New cost-effective human leukocyte antigen testing algorithm for screening of human leukocyte antigen-matched related donor in thalassemia major patient pretransplant workup: A single-center study from resource-constrained settings

Introduction: India has a huge disease burden of thalassemia major with an estimated 40 million carriers and over a million thalassemia major patients. Very few patients are optimally treated, and the standard of care “hematopoietic stem cell transplant” (HSCT) is out of reach for most patients and their families. The cost of HSCT is significant, and a substantial proportion of it goes to human leukocyte antigen (HLA) testing of family members (HLA screening) in hope of getting a matched related donor (MRD) for HSCT. The aim of this study was to establish that a new proposed testing algorithm of HLA typing would be more cost-effective as compared to the conventional HLA screening within MRD families for possible HSCT. Material and Methods: Buccal swab samples of 177 thalassemia patients and their prospective family donors (232) were collected. Using a new HLA testing algorithm, samples were tested for HLA typing in a sequential manner (first HLA-B, then HLA-A, and finally HLA-DR) using the sequence-specific oligonucleotide probe method on the Luminex platform. Results: The new sequential HLA-A, HLA-B, and HLA-DRB1 testing algorithm showed a 49.1% reduction in cost compared to the conventional HLA testing algorithm. Furthermore, 40 patients (22.59%) were found to have HLA-MRD within the family among other samples that were tested. Conclusion: The new HLA testing algorithm proposed in the present study for identifying MRD for HSCT resulted in a substantial reduction in the cost of HSCT workup.

Current status of trachoma in India: Results from the National Trachoma Prevalence Survey

Purpose: In the mid?twentieth century, trachoma was endemic in the northwestern states of India. We aimed to generate recent estimates of prevalence of trachomatous inflammation, follicular (TF) and trachomatous trichiasis (TT) in ten suspected?endemic districts across seven previously hyper?endemic states and union territories for trachoma in India including Delhi, Rajasthan, Haryana, Punjab, Gujarat, Uttarakhand and the Andaman and Nicobar Islands. Methods: Population?based prevalence surveys were undertaken in 10 districts. In each of those districts, two?stage cluster sampling was used to select a sample of 2000 children aged 1–9 years and all adults aged ?15 years in the enumerated households from a total of 20 clusters per district. Consenting eligible participants were examined for trachoma by trained ophthalmologists using the World Health Organization’s simplified grading system. Data were analyzed at the district level. Results: A total of 13,802 households were surveyed in which 19,662 children were examined for TF and 44,135 adults aged ?15 years were examined for TT. District?level TF prevalence in 1–9?year?olds ranged from 0.1% in Bikaner (95% CI: 0.01–0.3) to 2.1% in Dholpur (95% CI: 1.6–2.8) and that of trichiasis ranged from 0.7 per 1000 in Pauri Garhwal (95% CI: 0.01–1.4) to 22.1 per 1000 (95% CI: 15.8–28.4) in Car Nicobar. In four districts (Car Nicobar, Dholpur, Hoshiarpur, Tonk), trichiasis prevalence in adults aged ?15 years was ?0.2%. Conclusion: TF was not a public health problem in any of the districts surveyed; thus, antibiotic mass drug administration is not needed. However, TT among adults was found to be above 0.2% in four districts; thus, further trichiasis surgery interventions at the public health level are warranted to achieve elimination. These findings will facilitate planning for elimination of trachoma as a public health problem in India.

Additive Manufacturing: A 3-Dimensional Approach in Periodontics

Additive manufacturing technology or 3-dimensional printing has been used since ages in various fields including medical. Their addition to dentistry is recent and has tried to revolutionize the field. It is being used in various fields of dentistry like endodontics, prosthodontics, orthodontics, oral and maxillofacial surgery and recently in periodontics and Implantology. With introduction of recent “layer-by-layer” additive technology, their use in periodontal field has changed its treatment planning. It is use in preparation of customized scaffold with or without stem cell therapy, ridge augmentation, sinus lift and guided implant surgery, implant fixtures, education models,drug technology and many more. This review has tried to explain the various applications of the additive manufacturing in the field of periodontics with recent evidences. This paper highlights the role of 3-dimensional printing which can change the future of periodontal management.

Gingival Presentation of Verrucous Carcinoma- A Rare Case.

Verrucous carcinoma also known as Ackerman’s tumour is a variant of well differentiated squamous cell carcinoma that affects cutaneous and mucosal surfaces. Ackerman’s tumour accounts for 1-10% of cases of Squamous Cell Carcinoma in the epithelial lining of oral mucosa and gingiva. It appears as slowly enlarging warty, exophytic cauliflower like overgrowth, grey or white in colour and is seen commonly in older males.1 Tobacco consumption has been the primary aetiology of verrucous carcinoma.2,3 The oncogenic viruses HPV 16 and 18 are also implicated in the aetiology of this condition.4 Other etiological factors may include smoking, poor hygiene and alcohol abuse. Verrucous carcinoma shows typical clinical behaviour being locally invasive. The rate of nodal metastasis is less, neck dissection and radiotherapy are the least opted modalities for treatment. The treatment of this is usually surgical excision and prognosis is fair. In this paper we report a typical gingival presentation of verrucous carcinoma bilaterally along with the clinicopathological diagnosis and a review of scientific literature.

Prevalence of visual impairment due to uncorrected refractive error: Results from Delhi‑Rapid Assessment of Visual Impairment Study.

Aim: To estimate the prevalence of visual impairment (VI) due to uncorrected refractive error (URE) and to assess the barriers to utilization of services in the adult urban population of Delhi. Materials and Methods: A population‑based rapid assessment of VI was conducted among people aged 40 years and above in 24 randomly selected clusters of East Delhi district. Presenting visual acuity (PVA) was assessed in each eye using Snellen’s “E” chart. Pinhole examination was done if PVA was <20/60 in either eye and ocular examination to ascertain the cause of VI. Barriers to utilization of services for refractive error were recorded with questionnaires. Results: Of 2421 individuals enumerated, 2331 (96%) individuals were examined. Females were 50.7% among them. The mean age of all examined subjects was 51.32 ± 10.5 years (standard deviation). VI in either eye due to URE was present in 275 individuals (11.8%, 95% confidence interval [CI]: 10.5–13.1). URE was identified as the most common cause (53.4%) of VI. The overall prevalence of VI due to URE in the study population was 6.1% (95% CI: 5.1–7.0). The elder population as well as females were more likely to have VI due to URE (odds ratio [OR] = 12.3; P < 0.001 and OR = 1.5; P < 0.02). Lack of felt need was the most common reported barrier (31.5%). Conclusions: The prevalence of VI due to URE among the urban adult population of Delhi is still high despite the availability of abundant eye care facilities. The majority of reported barriers are related to human behavior and attitude toward the refractive error. Understanding these aspects will help in planning appropriate strategies to eliminate VI due to URE.

Host modulation and host modulating agents in periodontal therapy.

Specific microorganisms initiate the immune-inflammatory processes that destroy tissue in periodontitis. Recent work has demonstrated, in addition to bacterial control, that modulation of the host immuneinflammatory response is also capable of controlling periodontitis. The concept of host modulation is fairly new to field of dentistry but is universally understood by most physicians who routinely apply the principles of host modulation in the management of various chronic progressive disorders. In dentistry the term was introduced by William and Golub and later on expanded by others in dental profession. This article gives an overview of host modulation and host modulation agents.

Penicillamine induced pseudoxanthoma elasticum with elastosis perforans serpiginosa.

Long term D-penicillamine therapy, especially when used to treat Wilson's disease has been shown to cause elastosis perforans serpiginosa, pseudoxanthoma elasticum perforans and other degenerative dermatoses. We report a 23-year-old male patient who presented with multiple firm papules, nodules over the neck, axillae, front of elbows for five years. He was a known case of Wilson's disease on long-term treatment with penicillamine for the past 12 years. The papulonodular lesions were non-tender and some were discrete while others were arranged in a circinate pattern. There was central scarring of the skin within the circinate lesions. In addition, there were several small yellowish papules on both sides of the neck which eventually became confluent to form plaques. Histopathology confirmed the diagnosis of elastosis perforans serpiginosa and pseudoxanthoma elasticum. He was treated with cryotherapy (using liquid nitrogen through cryojet) for former lesions. The lesions showed remarkable improvement after five sittings. Now the patient is under trientine hydrochloride (750 mg twice daily) for Wilson's disease.