Posterior superior alveolar nerve block alone in the extraction of upper third molars: a prospective clinical study

Background@#Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction. @*Methods@#A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used. @*Results@#In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation. @*Conclusion@#The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.

Pleomorphic Adenoma of a Minor Salivary Gland of the Hard Palate Report of a Case

The pleomorphic adenoma is the most common benign tumor of the minor salivary glands and is comprised of epithelial and mesenchymal tissues. The majority of the salivary gland tumors occur in the second decadeof life with a slight predilection for females. Clinically it presents as a firm or rubbery submucosal mass without ulceration or surrounding inflammation. Diagnosis is established on the clinical examination and histopathology, supplemented with plane radiographs, computerized tomography, and magnetic resonance imaging when necessary. Here, we report a case of pleomorphic adenoma of the hard palate in a 21-year-old female patient with a painless swelling in the left palatal region of nine months duration.

A cross sectional study on proper use of iodized salt in communities of rural areas and its relevant factors in Prakasam district, Andhra Pradesh, India

Background: The coverage of adequately iodized salt in old Andhra Pradesh was 63.6%, which is below the national average. Despite of high coverage rural households were less likely to consume adequately iodized salt. Objectives were (1) to find out the use of iodized salt and practices among community and knowledge regarding iodine deficiency diseases (2) to test salt at the household level to assess level of iodine.Methods: Community based cross-sectional study conducted from July to December 2016 in RHTC, Maddipadu, Prakasam district. Proportionate households from four villages of this area were interviewed for the purpose of study. Factors related to use of iodized salt in the communities like type of salt using in houses, storage practices, practices during cooking, knowledge regarding iodine deficiency disorders were assessed. The salt was tested for iodine using iodine rapid test MBI kits. The data was collected using pre-tested questionnaire and analyzed by using SPSS 22.0 version.Results: Most of households (68.5%) were between 25-50 years age, 68% wives were illiterate and 48.5% wives involved in labor work. Majority (83.6%) of the families were using iodized packed salt, 75% had adequately iodized salt with ≥15 ppm and 25% with inadequate iodized salt <15ppm. Association between illiterate wives and poor knowledge regarding iodized salt found to be significant (p<0.005).Conclusions: Specific education regarding proper storage, handling, duration and the importance of iodized salt needs to be implemented to increase community awareness and to focus on behavior change communication to bring positive attitude toward utilization of iodized salt.

Iron Deficiency Anaemia- A Case Report with Oral Manifestations

Iron deficiency anaemia is the most common nutritional deficiency disorder in children and is worldwide in distribution. It is characterised by fatigue, weakness, pallor and koilonychias. Thus oral physician play an important role in diagnosis and thereby prevention of anaemia, as oral manifestations may be the earliest feature of the condition. The purpose of this article is to present a case of iron deficiency anaemia of unknown cause in a 16 year old female child.

Assessment of Extra Dural Hematoma – Factors affecting morbidity, mortality and outcome

Background: Extradural hematomas occur in approximately 2% of all patients of head injuries and 5- 15% of fatal head injuries. EDH is considered to be one of the most serious conditions of head injury requiring immediate diagnosis and surgical intervention. Aim and Objectives: The purpose of this study was to evaluate the clinical presentation of patients with extradural hematoma and to decide upon the mode of management and to study the results of the management and the outcome and the factors affecting morbidity and mortality. Materials and Methods: Patients with EDH admitted in Neurosurgery Department, King George Hospital Andhra Medical College, Visakhapatnam were studied. Study period was one year July 2018 to June 2019. The sample size of the study was 106 patients who fulfill the inclusion and exclusion criteria. All the patients with head injury, diagnosed to have EDH on CT scan were included in the study. The management includes conservative measures and/or surgical intervention. The patients’ outcome was assessed during the hospital stay, at discharge and followed up to 6 months after discharge. The various factors were analyzed which are likely to affect the outcome. Results: Temporo-parietal and temporal region was the most common location of EDH. The most significant factors which influences outcome are - time of surgical intervention, older age group, low GCS and associated injuries on CT scans like contusions and other injuries. The patients were followed after 1, 3 and 6 months. P Prahaladu, M V Vijaya Sekhar, K Satyavara Prasad, Hemal Chheda. Assessment of Extra Dural Hematoma - Factors affecting morbidity, mortality and outcome. IAIM, 2019; 6(9): 102-107. Page 103 Conclusion: From this study, it was observed that neurological status of patient at the time of presentation, time of surgical intervention, associated injuries on CT scan and the volumetric details of EDH are the most important factors in management and outcome of EDH.

Factors affecting outcomes in compound depressed frontal bone fractures: Institutional study

xIntroduction: Compound depressed frontal bone fractures exhibits some peculiarities such as frequent involvement of frontal sinus and olfactory nerve and tract, which lie on the floor of the anterior cranial fossa. The primary aim of our study is analyzing factors influencing the outcomes in compound depressed fractures of frontal bone .This will help in improving outcomes and management of compound depressed frontal bone fracture. Material and methods: Study was conducted at tertiary care institute by collecting data of 40 patients operated surgically from August 2018 to July 2019. The study included patients who were diagnosed with compound depressed frontal bone fracture and underwent surgical management at our institute. Follow-up was performed at least 3 months after the trauma. The variables evaluated were mortality, GOS, occurrence of rhinorrhea, meningitis, late post-traumatic epilepsy and smell disturbances. Results: Most of our patient with GCS 13-15 was discharged with good clinical outcome and no complication on follow-up. Patient with low GCS and delayed presentation are at risk and adds up morbidity and mortality. Conclusion: Early surgical intervention in patients with GCS 13-15 is associated with good outcomes and low complication rate associated with meningitis or CSF leak.

Smart use of smart phones in severe TBI (Traumatic Brain Injury) – A miniature Tele therapy.

This is the era of Smart phones. Smart phones have revolutionised all the fields including the field of medicine. Absence of internet coverage in the remote rural areas which was a constraint and limitation for their use has also been overcome by the technological advancements in the yesteryears. Simultaneously the availability of CT and MRI scan has seen the light in the District Headquarters hospitals of North Coastal Andhra Pradesh. In trauma care, the ubiquitous concept of the “golden hour” suggests that the time between the occurrence of an accident and the receipt high quality, appropriate treatment is a critical factor in patient survival. Therefore, saving time from the moment of occurrence all the way through to the moment of appropriate treatment is critical. Introduction of various APPs in Smart phones has made transmission of visual images instant and easy from any remote corner of the world. This advancement in function, applied to the health care sector in India made an enormous difference in providing emergency specialist care services to the remote areas of India.

Unusual complications of Ventriculo Peritoneal Shunt: 15 years experience.

Ventriculo-Peritoneal shunt is the most commonly performed surgery for hydrocephalus, universally Many complications are reported, of which the shunt malfunction and infection are most commonly encountered. These common complications can be minimized, by precautions like– senior surgeons operating shunt cases, as the first case in the operation, with minimal personnel in the operation and thoroughly scrubbing the part for minimum five minutes. However, in few cases, – even in the experienced hands and with all precautions, some rare complications like extrusion of the lower end through anus, vagina, into scrotum were described. In our experience of over 15 years, wide range of complications was seen apart from malfunction and infection. Exposure of the part of shunt system, with excoriation of overlying skin, peritubal leaks, disconnection of shunt system with CSF leaking out, loculation in between the loops of bowel/ omentum, extrusion of the lower end through anus etc. were encountered and probable factors for these unusual complications were discussed.

Open skull fractures with brain fungation: Simple principles for good outcome Our experience.

The incidence of head injuries is increasing worldwide. The associated skull fractures are also increasing with rise in vehicular traffic. In the present study, a total of 214 cases of head injuries which were admitted into a Rangaraya Medical College Hospital from the time period of 2 years, were taken for the study. Out of them 124 cases presented with skull fractures ranging from simple linear to stellate, depressed, comminuted, compound and compound comminuted depressed fractures. Some fractures were extending to the base of skull and some to the vault and some were associated with facio-maxillary injuries. 17 cases out of the 124 open skull fractures, presented with cerebro- spinal fluid leak and brain matter seen directly herniating through the wound. The wounds in all the cases were contaminated, with many cases harboring hair, sand particles etc. Majority of them were secondary to road traffic accidents, but assaults and some directly hitting injuries under the influence of alcohol were also included. As there was an evident CSF leak and brain matter already present in the wounds, all the cases were taken up for emergency surgery. In spite of the grossly contaminated wounds, thorough wound debridement and closure of defects and duraplasty wherever feasible, resulted in very good improvement in all the cases. No mortality or procedure related morbidity was observed in any of these cases.

The Radix Entomolaris : A Rare Entity In Endodontics.

Mandibular molars can have an additional root located lingually (the radix entomolaris) or buccally (the radix paramolaris). If present, an awareness and understanding of this unusual root and its root canal morphology can contribute to the successful outcome of root canal treatment. This report discusses endodontic treatment of one Mandibular molar with a radix entomolaris or paramolaris, both of which are rare macrostructures in the Caucasian population. The prevalence, the external morphological variations and internal anatomy of the radix entomolaris and paramolaris are described. Avoiding procedural errors during endodontic therapy demand an adapted clinical approach to diagnosis and root canal treatment.

Prevention And Control of Oralccancer : Key Role of Dental Surgeon.

Oral cancer is one of the deadliest cancer . The incidence of this cancer is increasing every year, conversely this cancer is curable and even it is totally preventable. This paper reviews the preventive aspects of oral cancer.

Principal Component and Cluster Analyses in Pigeonpea [Cajanus cajan (L.) MillSp].

Forty nine genotypes of pigeonpea representing the broad spectrum of variation were assessed for twelve characters using principal component analysis and cluster analysis. These genotypes were grouped into 8 clusters by using cluster analysis. Principal component analysis identified five principal components with eigen values more than one which contributed 80.10 per cent of the cumulative variance. The genotypes LRG-41 and SM- 97, MRG-1001, WRG 51-Y, RST-16 and ICP 7035 were selected from the above analysis appeared to be desirable for inclusion in crossing programme aimed for improvement of pigeonpea.

Studies on Selection Indices in Pigeonpea [Cajanus Cajan (L.) Millsp].

Success of any breeding programme depends on the efficiency of selection. Hence, the knowledge of nature of association of various traits among themselves and with seed yield is quite important for devising an effective selection criterion for yield. The present study was carried out to assess the nature and extent of interrelationship among component traits affecting seed yield in pigeonpea (Cajanus cajan (L.) Millsp). Forty nine genotypes from different states Andhra Pradesh, Karnataka and Maharastra were evaluated in a randomized block design with three replications and the data recorded on 12 traits were subjected to statistical analysis. The correlation studies revealed the positive and significant association of seed yield with number of pods per plant, number of secondary branches per plant, number of primary branches per plant and plant height. Path analysis revealed that the number of pods per plant was important in formulating selection criteria for improvement of seed yield in pigeonpea.

Correlation Between Traits and Path Analysis Coefficient for Grain Yield and other Components in Rice (Oryza Sativa L.) Genotypes.

Current research was conducted out at the Wet land farm of S.V. Agricultural College, Tirupati during kharif, 2011 and rabi, 2011-12 crop seasons. The objective was to establish the nature of relation between grain yield and yield components by partitioning the correlation coefficients between grain yield and its components into direct and indirect effects by using simple correlation and path analysis. A correlation coefficient and path analysis study was conducted with six parents and their 15 F1 crosses for eleven component characters including grain yield. The obtained results indicated that number of grains per panicle, total number of productive tillers per plant, harvest index, kernel L/B ratio, milling percentage and panicle length showed highly significant positive association with grain yield per plant. In the path coefficient analysis, number of grains per panicle and total number of productive tillers per plant should be considered as the main yield components because these traits showed the highest positive direct effects towards increasing grain yield with the values of +0.773 and +0.572, respectively. Depending on the findings of present study, number of grains per panicle and total number of productive tillers per plant may be used an effective selection criterion to improve genetic yield potential of rice genotypes.

Inhalant abuse- A rising public health problem.

These days inhalant abuse is common in both rural and urban settings. Laymen and professionals alike are negligent of this abuse. It is widely seen in children and can sometimes follow into adulthood too. Children try it out initially due to their anxiousness but later on get addicted to it. Parents are more worried about their children being exposed to drugs like cocaine and marijuana. But the fact is that children are more addicted to the inhalants that are commonly found in household things. Even a single episode of inhalant abuse can result in serious health problems. It can seriously impair the vital organs like heart, brain and kidneys. Repeated abuse is seen due to the elated feel that they experience after its use that resembles alcohol consumption. It produces initial excitation, drowsiness, disinhibiting, wooziness and agitation. In order to prolong the period of intoxication, they abuse repeatedly which in severe cases can even lead to death. Other causes of death can be due to suffocation, seizures, and coma or due to choking. Detoxification programs along with proper support and care from the family and friends will help the abusers to bring back the lost colour in their life. A systemic review of various electronic bibliographic by utilizing suitable search terms were used to obtain the data.

Comparision of cluster formation by mahalanobis’ D2 and metroglyph analyses in groundnut (Arachis Hypogaea L.).

Fifty genotypes of groundnut were classified into five and seven clusters in D2 and Metroglyph methods of analyses respectively. Harvest Index and 100-seed weight were the main contributors to total divergence as per metroglyph analysis. The characters on X and Y axes in scattered metroglyph diagram determine the grouping of genotypes, hence it poses a problem for judicious selection of these characters. The comparative study of these methods indicated that metroglyph analysis would be suitable for preliminary grouping when large number of genotypes are considered at a time. The differences between the two methods, the number of clusters formed, inter cluster distance, characters considered for grouping and superimposition of genotypes within the cluster indicated that D2 analysis was more effective compared to metroglyph analysis.

Character association and path analysis in groundnut (arachis hypogaea l.).

Correlation and path co-efficient analysis were carried out for pod yield and its component characters in 50 genotypes of groundnut. The genotypic correlation co-efficients were found to be of relatively higher magnitude than the corresponding phenotypic correlation co-efficients, indicating strong inherent association between the characters. Pod yield displayed significant positive association with kernel yield per plant, mature pods per plant, total pods per plant, harvest index, 100-seed weight, root weight, plant height and shoot weight. Path co-efficient analysis revealed high direct effects of kernel yield per plant and harvest index on pod yield. Hence, it would be rewarding to give due importance on the selection of these characters for rapid improvement in pod yield of groundnut.

Correlation and path coefficient analysis for yield and yield components in blackgram (vigna mungo (L.) hepper).

Correlation coefficient and path analysis studies was conducted with eight parents and their 28 F1 crosses for twelve component characters including seed yield and revealed significant positive association of pods per plant, harvest index and clusters per plant with seed yield in parental generation whereas in F1 generation, significant positive association of clusters per plant, pods per plant, days to maturity, days to 50% flowering, pods per cluster and 100-seed weight with seed yield was observed. Further, it was found that number of seeds per pod, harvest index, pods per plant and number of primary branches per plant showed high positive direct effects on seed yield in parents whereas in crosses, seeds per pod, pods per plant, harvest index and days to maturity showed high positive direct effect on seed yield. Hence selection based on these traits would be effective in increasing the seed yield.

Variability and genetic parameters for grain yield and its components and kernel quality attriburtes in CMS based rice hybrids (oryza sativa l.).

The present investigation was under taken to study the extent of variability and genetic parameters with 16 parents and 48 hybrids for nine yield and its components and twenty five quality characters. The magnitude of difference between PCV and GCV was relatively low for all the traits, indicating less environmental influence. High GCV and PCV were recorded for harvest index, total number of productive tillers per plant and gelatinization temperature in parents and for total number of productive tillers per plant, number of grains per panicle, gelatinization temperature and amylose content in hybrids. High heritability coupled with high genetic advance as per cent of mean were recorded for gelatinization temperature, harvest index, total number of productive tillers per plant, number of grains per panicle, kernel length, kernel L/B ratio and grain yield per plant in case of parents and for gelatinization temperature, amylose content, total number of productive tillers per plant, number of grains per panicle and harvest index in case of hybrids indicating the additive gene effects in the genetic control of these traits and can be improved by simple selection in the present breeding material.

Removal of lead from aqueous effluents by adsorption on coconut shell carbon.

The application of adsorption for removal of heavy metals is quite popular and activated carbon is universally used as an adsorbent. However, high cost of its preparation and regeneration has led to a search for alternative sorbents, especially in the developing countries. A number of sorbents are used to remove metals by adsorption from industrial effluents, which include insoluble starch, xanthates, modified cotton and wool, tree barks, activated carbon, plant leaves and agricultural products. Therefore, as an alternative, coconut shell carbon (CSC), a low cost sorbent derived from organic waste material, was used in the present work, for removal of lead from aqueous effluents. The results of the batch sorption studies indicated that the efficiency of lead removal by coconut shell carbon is comparable to that of commercially available activated carbon. From the kinetic and equilibrium studies, the sorptive capacity of coconut shell carbon for lead was found to be 30 mg/g. Desorption and subsequent recovery of the metal from the surface of the sorbent was successfully demonstrated. Parameters affecting the sorption were evaluated.