Effectiveness of Laser Fluorescence–Based Device in Detecting the Extent of Re-Mineralisation in Primary Teeth Compared to the Conventional Method: An In vitro Study

Background: Laser fluorescence (LF)–based clinical device DIAGNOdent™ is at present being used to detect caries. Can the same be used to detect therapeutic remineralisation of early white spot lesions? Aims: To explore the feasibility of using LF?based device in monitoring the changes following remineralisation of demineralised primary teeth. Materials and Method: The sample number for the present experimental in vitro study was 10. The LF based device readings were correlated with surface microhardness (SMH) test values to evaluate its efficiency. SMH analysis was performed using a microhardness tester (Tescol?HT1000AD). All the samples were demineralised, followed by remineralisation using fluoride varnish and pH cycling. The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 17.0 (IBM SPSS®) software. Paired t?test was performed to compare laser fluorescence readings and SMH test result values at baseline, after demineralisation, and after remineralisation. Pearson’s correlation was used to compare the relation between the laser fluorescence and SMH test. Results: A good negative correlation was seen between the two methods at the baseline readings even though it was not statistically significant (P = 0.069). A positive correlation between the methods existed following demineralisation which was not significant (P = 0.074). The correlation between the parameters following remineralisation showed a moderate negative correlation but was not significant (P = 0.55). Conclusion: DIAGNOdent™ values at baseline, after demineralisation, and after remineralisation was consistent with SMH values. Thus, DIAGNOdent™ can be explored to provide chairside assistance in identifying remineralisation of white spot lesions.

Effectiveness of Flipped Class Room Approach as a Teaching Methodology in Anatomy for Early Clinical Exposure Modules for First-Year Medical Students – An Interventional Study

Background: The National Medical Commission (NMC) of India has rolled out the competency based undergraduate medical curriculum in the year 2019 where there is more emphasis on integration of basic and clinical sciences, early clinical exposure (ECE) and clinical competence and skills. To achieve this it is essential to work on higher forms of cognitive work. Hence it reckons for the change in the teaching–learning methodology currently in practice. Thus we introduced a innovative teaching methodology such as flipped class room (FCR) methodology among first year medical graduates for early clinical exposure modules in anatomy. Materials and methods: This interventional study was conducted among the 1st year MBBS students of Sree Balaji Medical College & Hospital (2019–2020 academic year). The ECE modules were taught using both traditional lectures and FCR methodology. Pre and post tests were conducted for both the methodology. A comparative analysis of FCR teaching method with lecture based session was done by obtaining the scores of the students. A Structured questionnaire to assess the learner’s perception about FCR teaching methodology was obtained from the participants. The Results were analyzed using microsoft excel and SPSS software version 23. Evaluation of teaching tool was done by using Kirkpatrick model Results: Repeated measures Anova was applied and there was a significant difference within the two methodology and the interaction effect was also significant with P value 0.001. Although both methods show increase in mean from pre to post test the mean increase in flipped class method is more than the lecture. Spearman’s correlation was done which showed there is a significant relationship between both the methods with p value 0.001 correlation co-efficient r was 0.377. Overall Response to FCR method received higher rating. Conclusion: FCR methodology creates the opportunity to meet the needs of students through various instructional activities. There is a positive reinforcement and improvement in the student’s performance.

Comparison of the efficacy of parental brushing using powered versus manual tooth brush A randomized, four-period, two-treatment, single-blinded crossover study

Background: Children <5 years of age need parental assistance with tooth brushing. Purpose: The aim is to compare the efficacy of manual and powered toothbrushes for plaque removal when used by parents to brush their children's teeth. Methods: This randomized, four-period, two-treatment, examiner-blinded, crossover clinical trial comprised children aged 3–5 years. Tooth brushing was performed by the parent using a manual or powered toothbrush. Pre- and post-brushing plaque assessments were performed using the Turesky Modified Quigley-Hein Plaque Index. Differences in plaque scores were calculated using the paired t-test. Results: A significant difference (P < 0.001) in the reduction of the plaque score was observed between the manual and powered tooth brushing groups. Conclusion: Powered toothbrushes performed significantly better than manual toothbrushes in terms of plaque removal when used by parents to brush their child's teeth.

HbA1c as a prognostic indicator in prediabetics with acute coronary syndrome

Background: The role of HbA1C in predicting the outcomes of acute coronary syndrome remains controversial. Lesser is known about it in non-diabetic patients. Therefore authors conducted a study to seek association between the HbA1C levels and the clinical outcome in non-diabetic patients who presented with acute coronary syndrome. Objective of the study was to estimate HbA1C levels in population of prediabetics and non-diabetics and to document and correlate major adverse cardiac events in prediabetic and non-diabetics.Method: This case control study included consecutive patients (n=68) without known diabetes mellitus admitted with acute coronary syndrome (STEMI, NSTEMI, UA) at our hospital. HbA1c was measured on admission. The patients were divided into 2 groups according to their HbA1c level (group 1 HbA1c<5.7%, group 2 HbA1c>5.7%). The main outcome was MACE (major adverse cardiac events including cardiogenic shock, arrhythmia, heart failure).Results: There was no significant difference between baseline characteristics of both groups but complications were seen in higher number cases with HbA1c >5.7%. No significant difference in mortality was found. On analysis HbA1c >5.7% was found to be an independent predictor of MACE.Conclusion: HbA1C is a predictor of major adverse cardiac events. Measurement of HbA1C levels may improve risk assessment in such patients presenting with ACS.

Evaluation of debris and smear layer removal with XP-endo finisher: A scanning electron microscopic study

Context: The presence of smear layer and debris can prevent the irrigant and sealer from penetrating the dentinal tubules thereby compromising the seal of the root canal filling. Aim: This study aims to evaluate the efficacy of XP-endo Finisher with ProTaper Next and HyFlex in smear layer and debris removal. Materials and Methods: Thirty-two extracted mandibular premolar teeth were selected and sectioned at the cementoenamel junction. The roots were then randomly divided into 4 groups. In group 1 and 2, canals were instrumented with X2 ProTaper Next (25 0.06 taper). In group 3 and 4, canals were instrumented with HyFlex system (25 0.06 taper). The canals in group 2 and 4 were further finished with XP-endo Finisher. Irrigation was carried out using 3% sodium hypochlorite during instrumentation, and 17% ethylenediaminetetraacetic acid was used as the final rinse. The roots were then split longitudinally. The canal wall was observed under the scanning electron microscope in coronal, middle, and apical thirds at a magnification of ×400 and ×1000 for evaluation of debris and smear layer, respectively. Photomicrographs were taken, and qualitative assessment for debris and smear layer removal was done. Statistical Analysis Used: The results were analyzed using Kruskal–Wallis test and Mann–Whitney U-test. Results: Lower debris and smear layer scores were seen in canal thirds instrumented with ProTaper Next and XP-endo Finisher (P < 0.01). Conclusion: The use of XP-endo Finisher as an adjuvant during shaping and cleaning produced cleaner root canal walls.

Review Of Langali (gloriosa Superba Linn) � Agada Tantra Perspective

Agadatantra is a branch of Ayurveda which deals with the symptoms and treatment of various animal, plant, artificial and latent poisons. The drug Langali (Gloriosa superb Linn) is being categorized under Moolavisha (poisonous roots) and is also one among the nine Upavishas (semi poisonous drugs) by different Ayurvedic pharmacopoeias. Even though it is poisonous it has got Shothahara (anti-inflammatory), Vranahara (wound healing), Krimigna (wormicidal), Shalyaharana (removal of foreign substances), Garbapaatana (abortificant) properties etc. It is being used by the Ayurvedic physicians in treatment of various ailments after proper purification. But its purificatory methods are not mentioned in Samhitas (treatises). It is mentioned in Ayurveda prakasha and traditional Agadatantra text books of Kerala. Here in this article an attempt is made to collect the information regarding Langali in Agadatantra perspective. The article includes both modern and Ayurvedic concepts in regards to its symptoms during poisoning and its treatment. Details regarding its purificatory methods and its therapeutic use in compound formulations as an antidote which has been mentioned in the traditional Agadatantra books which are available in Kerala have also been included.

Association between carotid intima media thickness and metabolic syndrome

Background: Metabolic syndrome and its individual criteria pose a risk for atherosclerosis and cardiovascular disease (CVD). Carotid intima media thickness (CIMT) is a well-known marker of subclinical atherosclerosis. This study was aimed to assess CIMT in patients with metabolic syndrome.Methods: This one year cross-sectional study was conducted in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2016 to December 2016. A total of 100 patients diagnosed to have metabolic syndrome based on national cholesterol education program adult treatment panel III (NCEP ATP III) criteria were studied. All the patients were subjected to carotid B mode ultrasonography.Results: The most common age group was 51 to 60years (29%). Out of 100 individuals who were diagnosed to have metabolic syndrome, 60% had five criteria, 29% had four criteria and 3% had three criteria. Most of the of the individuals (61.00%) had normal (≤0.10cms) CIMT while high (>0.10cm) levels were noted in 39.00% of the individuals. The mean CIMT was noted as 0.13±0.16cms. The mean SBP (150.15±10.39 vs 142.98±20.09mmHg; p=0.042), DBP (94.51±6.53 vs 90.16±9.91 mmHg; p=0.017), total cholesterol levels (243.53±65.74 vs 195.95±29.8 mg/dL; p<0.001) and triglyceride levels (221.07±48.44 vs 180.85±24.74mg/dL; p <0.001) were noted in individuals with raised CIMT compared to individuals with normal CIMT. Majority of the individuals had abnormal HDL (93.00%) and 41.94% of the individuals with abnormal HDL had raised CIMT (p=0.027).Conclusions: Some individuals with metabolic syndrome are likely to have raised CIMT. The rise in CIMT among the patients with metabolic syndrome is associated with raised SBP, DBP, abnormal HDL (specifically in males), total cholesterol and triglycerides.

Fibrinogen levels in type II diabetes mellitus patients with microvascular complications

Background: Diabetes increases the morbidity and mortality due to its propensity to develop micro and macrovascular complications. Recently the role of haemostatic factors, particularly fibrinogen, in atherosclerosis and its complications has invited considerable attention. The present study was conducted to study plasma fibrinogen levels in type II diabetes mellitus patients with microvascular complications.Methods: One hundred patients aged 18years to 60years with type 2 diabetes mellitus with microvascular complications were included in the study. HBA1c, plasma fibrinogen, urine routine examination, fundoscopy, monofilament testing, FBS, PPBS were done. Descriptive statistics was used to analyse data.Results: Out of 100 diabetes patients with microvascular complication studies, 88 patients were found to have hyperfibrinogenaemia. Out of 100 patients 67 patients had HbA1c of more than 8%, and all of them had elevated fibrinogen levels (p <0.0001). The prevalence of hyperfibrinogenemia was higher in patients with diabetic retinopathy (90%), when compared to those without diabetic retinopathy (83.33%) although it was statistically not significant (p=0.266).Conclusions: Hyperfibrinogenemia among type 2 diabetes mellitus patients with microvascular complications was high. Glycaemic control has a significant impact on the fibrinogen levels. Longer the duration of diabetes, there was a higher prevalence of hyperfibrinogenemia.

Evaluation of bioflavonoids on the immediate and delayed microtensile bond strength of self-etch and total-etch adhesive systems to sound dentin

Aim: This study aims to evaluate the effect of two bioflavonoids (epigallocatechin-3-gallate [EGCG] and catechin) and a protein inhibitor (chlorhexidine [CHX]) on the immediate and delayed microtensile bond strength of self-etch and total-etch adhesive systems to sound dentin. Materials and Methods: The occlusal surfaces of 96 mandibular human third molar teeth specimens were ground after removal of the excess tissues, to expose the middle dentin. The dentin specimens were randomly allocated into four groups, each consisting of 24 teeth (n = 24) according to the application of the enzyme inhibitor. The adhesive system used in this study was Adper easy bond, a self-etch adhesive system, and Adper Single Bond 2, a total-etch adhesive system. Microtensile bond strength testing was conducted using thermocycler 2000, Heto-Holten A/S. Results: All the three enzyme inhibitors increase the bond strength values of the resin–dentin interphase when used during dentin bonding. The EGCG enzyme inhibitor has shown the highest immediate bond strength to dentin when used with both the adhesive systems.

A rare variant of ankyloblepharon filiforme adnatum associated with skin hypopigmentation: A case report from South India.

We report ankyloblepharon filiforme adnatum (AFA) along with associated skin lesions in a 7‑day‑old child from South India. It could be a variant of the well described ankyloblepharon‑ectodermal defects‑cleft lip and palate syndrome also called Hay–Wells syndrome wherein AFA, skin lesions, and clefting are characteristic. The ocular features, genetic inheritance, and possible systemic associations, along with the options for management, are discussed. The need for awareness among ophthalmologists of its systemic associations is discussed to ensure that proper multidisciplinary care is offered to the individuals affected by this rare disorder. This article also highlights the unusual hypopigmented skin lesions found in this infant, which has been scantily reported in the literature, as a possible variation in patients of Indian ethnicity.

Clinical, biochemical & cytomorphologic study on Hashimoto’s thyroiditis.

Background & objectives: Despite, the extensive salt iodization programmes implemented in India, the prevalence of goiter has not reduced much in our country. The most frequent cause of hypothyroidism and goiter in iodine sufficient areas is Hashimoto’s thyroiditis (HT). This study records the clinical presentation, biochemical status, ultrasonographic picture and cytological appearance of this disease in a coastal endemic zone for goiter. Methods: Case records of patients with cytological diagnosis of HT were studied in detail, with reference to their symptoms, presence of goiter, thyroid function status, antibody levels and ultrasound picture. Detailed cytological study was conducted in selected patients. Results: A total of 144 patients with cytological proven HT/lymphocytic thyroiditis were studied. Ninety per cent of the patients were females and most of them presented within five years of onset of symptoms. Sixty eight per cent patients had diffuse goiter, 69 per cent were clinically euthyroid and 46 per cent were biochemically mildly hypothyroid. Antibody levels were elevated in 92.3 per cent cases. In majority of patients the sonographic picture showed heterogeneous echotexture with increased vascularity. Cytological changes were characteristic. Interpretation & conclusions: our study showed predominance of females in the study population in 21-40 yr age group with diffuse goiter. We suggest that in an endemic zone for goiter, all women of the child bearing age should be screened for HT.

Primary pulmonary diffuse large B-cell non-Hodgkin's lymphoma in a child.

A 3-year-old girl presented with a history of intermittent fever of six months duration associated with respiratory symptoms consisting of recurrent cough, fever, wheeze and a suspected history of contact with tuberculosis (TB). Chest radiograph revealed pulmonary infiltrates mimicking miliary TB. She was started on anti-tuberculous treatment, but in view of clinical deterioration, a further work-up including a lung biopsy revealed non-Hodgkin’s lymphoma (NHL). This case documents the extremely rare occurrence of pulmonary involvement and miliary infiltrates on the chest radiograph in NHL.

Magnetic resonance imaging for the ophthalmologist: A primer.

Magnetic resonance imaging (MRI) and computerized tomography (CT) have added a new dimension in the diagnosis and management of ocular and orbital diseases. Although CT is more widely used, MRI is the modality of choice in select conditions and can be complimentary to CT in certain situations. The diagnostic yield is best when the ophthalmologist and radiologist work together. Ophthalmologists should be able to interpret these complex imaging modalities as better clinical correlation is then possible. In this article, we attempt to describe the basic principles of MRI and its interpretation, avoiding confusing technical terms.

Ocular clinical profile of patients with pseudoexfoliation syndrome in a Tertiary Eye Care Center in South India

To study the clinical profile of pseudoexfoliation [PEX] syndrome in a hospital setting. A case series of patients with PEX, with and without glaucoma attending the general ophthalmology clinic of a tertiary care center in South India. All patients underwent a complete ophthalmologic evaluation including recording diurnal variation of tension [DVT], gonioscopy and visual field assessment. The study cohort comprised 529 patients [752 eyes]. There were 296 [56%] females. The highest number of patients [261 patients] was from the age group between 60 and 69 years. Of 752 eyes, 57.8% eyes had unilateral PEX and 72% had established PEX. Gonioscopy showed open angles in 98.1% of eyes. Intraocular pressure [IOP] greater than 21 mmHg in at least 1 of 4 measurements was recorded in 5.7% eyes. DVT was normal in 96.4% of unilateral PEX eyes, similar to fellow non-PEX eyes. Pseudoexfoliation glaucoma occurred in 1.9% of eyes and 4.7% of eyes were glaucoma suspects. There was no correlation between the stage of PEX and increased IOP. Mean central corneal thickness of PEX eyes was 522 +/- 27æ. Pupillary dilatation in 90.5% eyes with early PEX was=7 mm. Conclusions: A small percentage of PEX eyes had raised IOP, and the number of eyes with glaucomatous optic neuropathy was even lower. PEX eyes did not demonstrate wide fluctuations in IOP. No correlation was found between raised IOP and stage of PEX. There was good pupillary dilatation in early stage PEX eyes suggesting that all PEX eyes may not have poor pupillary dilatation and related complications

Orbito-sinal foreign body.

Perforating injuries of the orbit involving the paranasal sinuses are uncommon. We report a case in which a large wooden foreign body lodged in the posterior orbit and maxillary sinus was surgically removed by a combined approach by ophthalmologists and ear, nose and throat surgeons.

Clinicopathological study of itchy folliculitis in HIV-infected patients.

Background: Itchy folliculitis are pruritic, folliculo-papular lesions seen in human immunodeficiency virus (HIV)-infected patients. Previous studies have shown that it was impossible to clinically differentiate between eosinophilic folliculitis (EF) and infective folliculitis (IF). Also, attempts to suppress the intense itch of EF were ineffective. Aims: The present study is aimed at correlating clinical, histopathological and immunological features of itchy folliculitis in HIV patients along with their treatment. Methods: The present prospective study lasted for 36 months (September, 2005 to August, 2008) after informed consent, data on skin disorders, HIV status and CD4 count were obtained by physical examination, histopathological examination and laboratory methods. Results: Of 51 HIV-positive patients with itchy folliculitis, the predominant lesion was EF in 23 (45.1%) followed by bacterial folliculitis in 21 (41.2%), Pityrosporum folliculitis in five (9.8%) and Demodex folliculitis in two (3.9%) patients. The diagnosis was based on characteristic histopathological features and was also associated with microbiology confirmation wherever required. EF was associated with a lower mean CD4 count (180.58 ± 48.07 cells/mm 3 , P-value < 0.05), higher mean CD8 count (1675.42 ± 407.62 cells/mm3) and CD8/CD4 ratio of 9.27:1. There was significant reduction in lesions following specific treatment for the specific lesion identified. Conclusion: Clinically, it is impossible to differentiate itchy folliculitis and therefore it requires histopathological confirmation. Appropriate antimicrobial treatment for IF can be rapidly beneficial. The highly active antiretroviral therapy along with Isotretinoin therapy has shown marked reduction in the lesions of EF. Familiarity with these lesions may help in improving the quality of lives of the patients.

Polymorphous low-grade adenocarcinoma of parotid gland: a rare occurrence.

Polymorphous low-grade adenocarcinoma (PLGA) is a rare salivary gland malignant tumor of low aggressiveness, commonly occurring in minor salivary glands. Its occurrence in major salivary gland has been documented albeit rarely. The striking histological feature is architectural diversity combined with benign cytologic features. We report a case of PLGA arising from left parotid in a 25-year-old male patient. On light microscopy, varied patterns were seen .The cells were uniform with bland nuclei. Neural invasion was noted.