descriptive analysis of variables (frequency distribution), and the Chi-squared test was used for the association of sociodemographic factors with performance qualifier score. Results: The prevalence rate of 2.08% for locomotor disability (male = 57% and female = 43%) was noted, with 31% from 40 to 60 years, 49% were illiterate, and 60% were from lower class. The main etiologies were cerebrovascular accident (25%) and cerebral palsy (23%). About 80% faced some difficulties in mobility domain, 57% in self-care, and 63% in interpersonal skills. Statistically significant association was seen for self-care domain with education level (P = 0.04) and for interpersonal skill domain with age groups and diagnosis (P = 0.022 andP = 0.035, respectively). Conclusion: The overall prevalence of locomotor disability in rural Jodhpur was 2.08%, higher for males and higher from 40 to 60 years. Most disabled were illiterate and were from low socioeconomic status. Self-care, mobility, and interpersonal skills were primarily affected and require proper intervention

Knowledge and parity: Perspectives of usage of emergency contraceptive pills among women of a rural area of Delhi

Context: Correct use of emergency contraceptive pills (ECPs) may prevent up to 95% of unwanted pregnancies which may significantly decrease unsafe abortions and maternal mortality. Aims: Assessment of knowledge and use of ECPs among women and to explore factors associated with them. Materials and Methods: This was a facility-based cross-sectional study. Data were collected using a prestructured, pretested questionnaire from 381 reproductive age women (15­49 years) selected by systematic random sampling. Statistical Package for the Social Sciences version 16 and Epi info (version 7.0.) were used for all statistical analyses. Descriptive analysis was performed, and results were expressed in terms of frequencies and percentages. The Chi-square and Fisher's exact test were used as tests of significance in univariate analysis. Determinants of use of ECPs were identified using logistic regression. Results: Of 381 women interviewed, awareness level of ECPs (ever heard about ECPs) was found to be 34% (n = 128). Ever use of emergency contraception was reported by 38 (9.7%). Age (odds ratio [OR] = 3.02, 95% confidence interval [CI] [1.88­4.87]), education (OR = 0.086, 95% CI [0.047­0.158]), husband's education (OR = 0.11, 95% CI [0.067­0.187]), socioeconomic status (OR = 6.14, 95% CI [3.28­11.51]), and family status (OR = 2.6, 95% CI [1.59­4.24]) were found to be significantly associated with the use of emergency contraceptives. Conclusions: The study identified that most respondents lack adequate knowledge about ECPs, and ever use of ECPs was very low. Factors that were associated with the use of ECPs were age, literacy, socioeconomic status, and knowledge about the method. Creating a sustainable awareness on ECPs and their use may serve them with power to control their parity

Estimation of superoxide dismutase levels in saliva and gingival crevicular fluid among smokers and non-smokers in periodontitis patients - an observational study

Background: Smoking, which is an important risk factor for periodontitis, induces oxidative stress in the body and causes an imbalance between reactive oxygen species (ROS) and antioxidants, such as superoxide dismutase (SOD). The present study was done to quantify and compare the level of SOD enzyme levels in gingival crevicular fluid (GCF) and saliva among smokers and nonsmokers. Methodology: One hundred and thirty-five individuals in the age range of 20­55 years, including 45 light smokers, 45 heavy smokers, and 45 nonsmokers (controls), were selected and the clinical parameters recorded were plaque index, probing depth, and attachment loss. Smokers were divided into light smokers (<10 cigarettes/day) and heavy smokers (>10 cigarettes/day) and into three subgroups: healthy, mild periodontitis, and moderate periodontitis. GCF and saliva samples were collected then SOD levels were analyzed using spectrophotometric assay. Results: The mean levels of SOD in the GCF and saliva of smokers were decreased compared to controls. Intra- and inter-group analyses showed a significant reduction in the levels of SOD in the GCF and saliva of heavy smokers compared to light smokers and the control group. Conclusions: There was a progressive reduction in SOD levels from healthy nonsmokers to light smokers to heavy smokers

Content analysis of mobile health applications on pregnancy yoga

Background: The awareness of yoga has improved its utilisation for health benefits across the globe. This work analysed the contents of the available mobile apps on Android and iPhone operating system (iOS) platforms. Understanding the existing apps will form a base to develop a better app to encourage and mentor the pregnant women while performing yoga for health benefits.Aim: The aim of this study is to analyse the contents of the available mobile apps on Android and iOS platforms on 'Pregnancy Yoga'.Methods: Both the researchers independently searched online and analysed the contents present in the mobile health apps (mhealth apps) related to pregnancy yogas that were available in two platforms ­ The Apple and Google Play stores. A search for pregnancy yoga apps in both these platforms yielded a total of 100 and 200 apps, respectively. A cross-sectional study was performed on this sample of 300 available mobile apps.Results: Out of the 300 mhealth apps identified, it was found that five pregnancy yoga apps from iOS and 45 from Google Play stores were relevant to pregnancy yoga and the other apps focused either on pregnancy-related health tips or common yoga apps. Therefore, only 50 (16.6%) mhealth apps could be included as per the criteria. The mobile apps that met the inclusion criteria were 5 (1.6%) from iOS and 45 (15%) from Google play stores.Conclusion: The study shows that the content of a number of apps is not sufficient and evidences the presence of apps that include videos to track yoga poses, their benefits for each trimester, especially videos, and also the apps that enable one to set-up reminders. Pranayama techniques such as bhamari, sithagiri and yoga nithra (relaxation) require information to improve the well-being of pregnant women. These data are not included in the pregnancy mobile apps. Hence, there is a need for well-designed applications to promote yoga in every stage of pregnancy. The available apps should be able to track the yoga practice and provide immediate feedback and consultation by experts

Oral manifestations of dengue fever

Background: Dengue is a life­threatening viral infection which has become an epidemic in India in the postmonsoon period (August­November). It mostly associated with nonspecific fever and rashes, arthralgia, myalgia, and thrombocytopenia in severe cases. Objective: This study aimed to study the oral manifestations of dengue fever and to observe the various features of oral presentation then to validate the significance and importance of oralmanifestation in the diagnosis of dengue fever.Materials and Methods: Patients meeting the inclusion criteria were subjected to detailed history, oral examination, and relevant investigations. Results: Intraoral manifestations were present in 24 (48%) patients, anf these included petechiae (29.2%), bleeding gums (16.6%), ulcer (4.2%), dryness of mouth (4.2%), and combined features (45.8%). Extraoral manifestations were present in 4% of the cases. Conclusion: This study highlights the thrombocytopenia related oral haemosrrhagic manifestations of dengue fever

Characteristics of Craniofacial Trauma in a Rural Hospital in South India

Background/Purpose:Purpose of this study was to evaluate the population characteristics of patients with both head injury and facial fractures in rural centre.Methods:This study was a retrospective study performed at Justice K.S. Hegde Charitable Hospital; Deralakatte (Mangalore) and a total of 36 patients were reviewed. Type of fracture; mechanism; clinical features and pattern of injuries were noted. All patients who sustained both cranial and facial injuries were included in this study.Results: Mean age was 32.64 years (range; 4 years to 70 years) with a male to female ratio of 35:1. Motor vehicular accidents (44.4) were most common cause of injury followed by fall (22.2). Most common areas involved were upper face (36.1) and lower face (25) followed by combination of upper and middle face (11.1) other areas were less commonly involved. Headache and vomiting were most common clinical features followed by loss of consciences. Closed head injuries were the most common neurological injury (14 cases) followed by skull fractures (5 cases). Most patients with upper facial fractures or combination of it had associated injuries. There was no mortality in the present series.Conclusion: This study further supports that injury patterns in developing countries particularly in rural area are no different from developed countries and needs to follow similar preventive and counseling measures