Comparison of Pre- and Posttreatment Airway Volume in Patients with Temporomandibular Joint Disorders Treated with Ultra-Low Frequency Transcutaneous Electrical Nerve Stimulation Using Cone Beam Computed Tomography

Abstract Introduction Temporomandibular joint disorders (TMD) present with a multitude of symptoms that can range from headaches to shoulder pain. Patients frequently present with pain in the ear, dizziness, and vertigo. It is noted that some patients who report TMDs also have a history of sleep disturbances, which is noted in cone beam computed tomography (CBCT) as a reduction in the oropharyngeal airway volume. Objective To evaluate the airway volume in pre- and posttreatment of TMD with the use of neuromuscular orthotics made with ultra-low frequency transcutaneous electrical nerve stimulation (ULF-TENS). Methods A total of 15 patients were evaluated for TMDs using the related criteria. Those included were treated with ULF-TENS with evaluation of the airway volume both pre- and posttreatment using CBCT and the Dolphin 3D volume analysis software. Results While the symptoms were shown to be significantly reduced in patients who were treated with this particular modality, the airway volume varied in those who reported a reduction after a period of 3 months and those that reported after a period of 6 months. Conclusion Posttreatment evaluation of the airway should be done after a period of 6 months for a more objective evaluation. A multidisciplinary evaluation of the patient is required in such cases.

Maternal and perinatal outcome of Evan’s syndrome: a 5 years study in a tertiary care centre

Background: Evans syndrome is a rare autoimmune disorder characterized by simultaneous or sequential presence of a positive antiglobulin test, autoimmune haemolytic anemia (AIHA), and immune thrombocytopenia (ITP). It is characterised by frequent exacerbations and remissions within a chronic course. It was first described by Robert Evans in 1951.  Incidence of AIHA is 1 per 75 - 80,000 and ITP is 5.5 /100000 per general adult population.  Incidence of Evans syndrome is 1.8% to 10% of patients with ITP. Objective was to study the maternal and perinatal outcome of women with Evans syndrome (E).Methods: About 4 antenatal mothers were identified with Evans syndrome at St. Johns medical college and hospital, Bengaluru during the study period of 5 years from July 2013-July 2017. They were followed up during their antenatal, intra natal and postnatal period and outcomes were studied. All patients included in the study fulfilled the criteria for Evans syndrome.Results: There were 4 cases of Evans syndrome, with a total number of deliveries of 11859, during this 5 year study. Incidence was 0.09 per 1000 births. All patients presented with bleeding manifestations ranging from mucosal haemorrhage to subarachnoid haemorrhage (SAH) at the time of diagnosis. All patients were on treatment with either 1st or 2nd line of management with corticosteroids/ azathioprine. None had bleeding during pregnancy after the initiation of treatment. Patients had antenatal complications like preeclampsia 25%, IUGR 25%, oligohydraminos 50%, IUD 25%. 2 patients received platelet transfusions intrapartum. None had intrapartum or postpartum haemorrhage. There were no maternal and neonatal mortality.Conclusions: Evans syndrome in pregnancy is a rare condition and requires multi disciplinary approach involving specialists from obstetrics, neonatology, and hematology. Close maternal and fetal surveillance and management during pregnancy is essential to increase the possibility of a favourable pregnancy outcome in these women.

Effectiveness of topical green tea against multidrug-resistant Staphylococcus aureus in cases of primary pyoderma: An open controlled trial

Background: Antimicrobial activity of green tea against Staphylococcus aureus both in vitro and in vivo has been reported recently. Studies on clinical efficacy and safety of green tea as antibacterial agent against S. aureus in human cases are rare. Objectives: To evaluate the clinical effectiveness and safety of topical green tea on primary pyoderma caused by S. aureus. We also attempted to determine the minimum inhibitory concentration of green tea against S. aureus and methicillin-resistant S. aureus. Methods: Open label, prospective, placebo-controlled study included community-acquired primary pyoderma cases caused by S. aureus. Severity grading was done on a scale of 1–5. Green tea ointment 3% and placebo ointment were used. Cure was defined on the basis of negative culture and assessment of clinical improvement. Minimum inhibitory concentration was determined by agar dilution method. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 16. Results: Of the 372 patients, 250 received green tea and 122 received placebo. Multidrug-resistant S. aureus was isolated in 89.1% in green tea group and 81.1% in placebo group, respectively. Methicillin-resistant S. aureus was isolated in 24 patients. Cure was seen in 86% in green tea group and 6.6% in placebo group which was statistically very significant. The number of days for comprehensive cure in green tea group was 9.2 ± 6.4 days. All patients with methicillin-resistant S. aureus infection in the green tea group were cured. Minimum inhibitory concentration of green tea against S. aureus was 0.0265 ± 0.008 μg/ml and against methicillin-resistant S. aureus was 0.0205 ± 0.003 μg/ml. Limitations of the Study: Comparative trial was not conducted in the same patient with different lesions; children less than seven years were not considered as the school authorities did not permit for younger children to be included in the study and true randomization and blinding of investigators were not done. Conclusions: Green tea has a significant antibacterial effect against multidrug-resistant S. aureus. Minimum inhibitory concentration of green tea is established and is promising in methicillin-resistant S. aureus infections.

Comparative Analysis of Conventional Flap Surgery vs Laser Assisted Periodontal Flap Surgery: A Report of Two Cases.

The objective of periodontal surgery is to restore periodontal health and to prevent further relapse. Traditionally scalpels were used in periodontal surgery. Recent advancements in laser have set a milestone in the field of periodontal surgery. So considering the above facts, the objective of this case series is to analyze the pre and post–operative results obtained between conventional periodontal flap surgery and diode laser assisted periodontal flap surgery. Two chronic periodontitis patients with generalized probing pocket depth of more than 7mm was selected for this clinical study. Both the patients had angular bone loss in the upper quadrant and generalized horizontal bone loss in the lower quadrant. So scalpel periodontal surgery was planned for the upper quadrant and diode- laser assisted flap surgery in the lower quadrant. Post-operative results based on clinical parameters and patient perspective were recorded. Clinically significant improvement in probing pocket depth and clinical attachment levels were observed in both the surgical sites. Patient acceptance and comfort were more in laser treated sites compared to conventional surgical sites.

Lipid peroxidation and DNA damage in different stages of acute renal failure.

Introduction: Oxidative stress is an imbalance between the formation of Reactive oxygen species and protective antioxidant defense. It is known that oxidative stress increases the Acute renal failure. Measurement of oxidative stress parameters may be a simple tool for monitoring the progression of acute renal failure. Aim: The aim of this study was to evaluate oxidative stress in acute renal failure patients by Lipid peroxidation product Malondialdehyde (MDA), Total antioxidant capacity (TAC) and oxidative DNA damage product and compare its level among the patients of varying severity as per RIFLE classification. Materials and methods. We conducted a cross sectional study to compare oxidative stress parameters. Blood samples were collected from 62 patients with ARF, admitted to the Vinayaka Mission’s Medical College & Hospital, Salem from March 2009 to July 2010. We further subdivided the patients according to RIFLE classification. Results: The levels of MDA, Index of oxidative status MDA/TAC and DNA damage product 8 OH deoxy guanosine were significantly higher among failure group when compared to risk and injury. Total antioxidant capacity and super oxide dismutase (SOD) were found to be decreased.

Synthesis and characterization of silver nano particles from wrightia tinctoria.

In our present study the conventional (physical and chemical) method of nano particles synthesis was replaced with biological synthesis of silver nanoparticles by using the leaf extract of Wrightia tinctoria. New drug delivery system has been enhanced with noval techniques like nano particle synthesis and its role in drug delivery system, by exploiting the nanotechnology in particle synthesis. The aqueous extract of Wrightia tinctoria leaves was prepared and mixed with 1mM AgNO3 solution. After 48 hours the reduction of silver nitrate to silver nanoparticles (AgNPs) was confirmed by UV-visible spectrophotometer. The size of Silver nanoparticles were characterized by XRD and FTIR and the size were of 19 – 68nm. The biosynthesis of AgNPs using Wrightia tinctoria leaf extract is very simple and economic. This green chemistry approach is amenable to large scale commercial production. The use of environmentally benign and renewable plant material offers enormous benefits of eco-friendliness.

Oxidative stress, interleukin (IL-6) and atherogenic index of plasma in diabetic nephropathy.

Plasma IL-6 and serum MDA were significantly high in microalbuminuria and macroalbuminuria as compared to normal controls and normoalbuminuria. Plasma TAC was significantly decreased in all the groups of diabetic patients as compared to normal controls. Significant increase in lipid parameters and AIP were observed in macroalbuminuria and microalbuminuria as compared to normal controls. Plasma IL-6 showed negative correlation with HDL-c (r=-0.255) and significant positive correlation was observed between MDA and HbA1c (r=0.537) in diabetic patients. Conclusion: Increased IL-6, MDA levels and decreased plasma TAC levels in diabetic patients revealed inflammation with increased oxidative stress, which may involve in the development of renal damage. The associated altered lipid profile and high risk AIP indicates the risk of developing cardiovascular complications in diabetic patients with macroalbuminuria.

Current perspectives of herpesviral retinitis and choroiditis.

Vision-threatening viral retinitis are primarily caused by members of the herpesvirus family. The biology and molecular characterization of herpesviruses, clinical presentations of retinopathies, pathology and pathogenesis including the host responses, epidemiology and the laboratory methods of aetiological diagnosis of these diseases are described. Clinical syndromes are acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis, multifocal choroiditis and serpiginous choroiditis besides other viral retinopathies. Herpes simplex virus (HSV) retinitis is more common in immunocompetent persons while varicella zoster virus (VZV) affects both immunocompetent and immunosuppressed patients equally. CMV retinitis is most common among patients with AIDS. The currently employed laboratory methods of antigen detection, virus isolation and antibody detection by enzyme linked immuno-sorbent assay (ELISA) have low sensitivity. Polymerase chain reaction (PCR) has increased the value of diagnosis due to its high clinical sensitivity and absolute specificity in detection of herpesviruses in intraocular specimens.

Use of uniplex polymerase chain reaction & evaluation of multiplex PCR in the rapid diagnosis of viral retinitis.

BACKGROUND & OBJECTIVES: Polymerase chain reaction (PCR) has been known to be a rapid and accurate diagnostic test for causative viruses of viral retinitis, but cost is the limiting factor. In the present study an attempt was made to standardize a multiplex PCR (mPCR) on intraocular specimens from patients with viral retinitis for the detection of one or more viruses [herpes simplex virus (HSV), varicella zoster virus (VZV) or cytomegalovirus (CMV)] in order to reduce the period of time required for uniplex polymerase chain reaction (uPCR). METHODS: Using the uniplex PCR (uPCR) primers, a nested mPCR was developed and standardized for the simultaneous detection of HSV, VZV and CMV. mPCR and uPCRs were applied on 9 stored specimens and 38 prospective specimens obtained from patients with viral retinitis. RESULTS: The specificity and sensitivity of the mPCR were concordant with that of uPCRs. Clinical specificity and sensitivity of mPCR was further confirmed by the detection of the same herpes viral DNA on the 9 stored specimens. Of the 38 specimens collected prospectively, mPCR detected HSV in 3 (7.9%), VZV in 9 (23.7%), CMV in 5 (13.2%) and both VZV and CMV in 2 (5.3%). Co-infections of two viruses were found in 7 (14.89%) of the 47 specimens. INTERPRETATION & CONCLUSION: mPCR is a rapid, specific and sensitive diagnostic tool in viral retinitis. Compared to uPCR, mPCR is less time-consuming and cost effective.

Laboratory methods in the detection of herpes simplex virus (HSV) in keratitis--a 9-year study including polymerase chain reaction (PCR) during last 4 years.

Conventional methods of fluorescent antibody test (FAT) and virus isolation (VI) and molecular method of polymerase chain reaction (PCR) were compared for the detection of HSV in keratitis during a 9-year period. Of 186 corneal scraping specimens, 108 were subjected to FATand VI in the pre-PCR period (initial 5 years) while 78 to FAT, VI and PCR in the PCR period (latter 4 years). HSV was detected by FAT in 44/186 (23.7%), VI in 18/186 (9.7%) and PCR in 27/78 (34.6%) specimens. Overall, HSV was diagnosed in 56/186 (30.1%) specimens. PCR has increased the clinical sensitivity by 12.8%, which is statistically significant (McNemar test, P-0.002). VI should be replaced by PCR. FAT though less sensitive should always be employed as a routine to give an early diagnosis, the results of which could be further confirmed, if necessary, by PCR, which is a more sensitive and specific diagnostic tool.

Detection of cytomegalovirus from vitreous humor in a patient with progressive outer retinal necrosis.

A case of progressive outer retinal necrosis (PORN) caused by Cytomegalovirus (CMV), and diagnosed by polymerase chain reaction (PCR) is reported.

Preparation of amniotic membrane for ocular surface reconstruction.

We describe the preparation and preservation of human amniotic membrane required for transplantation in the management of ocular surface diseases. Informed consent is obtained and the donor is screened to exclude risk of transmissible infections such as human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, and Treponema pallidum infections. Ideally, the media and washing solutions needed for the preparation of amniotic membrane are prepared only a week to 10 days prior to use and not stored in the freezer weeks ahead. The AM obtained under sterile conditions after elective caesarian section is washed free of blood clots and chorion. With the epithelial surface up, amniotic membrane is spread uniformly without folds or tears on individually sterilized 0.22 micron nitrocellulose membranes of the required sizes. The prepared filter membrane with the adherent amniotic membrane is placed in the preservative medium and stored at -80 degrees C. The membranes are released when the repeat serology for HIV after the window period has excluded virus infection in the donor. Depending on consumption they may be used up to 6 months after preparation, though many have recommended storage for an indefinite period. Since the amniotic membrane has only incomplete expression of HLA antigens and amniotic epithelial cells do not express them, it is not rejected after transplantation. The presence of several cytokines in the amniotic membrane promotes epithelialization with reduction of fibrosis during healing.

Diagnostic value of enzyme linked immuno-sorbent assay for cytomegalovirus disease.

BACKGROUND: Since interpretation of results of enzyme linked immuno-sorbent assay (ELISA) for diagnosis of Cytomegalovirus (CMV) infection in India is difficult, its diagnostic value required evaluation. AIMS: To evaluate the diagnostic value of ELISA against polymerase chain reaction (PCR) in CMV disease. SETTINGS AND DESIGN: Results of ELISA test for CMV antibodies in CMV-DNA PCR positive and negative patients and normal healthy blood donors were analysed. METHODS AND MATERIAL: Anti-CMV antibodies were assayed by ELISA on the sera of 26 CMV PCR positive and 21 PCR negative patients and 35 normal healthy blood donors. STATISTICAL ANALYSIS: Chi square and Fischer exact test were used for statistical analysis. RESULTS: Anti-CMV antibodies (IgG or IgG and IgM) were present in 20 (76.9%) of 26 PCR positive and 13 (61.9%) of 21 PCR negative patients. ELISA was negative in six (23.1%) of 26 PCR positive patients. Of the 28 paediatric patients, ELISA was positive in 14 (73.7%) of 19 PCR positive and three (33.3%) of nine PCR negative patients showing a statistically significant difference (Chi square test, P value 0.038). Among the 19 patients having complications after organ transplant, ELISA showed anti-CMV antibodies in six (85.7%) of seven PCR positive and 11 (91.7%) of 12 PCR negative patients showing no significant difference. CMV-DNA was not detected in the buffy coat of 35 sero-positive blood donors. CONCLUSION: ELISA has no diagnostic value in the detection of CMV activation although it may help in the differential diagnosis of CMV infection in the paediatric age group.

Polymerase chain reaction based restriction fragment length polymorphism for the genotyping of cytomegalovirus (CMV) from patients with CMV disease in Chennai.

BACKGROUND & OBJECTIVES: Since cytomegalovirus (CMV) is heterogenous and exhibits genomic polymorphism, polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) was applied to identify the glycoprotein B subtypes in patients diagnosed to have CMV disease. METHODS: CMV standard strain (AD 169) and 55 clinical specimens from 50 patients (35 males; 15 females) positive for CMV by PCR coding for the morphological transforming region II gene were subjected to PCR coding for gp 55 region of CMV gB gene. PCR amplified products were subjected to RFLP using Hinf I. RESULTS: Of 50 patients, 26 (52.0%) (20 males; 6 females) were positive by PCR (gB gene). Upon RFLP, AD 169 and CMV strains of 14 (53.8%) patients (14 males) were typed as subtype II, and 12 (46.1%) (6 males; 6 females) as subtype III. Of 11 paediatric patients, 7 (63.6%) were infected with CMV subtype II and 4 (36.4%) with subtype III. CMV strains of the dual specimens from 3 PCR positive patients belonged to the same subtype. INTERPRETATION & CONCLUSION: In this study on CMV genotypes, CMV gB subtypes II and III were found in 53.8 and 46.1 per cent patients studied respectively, while I and IV were not present.

Use of nested polymerase chain reaction for the detection of cytomegalovirus in clinical specimens.

BACKGROUND & OBJECTIVES: Since fluorescent antibody test (FAT) has low sensitivity in the rapid detection of cytomegalovirus (CMV) in clinical specimens, a nested polymerase chain reaction (nPCR) to detect the CMV-DNA was evaluated. METHODS: nPCR and FAT were carried out to detect CMV in single specimens from 104 patients and dual specimens from 32 patients with suspected active CMV infection. Of the 136 patients, 3 were HIV positive. RESULTS: CMV was detected by FAT alone in 3 (1.8%) and FAT and nPCR in 16 (9.5%) specimens and by nPCR alone in 84 (50.0%) specimens from 74 (54.4%) patients. nPCR increased the clinical sensitivity by 50.0 per cent in the specimens and 54.4 per cent in the patients (McNemar test, P < 0.001). Urine was found to be the ideal specimen for the detection of CMV as the detection rate in the urine was statistically higher (McNemar test, P < 0.05) than in the blood. Buffy coat and plasma samples from 35 normal blood donors were subjected to nPCR and ELISA respectively. CMV-DNA was not detected in any of the samples while anti-CMV antibodies were detected in all of them. INTERPRETATION & CONCLUSION: The results showed that presence of CMV-DNA in the specimen indicates active infection and nPCR is a rapid, sensitive, specific and a more reliable diagnostic tool than FAT.

Herpes simplex virus DNA in the lens one year after an episode of retinitis.

The present report describes a case where HSV was detected by polymerase chain reaction (PCR) in the lens cortical material removed during cataract surgery one year after resolution of retinal inflammation in a patient with ARN.