Morphological Study of Accessory Foramina in Dry Mandible and Its Clinical Significance

Background: To provide anatomical information on theposition and incidence of accessory foramina in mandible asthey are important for dental surgeons and anesthetists inachieving complete nerve blocks and for avoiding injury toneurovascular structures passing through them.Objective: To study the incidence of accessory foramina in drymandible in population of Bihar & compare it with incidenceamong various races of the world.Materials & Methods: Present study is a cross sectional studywhich has been carried out on 56 dried fully ossified adulthuman mandibles, which were examined in the Department ofAnatomy and Forensic Medicine of Indira Gandhi Institute ofMedical Sciences, Patna, Bihar. The age of the bones used inthe study was not predetermined. Only fully ossified dried,macerated and thoroughly cleaned mandibles which werecomplete in all respects, in order to give the correctobservations, were included in the study while the mandibleshaving any deformity or pathology were excluded. Theaccessory foramina and their positions were observed.Results: Accessory mandibular foramina were found in 55.36%, accessory mental in 23.22 %, and retromolar in 17.85% ofthe cases. The accessory foramen observed most commonly inright side (39.28%) followed by bilateral (37.5%) then left side(19.65%).Conclusion: The anatomical variability of incidence andposition of accessory foramina should be considered as theymay be used to give additional locoregional anesthesia in caseof failed mandibular blocks. Knowledge of the commonestpositions will be beneficial for oncologists and oromaxillofacialsurgeons in planning graft implants.

Mullerian Duct Anomaly- A Spectrum of Varied Clinical Manifestations

Introduction: Multiple integrated steps are required fornormal development of the female genital tract. A wide varietyof malformations can occur when this system is disruptedeither in form of non- development or defective fusion orfailure of resorption. The purpose of this study was to reviewthe spectrum of symptoms with which mullerian anomaliespresent so that timely intervention could be done to savesexual and reproductive life.Material and methods: The study was done in the departmentof Obstetrics and Gynaecology of a tertiary care teachinghospital in Bihar. Only the admitted cases i.e,those whorequired surgical correction were taken into study.Results: Majority of patients presented with severeabdominal pain(71.4%) followed by menstrual problems(46.4%), and urinary symptoms (35.7%) including vvf. 25%patients reported subfertility, 14.2% abdominal lump and14.2% dyspareunia, 10.7%PID and 10.7% rectal pressuresymptoms.Majority had transverse vaginal septum (28.5%),followed byMRKHS and OHVIRA syndrome (14.2% each),Conclusion: The variety of ways with which mullerian ductanomalies present hints that clinical suspicion should be thereif early diagnosis is not to be missed.

Renal Tubular Acidosis Presenting as Nephrogenic Diabetes Insipidus

Background: Nephrogenic diabetes insipidus (DI) can be primary or secondary to variouscauses. Case Characteristics: One child with Fanconi syndrome with proximal renaltubular acidosis (RTA) due to nephropathic cystinosis, and other with Distal RTA withhearing loss. Observation: Both cases showed features of nephrogenic DI, which resolvedafter treating the primary pathology. Message: Renal Tubular acidosis may causenephrogenic DI.

American Academy of Pediatrics Clinical Practice Guidelines for Screening and Management of High Blood Pressure in Children and Adolescents: What is New?

Childhood hypertension has become a significant health concern. There have been a slew of important new findings in this field over thelast decade. This has led to an update by the American Academy of Pediatrics of the original recommendation of United States FourthWorking Group on blood pressure. We herein describe the important changes in the guideline, which include an updated normativedata, change in blood pressure classification, strong endorsement of ambulatory blood pressure measurement and the reduction in theblood pressure target for both chronic kidney disease and non-chronic kidney disease hypertensive children.

Rasburicase for Acute Kidney Injury.

Background: Acute kidney injury (AKI) continues to have significant mortality and morbidity and the search is on for any novel therapeutic intervention. Case characteristics: Two cases of AKI with elevated SUA (serum uric acid). Intervention: Rasburicase. Outcome: In Case 1 (late preterm male with AKI) rasburicase resulted in a significant reduction of SUA along with improvement in renal parameters. In Case 2 (6 yrs old boy with multi organ failure), rasburicase failed to provide any significant benefit despite fall in SUA.Message: The effect of rasburicase in AKI needs to be studied.

Distal Renal Tubular Acidosis with Hereditary Spherocytosis.

Hereditary spherocytosis (HS) and distal renal tubular acidosis (dRTA), although distinct entities, share the same protein i.e. the anion exchanger1 (AE1) protein. Despite this, their coexistence has been rarely reported. We hereby describe the largest family to date with coexistence of dRTA and HS and discuss the molecular basis for the co-inheritance of these conditions.

Ambulatory Blood Pressure Monitoring in Children.

Recently there have been great advances in the use of ambulatory blood pressure monitoring (ABPM) in children. A major boost has been the publication of normative data for blood pressure in children. ABPM has been able to detect significant differences in blood pressure in many disease states including chronic renal failure, polycystic kidney disease and post renal transplantation and has helped in identifying both white coat hypertension and masked hypertension. Current evidence does suggest that sole reliance on clinic blood pressure might not be always appropriate and ABPM has a definite role in pediatric hypertension.