Study of neoadjuvant chemotherapy in advanced malignant ovarian germ cell tumors at a tertiary center in western India.

OBJECTIVE: To study clinical characters and outcomes in patients of malignant ovarian germ cell tumor (MOGCT) undergoing surgery following neoadjuvant chemotherapy (NACT). METHODS: Retrospective study of patients undergoing surgery following NACT for MOGCT at our institute. Platinum based chemotherapy was given in all patients in NACT. RESULTS: Between March 2013 and February 2023, 30 patients had surgery after NACT. Patient's median age was 22 years (range, 12 to 35 years) and median follow up 42months (range, 6 to 132 months). Majority had endodermal sinus tumor (n=12), dysgerminoma (n=9) and mixed GCT (n=7). All had either International Federation of Gynecology and Obstetrics (FIGO) stage 3 (n=19) or FIGO stage 4 disease (n=11). Complete response to NACT seen in 5 patients and 23 patients had partial response. Fertility sparing surgery in 18 patients and complete surgery in 12 patients. Suboptimal surgery was seen in 4 patients. Currently, 20 of 30 patients are alive and disease free, 3 lost for follow up and 7 patients had progression after adjuvant therapy. Five patients had mortality-4 with progression and 1 with bleomycin toxicity. Fifteen of 17 eligible patients have resumed menstruation and one had successful pregnancy. Prognostic factors noted in study are stage, optimal surgery and viable tumor in histopathology. Dysgerminoma had better outcome than other histology. CONCLUSION: NACT may be a reasonable option in patients with extensive unresectable disease or in whom fertility sparing is not possible or in the poor general condition. Fertility sparing surgery can be attempted post neoadjuvant chemotherapy without adversely affecting prognosis.

The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study.

Aim: The study aimed to assess the anxiety and stress levels on acceptance of dental treatment in child patients approaching dental extraction procedures before and after nitrous oxide (N2O) inhalation sedation (IHS) by measuring serum amyloid A (SAA) and salivary cortisol (SC). Materials and methods: A total of 32 children, ages ranging from 6 to 10 years, were randomly grouped as TI (before N2O IHS) and TII (after N2O IHS). Saliva samples were taken for biochemical evaluation of SAA before and after the procedure. Subjectively anxiety and stress levels were evaluated using modified child dental anxiety scale (MCDAS). Wilcoxon rank-sum test was used to compare the means of dental anxiety, SAA, and SC before and after N2O IHS. The Karl Pearson correlation coefficient was employed to determine the correlation between dental anxiety and SAA and SC before and after N2O IHS. Results: There were significant differences in the dental anxiety level in child patients after administration of N2O IHS, and it also showed an increased rate of acceptance of dental treatment. Conclusion: This study showed that N2O is a safe and effective method in reducing dental anxiety and increasing acceptance of dental treatment in child patients with improved behavior and with no adverse effects. Clinical significance: Anxiety and stress will always hinder the acceptance of dental treatment in child patients, especially during extraction procedures. N2O IHS is a safe and effective technique to overcome anxiety and stress in child patients and as well as allows them to undergo dental treatment with improved behavior. How to cite this article: Kunta S, Arora RV, Jain R, et al. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):302-307.

A Scanning Electron Microscopic Study on Effect of Blood and Artificial Salivary Contamination on Marginal Adaptation of Mineral Trioxide Aggregate, When Used as a Retrograde Filling Material: An In Vitro Study.

AIM AND OBJECTIVE: The present study was conducted to evaluate the marginal adaptability of mineral trioxide aggregate (MTA) as a root-end filling material when manipulated using two different IV fluids intended for pediatric usage; in the presence of blood and salivary contamination. MATERIALS AND METHODS: Sixty single-rooted teeth were selected. Conventional endodontic root canal preparation was performed on all specimens followed by root-end resection and retrograde cavity preparation. The roots were randomly divided into two groups (n = 30). In the specimens of group I, fresh blood was used as a contaminant and in group II artificial saliva was used as a contaminant. In both groups, MTA (e-MTA, Kids-e-Dental®) manipulated using either Ringer's lactate IV fluid (n = 15) or Tetraspan IV fluid (n = 15) was used for root-end filling in blood or artificial saliva-coated retrocavities. Furthermore, these roots were placed in beakers pooled with fresh phlebotomized blood or artificial saliva. After incubating for 48 hours, the roots were divided longitudinally to expose the retrofilled cavities and were then sputter-coated with gold-platinum dust. To assess the marginal adaptation of MTA to radicular dentin "maximum gap width" and "gap perimeter" were measured in images obtained from scanning electron microscopy of root specimens. SPSS 21 was employed for statistical analysis at (p < 0.05). Mann-Whitney U test and ANOVA were used for analyzing the data obtained. RESULTS: The gap width was more among samples exposed to blood (p < 0.05) than artificial saliva. No significant difference was reported in the gap perimeter when cavities were filled with MTA mixed with either IV fluids (p > 0.05). CONCLUSION: Exposure to blood during setting had a negative effect on gap width when retrocavities were filled with MTA using Tetraspan. No effect was seen on the arch perimeter in retrocavities filled with MTA mixed with Ringer's lactate or Tetraspan. CLINICAL SIGNIFICANCE: For avoiding failure, it is critical to select a biocompatible root-end filling material with high sealing ability. Hence, by doing the same, the clinical situation can be simulated. HOW TO CITE THIS ARTICLE: Mody A, Arora R, Chauhan P, et al. A Scanning Electron Microscopic Study on Effect of Blood and Artificial Salivary Contamination on Marginal Adaptation of Mineral Trioxide Aggregate, When Used as a Retrograde Filling Material: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(5):674-680.

Female genital tract melanoma: Analysis from a regional cancer institute.

OBJECTIVE: Malignant melanoma of the genital tract comprises 3% of all melanomas afflicting females. They are characterized by poor prognosis with 5-year survival of 0-25% and high incidence for distant metastasis. This study was performed to assess various clinical features, treatment options, and thre management of genital melanomas. MATERIALS AND METHODS: This was a retrospective analysis where records of patients with genital melanomas between 2005 to 2018 were reviewed to obtain demographic and clinical information, including age of diagnosis, presenting symptoms, performance status, pathology reports, treatment, follow-up, and survival. RESULTS: Between 2005 and 2018, 31 women were analyzed. The median age was 53.5 (range: 28.5-85) years. Vaginal bleeding was the most common presenting symptom (80.6%), followed by discharge (29%), mass in the vagina/perineum (19.3%), pain (16.1%), and difficulty in micturition (9.6%). The most common site of origin was the vagina (67.7%), followed by that vulva (19.3%) and cervix (12.9%). Tumor diameter was more than 3 cm in 74.2% (23/31). Out of 31 patients, only 16 opted for treatment. Four patients underwent surgery, 10 received primary chemotherapy, and two needed palliative radiotherapy for heavy bleeding. The median survival in the treatment group was 5 (range: 2.5-28) months, almost similar to patients not receiving any treatment (5 months, range: 2-11). CONCLUSION: Genital melanoma are rare but aggressive tumors. Diagnosis is usually made with biopsy. No effective treatment strategy is yet available. However, surgery is the preferred first- line treatment, radiotherapy and chemotherapy have been used in adjuvant settings.

Prognostic value of lymph node ratio in surgically treated cases of vulvar cancer: a tertiary care centre experience.

OBJECTIVE: This study aimed to study the patterns of recurrence in surgically treated cases of vulvar cancer (VC) and determine the factors associated with recurrence, with a special emphasis on lymph node ratio (LNR). METHODS: This retrospective study examined VC patients primarily treated with surgery at our institute from January 2005 to December 2015. Demographic data, clinical characteristics, surgicohistopathological data, adjuvant treatment, follow up, and recurrence site and treatment were studied. RESULTS: Among the 111 cases treated, a recurrence rate of 18.9% was noted. Recurrence was most commonly local (61.9%). On univariate and multivariable analyses of clinicopathological parameters, an LNR >20 had the highest hazard ratio for recurrence. CONCLUSION: LNR may provide useful prognostic information in VC patients with positive inguinal lymph node status.

Does preoperative CA-125 cutoff value and percent reduction in CA-125 levels correlate with surgical and survival outcome after neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer? - Our experience from a tertiary cancer institute.

AIM: The aim of the study is to evaluate percent fall in CA-125 levels after neoadjuvant chemotherapy (NAC) and preoperative CA-125 value to predict surgical and survival outcomes in women with advanced-stage epithelial ovarian cancer (EOC). METHODS: A retrospective review of 406 women receiving NAC for advanced-stage EOC from January 2012 to July 2015 was conducted. Data were collected for demography, radiographic profile, CA-125 levels before and after NAC, chemotherapy, and surgicopathological information. Percent fall in CA-125 was categorized into two groups: <95% (R < 95) and >95% (R > 95) fall from prechemotherapy to preoperative levels. Similarly, women were also categorized using preoperative CA-125 levels of <100 and >100 U/ml. A subset of women from January 2012 to December 2013 was followed to June 2015 for evidence of any recurrence to determine survival outcomes. RESULTS: About 56% women had R > 95 and 44% had R < 95. As compared to R < 95, R > 95 group was more likely to have complete cytoreduction (P = 0.00). Furthermore, women with R > 95 had significant better progression-free survival (PFS) as compared to women with R < 95 (P = 0.009) but no difference in overall survival (OS) (P = 0.28). Women with preoperative CA-125 <100 had significant higher number of complete cytoreduction (55% vs. 40%; P = 0.00) and were associated with both PFS (P = 0.007) and OS benefit (P = 0.02). CONCLUSION: Our data showed that >95% fall in CA-125 and an absolute preoperative CA-125 value of <100 U/ml is associated with better surgical and survival outcome in women with advanced EOC. These data are important in patient counseling and treatment planning.

Caries risk in children of Udaipur City, India using genetic taste sensitivity to 6-n-propylthiouracil.

AIMS AND OBJECTIVES: Dental caries still remains the single most common disease of childhood. The present study was conducted to test the hypothesis that a higher prevalence of dental caries would be observed among nontaster children compared to medium tasters or supertasters of 6n propylthiouracil impregnated filter papers. MATERIALS AND METHODS: The present study was conducted on a random sample of 600 school children aged 6-12 years in Udaipur city. 6-n-propylthiouracil strips were prepared. The food preference questionnaire was filled by the participants, and their decayed missing filled status as well as taste sensitivity to the propylthiouracil impregnated filter papers were noted. The data obtained was then used for statistical analysis using chi square, analysis of variance, and Students t-tests with the consult of a statistician using the Statistical Package for the Social Sciences version 17 software. RESULTS: Nontasters had a greater caries experience than the supertasters and medium tasters. Females were found to be more tasters than nontasters. It was also found that nontasters belonged to caries active group more than the tasters. CONCLUSION: The caries status was higher among the nontaster children with more sweet preference than in taster children and they belonged more to the caries active group.

Antibacterial Activity of Two Chemomechanical Caries Removal Gels on Carious Dentin of Primary Teeth: An in vitro Study.

INTRODUCTION: Chemomechanical caries removal (CMCR) is an effective method of caries removal especially for primary teeth as they cause less discomfort when compared with conventional caries removal. The most significant thing about caries removal is the elimination of cariogenic bacteria. This study compares the antibacterial activity of two CMCR gels. MATERIALS AND METHODS: A total of 40 primary molar teeth with carious dentin were split along the long axis in a laboratory. Total viable count (TVC) was taken for the teeth before splitting as a measure of colony-forming units per milliliter (CFU/mL). Each half was treated with either Carisolv or Carie-Care CMCR gels. Clean dentin samples were evaluated for Streptococcus mutans (SM) and Lactobacillus acidophilus (LB) after removal of carious tissue using the caries removal gels using serial dilutions and incubating on specific agar plates. RESULTS: The results showed significant reduction in mean TVC after use of both the CMCR gels. Both gels reduced the CFU/mL of SM and LB to a significant level (p < 0.05). However, there was no significant difference between the antibacterial activities of the two CMCR gels. CONCLUSION: The CMCR gels (Carisolv and Carie-Care) significantly reduced the residual TVC as well as SM and LB in carious primary dentin. Both CMCR gels had a similar antibacterial activity on the carious dentin of primary teeth. CLINICAL SIGNIFICANCE: The CMCR gels tested have a significant antibacterial activity and can be effectively used for elimination of caries-causing bacteria in primary teeth.

Ovarian Fibroma: A Clinico-pathological Study of 23 Cases with Review of Literature.

PURPOSE: The purpose of this study was to correlate the clinical findings, RMI-4 index and frozen section, in cases of ovarian fibroma with the final histopathology. METHODS: This is a retrospective study of clinical and pathological features of 23 patients of ovarian fibroma. The patient's age ranged from 34 to 66 years (mean-49 years). The most common presenting symptom was abdominal pain. On clinical examination, the mean size of ovarian tumor was 9.5 cm, CA-125 levels were found to be raised in 14 patients, and it was associated with ascites in 10 patients. USG showed a well-circumscribed mass (with a mean size of 14 cm), on the left side in 14 cases and on the right side in 9 patients. RMI-4 was calculated in all the patients, and it revealed the possibility of a benign histology in 17 patients. All patients underwent exploratory laparotomy with the removal of ovarian tumor followed by frozen section examination. All but one (22/23) patient had positive correlation among frozen section and final histopathological findings. RESULT: Ovarian fibroma generally tends to occur in post-menopausal women. All the patients in our study of ovarian fibroma were symptomatic, with the presence of palpable mass in majority of patients. RMI-4 Index correlated very well with benign nature of disease. Frozen section has an invaluable role at surgery; fertility-conserving surgery is the choice in young women. CONCLUSION: Clinical findings, RMI-4 Index and frozen section, play vital roles before and during surgery in cases of benign ovarian tumors.

Postendodontic restoration of severely decayed primary tooth using modified omega loop as a post.

The esthetic concern of severely mutilated primary anterior teeth in the case of early childhood caries has been a challenge to pediatric dentist. Early childhood caries is the most common chronic disease of the preschool child. The case report presented here is of a three year old boy with severely decayed maxillary anterior teeth. After root canal treatment, the primary maxillary central incisors were reinforced using modified omega post and followed by using celluloid strip crowns. The technique described here offers a simple and effective method for restoring severely decayed primary anterior teeth that reestablishes shape, function, and esthetics.

Assessment of microbial contamination on twice a day used toothbrush head after 1-month and 3 months: An in vitro study.

PURPOSE: The purpose of vitro study was to assessment of the bacterial contamination on daily twice-used toothbrushes in different conditions after 1-month and 3 months. MATERIALS AND METHODS: Forty children aged between 6 and 12 years were selected for this study. Toothbrushes and toothpaste were distributed among those children. Among those children, 20 children brushed their teeth for 1-month and 20 brushed their teeth for 3 months twice a day. Among those, 10 were kept in same brush box with a family member and 10 were kept in separate brush box after the use. Toothbrush from every child was recollected to investigate the contamination of microorganisms. Head of the toothbrushes transferred to a tube containing 10 ml of tryptone soy broth. This was followed by vortex mixing for 1 min to dislodge suspected adherent bacteria. The bacterial suspension was serially diluted to obtain dilution factors of up to 10(-3). 1 ml each of the dilution factors was obtained using a sterile pipette and plated on plate count agar. Petri dishes containing agar media were incubated and examined using a compound microscope. RESULTS: There was high mean difference between 1-month and 3 months, twice a day used toothbrush those kept with family members and those kept separate. CONCLUSIONS: Toothbrush should keep in a separate box. Moreover, toothbrush should to be change after 3-4 weeks.

Maternal Dental Anxiety and its Effect on Caries Experience Among Children in Udaipur, India.

CONTEXT: Dental caries is a common oral disease among children. There are various factors that influence caries development. Parents and family environment influence oral health behaviours among children. Dental Anxiety is a common hindrance in seeking dental treatment. Mothers' dental anxiety may act as a barrier to seek professional advice about their children's caries experience. AIM: To evaluate dental anxiety among mothers and its possible relationship with caries experience in their children in Udaipur city, India. SETTING AND DESIGN: The sample was selected from those attending Darshan Dental College and Hospital, Udaipur for dental treatment. The study period was from June 2014 to November 2014. MATERIALS AND METHODS: A cross-sectional survey was designed. A total of 187 mother-child pairs were recruited for the study. The children's age ranged from 3-14 years. Modified Dental Anxiety Scale (MDAS), Hindi version, was used to evaluate dental anxiety among the mothers that categorizes the dental anxiety into five levels. Demographic detail such as age, educational level, and family income was also collected. The World Health Organization (WHO) criteria was utilized for the diagnosis of dental caries in children. DMFT (Decayed, missing and filled teeth) and DMFS (Decayed, missing and filled surfaces) scores were then calculated. STATISTICAL ANALYSIS: Statistical Package for Social Sciences (SPSS) version 20.0 was used to interpret data. Maternal anxiety scores taken as mean MDAS were compared with various independent variables. Statistical tests were used to compare maternal anxiety and children's caries experience. A p value equal or less than 0.05 was considered as statistically significant. RESULTS: Almost half (49.7%) of the mothers reported as being 'fairly anxious' or 'very anxious'. There was a significant (p=.001) difference in maternal dental anxiety level in relation to age of the children. Mothers of younger children reported higher anxiety scores. Similarly, mothers with lesser education and lesser family income reported higher anxiety scores. The mean decayed score in children of very anxious mothers and phobic mothers was significantly (p=.001) higher as compared to the children of the mothers with lower anxiety levels. CONCLUSION: There was a strong positive association between maternal dental anxiety and children's dental caries experience.

Comparison of relationship between salivary electrolyte levels and dental caries in children with Down syndrome.

AIM: The aim of this study was to relate the salivary electrolyte levels with dental caries in children with Down syndrome and to compare salivary electrolyte levels and dental caries of these children with their siblings. MATERIALS AND METHODS: Study population consisted of 30 Down syndrome children (study group) and their 30 healthy siblings (control group). Caries status was determined by dental caries indices in deciduous and permanent dentitions. Un-stimulated saliva from both groups was collected for salivary electrolyte examination. RESULTS: In the study group, mean caries experience in primary dentition was 1.00 ± 0.79 and in the control group it was 2.33 ± 1.42, the difference being statistically significant. Mean caries experience in the permanent dentition of the study group (0. 97 ± 0.76) was significantly lower than the control group (2.47 ± 1.25). Salivary electrolyte levels in the study group were significantly higher than the control group. CONCLUSION: There was a significant decrease in dental caries in primary as well as permanent dentition of Down syndrome patients with increase in their salivary electrolyte levels.

Role of cone beam computed tomography and white mineral trioxide aggregate in the successful management of a permanent anterior tooth with open apex.

Cone beam computed tomography (CBCT) is a recent three-dimensional (3D) radiographic imaging modality used for the accurate diagnosis, management and follow-up of endodontic problems. In tooth with open apex and periapical lesion, the use of new obturation material such as white mineral trioxide aggregate (wMTA) facilitates faster and more predictable closure of root apex and periapical healing. The objective of this case report was to evaluate the role of CBCT and wMTA obturation in management of a permanent anterior tooth with open apex and periapical lesion. After CBCT evaluation of maxillary left central incisor with open apex and periapical lesion, it was endodontically treated with wMTA obturation. The patient was recalled regularly for 6 months. CBCT was found to be a useful tool for the diagnosis and post-operative evaluation of this case. The wMTA used for obturation in two visit endodontic treatment resulted in successful outcome, both clinically and radiographically.

Comparative evaluation of microleakage of three restorative glass ionomer cements: An in vitro study.

PURPOSE: The aim of this study was to compare the microleakage of glass ionomers (conventional and resin modified) with that of recently introduced nanoionomers. MATERIALS AND METHODS: Standardized class I and class V cavities were prepared on 120 young permanent teeth. Samples were equally divided into group I (class I restorations) and group II (class V restorations), and further divided into subgroups. The subgroups were restored with Fuji IX, Fuji II LC, and newly introduced Ketac(™) N 100 (KN 100). Samples were thermocycled and submerged in Acridine dye for 24 h. Samples were sectioned to view under fluorescent microscope and marginal leakage was evaluated by Chi-square and Kruskal - Wallis test. RESULTS: Fuji IX showed the maximum leakage, followed by LC II and the least was observed in KN 100. In class I restorations, there was significant difference while comparing Fuji IX with Fuji LC II and KN 100 and nonsignificant difference between LC II and KN100. In class V restorations, Fuji IX and KN100, KN 100 and LC II showed significant difference. Fuji IX and LC II showed nonsignificant difference. CONCLUSION: Within the limitations of this study, Fuji IX showed the maximum microleakage. KN 100 showed minimum leakage, better sealing ability, and was more consistent.

Rehabilitation of complicated crown-root fracture by fragment reattachment and intraradicular splinting: case reports.

This paper describes the rehabilitation of two traumatised teeth in two patients namely; A maxillary left central incisor with a relatively rare combination of multiple fractures- uncomplicated crown fracture, complicated crown-root fracture along with an oblique fracture in middle third of the root and A traumatised mandibular central incisor with a horizontal fracture in cervical third of the root and complete separation of the fragments. In both cases, initially the fractured crown fragments were extracted which was followed by pulpectomy and placement of fiber posts luted with resin cement. The fractured fragments were then reattached to the respective teeth using resin cement. In the first case, the fractured incisal edge of the fragment was built up with a hybrid composite. Teeth were splinted with fibre splint (Ribbond) in both the cases. The patient was recalled regularly for follow ups for six months in first case. The patient presented with normal clinical and radiographic findings at each visit. In the second case, follow ups were carried out for 3 weeks and being continued and both the cases are still under observation by regular recalls. How to cite this article: Ruchi Arora, B Shivakumar, H Murali Rao, R Vijay. Rehabilitation of Complicated Crown-Root Fracture by Fragment Reattachment and Intraradicular Splinting: Case Reports. J Int Oral Health 2013; 5(5):129-38.