Comparison of Mandibular Buccal Shelf Bone Characteristics between Two Facial Types using Cone Beam Computed Tomography

Background: Mandibular buccal shelf (MBS) offers good quality and quantity of bone for orthodontic bone screw (OBS) insertion. Despite several reports of treated patients, there are numerous variables in selecting the exact placement site for OBS placement in the MBS. There are also anatomical variations in this area which must be considered. Objectives: This study aims to measure and compare the MBS bone characteristics for OBS placement using cone beam computed tomography (CBCT) between two different facial types. Materials and Methods: Eighty CBCT samples were collected (40 samples of group A horizontal growers and 40 of group B vertical growers). Each CBCT image was reconstructed and oriented with CS 3D CBCT software. The cortical bone thickness, the slope of the MBS, and buccolingual inclination of mandibular second molar were measured and analysed. Result: Cortical bone thickness among horizontal growers was 5.23 ± 0.58 mm and among vertical growers was 4.85 ± 0.37 mm. The slope of MBS among horizontal growers was 60.83 ± 6.15 degrees and among vertical growers was 66.75 ± 6.27 degrees. In both the parameters there was a statistically significant difference between the groups. There was no significant difference between the groups for the buccolingual inclination of 2nd molar. Conclusion: Increased cortical bone thickness and the flatter slope of MBS at the 2nd molar region allows for easier placement of OBS in horizontal growers than in vertical growers

Comparison of newer Kane formula with Sanders Retzlaff Kraff/Theoretical and Barrett Universal II for calculation of intraocular lens power in Indian eyes

Purpose: To compare the efficacy of Kane formula with Sanders Retzlaff Kraff/Theoretical (SRK/T) and Barrett Universal II in predicting intraocular lens (IOL) power in Indian eyes. Methods: This retrospective study conducted in a tertiary care eye hospital. Data from patients having uneventful cataract surgery with Tecnis ZCB00 IOL implantation were obtained from Lenstar and electronic medical records. Eyes were divided into subgroups based on axial length (AL) as short (<22.0 mm), medium (22� mm), and long (>24 mm). The predicted refractive outcome for each patient was calculated after optimizing the lens constant. Prediction error was calculated by subtracting the predicted spherical equivalent from achieved spherical equivalent 1 week post?surgery. The mean absolute error (MAE) and median absolute error (MedAE) and percentage of eyes within 0.25, 0.5, 1, and 2 D were calculated for each formula. Friedman test, Cochrane Q test were used for statistical analysis. Results: Out of the 350 eyes included in the study, we found that without lens constant optimization, Barrett formula performed better than SRK/T and Kane (P < 0.0001). Over the entire range of axial lengths, Kane formula performed slightly inferior compared to Barrett and SRK?T, both of which performed equally well (P = 0.006). On subgroup analysis, Kane formula performed inferiorly for medium eyes as compared to the other two. No significant differences were noted between the formulae for short and long eyes. Conclusion: Kane formula did not outperform Barrett Universal II and SRK/T in Indian eyes

Effectiveness of an educative ergonomic plan in reducing musculo-skeletal disorders among dental practitioners / Efetividade de um plano ergonômico educativo na redução de distúrbios osteormusculares entre dentistas

Objective: Work related musculo skeletal disorders (WMSD) are very common among dental practitioners who use precise hand-wrist motions and prolonged static postures. The aim of this study was to develop an educative ergonomic plan and test its effectiveness in reducing symptoms of musculo-skeletal disorders among dental practitioners. Material and Methods: This study was conducted on a random sample of 50 dental practitioners of both genders (25 male, 25 female) practising for more than 4 years in urban Bengaluru, India and showing symptoms of neck pain, back pain or wrist pain. In the first round of the questionnaire data was collected from all 50 dentists. Next an educative ergonomic plan was developed which included simple exercises and recommendations in the form of do's and don'ts. The study population were asked to follow the guidelines given and perform the exercises given in the poster daily for a period of 3 months. Then, the questions were again asked. The differences in responses during the first stage and second stage were analyzed. Results: The use of the ergonomic plan led to a statistically significant improvement in certain ergonomic practises such as practise of changing their positions during clinical practice, keeping shoulders and arm at correct level while working and keeping instruments within hand reach. There was a statistically significant reduction in pain levels after the use of the ergonomic plan. Conclusion: The ergonomic plan in the form of recommendations and exercises were an effective tool in improving ergonomic practises and reducing the symptoms of musculoskeletal disorders among dental practitioners. (AU)

Objetivo: Distúrbios osteomusculares relacionados ao trabalho (DORT) são muito comuns entre os dentistas que usam movimentos precisos de mão e punho e posturas estáticas prolongadas. O objetivo deste estudo foi desenvolver um plano ergonômico educativo e testar sua eficácia na redução de sintomas de distúrbios osteomusculares em dentistas. Material e Métodos: Este estudo foi realizado em uma amostra aleatória de 50 dentistas de ambos os sexos (25 homens, 25 mulheres) trabalhando há mais de 4 anos na área urbana de Bengaluru, Índia e apresentando sintomas de dor no pescoço, dor nas costas ou dor no punho. Na primeira etapa do questionário foram coletados dados de todos os 50 dentistas. Em seguida, foi desenvolvido um plano ergonômico educativo que incluía exercícios simples e recomendações na forma de fazer e não fazer. Os participantes foram solicitados a seguir as orientações dadas e realizar os exercícios indicados no pôster diariamente por um período de 3 meses. Em seguida, as perguntas foram feitas novamente. Foram analisadas as diferenças nas respostas durante a primeira etapa e a segunda etapa. Resultados: A utilização do plano ergonômico levou a uma melhora estatisticamente significativa em algumas práticas ergonômicas, como a prática de mudar de posição durante o atendimento clínico, manter ombros e braços no nível correto durante o trabalho e manter os instrumentos ao alcance das mãos. Houve redução estatisticamente significativa dos níveis de dor após a utilização do plano ergonômico. Conclusão: O plano ergonômico na forma de recomendações e exercícios foi uma ferramenta eficaz na melhoria das práticas ergonômicas e na redução dos sintomas de distúrbios osteomusculares entre os cirurgiões-dentistas. (AU)

Low incidence of GIPC3 variants among the prelingual hearing impaired from southern India

The broad spectrum of causal variants in the newly discovered GIPC3 gene is well reflected in worldwide studies. Except for one missense variant, none of the reported variants had reoccurred, thus reflecting the intragenic heterogeneity. We screened all the six coding exons of GIPC3 gene in a large cohort of 177 unrelated prelingual hearing impaired after excluding the common GJB2, GJB6 nuclear and A1555G mitochondrial variants. We observed a single homozygous pathogenic frameshift variant c.685dupG (p.A229GfsX10), accounting for a low incidence (0.56%) of GIPC3 variants in south Indian population. GIPC3 being a rare gene as a causative for deafness, the allelic spectra perhaps became much more diverse from population to population, thus resulting in a minimal recurrence of the variants in our study, that were reported by authors from other parts of the globe.

A rare case of symplastic leiomyoma: case report

Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. Atypical and bizarre leiomyoma synonymous with symplastic leiomyoma are rare smooth muscle tumors that contain cells with moderate to severe cytological atypia, still cell necrosis is absent and mitotic index is fewer than 10/10 HPF. A 42-year P1L1A3 with no comorbidities came with complaints of lower abdominal pain for one year and heavy menstrual bleeding for eight months, LMP- 15/2/19, regular cycles, changes 4-5 pads/day, clots (+) (+), dysmenorrhoea (+). Parity score of P1L1A3, LCB-24 years, not sterilized. On examination - moderately built and nourished, pallor (+). Per abdomen examination - uterus - 22 weeks size, irregular mass, arising from pelvis - no tenderness, lower border not made out. Per speculum examination - cervix and vagina healthy. Per vagina examination - cervix firm, posterior, left fornix: mass felt, non-tender. The patient underwent Abdominal hysterectomy and B/L salpingo-oophorectomy under CSEA. Intraoperative findings - uterus - 20 weeks size, enlarged, a posterior wall subserosal fibroid with degeneration of 6×8 cm. Microscopic appearance - uterus - myometrium shows changes in adenomyosis. Sections of smaller mass reveal structure of leiomyoma. Nuclei are large, hyperchromatic, and show coarse chromatin clumps. Many giant-sized cells with multiple large nuclei were seen. It showed large chromatin clumps. Stroma showed myxoid change. Diagnosis - symplastic leiomyoma, adenomyosis. Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. The regularity of the tumor margins, low mitotic activity, and absence of nuclear atypia or necrosis should be made for the exclusion of malignancy.

Aesthetic Correction of Gingival Pigmentation .Using Different Techniques

Men and women of the present generation are extremely conscious of how they present themselves before the world and have been giving enormous importance to their aesthetics in every facet to augment their personality. An appealing smile boosts one’s individuality. The harmony of the smile is attributable to the contour, colour, and position of the teeth in conjunction with the gingival tissue. Hence undesirable gingival pigmentation can be a major drawback in the aesthetics of the patient. Gingival pigmentation is defined as the discoloration of the gingiva due to lesions analogous with extrinsic as well as intrinsic factors.[1] The five primary pigments melanin, melanoid, oxyhaemoglobin, reduced haemoglobin and carotene are the main causative factors of depigmentation.[2]

A rare case of steroid cell tumor of ovary: case report

Steroid cell tumors of the ovary account for less than 0.1% of all ovarian tumors. These tumors may present at any age with presentations related to the hormonal activity and virilizing properties of tumor. A 61-year-old postmenopausal women presented with complaints of postmenopausal bleeding for 15 days. Parity score of P3L3, not tubectomised. Menopaused 16 years back. History of weight loss noted. She is a known case of diabetes mellitus for 6 years not on any treatment and a known case of depressive disorder for 35 years on treatment on trihexphenidyl lurasidone. Had undergone sigmoid colon polyp removal in June 2018. On examination, P/A- mild gaseous distension (+). P/S- cervix flushed with vagina, pulled up cervix. P/V- uterus size and position couldn’t be made out, anterior fornix fullness (+). Ultrasonography showed bulky uterus with fibroid 4x4cm, endometrial thickness- 9 mm? Krukenberg tumor and posterior mediastinal lymph nodes. Patient underwent Total abdominal hysterectomy with bilateral salpingo-oophorectomy with frozen section on 01/07/19. Frozen section: 1. Ovaries: right ovary - fibrothecoma, left ovary- simple cyst. 2. Uterus- endometrial hyperplasia with atypia. 3. Myometrium- leiomyoma and adenomyosis. Postoperative period was uneventful. On microscopic examination, impression: right ovary- steroid cell tumor, uterus-endometrial hyperplasia with cytological atypia. Ovarian steroid cell tumors are grouped under sex chord stromal tumors and are usually benign, unilateral and characterized by a steroid cell proliferation. Steroid cell tumors are associated with androgenic changes with variable frequency, ranging from 12% to over 50% respectively. The primary treatment is surgical extirpation of the primary lesion and there are no reports of effective radiation or chemotherapy. In a young patient with stage IA disease, a unilateral salpingo oophorectomy is adequate.

Displacement and periodontal stress analysis on palatally impacted canine - A finite element analysis

Objective: The aim of the study was to analyze the displacement and stress pattern in periodontal ligament (PDL) of palatally impacted canines (PIC) lateral incisors (LI) and first premolars (FP) adjacent to the impacted teeth when different magnitudes of orthodontic extrusion forces were applied along with variation in the inclination of the impacted teeth. Methodology: A three-dimensional finite element model of a maxilla containing a palatally impacted canine was made with three different inclinations of the palatally impacted canine (model one, model two, and model three). Forces of 50, 70, and 100 g were loaded on the impacted tooth. Results: There was steady increase in the initial rate of displacement in the three teeth when the magnitude of the force that was applied on to the PIC increased. The initial rate of displacement was more in the FP tooth as compared to LI and the impacted teeth. The von Mises stress on the PDL varied along with the variation in the inclination of the impacted canine. Conclusion: The study showed that there was variation in the displacement and the stress distribution in the impacted canine when it was placed in different angulations. The rate of displacement of the impacted teeth reduced when the crown of the palatally impacted canines (PIC) was inclined more mesial. The use of minimal forces is ideal to extrude the impacted canines as observed from the study that the PDL stress increases with increase in the magnitude of force.

A questionnaire based evaluation of teaching methods in Pharmacology among second MBBS students in Shadan Institute of Medical Sciences Hyderabad, Telangana, India

Background: Pharmacology is one of the important subjects studied during second year MBBS. The general stigma among students regarding pharmacology is that it is a dry and boring subject. Hence lecturers need to reform their teaching methods in order to make pharmacology teaching interesting and a significant learning experience by the students.Methods: A questionnaire based evaluation of 146 second MBBS students about teaching methods in pharmacology was conducted at Shadan institute of medical sciences, Hyderabad. Questionnaire was prepared from previous studies and validated by experts. The questionnaire was given to the students to be solved in one hour.Results: The mean age of the students was 20 plus or minus 2 years. There were 73% females and 27% males. 85% of students felt that pharmacology is an interesting subject. 67.2% wanted more of group discussions. 50.4% did not want any student seminars. 53.9% felt there should be more of problem stimulated lectures in pharmacology. 92% were interested in computer assisted learning. 57.5% of students preferred learning from textbook and class lectures. 68.1% students preferred to study pharmacology for regular tests only, 92% students wanted Multiple Choice Questions (MCQ’s) to be discussed in class.Conclusions: There is a definite need for modification of undergraduate curriculum so as to make pharmacology learning more understandable by students. Novel methods of teaching like small group discussions, computer assisted learning, bed side teaching etc can be adopted to make pharmacology an interesting and useful subject among students.

Maternal pregnancy associated plasma protein-A (PAPP-A) and uterine artery Doppler changes as predictors of pre-eclampsia: a prospective observational study from a teaching hospital in Mysore, Karnataka, India

Background: Hypertensive disorder affects 10-12% of pregnancies. Identifying women, who are at risk is conducive to prompt gestational management. PAPP-A is a protein complex produced by the developing trophoblasts. Low levels of PAPP-A at 10–14 weeks is a marker of impaired placentation and a smaller placental mass. Doppler imaging permits non-invasive evaluation of the uteroplacental circulation and is invaluable in the management of high-risk pregnancies. The uterine artery Doppler screening identifies patients at risk for developing preeclampsia. To study the association of PAPP-A and the uterine artery Doppler changes as predictor of pre-eclampsia in pregnant women at 11-14 weeks of gestation.Methods: This was a prospective study of 150 pregnant women presenting at 11-14 weeks of gestation for a prenatal check-up. After considering the inclusion and exclusion criteria, serum samples for PAPP-A were assayed. Ultrasound Doppler was used to obtain uterine artery flow velocity waveforms and mean pulsatility index and resistance index of uterine arteries were calculated. Cases were followed up till term and observed for development of pre-eclampsia.Results: 48.6% had low serum PAPP-A levels, in which 77% developed PE. The Mean PI and RI is 2.34±1.16 and 0.58±0.1 respectively. 30% women with abnormal PI values and 24% of women with abnormal RI values developed PE.Conclusions: The combination of maternal history with low serum PAPP-A levels and abnormal uterine artery Doppler at 11-14 weeks can be used as predictor of pre-eclampsia.

Successes and challenges of HIV/AIDS program in Oman: 1984-2015

We sought to provide an epidemiological situation of HIV in Oman and assess the ongoing impact of the program established in 1987 using data collected from national health reports between 1984 and 2015. Since the report of the first AIDS case in Oman in 1984, the numbers have steadily increased. Eighty percent of the cases were reported between 1996 and 2015. By the end of 2015, there were 2879 people known to be living with HIV [PLHIV] giving a prevalence of < 1%. More males were affected than females [p < 0.001]; 69.7% of affected males and 73.1% of females were aged 20-49 years. The highest HIV rate was in the Musandam governorate. Most [66.8%] new HIV infections were caused via unprotected sex, 8.3% from mother-to-child, 4.3% by intravenous drug abuse, 3.2% via blood transfusion, and 17.4% by unknown causes. PLHIV on antiretroviral drug therapy [ART] increased 57.0% by the end of 2015 [p < 0.0001]. A 23.0% reduction in mortality due to HIV was noted [p < 0.0001]. Maternal-to-child transmission per 100 000 live births were 11, 9, 17, 10, 6, and 4 from 2009 to 2014, respectively. In 2015, 67.6% of PLHIV knew their HIV status, 65.0% were on ART, and 48.0% achieved virological suppression. There is an urgent need to focus on the quality and coverage of treatment, as well as care and support to HIV patients with special attention to high-risk groups

eproductive health status and life skills of adolescent girls dwelling in slums in Chennai, India.

Background.Adolescent girls dwelling in slums are vulnerable to poor reproductive health due to lack of awareness about reproductive health and low life skills. These girls are in a crucial stage of their life cycle and their health can impact the health of future generations. Despite adolescents comprising almost one-quarter of the Indian population they are ill served in terms of reproductive health. Methods. This cross-sectional study was done among 130 slum-dwelling adolescent girls, aged 13–19 years, using multistage sampling method from five slums in Chennai, southern India. The reproductive and menstrual morbidity profile, personal and environmental menstrual hygiene was assessed to determine their reproductive health-seeking behaviour and life skills. Results. Ninety-five (73%) girls (95% CI 66.23–81.36) reported menstrual morbidity and 66 (51%; 95% CI 50.74– 52.25) had symptoms suggestive of reproductive/urinary tract infection. Of the girls surveyed, 55 (42%) were married. Nearly 25% (95% CI 23.07–26.92) of the married girls had a history of abortion and 18% (95% CI 11.32–25.07) had self-treated with medications for the same. Contraceptive use among ever-married girls was 22.7% (95% CI 20.83– 24.56). Even though 75% of respondents knew about HIV/ AIDS, their knowledge of modes of transmission and prevention were low (39% and 19%, respectively). Almost 39% of respondents felt shame or insecurity as the key barrier for not seeking reproductive healthcare. About 52% had low life skill levels. On logistic regression, menstrual morbidity was high among those with low life skills, symptoms suggestive of reproductive/urinary tract infection were high among those who were married before 14 years of age and life skills were high among those who belonged to the scheduled caste community. Conclusion. There is a high prevalence of menstrual/ reproductive morbidity, self-treated abortion and low knowledge about modes of HIV transmission/prevention and use of contraceptives among adolescent girls in slums in Chennai. There is a need to initiate community-level life skill education, sex education and behaviour change communication

Antifungal susceptibility testing of few medicinal plant extracts against Aspergillus spp. and Microsporum sp.

Mycoses are fungal infections, the incidence of which in immunocompromised patients is currently devastating and the drugs available at hand are reported to exhibit side effects. To surmount the prevailing difficulty of complete eradication of the fungal infection, exploring new arena is a requisite and nature’s wealth can be one area that may lead to a cure for fungal infections. In the present study, the whole methanolic extracts of few medicinal plants were evaluated against Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger and the dermatophyte Microsporum gypseum isolated from the soil. Enicostemma littorale and Wrightia tinctoria exhibited significant (P<0.001) inhibition of about 48% against A. niger. Eupatorium odoratum inhibited both A. fumigatus (52%) and A.flavus (32%) whereas Enicostemma littorale showed about 54% of significant (P<0.05) inhibition against A. fumigatus. Significant inhibition of M. gypseum was exhibited only by Sphaeranthus indicus flower extracts (65% at P<0.05) which was even higher than the inhibition exhibited by positive control ketaconazole (49%) at 0.1 mg/ml concentration. This study demonstrates that among the medicinal plants evaluated E.littorale, W.tinctoria, E.odoratum and S.indicus flower exhibited significant antifungal activity against the tested organisms.

Formulation and evaluation of sustained release matrix tablets of nicorandil.

In the present research, an attempt has been made to formulate sustained release matrix tablet of nicorandil, a novel potassium channel opener used in cardiovascular disease. The tablets were prepared by wet granulation method and studied the effect of matrix former xanthan gum and guar gum separately. Tablets were evaluated for uniformity of weight, drug content, friability, hardness, thickness, in vitro dissolution and swelling study. All the formulation showed compliance with pharmacopoeial standard. As the time increases, the swelling index was increased; later on it decreases gradually due to dissolution of outermost –gelled layer of tablet into dissolution medium. Comparison between xanthan gum and guar gum, it has been observed that swelling index of guar gum was significantly more compared to xanthan gum. The dissolution result shows that an increased amount of polymer resulted in retarded drug release. The maximum drug release was found to be 90% over a period of 12 hours in guar gum based tablets (F4). Similarly maximum drug release was found to be 96% over a period of 12 hours in Xanthan gum based tablets (F1). This indicates that the minimum quantity of guar gum and Xanthan gum that is drug to gum ratio of 1:1 is required to prepare the sustain release matrix tablets of nicorandil.

Antioxidants and lipid peroxidation in gestational diabetes--a preliminary study.

Increased free radical activity in gestational diabetes (GDM) can lead to a host of damaging and degenerative maternal and fetal complications. Hence antioxidant levels in blood of GDM mothers and cord blood were estimated. Erythrocyte glutathione (GSH), superoxide dismutase (SOD) and thiobarbituric acid reactive substances (TBARS), plasma vitamins C and E and serum total glutathione-S-transferase (GST), protein thiols and ceruloplasmin (Cp) were estimated spectrophotometrically in maternal blood of age matched controls and mothers with GDM and also in cord blood samples of the above. There was a significant increase in the erythrocytic GSH, serum total GST and protein thiols in GDM maternal blood when compared to controls whereas erythrocytic SOD exhibited a marked decrease in GDM cases. The changes in plasma vitamins C and E, Cp and erythrocytic TBARS in GDM were not significantly different from controls. Cord blood levels of protein thiols were also significantly increased in GDM. No significant changes were observed in the serum Cp and GST levels of the same. Hence, elevated glucose levels can induce oxidative stress in GDM mothers.