Demineralization of tooth enamel following radiation therapy; An in vitro microstructure and microhardness analysis

Objective: The objective of this study is to evaluate the effects of radiotherapy doses on mineral density and percentage mineral volume of human permanent tooth enamel. Materials and Methods: Synchrotron radiation Xray microcomputed tomography (SRμCT) and microhardness testing were carried out on 8 and 20 tooth samples, respectively. Enamel mineral density was derived from SRμCT technique using ImageJ software. Microhardness samples were subjected to Vickers indentations followed by calculation of microhardness and percentage mineral volume values using respective mathematical measures. Data were analyzed using paired t-test at a significance level of 5%. Qualitative analysis of the enamel microstructure was done with two-dimensional projection images and scanned electron micrographs using μCT and field emission scanning electron microscopy, respectively. Results: Vickers microhardness and SRμCT techniques showed a decrease in microhardness and an increase in mineral density, respectively, in postirradiated samples. These changes were related to mineral density variation and alteration of hydroxyapatite crystal lattice in enamel surface. Enamel microstructure showed key features such as microporosities and loss of smooth homogeneous surface. These indicate tribological loss and delamination of enamel which might lead to radiation caries. Conclusions: Tooth surface loss might be a major contributing factor for radiation caries in head-and-neck cancer patients prescribed to radiotherapy. Such direct effects of radiotherapy cause enamel abrasion, delamination, and damage to the dentinoenamel junction. Suitable measures should, therefore, be worked out to protect nontarget oral tissues such as teeth while delivering effective dosages to target regions

Demographic and Clinical Profile of Children with Severe Acute Malnutrition – An Experience from Nutritional Rehabilitation Centre in Jammu

Background: Childhood undernutrition remains a key public health challenge in India and is a significant contributor of Under-5mortality as these children have significantly higher risk of mortality and morbidity. Nutritional rehabilitation centres have beenset up by Government of India at facility level to provide medical and nutritional care to Severe Acute Malnourshied childrenunder the age of 5 years who have medical complications.Materials and Methods: Retrospective record based observational study conducted in NRC located at SMGS Hospital, GMCJammu. All the children upto 60 months of age, admitted in NRC during the study period, from September2018 to February2019 were included in the study.Aims and Objectives: To know the demographic details and clinical profile of comorbidities in children with Severe AcuteMalnutrition and to assess the outcome of these children.Results: A total of 118 children were admitted in the Nutritional Rehablitation Center during the study period 60% werefemales. 60% of the children were less than 12 months of age 20 % were between 13 and 24 months of life.Children belongedto all the districts, 22% from Jammu, 18% Reasi, 16% Udhampur, 15% Rajouri, 8% Kathua, 7% Poonch and 6% Samba.Bronchopneumonia (39.8%), Diarrhoea (30.5% ) and skin infections(11%) were the commonest morbidities. 73.5% of thechildren had associated anemia. Other comorbidities were septicemia (10.1%), CSOM (5.9%), UTI (5%), measles (5%) andtuberculosis (2.5%).Conclusion: Early diagnosis and standardized protocol based treatment in the NRCs has been very effective in reducing themorbidity and mortality in SAM patients.

Clinical Profile of Patients with Cerebral Palsy – A Hospital-based Study

Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide with the greatest burdenfound in developing countries. Motor impairments are the hallmarks of CP, but in many individuals, other impairments suchas vision, hearing, speech, cognition, behavior, and epilepsy may at times produce even greater activity limitation in daily life.Early diagnosis and comprehensive management with a multidisciplinary approach are required for satisfactory managementof a child with CP. In low- and middle-income countries, there are gaps in knowledge especially in spheres of epidemiologicalresearch, intervention, and service utilization.Materials and Methods: This cross-sectional observational study was conducted among the children coming to the inpatientand outpatient Department of Paediatrics SMGS Hospital, Government Medical College Jammu.Aims and Objectives: The aim of the study was to study the clinical pattern and etiological factors of CP and to determine the prevalenceof associated disabilities or handicaps in CP. Our study population included 100 cases of diagnosed CP up to 18 years of age.Results: A total of 100 children of CP were evaluated of which 59% were boys and 41% were girls. CP patients belonged tovarious age groups as, <2 years (46%), 2–4 years (30%), 4–6 years (12%), 6–12 years (10%), and 12–18 years (2%). CP patientscoming to our hospital belonged to various districts such as Jammu (27%), Rajouri (20%), Doda (17%), Reasi (11%), Udhampur(8%), Kathua (7%), Poonch (5%), and Samba (5%). The most common etiological factors were birth asphyxia (48%). The spastictype was the most common (65%), followed by ataxic (15%), dyskinetic (10%), and mixed (10%). Among the spastic quadriplegic,subtype was seen in 69%, diplegia in 23%, and hemiplegia in 8%. Speech delay was the most common associated problem(80%), followed by seizures (56%), feeding difficulty (46%), and contractures and deformities (20%). Formal vision assessmenthad been done in only 48% of the patients, among them, 30% had normal vision, 9% had refractive error, 7% were havingstrabismus, and 2% were blind. Spectacles were being used by only three patients. A mere 30% of the patients had undergonehearing assessment; among them, 6% were having moderate to profound hearing loss. Hearing aid was being used by twopatients. Physiotherapy services were being availed by 47% of patients. Early intervention and appropriate rehabilitation servicesshould be provided to such children to limit the disability. Medical college hospitals of India, where a number of these childrenreport with their various problems, can play an important role as nodal centers for evaluation and registration of such patients.

Acute bilirubin encephalopathy in term neonates: a hospital-based study

Background: Acute Bilirubin Encephalopathy and kernicterus is an important cause of cerebral palsy, developmental delay and hearing impairment in low-middle income countries. Interventions such as universal screening for neonatal jaundice, Rhesus immunoglobulins, intensive phototherapy and exchange transfusion have made kernicterus rare in high income countries, but in our set up such cases continue to be reported.  Methods: Retrospective observational study where case records of term neonates brought to the neonatal ICU with signs and symptoms of acute bilirubin encephalopathy during the years 2016 and 2017 were sought and analysed.Results: A total of ten term babies reported to the neonatal unit with severe hyperbilirubinemia along with signs and symptoms of bilirubin encephalopathy of which 60% were females. 90% had a birth weight of more than 2.5 kg and mean birth weight was 2.7±0.25 kgs. All the babies were out born. A 4 babies were born at home of which 3 pregnancies were completely unsupervised during the antenatal period. 90% of the babies were from the rural areas, 6 of the cases were from the districts Rajouri, Poonch and Reasi where the terrain is hilly, 2 from rural areas of Jammu and 1 from Kathua. Only 1 was from the Jammu city. The age at admission ranged from 3-9 days and serum bilirubin from 24 to 43.3 mg %. A 5 babies had ABO incompatibility, 1 Rh incompatibility, 1 sepsis, while no cause could be found in 3.Conclusions: Neonatal jaundice is often not easily appreciated by mothers and caregivers in the home setting until it becomes severe enough, at which point neurological damage may have already occurred. There is an urgent need to train the primary health care personnel in assessment and early identification of risk factors for severe neonatal hyperbilirubinemia. They can help the families to seek prompt treatment for this preventable cause of cerebral palsy and mental retardation.

Neurotoxic Snakebite In Jammu Region: Is It Cobra Or Krait

Background: The aim of this study is to analyze the clinical profile and outcome of the neurotoxic envenomation in children inJammu region and to identify the species based on the syndromic approach developed by WHO.Materials and Methods: A retrospective hospital record based descriptive study which analyses the case records of childrenreporting to pediatric emergency with signs and symptoms of neurotoxic envenomation.Results: A total of 22 cases of the neurotoxic envenomation reported between April 15 and October 15. These included 14males and 8 females between the age group of 2.5 years and 16 years. The highest incidence of snakebite was observed inthe age group of 4–8 years. A total of seven cases presented neuroparalytic symptoms and local signs suggesting cobra bite.Bite was reported in the afternoon or evening hours between 12.30 pm and 10.30 pm and 83% bites were outdoors. A total of15 children presented with neuroparalytic symptoms with no local signs suggesting krait bite. 86% of the bites were indoor withonset of symptoms between 12 am and 7 am.Conclusion: Both cobra and krait cause neurotoxic envenomation in children in Jammu region with krait bite accounting for 68%of the total cases. Most of these cases are brought to the pediatric emergency late. Training of the peripheral doctors regardingearly recognition of neurotoxic snakebite, species diagnosis as per the WHO syndromic approach, prompt institution of initialmanagement with neostigmine and after visit summary, endotracheal intubations and AMBU bag ventilation, and quick referralto a center with ventilator facility should help in reducing the morbidity and mortality due to krait and cobra bite in children.

Scrub Typhus in Children: Jammu Experience.

The present retrospective study describes clinical profile of the children hospitalized in SMGS hospital with Scrub Typhus infection in Jammu during period Oct 08 to Sept 09. 21 hospitalized children with clinical features suggestive of Rickettsial disease (fever, generalized rash) who tested ELISA positive for IgM against Scrub Typhus were included in the present study between the age of 5 years and 18 years. 52.4% children belonged to Sunderbani-Naushera - Rajouri belt and majority of them reported during the months of August to November. All children presented with fever and maculopapular rash. 61.9% had lymphadenopathy, 57.12% had edema and 46% patients had conjunctival congestion. 76.13%, 23.8%, 19.04%, 9.2% had hepatosplenomegaly , pain abdomen ,altered sensorium and gastrointestinal bleed respectively. All of the 21 children were treated with chloramphenicol. None of them died. Rickettsial infection is quite common in Jammu region and thus, high degree of suspicion, knowledge of geographical distribution and clinical features of Rickettsial disease helps in its early diagnosis and treatment.

Colloidion Baby.

A two day old male baby, third issue of a second degree consanguineously married couple with clinical features of colloidion baby is being presented. Early recognition of this clinical entity and early institution of appropriate therapy can definitely reduce morbidity and mortality in neonates.

Turner Syndrome

Turner Syndrome is one of the important chromosomal disorders characterised by loss (total or part) of sex chromosome. The manifestations being peripheral edema, short stature, extra skin fold, webbing of neck, renal and cardiovascular anomalies, sexual infantilism, learning disability etc. We present here a one month female baby who had classical features of Turner Syndrome. The karyotape analysis was consistent with the diagnosis.