Corticotomy‑assisted retraction: An outcome assessment.

Background: To assess the efficiency and treatment outcome of patients treated with corticotomy‑assisted en‑masse orthodontic retraction as compared with the en‑masse retraction without corticotomy. Materials and Methods: Forty adult patients with bimaxillary protrusion requiring correction of bidental proclination constituted the sample. The study group consisted of 22 patients (male 11, female 11) willing to undergo surgery to reduce the duration of their orthodontic treatment and 18 patients (male 9, female 9) desirous of undergoing conventional orthodontic treatment without surgical intervention constituted the control group. Comparison of rate of retraction and anchor loss between the study and the control group was assessed. Results: Average rate of space closure of 1.8 mm/month in the maxilla and 1.57 mm/month in the mandible was observed in the study group compared to 1.02 mm/month in the maxilla and 0.87 mm/month in the mandible in the control group. The rate of retraction accelerated during the first 2 months of retraction. Molar anchor loss of approximately 0.6 mm occurred in the study group, and 1.8 mm occurred in the control group during the 4 months. Conclusion: The rate of retraction with study group was twice as faster when compared to the control group, accelerating during the first 2 months of retraction. There was better anchorage control with the undecorticated molar segment during the retraction period but was found to increase as time advanced.

Stomaplasty--anterior advancement flap and lateral splaying of trachea, a simple and effective technique.

BACKGROUND: Stomal stenosis after laryngectomy is a common and distressing complication. Once sets in, it is generally progressive, causes problems and needs active intervention. AIM: To evaluate effectiveness of new simple method of stomaplasty in solving troublesome complication of stoma stenosis. SETTINGS AND DESIGN: Charts of eight patients who underwent modified stomaplasty and completed 1 year were reviewed. MATERIALS AND METHODS: A modified anterior advancement flap and lateral splaying of trachea for stoma plasty are described. This involves excision of scar tissue of the anterior two-third of trachea and interposition of the defect with an inferiorly based triangular skin flap. The tracheo-esophageal-prosthesis (TEP) site is left untouched. STATISTICAL ANALYSIS: Outcome were measured in relation with need for further stenting or any other revision procedure required and ability to use TEP for speech production. RESULTS: Eight patients underwent stoma revision surgery. Median preprocedure stoma diameter was 10 mm vertically (range 8-12 mm) and 6 mm horizontally (range 5-10 mm). This could be improved to 25 mm (range 22-30 mm) vertically and 16 mm (range 14-20 mm) horizontally after stoma revision. At 1-year follow-up, the median measurements were 20 mm (range 16-26) vertically and 14 mm (range 12-18) horizontally. Postprocedure, one patient required intermittent stenting at nighttime. All patients could use the TEP effectively. One patient who underwent salvage laryngectomy following chemoradiotherapy developed flap dehiscence. CONCLUSIONS: This is a simple and effective technique for stomaplasty. All patients treated with this technique had adequately large stoma for breathing and use of TEP.

Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers.

BACKGROUND: Chemo-radiotherapy has become the standard of care for loco-regionally advanced head and neck cancers. Platinum based regimens are the most effective. Although benefits are proven with chemo-radiation, acute toxicities are markedly increased. The dose and delivery schedules of Cisplatin have ranged from intermittent higher dose [100 mg/m2] every 3 weeks to low dose [6 mg/m2] daily administration. At present there is no data indicating which regimen is superior. PURPOSE: To compare acute toxicities of two chemotherapy schedules for head and neck cancers. MATERIALS AND METHODS: A total of 83 head and neck cancer patients treated with two schedules of concurrent chemo RT were analyzed, retrospectively, for treatment toxicity. In group A [51 patients], chemotherapy [CT] was administered on week 1, 4 and 7 [cisplatin 100 mg/m2] over a period of 2-3 days. In group B [32 patients], CT was delivered weekly [cisplatin 40 mg/m2]. Radiotherapy dose was 7000 cGy in 35 fractions for definitive concurrent chemo-radiation and 6600 cGy in 33 fractions for adjuvant treatment. RESULTS: Group B patients had increased grade III skin and hematological toxicity, where as patients in group A had more pharyngeal toxicity. Treatment interruptions and percentage of weight loss were higher in group B. Weekly CT schedule had higher rate of severe mucositis, which was statistically significant on both univariate [P = 0.005] and multivariate [P = 0.007] analysis. CONCLUSIONS: Three weekly CT is less toxic than weekly. Weekly CT can be made more acceptable by reducing the dose and using feeding tubes for nutrition.

Type 2 diabetes express highway, where is the 'U' turn?

The 'U' turn in Type 2 Diabetes Express Highway probably lies in lifestyle modifications--going back to traditional lifestyle with use of modern technology to achieve happiness. There is a difference between technology for comfort and technology for happiness.

An ergonomic study of chronic musculoskeletal pain in schoolchildren.

OBJECTIVE: Schoolchildren developing chronic musculoskeletal pain from carrying heavy backpacks (hereafter referred to as "pain") is a worldwide issue. The present study of two cohorts, consisting of 248 Indian and 103 American schoolchildren aged 9.0 to 20.6 years, using a semi-objective pain criteria, sought to answer the questions: Can pain be correlated with Body Mass Index (BMI), Weight Carried, Strength, Mood or Body Fat? What are the similarities and differences between the Indian and American schoolchildren in the above context? METHODS: After obtaining parental consent, the schoolchildren completed a questionnaire. Then, they were weighed with and without carry-on items and their height as recorded. Isometric arm and shoulder strengths were measured using the Jackson Strength Tester. Using a Skinfold Caliper, skinfold thicknesses at the right triceps and calf was measured. Using the Borg Pain Scale the students assessed the pain experienced from their own backpacks, rated the acute pain experienced while carrying a standard 10 kg. or 7 kg. backpack. RESULT: Half the schoolchildren reported pain located primarily in the shoulders and back (where most students carry their backpacks). Pain did not correlate with study variables (p > 0.05), and the student moods were mostly happy or neutral. Americans are five times as stressed or sad than the Indians, and the average weight carried decreased as the grade increased. The mean of the age, height, arm and shoulder strengths, and BMI for the 5th to 8th grade schoolchildren (younger groups) and the 9th to 12th grade schoolchildren (older groups), in India, was lower than their American counterparts (p < 0.05). In contrast, the weight carried to school by the Indian children was higher (p < 0.05). The mean pain level perceived by both the younger and older groups in both countries, was not statistically different (p > 0.05). CONCLUSION: Musculoskeletal pain in schoolchildren due to carrying heavy backpacks is a significant problem. There are some similarities, but a number of differences between the Indian and American schoolchildren. Implementing the Pain Prevention Screening is expected to minimize pain, if not lead to a pain-free child.

Diabetes mellitus in Dombivli--an urban population study.

OBJECTIVE: The present study was undertaken with the following aims and objectives. a) To determine the prevalence of diabetes. b) To compare the prevalence of newly diagnosed diabetic subjects, diagnosed by the ADA and WHO criteria. c) To determine to what extent prevalence rates are affected by gender, age and body mass index. METHODS: The study population consisted of 520 subjects aged 20 years and above selected by random sampling. Blood glucose both fasting and post glucose (75 gms) two hours sample were analyzed. Baseline clinical data like height, weight and blood pressure were recorded. Known cases of diabetes were excluded from the study. RESULTS: The prevalence of diabetes (fasting blood glucose) as per WHO criteria was 4.61% while it was 7.5% as per ADA criteria. The prevalence according to the two hour glucose reading was 6.15%. The mean glucose level increase with age. With increasing BMI the percentage of diabetic subjects also increases. The prevalence of impaired glucose tolerance (IGT) was 8.6% in subjects below 50 years and 13.4% in subjects older than 50 years. IGT values also increase with increasing age and BMI. 1.3% of subjects had normal fasting glucose level (< 126 mgm%) but high post glucose levels (> 200 mgm%). CONCLUSIONS: The prevalence of diabetes and IGT is higher as compared to earlier studies. The mean blood glucose and IGT increase with increasing age and BMI. Several subjects had normal fasting blood glucose but increased two hour blood glucose level indicating that fasting glucose alone should not be used to diagnose DM. Urbanization and life style of residents of Dombivli contribute to the high prevalence.

Neuropathy in rheumatoid arthritis.

BACKGROUND: Paucity of Indian literature on rheumatoid neuropathy creates a lacuna in the critical evaluation and discussion of the subject. We did this study to find out the incidence and pattern of neuropathy and to correlate it with disease parameters and other extra-articular involvement. MATERIAL AND METHODS: We studied 31 patients of rheumatoid arthritis (RA) classified by ACR criteria. Electromyography and nerve conduction studies (EMG/NCV) were done in all the patients apart from routine laboratory and radiological investigations. Electrocardiograph (ECG), pulmonary function tests (PFT) and ophthalmological examination were also carried out to ascertain extra-articular involvement. RESULTS: Ten out of 31 RA patients had neuropathy of which five each were overt and subclinical respectively. Only one patient had entrapment neuropathy. Four of the ten patients had pure motor neuropathy whereas the other six were sensori-motor neuropathies. Four patients had mononeuritis multiplex and five had symmetrical peripheral neuropathy. Nine of the ten neuropathic patients had RA for more than 2 years. Seven patients had other extra-articular features along with neuropathy. CONCLUSIONS: One-third of patients with RA have evidence of neuropathy. Disease parameters such as activity, rheumatoid factor and functional and radiological grade do not correlate with neuropathy. Non-entrapment sensori-motor type of neuropathy is the most common type.

Enterogenous duplication cyst presenting as obstructed inguinal hernia.

We report a 5-year-old boy with enterogenous tubular duplication cyst presenting as obstructed inguino-scrotal hernia.

Modified Glasgow Coma Scale to predict mortality in children with acute infections of the central nervous system.

BACKGROUND: This study aimed to identify the predictors of hospital mortality in children with acute infective disorders of the central nervous system using an aggregate Modified Glasgow Coma Scale (MGCS) score and other clinical variables assessed within 24 hours of hospitalization. METHODS: We did a prospective cohort study in a teaching and referral hospital in Lucknow, North India. Consecutive children aged 1 month to 12 years of age admitted with acute infective disorders of the central nervous system were included in the study. The diagnosis was based on the presence of symptoms of fever, headache or irritability with or without vomiting, and either altered sensorium or first episode of seizures or both. The main outcome measure was hospital-based mortality. RESULTS: Of the 230 patients included in the study, 42.2% had pyogenic meningitis, 36.9% had tuberculous basal meningitis and 20.9% had meningo-encephalitis. There were 43 (18.7%) deaths of which 44.2% were within 3 days of admission. Death was associated with the day 1 aggregate MGCS score only. The area under the curve of four strata of aggregate MGCS was 0.63 (SE 0.05). The likelihood ratio for discharge with an aggregate MGCS score of < 5 was 0.52 (95% CI:0.29-0.95) and > 10 was 5.52 (9% CI:1.02-31.96). CONCLUSION: The MGCS can be used to predict discharge in patients with acute infective disorders of the central nervous system within 24 hours of hospitalization. The scale is simple, can be applied at the bedside and does not depend on any investigations. In developing countries with limited investigative facilities it can be used for identification and selective referral of patients with a higher risk of death to specialized centres. This study validates the predictive value of the MGCS.

Antiamoebic activity of 3,3'-fluro-4,4'-di-(pyrrolidine-2-ylidene amino)-diphenyl (liroldine), against experimentally infected intestinal and hepatic amoebiasis.

HL 707, Liroldine, a novel synthetic compound, was found effective against both extraintestinal and intestinal amoebiasis in animal models. Its activity against hepatic infection in golden hamsters is comparable with that of different derivatives of nitroimidazoles used for human treatment. Against intestinal amoebiasis in Wistar rats, the activity was superior to nitroimidazoles and chloroquine. Paramomycin was comparable and diloxanide furoate was marginally superior. The comparative in vitro and in vivo studies with standard marketed drugs and Liroldine indicate an excellent profile of the compound against experimental amoebiasis. LD50 of Liroldine determined in mice is 910 mg/kg x 1, po and 940 mg/kg x 1 ip).

Cri du chat syndrome.

Three cases of cri du chat syndrome with varying ages of presentation are compared and contrasted to highlight the clinical features and evolution of the phenotype with time.

Association of gastroesophageal reflux (GER) with bronchial asthma.

Eighty children with bronchial asthma and ten control cases underwent radionuclide gastroesophagography for the detection of gastroesophageal reflux. Thirty nine per cent asthmatic children demonstrated esophageal reflux on scintiscanning. The ten control subjects had no reflux. The presence of reflux correlated strongly with the presence of nocturnal exacerbation of symptoms. Bronchodilator therapy did not affect the prevalence of GER in asthmatic children.

Sickle cell syndromes in and around Bardoli.

The study comprised of 2 groups. In group I sickling test was done in students studying in a school which mainly caters to the educational needs of the backward community. Out of 130 students examined 24 were found to be sicklers. The distribution of this cases among various castes/tribes were as follows--Choudharys (Cd)-13, Gamits (Gt)-4, Dhodhia Patels (DP)-4, Koknis (K)-2 and Koli Patel (KP)-1. In group II, patients admitted in the hospital between Jan '81 to June '82 were studied. The prevalence of sickle cell syndrome was 1.74%. The most common mode of presentation were limb pains and weakness. Hemoglobin values ranged from 3.0 gram% to 12 gms%. 35 cases of HbSS, 149 cases of HbAS and 1 case of Sickle Beta thalassemia were seen. The distribution of the cases amongst the various tribes and castes were as follows-Cd-93, Gt-56, DP-23, KP-7, K-4 and Rathods (R)-2. No cases were found in Anavil Brahmins or Patidar Patels. Clinical and pathological observations included palpable splenomegaly in 54 cases, splenic abscess in 1 case, isothenuria in large number of patients, microscopic hematuria in 6 cases and frank hematuria in 1 case. Osteomyelitis and cholecystitis were seen in one case each.

Acute appendicitis mistaken as acute rejection in renal transplant recipients.

Case histories of 2 renal transplant recipients are reported who had presenting features of fever, leukocytosis and pain/tenderness over right iliac fossa and were diagnosed to be due to acute appendicitis rather than more commonly suspected acute rejection episode which has very similar features. Diagnosis of acute appendicitis was suspected on the basis of rectal examination and later confirmed by laparotomy. The purpose of this communication is to emphasize the need for proper diagnosis in patient with such presentation; otherwise wrong treatment may be received.