Correlating Nasal Patency with Obstructive Sleep Apnea in Obese Versus Non-Obese Patients: An Acoustic Rhinometry Study.

The aim of this study was to correlate nasal patency with Obstructive Sleep Apnea (OSA) in obese versus non-obese patients using Acoustic Rhinometry (AR). Eccovision® Acoustic Rhinometer equipment was used to compare nasal cross-sectional areas (CSA1,2 & 3 corresponding to nasal valve region, anterior portion of middle & inferior turbinate and posterior portion of middle & inferior turbinate respectively) and volume in age and gender matched sample divided into three groups: Group 1: Non-obese patients without OSA (25 patients, 13 males and 12 females); Group 2: Non-obese patients with OSA (25 patients, 14 males and 11 females); Group 3: Obese patients with OSA (25 patients, 13 males and 12 females). The mean nasal cross-sectional areas and volume were lower in Group 2 compared to Group 1 but statistically non-significant (P value > 0.05 for all). The mean nasal cross-sectional areas and volume were significantly lower in Group 3 as compared to Groups 1 and 2 (P value < 0.05 for all). BMI showed a statistically significant positive (direct) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). The nasal cross-sectional areas and volume showed a statistically significant negative (inverse) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). OSA diagnosed cases with high BMI may not present with an obvious nasal obstruction; the nasal patency may still be compromised due to reduced nasal lumen secondary to obesity. AR, being cost-effective and non-invasive modality; is advocated to evaluate pre-treatment nasal patency, as well as follow up evaluation to ascertain improvement after the intervention.

(E)-5-(4-Methyl-benzyl-idene)-1-phenyl-4,5,6,7-tetra-hydro-1H-indazol-4-one.

In the title compound, C21H18N2O, the non-aromatic six-membered ring adopts a distorted envelope conformation with one of the methyl-ene-C atoms being the flap atom. The dihedral angle between the phenyl and 4-tolyl rings is 75.3 (1)°. The 1,2-diazole ring forms dihedral angles of 41.9 (1) and 65.5 (1)° with the phenyl and 4-tolyl rings, respectively. In the crystal, stabilizing C-H⋯O, C-H⋯π and π-π inter-actions are evident. The calculated Hirshfeld surfaces highlight the prominent role of C-H⋯O inter-actions (8.6%), along with H⋯H (51.7%) and C⋯H/H⋯C (29.2%) surface contacts.

(E)-5-(4-Chloro-benzyl-idene)-1-phenyl-4,5,6,7-tetra-hydro-1H-indazol-4-one: crystal structure and Hirshfeld surface analysis.

In the title compound, C20H15ClN2O, the non-aromatic six-membered ring adopts a distorted envelope conformation with methyl-ene-C atom nearest to the five-membered ring being the flap atom. The dihedral angle between the phenyl and chloro-benzene rings is 74.5 (1)°. The heterocyclic ring forms dihedral angles of 37.9 (1) and 64.3 (1)° with the phenyl and chloro-benzene rings, respectively. In the crystal, weak C-H⋯O inter-actions feature predominantly within the three-dimensional architecture. The inter-molecular inter-actions are further analysed with the calculation of the Hirshfeld surfaces highlighting the prominent role of C-H⋯O inter-actions, along with H⋯H (36.8%) and C⋯H/H⋯C (26.5%) contacts.

Seroprevalence of Scrub Typhus in Patients Attending Dhulikhel Hospital, Kavre.

Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness. It is caused by Orientia tsutsugamushi. Scrub Typhus is frequently observed in South Asian countries. However, clear epidemiological information of this disease is lacking in case of Nepal. Nepal has shown steady increase in cases of Scrub Typhus since 2015. The epidemiological data related to this disease would support the decision making and surveillance design for early outbreak detection and immediate responses including prevention and treatment of scrub typhus in Nepal. Objective To understand prevalence of Scrub Typhus in subjects who had visited outpatient department at Dhulikhel Hospital. Method In this study, we have studied antibody test data (n=784) for Scrub Typhus from 2019 to 2021. The tests were performed on serum samples of patients who had visited OPD at Dhulikhel Hospital with fever lasting more than 5 days. The kit used in analysis was Scrub Typhus Detect™ IgM ELISA Kit from InBios International. Result Out of the total subjects (n=784), 133 were positive (16.9%) for IgM antibody of Scrub Typhus. The positivity in female (18.6%) was higher than the male subjects (15.3%). The positivity rate was variable among the different age groups, with highest positivity for age group 0-14 years (25%). The seasonal variation was also observed among the seropositive cases. Conclusion Scrub Typhus being a neglected tropical disease has high prevalence. It can be postulated that female subjects and subjects of age group 0-14 years are vulnerable to the infection with Scrub Typhus. There is need to increase the surveillance of Scrub Typhus to add the knowledge for diagnosis and treatment.

Plasma cell gingivitis: A perplexing and rare clinical entity.

Plasma cell gingivitis (PCG) is a diagnostic dilemma for clinicians. It is also referred to as atypical gingivostomatitis, idiopathic gingivostomatitis, allergic gingivostomatitis, and plasma cell gingivostomatitis which are characterized by bright fiery red gingiva with spontaneous bleeding on slight provocation. It is often confused with inflammatory gingival enlargement, erythematosus lichen planus, and other lesions. One such rare and benign entity is discussed in this article and managed after thorough clinical, radiological, histopathology, immunohistochemistry analysis.

Long-Term Study of Relapse After Mandibular Orthognathic Surgery: Advancement Versus Setback.

Background: Relapse is a continuing process and should be evaluated on a long rather than short term. Materials and Methods: Treatment records of 46 patients who underwent mandibular orthognathic surgery were divided into two groups, i.e. Group 1: Mandibular Advancement (MA) surgery (n = 26) and Group 2: Mandibular Setback (MS) surgery (n = 20). Lateral cephalograms were traced at T0 (01 week before surgery), T1 (01 week after surgery), T2 (01 year after surgery) and T3 (minimum 05 years after surgery) to study short- and long-term skeletal and dental relapse in horizontal, vertical and angular parameters selected for the study. Relapse was correlated with gender, age, amount of surgical movement and intra-operative change in mandibular plane angle to study effect of these factors on relapse. Results: All horizontal, vertical and angular parameters studied showed significant relapse at short term (from T1 to T2) which continued significantly till long-term evaluation (T2 to T3) in both groups (P value < 0.001). Horizontal relapse in all parameters, vertical relapse in all parameters (except Pog and overbite at T1-T2) and angular relapse in all parameters (except Ramus inclination at T1-T2) was significantly higher in Group 2 compared to Group 1 (P value < 0.001 for all). Relapse showed significant and positive correlation with amount of surgical movement and intra-operative change in mandibular plane angle in both groups (P value < 0.05 for all). Conclusion: Both MA and MS surgeries show significant relapse on both short- and long-term evaluation which it is higher in MS as compared to MA surgeries.

Clinico-Pathological Correlation of Colorectal Diseases by Colonoscopy and Biopsy.

Background Colonoscopy is a simple, safe and well tolerated procedure, the visualization of the mucosa of the entire colon and terminal ileum to detect intestinal abnormalities and obtain biopsy leads to the early detection of the pathologic process and institution of appropriate therapy. Objective To find out the correlation between clinical and histopathological diagnosis of colorectal diseases. Method A cross-sectional study was conducted at Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital from Jan. 2015 - Jan. 2016. Altogether, 95 colonoscopic biopsies were examined and recorded clinical data using pre-designed pro forma. The specimens were grossed, processed and embedded using standard procedures, stained with Hematoxylin and Eosin stain and were analyzed using light microscope. Special stains Ziehl Neelsen, and Periodic Acid-Schiff were used whenever necessary. Result Analyses of 95 cases of colonoscopic biopsies were done. The most common clinical diagnosis was polyp in 49 cases (51.57%) and the common histopathological diagnosis was non-neoplastic polyps 31(32.63%). There was no correlation in cases for suspected infectious colitis, microscopic colitis and hemorrhoids. Conclusion Colonoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of colorectal lesions. The clinico-pathological correlation for neoplastic lesions was excellent. However, correlation was poor in non-neoplastic lesion.

Effect of Mandibular Setback Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions.

INTRODUCTION: The changes in length and height of tongue following mandibular setback (MS) surgery may affect pharyngeal airway dimensions. There is limited literature correlating tongue dimensional changes with linear and volumetric airway changes following MS with bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class III patients. MATERIALS AND METHODS: Treatment records of 18 patients who underwent MS with BSSRO were evaluated for changes in tongue and linear airway dimensions, mean airway volume and area at T1 (1-week pre-surgery), T2 (6-month post-surgery) and T3 (2-year post-surgery). Amount of MS was recorded from case sheets of patients. Mean tongue length reduced, whereas mean tongue height increased at T2 compared to T1 (P value = 0.001 for both). Linear, area and volumetric airway parameters at T2 were significantly reduced (P value = 0.001). All parameters showed statistically nonsignificant increase from T2 to T3 (P value > 0.05). Correlation analysis showed that change in tongue length at T3 did not show statistically significant correlation with amount of MS, changes in linear, area and volumetric airway parameters (P value > 0.05). However, the change in tongue height at T3 showed a significant (P value < 0.05) negative correlation (r value = - 0.742) with change in posterior airway space (PAS). CONCLUSIONS: The appraisal of tongue length and height after MS surgery should be an integral part of diagnosis and treatment planning. The retro-positioning of tongue and increase in its height after MS surgery may compromise pharyngeal airway especially PAS. Additional options such as bi-jaw surgery, debulking of tongue volume and genioplasty should be explored to minimize adverse effects post-surgically.

Full coverage crowns for rehabilitation of MIH affected molars: 24 month randomized clinical trial.

BACKGROUND: Teeth affected with severe molar incisor hypomineralization (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations. AIM: To evaluate and compare the clinical performance of zirconia, lithium disilicate, and cast metal crowns as full-coverage restorations on MIH-affected first permanent molars (FPMs). METHODS: 60 MIH affected FPMs requiring full-coverage crowns were identified in children aged 8-15 years and were randomly allocated to the three treatment groups according to the type of full coverage restoration received using block randomization technique. After an adequate removal of the MIH defect and restoration with composite resin, the tooth preparation was done followed by fabrication of crown and its cementation using resin cement. The intergroup comparison was done on the basis of USPHS criteria, gingival, plaque scores, patient and parents acceptance through a visual analog scale to decipher their clinical performance at 6, 12, 24 months. RESULTS: After 24 months, the crowns showed similar clinical success in terms of the criterias used to compare their clinical performance. The retention, marginal adaptation, relief from hypersensitivity, proximal contact, gingival health with no statistically significant difference among the three groups. CONCLUSION: Based on the observations, Lithium disilicate, Zirconia and full cast metal crowns showed similar clinical success in rehabilitation of First permanent molars with severe MIH over 24 months of evaluation. The clinical success is not influenced by the material of the restoration. However, prospective studies with a longer follow-up are required to reach a more definitive conclusion.

Evaluation of Airway Dimensions Following Mandibular Setback with Surgery-First Orthognathic Versus Conventional Orthognathic Approach.

BACKGROUND: To evaluate changes in airway dimensions following mandibular setback with conventional orthognathic approach (COA) and surgery-first orthognathic approach (SFOA). MATERIALS AND METHODS: Treatment records of 20 patients who underwent mandibular setback with SFOA/COA were divided into two groups (COA and SFOA, ten patients in each group). Acoustic pharyngometry values were obtained at T0 (01 week prior to surgery), T1 (01-month post-surgery) and T2 (01-year post-surgery). Percentage change in mean volume and area was obtained at T1 (T1-T0) to evaluate airway changes and at T2 (T2-T1) to compare relapse of airway changes in both groups. Changes in airway per mm setback at T1 (T1-T0) and T2 (T2-T1) were also obtained in both groups. RESULTS: For both parameters, SFOA showed greater reduction at T1 and greater relapse at T2 as compared to COA. The reduction in airway volume at T1 was 0.56 mm/mm setback in COA compared to 1.06 mm/mm setback in SFOA (P-value > 0.05). The relapse in airway volume at T2 was 0.15 mm/mm setback in COA compared to 0.25 mm/mm setback in SFOA (P-value > 0.05). The reduction in area at T1 was 0.062 mm/mm setback in COA compared to 0.110 mm/mm setback in SFOA (P-value > 0.05). The relapse in area at T2 was 0.016 mm/mm setback in COA compared to 0.034/mm setback in SFOA (P-value < 0.05). CONCLUSION: In setback cases, SFOA has greater airway reduction immediate post-surgically and greater relapse at 01-year follow-up. Predicting these changes at diagnostic and treatment planning stage may prevent potential adverse events on airway.

A multicentre prospective double blinded randomised controlled trial of intravenous iron (ferric Derisomaltose (FDI)) in Iron deficient but not anaemic patients with chronic kidney disease on functional status.

BACKGROUND: Iron deficiency (ID) is common in patients with chronic kidney disease (CKD). Intravenous (IV) iron in heart failure leads to improvement in exercise capacity and improvement in quality-of-life measurements; however, data in patients with CKD are lacking. METHODS: The Iron and the Heart Study was a prospective double blinded randomised study in non-anaemic CKD stages 3b-5 patients with ID which investigated whether 1000 mg of IV iron (ferric derisomaltose (FDI)) could improve exercise capacity in comparison to placebo measured at 1 and 3 months post infusion. Secondary objectives included effects on haematinic profiles and haemoglobin, safety analysis and quality of life questionnaires (QoL). RESULTS: We randomly assigned 54 patients mean (SD) age for FDI (n = 26) 61.6 (10.1) years vs placebo (n = 28; 57.8 (12.9) years) and mean eGFR (33.2 (9.3) vs. 29.1 (9.6) ml/min/1.73m2) at baseline, respectively. Adjusting for baseline measurements, six-minute walk test (6MWT) showed no statistically significant difference between arms at 1 month (p = 0.736), or 3 months (p = 0.741). There were non-significant increases in 6MWT from baseline to 1 and 3 months in the FDI arm. Haemoglobin (Hb) at 1 and 3 months remained stable. There were statistically significant increases in ferritin (SF) and transferrin saturation (TSAT) at 1 and 3 months (p < 0.001). There was a modest numerical improvement in QoL parameters. There were no adverse events attributable to IV iron. CONCLUSION: This study demonstrated a short-term beneficial effect of FDI on exercise capacity, but it was not significant despite improvements in parameters of iron status, maintenance of Hb concentration, and numerical increases in functional capacity and quality of life scores. A larger study will be required to confirm if intravenous iron is beneficial in iron deficient non-anaemic non-dialysis CKD patients without heart failure to improve the 6MWT. TRIAL REGISTRATION: European Clinical Trials Database (EudraCT) No: 2014-004133-16 REC no: 14/YH/1209 Date First Registered: 2015-02-17 and date of end of trail 2015-05-23 Sponsor ref R1766 and Protocol No: IHI 141.

Co-Amorphization of Ibuprofen by Paracetamol for Improved Processability, Solubility, and In vitro Dissolution.

Co-amorphous (COAM) systems of ibuprofen (IB) and paracetamol (PA), in clinical dose ratios, were prepared by ball milling to enhance solubility and dissolution of IB. Subsequently, COAM were characterized by solubility, processability, XRPD, DSC, ATR-FTIR, SEM, in-vitro dissolution and accelerated stability studies. Maximum increase in aqueous solubility of IB was seen in 500:200 mg dose ratio (COAM 1) with 6.7 fold rise from 78.3 ± 1.1 to 522.6 ± 1.29 ∆g/ml. COAM 1 exhibited 99.80 ± 0.58% dissolution of IB at 20 min in phosphate buffer, significantly high (P < 0.05) compared to plain IB. Thus saturation solubility and dissolution rate of IB was found significantly improved unlike PA. The flowability/ processability of COAM system was remarkably improved compared to pure IB, speculated due to as formation of miniscular forms of PA-IB, having strong adhesive interactions. XRPD and DSC results confirmed amorphization of IB. ATR-FTIR results evidenced hydrogen bonding interactions between both the drugs. In accelerated stability studies, flowability, XRPD, DSC and in-vitro dissolution studies demonstrated insignificant changes, thus confirming successful stabilisation of IB by PA.

Oral Cysticercosis Presenting as an Innocuous Lesion.

Cysticercosis is a parasitic infection with potential of causing significant morbidity especially in developing countries. The larval form of the parasite Taenia Solium, 'Cysticercus Cellulosae' primarily colonizes in the small intestine and has the potential to disseminate to different sites of the body. Oral presentation is rare and difficult to detect owing to its innocuous presentation. This report describes the presentation of cysticercosis involving the tongue and presenting as a submucosal mass. An incisional biopsy was performed and evaluation of the histopathological features lead to the diagnosis of oral cysticercosis. This article highlights the importance of inter-departmental collaboration for the accurate diagnosis and effective management of oral cysticercosis in order to avoid potential systemic complications.

Utility versus futility of facebow in the fabrication of complete dentures: A systematic review.

AIM: The aim of this review was to investigate utility or futility of facebow for fabrication of complete denture prosthesis to maximise clinical efficiency and acceptability of complete dentures. SETTINGS AND DESIGN: Systematic review following PRISMA guidelines. MATERIALS AND METHODS: A study question was designed based on PICOT model which was used to evaluate whether facebow transfer is required or not for fabrication of complete denture prosthesis. An extensive search was carried out manually and using electronic databases such as PubMed-Medline, Cochrane, Google Scholar, and Clinicaltrials.gov. Parameters under review included patient satisfaction, masticatory efficiency, occlusal adjustments, clinician time, stability and retention. Boolean operators, MeSH terms and limiters were applied to develop the search and reach to conclusive studies pertaining to study design. Literature dated between 1950 and 2019 were selected. The data extraction and assessment of the studies was done by two independent investigators. STATISTICAL ANALYSIS USED: No meta-analysis was conducted due to heterogeneity of data obtained. RESULTS: 13690 studies were shortlisted, 13672 were excluded based on title and abstract. By the end of search phase, 07 RCTs were considered relevant. 04 studies concluded comparable/ no differences in outcome with and without use of facebow for fabrication of complete denture prostheses, whereas 03 studies concluded better results without the use of facebow. CONCLUSION: The use of facebow results in fabrication of complete denture prostheses with similar results in terms of clinical efficiency and patient acceptability as compared to simplified techniques using anatomical landmarks. Variations in assessment criteria, non uniform distribution of sample size amongst different clinical trials and subjective questionnaire based criteria are the weaker links in the review. Extensive research and long term standardised studies with objective criteria for assessment are required for comprehensive and conclusive results to establish the need for change in clinical practice.

Effect of Mandibular Advancement Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions.

INTRODUCTION: The spatial position and dimensions of oral and pharyngeal soft tissues change post-mandibular advancement (MA) surgery which involves changes in position of soft palate, tongue and associated musculature. There is no study which simultaneously evaluates changes in tongue length and height post-MA surgery and correlates these changes with changes in upper airway dimensions and the amount of MA. MATERIALS AND METHODS: Treatment records of 18 patients that underwent MA with bilateral sagittal split ramus osteotomy were evaluated at T1 (01 week before surgery) and T2 (06 months post-surgery). Linear airway and tongue measurements were done on lateral cephalogram. Mean volume and mean pharyngeal area values were recorded from the acoustic pharyngometry (AP) records of patients. RESULTS: A statistically significant increase in tongue length (P value < 0.001) and nonsignificant change in tongue height were observed at T2 (P value > 0.05). A statistically significant increase in airway parameters recorded on both lateral cephalogram and AP was observed at T2 (P value < 0.001). Correlation analysis did not show a statistically significant correlation of change in tongue length and tongue height at T2 with the amount of MA, change in airway parameters on lateral cephalogram and AP (P value > 0.05). CONCLUSIONS: Mandibular advancement surgery is a viable option for improvement in pharyngeal airway in skeletal Class II patients with retrognathic mandible. Changes in tongue length observed in our study may correspond to the stretch of protruders of tongue, especially genioglossus, and may point toward possible relapse on a long-term follow-up.

Evaluation of Nasal Patency Among Patients With Unilateral Cleft Lip and Palate: Cleft Versus Non-Cleft Side.

OBJECTIVE: To evaluate the nasal patency using acoustic rhinometry (AR) in patients with unilateral cleft lip and palate (UCLP) and to ascertain the rhinological importance of the same. METHODS: Eccovision Acoustic Rhinometer system was used for assessment of nasal cross-sectional area (CSA) and volume in 15 patients with UCLP. The CSA1, CSA2, and CSA3, which represent the CSA at the nasal valve area and anterior end of the inferior turbinate, the anterior half of the inferior turbinate and the anterior end of the middle turbinate, and the region of middle portion of middle turbinate, respectively, were compared on the cleft and non-cleft side. RESULTS: The mean ± SD of CSA1, CSA2, and CSA3 as well as the overall nasal CSA were significantly higher on non-cleft side compared to cleft side (P value < .001). The mean ± SD of nasal volume was also significantly higher in non-cleft side compared to cleft side (P value < .001). CONCLUSIONS: The nasal patency among patients with UCLP demonstrates a range of impairments that can be objectively measured using acoustic rhinometry. The orthodontic, orthopedic, or orthosurgical management of maxillary deficiency in these patients can affect the nasal area and volume and can have an impact on breathing, speech, and sleep. The pretreatment assessment may be useful to identify patients who are at potential risk of deterioration of nasal patency and airway post-intervention. Taking into consideration the multiple diagnostic procedures in the course of long-term multidisciplinary treatment of patients with cleft lip and palate, a noninvasive investigation technique such as AR may be the preferred mode of investigation to ascertain nasal patency.

Forensic odontology: The prosthetic ID.

The term "forensic science" involves forensic (or forensis, in Latin), which means a public discussion or debate. In a more modern context, however, forensic applies to courts or the judicial system. Combine that with science, and forensic science means applying scientific methods and processes to solving crimes. People can be identified by their fingerprints, foot creases, and from traces of their DNA from blood, skin, hair, saliva, and semen by DNA analysis. However, in situations where these records are unavailable or unusable due to the nature of the disaster, the dental records and aids prove to be useful for victim identification. This article aims at highlighting the importance of the dental records and the forensic odontology in the accurate and efficient identification of the conflict victims or deceased to serve as an important adjunct to the forensic medicine in a simplified manner.

A census of baryons in the Universe from localized fast radio bursts.

More than three-quarters of the baryonic content of the Universe resides in a highly diffuse state that is difficult to detect, with only a small fraction directly observed in galaxies and galaxy clusters1,2. Censuses of the nearby Universe have used absorption line spectroscopy3,4 to observe the 'invisible' baryons, but these measurements rely on large and uncertain corrections and are insensitive to most of the Universe's volume and probably most of its mass. In particular, quasar spectroscopy is sensitive either to the very small amounts of hydrogen that exist in the atomic state, or to highly ionized and enriched gas4-6 in denser regions near galaxies7. Other techniques to observe these invisible baryons also have limitations; Sunyaev-Zel'dovich analyses8,9 can provide evidence from gas within filamentary structures, and studies of X-ray emission are most sensitive to gas near galaxy clusters9,10. Here we report a measurement of the baryon content of the Universe using the dispersion of a sample of localized fast radio bursts; this technique determines the electron column density along each line of sight and accounts for every ionized baryon11-13. We augment the sample of reported arcsecond-localized14-18 fast radio bursts with four new localizations in host galaxies that have measured redshifts of 0.291, 0.118, 0.378 and 0.522. This completes a sample sufficiently large to account for dispersion variations along the lines of sight and in the host-galaxy environments11, and we derive a cosmic baryon density of [Formula: see text] (95 per cent confidence; h70 = H0/(70 km s-1 Mpc-1) and H0 is Hubble's constant). This independent measurement is consistent with values derived from the cosmic microwave background and from Big Bang nucleosynthesis19,20.

A single fast radio burst localized to a massive galaxy at cosmological distance.

Fast radio bursts (FRBs) are brief radio emissions from distant astronomical sources. Some are known to repeat, but most are single bursts. Nonrepeating FRB observations have had insufficient positional accuracy to localize them to an individual host galaxy. We report the interferometric localization of the single-pulse FRB 180924 to a position 4 kiloparsecs from the center of a luminous galaxy at redshift 0.3214. The burst has not been observed to repeat. The properties of the burst and its host are markedly different from those of the only other accurately localized FRB source. The integrated electron column density along the line of sight closely matches models of the intergalactic medium, indicating that some FRBs are clean probes of the baryonic component of the cosmic web.

A clinical and radiographic investigation comparing the efficacy of cast metal and indirect resin onlays in rehabilitation of permanent first molars affected with severe molar incisor hypomineralisation (MIH): a 36-month randomised controlled clinical trial.

PURPOSE: Definitive restorative management of young permanent molars affected with severe MIH is still elusive with a dearth of conservative restorative options. The present trial compared the 36 months clinical and radiographic performance of minimally invasive cast metal and indirect resin onlays for rehabilitation of permanent first molars affected with severe MIH. METHODS: In this parallel group open label randomised trial, 42 vital molars affected with severe MIH in 30 children, aged 8-13 years were randomly allocated using stratified permuted block randomization to receive either a cast metal onlay or an indirect composite onlay (n = 21 each). Clinical and radiographic evaluations of these onlays were carried out at 9, 18 and 36 months using the USPHS criteria. Cumulative survival rate as well as the calculated clinical success rates of both types of onlays were also determined. The longevity of onlays was assessed using Kaplan-Meier survival analysis. RESULTS: At 36 months, overall retention rate was found to be 95% with complete elimination of any pre-existing sensitivity. Cumulative survival rates were found to be 95% vs. 100%, p = 0.67, while the calculated clinical success rates were 90% and 85.7% for metal and resin onlays, respectively, with no significant differences (p = 0.76). Mean survival rates based on Kaplan-Meier analysis were determined to be 85% vs. 100% for the metal and composite groups, respectively (p = 0.075). CONCLUSIONS: Irrespective of the type of material used, onlays offer a predictable and conservative restorative alternative for molars affected with severe MIH. CLINICAL TRIAL REGISTRY: The trial is registered under Clinical Trial Registry India (CTRI/2016/10/007379).