Biphenotypic sinonasal sarcoma—A recently described entity with many mimics: A case report

Biphenotypic sinonasal sarcoma (BSNS) is a recently described, low-grade, slow-growing sarcoma with neural and myogenic features with exclusive location in sinonasal track and characteristic PAX3- MAML3 gene fusion. Differentiating this tumor from its commoner mimics needs knowledge of this entity to avoid over treatment. This tumor has unique morphology, clinical course, and genetics. We report this in a 47-year-old female who was diagnosed with such a rare, solitary fibrous tumor—hemangiopericytoma (HPC-SFT) on limited initial biopsy. On subsequent excision, typical morphology and immunohistochemistry helped to clinch the diagnosis.

A comparative study of antibody response, virus neutralization efficiency & metabolites in SARS-CoV-2-infected adults & children

Background & objectives: COVID-19 has been a global pandemic since early 2020. It has diverse clinical manifestations, but consistent immunological and metabolic correlates of disease severity and protection are not clear. This study was undertaken to compare seropositivity rate, antibody levels against nucleocapsid and spike proteins, virus neutralization and metabolites between adult and child COVID-19 patients. Methods: Plasma samples from naïve control (n=14) and reverse transcription (RT)-PCR positive COVID-19 participants (n=132) were tested for reactivity with nucleocapsid and spike proteins by ELISA, neutralization of SARS-CoV-2 infectivity in Vero cells and metabolites by 1H nuclear magnetic resonance (NMR) spectroscopy. Results: An ELISA platform was developed using nucleocapsid and spike proteins for COVID-19 serosurvey. The participants showed greater seropositivity for nucleocapsid (72%) than spike (55.3%), and males showed higher seropositivity than females for both the proteins. Antibody levels to both the proteins were higher in intensive care unit (ICU) than ward patients. Children showed lower seropositivity and antibody levels than adults. In contrast to ICU adults (81.3%), ICU children (33.3%) showed lower seropositivity for spike. Notably, the neutralization efficiency correlated with levels of anti-nucleocapsid antibodies. The levels of plasma metabolites were perturbed differentially in COVID-19 patients as compared with the naive controls. Interpretation & conclusions: Our results reflect the complexity of human immune response and metabolome to SARS-CoV-2 infection. While innate and cellular immune responses are likely to be a major determinant of disease severity and protection, antibodies to multiple viral proteins likely affect COVID-19 pathogenesis. In children, not adults, lower seropositivity rate for spike was associated with disease severity

In Silico Modeling and Docking Analysis of CTX-M-5, Cefotaxime-Hydrolyzing ?-Lactamase from Human-Associated Salmonella Typhimurium

Objective: To computationally model the CTX-M-5 ?-lactamase and establish its structure, which is exclusively present in human-associated Salmonella. Methods: The CTX-M-5 aminoacid sequence (Uniprot ID:O65975) of Salmonella enterica subsp. enterica serovar typhimurium was retrieved from UniProt database and subjected to homology modeling using MODELLER 9v7. The homology models were duly validated using RAMPAGE tool by generating Ramachandran plots, ERRAT graphs, and ProSA score. DoGSiteScorer server and ConSurf server were used to detect the cavities, pockets, and clefts to identify conserved amino acid sites in the predicted model. Subsequently, the modeled structure was docked using CLC Drug Discovery Workbench against proven drugs and known inhibitors. Results: Obtained high-quality homology model with 91.7% of the residues in favorable regions in Ramachandran plot and qualified in other quality parameters. Docking studies resulted in a higher dock score for PNK (D-benzylpenicilloic acid) molecule when compared to other reported inhibitors. Conclusion: This in silico study suggests that the compound PNK could be an efficient ligand for CTX-M-5 ?-lactamase and serve as a potent inhibitor of CTX-M-5.

Nutritional requirements for the elderly in India: A status paper

Advances in the medical field and healthcare sector during the last few decades have resulted in increased longevity. Increased lifespans have in turn led to a rapid global rise of the elderly population. However, ensuring the health and quality of life, especially in the context of chronic age-related ailments, among the growing geriatric population is a challenge. Ageing is associated with several changes in body composition including a decline in the lean body mass usually accompanied by an increase in body fat content which have a bearing on the nutrient requirements for the elderly. The nutrient requirements currently recommended for Indian adults are primarily computed using a factorial approach, that considers the cumulative loss of nutrients and is adjusted for optimal body weights and bioavailability. It is logical that physiological and metabolic changes associated with ageing influence several of these factors: body weight, lean mass, energy expenditure, nutrient retention and bioavailability and thus alter nutrient requirements compared to the adult population. Acknowledging these age-related changes, some international organizations have suggested nutrient requirements specific to the elderly. Given the contextual differences in physiology, caution needs to be exercised in adopting these guidelines for the Indian elderly. In addition, in the Indian context, there is sparse information on the diet and nutrient intakes vis-à-vis nutritional status and physiology of the elderly. This status paper highlights some of the pertinent issues related to nutritional requirements for the elderly that advocate a need for deriving nutritional requirements for the elderly in India

COVID-19 – Changes in Workload and Clinical Practice in Trauma and Orthopaedics in a District General Hospital in the United Kingdom

@#Introduction: COVID-19 has had a significant impact on the entire health system. The trauma and orthopaedic service has been compelled to alter working practices to respond proactively and definitively to the crisis. The aim of this study is to summarise the impact of this outbreak on the trauma and orthopaedic workload and outline the response of the department. Materials and Methods: We retrospectively collected data comparing patient numbers pre-COVID-19, and prospectively during the early COVID-19 pandemic. We have collected the numbers and nature of outpatient orthopaedic attendances to fracture clinics and elective services, inpatient admissions and the number of fracture neck of femur operations performed. Results: The number of outpatient attendances for a musculoskeletal complaint to Accident and Emergency and the number of virtual fracture clinic reviews reduced by almost 50% during COVID-19. The number of face-to-face fracture clinic follow-ups decreased by around 67%, with a five-fold increase in telephone consultations. Inpatient admissions decreased by 33%, but the average number of fracture neck of femur operations performed has increased by 20% during COVID-19 compared to pre-COVID-19 levels. Conclusion: We have noted a decrease in some aspects of the trauma and orthopaedic outpatient workload, such as leisure and occupational-related injuries but an increase in others, such as fracture neck of femurs. Many injuries have significantly reduced in numbers and we consider that a model could be developed for treating these injuries away from the acute hospital site entirely, thereby allowing the acute team to focus more appropriate major trauma injuries.

Efectos del tratamiento homeopático individualizado en la hipertensión esencial de estadio I: ensayo aleatorizado, simple ciego, controlado con placebo / Effects of Homeopathic Treatment Individualized in Hypertension Stage I Essential: Randomized Trial, Single Blind, Placebo controlled

Fundamentos: la hipertensión arterial es el cuarto principal factor de riesgo de muerte e incapacidad, así como el responsable de más de 1.6 millones de fallecimientos en la India. Los informes de casos clínicos, los estudios observacionales y los ECA evidencian los efectos de los medicamentos homeopáticos en la hipertensión. Objetivos: los resultados de este estudio se añaden a la evidencia de la eficacia del uso de los medicamentos homeopáticos individualizados en la hipertensión de estadio I. Materiales y métodos: Se ha realizado un ensayo aleatorizado, simple ciego y controlado por placebo entre octubre de 2013 y marzo de 2018. El parámetro primario fue evaluar los cambios en la presión sistólica (PS) y la presión diastólica (PD) mensualmente durante tres meses. 217 pacientes de los 2,127 pacientes examinados cumplieron los criterios de selección y fueron aleatorizados para recibir un medicamento en potencias Q (o potencias LM) más indicaciones para la modificación del estilo de vida (MEV) (116 pacientes) o bien placebo + MEV (101 pacientes). La modificación del estilo de vida incluyó actividad física y dieta como parte de la pauta terapéutica. El análisis fue de intención de tratamiento. Resultados: Las mediciones ANOVA repetidas entre los grupos mostraron una diferencia estadística significativa (Lambda de Wilks 0.85, F=12.12, dF=213, P=0.0001) tanto en la PS como en la PD a favor de la Homeopatía individualizada. La prueba t independiente post hoc mostró una reducción media significativa de la PS [diferencia media 7.12 mmHg, IC del 95%; CI 4.72 a 9.53, P=0.0001] y un descenso medio de la PD [diferencia media 5.76 mmHg, IC del 95%: 4.18 a 7.23, P=0.0001] a favor del grupo con Homeopatía más MEV. Los medicamentos más utilizados fueron: Sulphur (n=24), Natrium muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) y Phosphorus (n=10). Conclusiones: Se ha constatado que la Homeopatía individualizada junto con la MEV fue más eficaz que el placebo junto con la MEV en los pacientes que sufren hipertensión en estadio I. Se precisan más ensayos en un marco estricto. (AU)

Background: Hypertension (HTN) is a leading risk factor for death and disability and responsible for over 1.6 million deaths in India. Clinical case reports, observational studies and randomised controlled trials show the effects of homoeopathic medicine in HTN. Objectives: The results of this study will add to the evidence of effectiveness of individualised homoeopathic medicine in Stage I HTN. Methods: A single-blind, randomised, placebocontrolled trial was undertaken from October 2013 to March 2018. The primary outcome measure was to evaluate the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) every month for 3 months. Of 2,127 patients screened, 217 patients who fitted the inclusion criteria were randomised to receive either homoeopathic Q potencies (or LM potencies) plus lifestyle modification (LSM)=116 or placebo + LSM=101. LSM included physical activity and diet as part of the treatment regimen. Analysis was by intention to treat. Results: Repeated-measure ANOVA between the groups showed statistically significant difference (Wilk lambda 0.85, F=12.12, df=213, P=0.0001), in both SBP and DBP favouring Individualised Homoeopathy (IH) along with LSM. Post hoc independent t-test showed a significant mean reduction in SBP (mean difference 7.12 mmHg, 95% confidence interval [CI] 4.72-9.53, P=0.0001) and DBP (mean difference 5.76 mmHg, 95% CI: 4.18-7.23, P=0.0001) favouring Homoeopathy plus LSM group. Sulphur (n=24), Natrum muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) and Phosphorus (n=10) were the most useful medicines. Conclusion: IH in LM potency along with LSM was found effective over placebo along with LSM in the patients suffering from Stage I HTN. Further trials in rigorous setting are warranted. (AU)

Profile of Cleft Lip and Cleft Palate at a Public Hospital in Southern India

Objective: To analyze the pattern of cleft lip and cleft palate cases and their operativemanagement at a tertiary-care hospital. Methods: Data of all patients (<18 year) with cleft lipand cleft palate operated between 2011 and 2016 were extracted from the records andanalyzed. Results: The final analysis included1643 cases (60.9% males). Mean (SD) age atthe time of surgery was 8.9 (10.17) years. Left-sided cleft clip was more common. Completehard palate type of cleft palate on left was present in 787 (47.90%). Primary Cleft Palaterepair was most common procedure (492, 29.9% children, followed by primary lip noseunilateral in 458 (27.9%) and lip nose revision in 298 (21.1%). Conclusion: Data on age atpresentation and procedures used for correction of cleft lip and cleft palate are presented.

Efficacy of Ketamine Hcl and Tramadol Hcl by epidural route for lower abdominal surgeries

Background: Pain pathway has profound implications for management of acute pain and provoked interest in the use of pre-emptive analgesia and new methods of postoperative pain management with new agents like opioid and non-opioid drugs either independently or in combination. The objective of the study was to study efficacy of Ketamine Hcl and Tramadol Hcl (preservative free) by epidural route for lower abdominal surgeries.Methods: This study has been conducted on hundred patients in the age group of 20 to 50 years. These patients have undergone various lower abdominal surgeries, gynecological and surgical procedures. Failed epidurals, catheter kinking, catheter migration and dural puncture cases are excluded from the study. The patients were divided into two groups namely Group-A and Group-B, with 50 patients in each group.Results: Both groups were similar in terms of age, sex and weight. In Group-A patients who received 30 mg of Ketamine, the mean time of onset of analgesia being 17.01+2.65 minutes compared to 12.18+2.28 minutes in Group -B patients who received 100 mg of tramadol, In Group-A the mean time of duration of analgesia is 6.75+0.46 hours compared to 9.36+0.84 hours in Group-B. Nausea and vomiting (24% vs. 2%), urinary retention (4% vs. 2%) was more in group B compared to group A patients. Backache was equal in both the group patients (6% vs. 6%). Pain on injection more in group A patients i.e. 8% compared to only 2% in patients who belonged to group B.Conclusions: Epidural tramadol is superior to epidural ketamine for postoperative pain relief.

Isolation And Characterisation Of Rapamycin, Temsirolimus Regio Isomer (MONOESTER) And Temsirolimus Diester In Temsirolimus Drug

Objective: Separation and identification of the process impurities in the manufacture of temsirolimus drug viz., rapamycin, temsirolimus regioisomer (monoester) (TS monoester), and temsirolimus diester (TS diester). Methods: During the process development of temsirolimus (TS), three process impurities-rapamycin, temsirolimus regioisomer (monoester) and temsirolimus diester-were detected by high-performance liquid chromatography (HPLC). Impurities were isolated by medium pressure liquid Chromatography (MPLC) and characterized by ESI-MS/MS, 1H NMR, FT-IR spectral data. Results: These impurities are characterised with the help of ESI MS/MS, 1H NMR, and FT-IR data. The impurities are identified and characterised as the process impurities. One of them is the starting material i.e. rapamycin and the other two are formed during the manufacture of the drug. This method offers advantages over using photodiode-array UV detection (LC-PDA) for the determination of peak purity, viz. components with similar UV spectra can be distinguished. Conclusion: The structures of these impurities were characterized as rapamycin, TS Monoester, and TS Diester. Out of these process impurities, rapamycin has been previously identified while the other two are previously unreported.

Nutrigenomics: Opportunities & challenges for public health nutrition

The hierarchical information flow through DNA-RNA-protein-metabolite collectively referred to as 'molecular fingerprint' defines both health and disease. Environment and food (quality and quantity) are the key factors known to affect the health of an individual. The fundamental concepts are that the transition from a healthy condition to a disease phenotype must occur by concurrent alterations in the genome expression or by differences in protein synthesis, function and metabolites. In other words, the dietary components directly or indirectly modulate the molecular fingerprint and understanding of which is dealt with nutrigenomics. Although the fundamental principles of nutrigenomics remain similar to that of traditional research, a collection of comprehensive targeted/untargeted data sets in the context of nutrition offers the unique advantage of understanding complex metabolic networks to provide a mechanistic understanding of data from epidemiological and intervention studies. In this review the challenges and opportunities of nutrigenomic tools in addressing the nutritional problems of public health importance are discussed. The application of nutrigenomic tools provided numerous leads on biomarkers of nutrient intake, undernutrition, metabolic syndrome and its complications. Importantly, nutrigenomic studies also led to the discovery of the association of multiple genetic polymorphisms in relation to the variability of micronutrient absorption and metabolism, providing a potential opportunity for further research toward setting personalized dietary recommendations for individuals and population subgroups.

Incidence of Helicobacter pylori in Perforated Duodenal Ulcers: A Prospective Study

Introduction: It was found that duodenal ulcer patients tend to have an elevated maximal acid output (MAO), in response to histamine or pentagastrin, reflecting a greater parietal cell mass (Blair et al., 1987). In addition, the physiology control of acid secretion is abnormal. Basal acid is increased to greater extent than would be predicted from the increase in MAO. A work on hormonal control focused on the antral acid-stimulating hormone gastrin. Research showed that the inhibition of gastrin release by intragastric acid is decreased in duodenal ulcer patients (Moss and Calam, 1992). Somatostatin is an important mediator of gastric inhibition, and both the number of immunoreactive somatostatin cells and the amount of somatostatin peptide in gastric antral mucosa are diminished in duodenal ulcer patients (Mc Henry Jr et al., 1993). Helicobacter pylori decreases the reflex inhibition of peptone-stimulated gastrin release by luminal acid. This reflex is known to be mediated through the release of somatostatin. Eradication of H. pylori from duodenal ulcer patients elevates somatostatin RNA by about 2 times in antral and duodenal mucosa but not in corpus biopsies, reflecting the typical distribution of mucosal involvement in duodenal ulcer patients (Sipponen, 1992). Materials and Methods: A total of 25 patients who underwent surgery for perforated duodenal ulcer on emergency basis in the Department of General Surgery in S.V.S. Medical College between October 2012 and September 2014 were included in this study. Inclusion Criteria: (1) Patients between 18 and 70 years of age and (2) patients having perforated duodenal ulcers were included in the study. Exclusion Criteria: (1) Patients below 18 years and above 70 years of age, (2) patients on nonsteroidal anti-inflammatory drugs (NSAIDs) for more than 1 month duration, (3) patients who have received anti-H. pylori treatment, and (4) patients with gastric ulcers or ulceroproliferative growth were excluded from the study. The study population consisted of 150 patients between the age group of 18 and 55 years. Exploratory laparotomy was performed in all cases. Two mucosal biopsies were taken through the perforation. One specimen is immediately put into a preformed H. pylori detection kit for rapid urease test (RUT), which shows the presence of urease-producing bacteria by a change in the color of the medium within a time frame which is read as follows. Results: The mean age of the patient is 43.6 years. All the patients are males. 80% are smokers (21 of 25 patients). Three were addicted to pan chewing and 4 were in the habit of gutka chewing. 14 of 25 patients had a history of pain abdomen more in the epigastrium relived by taking antacids/H2 blockers. 15 of 25 patients had a history of NSAID abuse. None of the patients ever used steroids. 49% of patients whose mucosal biopsy was subjected to RUT tested positive for urease (10 strongly positive and 4 moderately positive). 11 of 25 tested negative for RUT. 16 of the 20 patients (80%) whose mucosal biopsy was, especially, investigated for H. pylori by Genta tested positive for the bacteria. Conclusions: This study has demonstrated that H. pylori is present both at the ulcer edge and antrum in a large percentage of perforated ulcers, and ulcer relapse in the form of perforation is probably correlated with pre-existing H. pylori infection. What remains to be evaluated is the relationship between the presence/absence of infection and future relapse and perhaps also H. pylori eradication and relapse, in perforated peptic ulcer patients treated with simple repair only. However, our study showed 50% association of H. pylori with duodenal ulcer perforation, and the extensive usage of antibiotics and liberal utility of proton pump with or without combination of H2 receptor blockers shows 50% positivity and 50% negativity with the incidence of H. pylori

Evaluation of Serum C-reactive Protein in Acute Appendicitis and its Correlation with Histopathology

Introduction: Acute appendicitis is the most common abdominal surgical emergency. Despite extraordinary advances in radiographic imaging and diagnostic laboratory investigations, the diagnosis of acute appendicitis remains an enigmatic challenge in this modern era. The wide range of causes and varied patient presentations pose a formidable diagnostic and therapeutic dispute. Appendicectomy is the most common cause of acute surgical abdomen with a lifetime risk of 7%.[1] Classic clinical and laboratory findings usually allow for prompt diagnosis and treatment. Materials and Methods: In a prospective study, 100 patients clinically diagnosed as acute appendicitis were selected by purposive sampling method and evaluated as per criteria for serum c-reactive protein (CRP) levels and leukocyte count preoperatively and were followed up postoperatively with histopathology reports. The data were analyzed for finding the significance of serum CRP in the diagnosis of acute appendicitis. Results: CRP was positive in 75 of 77 patients who had histologically proven acute appendicitis and in 3 with normal appendix. The sensitivity, specificity, and diagnostic accuracy were 97.4%, 86.96%, and 95%, respectively. Leukocytosis and neutrophilia when used alone were not specific for acute appendicitis, but when combined with CRP value, diagnostic accuracy was high. Ultrasonography was useful in establishing alternative diagnoses but had low sensitivity for acute appendicitis. Conclusions: CRP contains important diagnostic information and hence should always be included in the diagnostic workup of acute appendicitis. Since acute appendicitis is very unlikely in those patients with normal white blood cell count and CRP value, conservative treatment is advised.

Comparative Evaluation of Canal Centering Ability between Protaper Rotary and Self Adjusting File in Oval Shaped Canals – A Cone Beam Computed Tomographic Analysis

Background: Self Adjusting Files have been introduced to overcome the disadvantage of protaper rotary files, especially for oval root canal centering. Aims and Objectives: To evaluate the canal centering ability between rotary protaper and self adjusting file in oval shaped canals using cone beam computed tomography. Methods:The study was carried out on 20 single rooted mandibular premolars. To compare the canal centering ability produced by different techniques, pre-instrumentation, post-instrumentation, cross section images of specimen at 3, 6 and 9 mm from the apex were obtained from the 3D CBCT images of each individual group. The images captured digitally using Image Tools Software were compared. Results: Inter group comparison of mean ratio of both the groups at 3, 6 and 9 mm after preparation of canal showed statistically significant difference between both the groups (p<0.05). Intra group comparison of mean ratio of both the groups at 3, 6 and 9 mm after preparation of canal showed that the difference between both the groups was not statistically significant (p>0.05).Conclusion: The canal centering ability of self adjusting file was efficient than protaper rotary files.

Comparison of Efficacy of Pentoxifyllin with Standard Regimens Dexamethasone and Hyaluronidase in Patients with Oral Submucous Fibrosis

Aims and objectives The purpose of the study was to clinically evaluate the efficacy of oral pentoxifylline 400mg tablets in comparison to intra-lesional injections of dexamethasone (4 mg/ml), hyaluronidase 1, 500 IU and 0.5 ml of lignocaine 2% and a combination of the two in the management of oral sub-mucous fibrosis (OSF) patients. Materials and methods The study population consisted of randomly selected 75 patients with OSF. Patients were divided into three groups. A total of 25 patients were allocated each in dexamethasone group, dexamethasone and pentoxifylline group and pentoxifylline group. Dexamethasone group received weekly intra-lesional injections of dexamethasone (4 mg/ml), hyaluronidase 1, 500 IU and 0.5 ml of lignocaine 2% for a period of 12 weeks. Pentoxifylline group received oral pentoxifylline 400-mg tablets thrice daily for 12 weeks. Dexamethasone and pentoxifylline group received both the drugs. Parameters taken in the study were burning sensation and mouth opening. Results In the present study, improvement in the patients symptomatic parameters were statistically significant (p < 0.001) within groups (intra-group comparison), but not significant (p > 0.001) when compared between the groups (inter-group comparison). Conclusion Study found that the parameters like burning sensation and mouth opening showed statistically significant improvement for all the drug groups. The drug pentoxifylline showed similar improvement in the clinical parameters as that of dexona. For this reason, pentoxifylline can be indicated as a good alternative treatment for OSF in patients in whom dexamethasone is contraindicated, or those who cannot make frequent visits for intra-lesional injections.

Evaluation of fracture resistance of mandibular incisors before and after endodontic treatment and metal ceramic crown placement

Background: Mandibular incisors are the smallest among the permanent dentition, with thin enamel and dentin. Intact teeth do not fracture easily while mastication. Objectives: To evaluate the fracture resistance of mandibular incisors after endodontic treatment and metal ceramic crown placement. Materials and methods: Eighty recently extracted intact mandibular incisors were divided into four groups of twenty each based on root canal treatment and crowns, intact natural tooth without RCT and crown preparation was used as control group. Each tooth was mounted separately in acrylic block and subjected to loading in universal load testing machine until fracture, results were analyzed by one-way ANOVA and Turkey’s multiple post hoc procedures. N Sandeep, G. Ramaswamy Reddy, Kancham Kalyan Kumar Reddy, K Subash Chander, Vasanthi Bondugula, Ram B. Basany. Evaluation of fracture resistance of mandibular incisors before and after endodontic treatment and metal ceramic crown placement. IAIM, 2017; 4(11): 18-26. Page 19 Results: The results showed that Fracture resistance of teeth restored with metal ceramic crowns was very high when compared to the teeth without crowns (p<0.05).There was no statistically significant difference between intact and endodontically treated teeth (p>0.05). Conclusion: The study concluded that endodontic treatment and tooth preparation followed by metal ceramic restoration increased the fracture resistance of mandibular incisors.

Clinical effects of photodynamic and low‑level laser therapies as an adjunct to scaling and root planing of chronic periodontitis: A split‑mouth randomized controlled clinical trial.

Background: There are limited clinical experiments addressing the effects of photodynamic therapy (PDT) and low‑level laser therapy (LLLT) as an adjunct to conventional scaling and root planing (SRP) alone. Aim: The aim of this clinical trial was to evaluate the clinical effects of adjunctive use of PDT, combination of PDT with LLLT as adjunct to conventional SRP alone in the treatment of chronic periodontitis. Materials and Methods: In a single‑centered randomized and controlled clinical trial, 24 patients (15 males and 9 females) with untreated chronic periodontitis were randomly assigned in a split‑mouth design into three treatment groups which included Group I: SRP only, Group II: SRP and PDT (1% methylene blue [MB] solution), and Group III: SRP, PDT, and LLLT. Clinical parameters such as plaque index, gingival index, modified sulcular bleeding index, probing depth (PD), and clinical attachment level (CAL) were measured at baseline, 1, 3, and 6 months after therapy. Results: Within each group, significant improvements (P < 0.001) were found for all variables in 6‑month follow‑up compared with baseline. The improvement in clinical parameters was significantly greater in Group III compared to Group I and Group II. The mean PD (mm) reduction from baseline to 6 months in Group I was 2.50 ± 0.54, Group II was 2.57 ± 0.53, and Group III was 3.14 ± 0.50. The mean CAL (mm) gain from baseline to 6 months in Group I was 2.63 ± 0.47, Group II was 2.55 ± 0.44, and Group III was 3.07 ± 0.55. Conclusion: In patients with chronic periodontitis, a combination of a single application of PDT (using a 980 nm laser and MB) and LLLT provide additional benefit to SRP in terms of clinical parameters 6 months following the intervention.

Intrathecal Anaesthesia for Elderly Patients Undergoing Short Transurethral Procedures: A Dose-Finding Study.

Background: To reduce effects associated the adverse hemodynamic effects associated with the spinal anesthesia– induced medical sympathectomy, combinations of very small doses of local anesthetic and adjuvant opioids are frequently administered. However, for elderly patients undergoing transurethral procedures, the optimal bupivacaine-fentanyl dose is unknown. The aim of the study is to find the optimal dosage of intrathecal anesthesia for elderly patients undergoing short transurethral procedures with bupivacaine–fentanyl, with stable hemodynamics. Methods: The study included 75 patients, ASA I, II and III scheduled for transurethral procedures at Kamineni hospitals, L.B. Nagar, Hyderabad which is a 350 bedded super-speciality tertiary care center. These patients were randomly allocated into three groups, 25 patients in each group. Group A received 7.5 mg bupivacaine, Group B were given 5 mg bupivacaine along with fentanyl 20 μg while patients in Group C received bupivacaine 4 mg with fentanyl 20 μg. Intrathecal fentanyl as an analgesic adjuvant to bupivacaine anesthesia. Intraoperative pain was assessed using Visual Analog Scale (VAS). Demographics, time intervals, and continuous variables (MAP, heart rate, SpO2, VAS) were analyzed using the one-way analysis of variance (ANOVA) test. Results: Demographic characteristics as well as intraoperative MAP, heart rate and SpO2 were similar among groups. Intraoperative rescue fentanyl requirements were significantly higher in group C (bupivacaine 4 mg + fentanyl 20μg) when compared with those in the other two groups. In group A (bupivacaine 7.5 mg), there was significant difference in mephenteramine requirements. Conclusion: Of the doses investigated bupivacaine 5 mg with fentanyl 20μg, provided adequate analgesia and was associated with hemodynamic stability and the fewest side effects.

Peripheral Neurectomy of Infraorbital Nerve -A Treatment Option for Trigeminal Neuralgia: A Case Report.

Trigeminal neuralgia or tic douloureux is a commonly diagnosed facial pain syndrome with a female predominance and with peak occurrence in the age group of above 50 years. Treatment options range from conservative pharmacologic therapy to invasive surgical procedures. The mode of treatment is based on patient’s systemic health, compliance and severity of the disease. Peripheral neurectomy is the safest and simplest method that can be accomplished under local anesthesia with minimum risks and excellent pain relief to the patient. However, there are incidences where this mode of treatment also fails to manage the disease, and further surgical options must be considered. In this case report, we present a case of a 50-year-old female patient who has undergone peripheral neurectomy of infraorbital nerve.

Functional Occlusion And Temperomandibular Joint.

The ideal goal of modern dentistry is to restore the patient to normal contour, function, comfort, esthetics, speech, and health. Optimal functional occlusion is necessary for maintaining stability, prevent and treat temporomandibular joint disease syndrome . This article reviews the concepts of functional occlusion in the context of orthodontics.