Socio-demographic factors, clinico-radiological profile of patients with traumatic cervical spine injury in South India, and its association with short-term clinical outcome.

Background: Spinal cord injury is a devastating condition to an individual and his/her family imposing an economic burden on the family, society, and the country. Finding out the demographic and morbidity profile of cervical spine injuries is essential for formulating means and ways for its prevention and treatment. Aim: This study aimed at assessing the clinico-radiological and socio-demographic profile of cervical spine injury patients and their association with short-term clinical outcomes. Methods: This was a prospective observational study that included 120 patients with cervical spine/cord injury. Social, demographic, clinical, and radiological parameters of the study participants were recorded. Improvement, worsening, and neurological stability at 2 weeks follow-ups were considered as a short-term outcome. The association of neurological outcomes with clinico-radiological profile and socio-demographic characteristics was analyzed to study the level of significance. Results: The study found that nearly 81% of the study participants were involved in heavy physical activity, and 45% of the cases sustained cervical spine injury because of falls from height. About 37% and 55% of patients had complete and incomplete cord injury, respectively. Computerized tomography of the spine injury patients showed a fracture, subluxation, and locked facets. Magnetic resonance imaging showed disco-ligamentous injury and cord contusion in these patients. Nearly 29% of patients showed motor improvement, and around 4% of patients had a worsening of their neurological status after 2 weeks. Conclusion: Most of the people who sustain cervical spine injuries are involved in heavy physical work. Female gender, incomplete cord injury, and unilateral locked facet in subluxation are associated with good neurological outcomes. This study will form a preliminary base to build a larger database on spinal cord injury at the regional and national levels.

Diagnosis and treatment outcomes of Cushing's disease during pregnancy.

PURPOSE: We report a case of a pregnant woman with Cushing's disease (CD) and performed a systematic review of literature on diagnosis, treatment, maternal and fetal outcomes of CD in pregnancy. METHODS: A PubMed search was performed for manuscripts in English language from inception till June 2020. Cases of CD with hypercortisolism during pregnancy were included and categorized into three groups based on treatment received. Data on diagnostic modalities, CD remission, materno-fetal outcomes were analysed. RESULTS: Fifty-five patients of CD with 62 pregnancies were analysed. 24-h urinary free cortisol(UFC) was elevated by a mean of 5.4 ± 4.2 fold upper limit of normal non-pregnant level. 12/19 (63.1%) CD patients had more than threefold elevation of UFC measured during pregnancy. Mean midnight serum cortisol was 753.7 ± 270.5 nmol/l. At a midnight serum cortisol cut off of 440 nmol/l, 15/16 patients were correctly identified as CD. 23.2% underwent trans-sphenoidal surgery (group 1), 16.1% received only medical treatment (group 2) while 60.7% received no treatment (group 3) during pregnancy. Remission rates for CD in groups 1 and 2 were 76.9% and 77.8%, respectively. Adverse maternal and fetal outcomes were seen in 53.9% and 59.3% of the patients, respectively and were not significantly different between groups, although, lesser live births and greater pregnancy losses were seen in group 3. CONCLUSION: Midnight serum cortisol had better sensitivity than UFC for diagnosing hypercortisolism due to CD during pregnancy. In general, CD should be treated during pregnancy in order to optimize maternal and fetal outcomes as a trend towards increased live births is seen in treated subjects.

Systematic analysis of factors that cause loss of preload in dental implants.

Screw loosening is the most common factor associated with dental implant failure. One of the major cause for screw loosening is the "loss of preload". Several factors including screw geometry, material properties particularly stiffness, surface texture and condition of mating surfaces, degree of lubrication, rate of tightening, integrity of joint etc. OBJECTIVE: This review analyses the factors that are responsible for the loss of preload. MATERIAL AND METHODS: Screw geometry, Implant- Abutment Connection type (external hexagon platform, morse taper), Material properties viz Stiffness, Resilience, Materials viz gold, titanium, titanium alloy, Surface texture of the abutment screw, Condition of mating surfaces, Lubrication, Torque value, Rate of tightening (10, 20, 35N and retorque after 10mins) are taken into consideration in this study. The MEDLINE-PubMed database was searched from September 2016 to 10 years previously. Several journals were hand searched and from cross references. The outcome analysed are the factors that are responsible for loss of preload. RESULTS: The search yielded 84 articles. After excluding duplicated abstracts and applying the inclusion and exclusion criteria, 36 studies were eligible for analysis. The result shows that loss of preload can occurs depending upon the type of material used, torque method, torque sequences, abutment connection type, influence of lubrication, abutment collar length. However we detected some potential limitations in the studies selected, mainly a minimum number of samples used for the study. Hence we suggest further studies to guarantee an excellence in methodological quality. CONCLUSION: Based on the available data it can be summarized that the knowledge of preload loss must be known for the clinicians to avoid such screw loosening and subsequent implant failure.

Systematic analysis on the efficacy of bone enhancement methods used for success in dental implants.

Bone grafting is beneficial in enhancing bones that are lost due to trauma or natural or pathologic process. Autogenous bone, allogenic bone, xenogeneic bone, bone substitutes, and alloplasts can also be used for this purpose. Bone quantity should be adequate for the placement of implants, which necessitate the use of bone grafts before implant placement. OBJECTIVE: This review analyses the different bone graft materials that are used for grafting around implants and evaluate if these grafts yield successful implant osseointegration over a period of time. MATERIALS AND METHODS: The MEDLINE-PubMed database was searched from September 2016 to 10 years previously. Several journals were hand searched and from cross-references. The primary outcome measure that was analyzed was the survival rate of dental implants in the grafted sites at 6 months-1 year, and the secondary outcomes were success rates of dental implants over a period of 3-5 years' follow-up. RESULTS: The search yielded 213 articles. Ultimately, 31 studies meeting the eligibility criteria were selected. The analysis shows that autologous bone grafts can be preferred over allografts and xenografts for grafting implant sites, which showed less complication and high success rate. CONCLUSION: Based on the available data in the current existing studies with a follow-up period of at least 3-5 years, it can be summarized that the autologous bone grafts can be preferred over allografts and xenografts for grafting implant sites since they are stable for at least 3-5 years.

Assessing the Viability of Hadad Flap by Postoperative Contrast-Enhanced Magnetic Resonance Imaging.

INTRODUCTION: The Expanded Endonasal Approaches (EEAs) have been widely used for various skull base lesions. The reconstruction of the skull base defects is of vital importance to prevent postoperative complications. The vascular pedicled-nasoseptal flap (Hadad-Bassagasteguy flap) is used as a workhorse in reconstruction of majority of the defects. AIM: The purpose of this study was: (a) To assess the postoperative MRI appearance of vascularised pedicled nasoseptal flap for its viability; (b) To determine the variations in MRI that may suggest potential flap failure. MATERIALS AND METHODS: A prospective study of 13 patients was done, who underwent endoscopic skull base surgery with reconstruction using the Hadad-Bassagasteguy flap. Pre-operative MRI was done to assess the size, extent and location of the lesion and a postoperative MRI was done to evaluate flap configuration, enhancement patterns, location, flap thickness and signal intensity characteristics. RESULTS: The postoperative MRI of all patients showed a detectable flap covering over the skull base defects forming an "open cup" appearance. They were uniformly isointense on T1-weighted/ fat suppressed images to the adjacent nasal mucosa and hyperintense on T2-weighted images. On the MRI scans done after four weeks, all 13 of our patients had enhancing flaps. One flap migrated slightly to the left side; however, there was no Cerebrospinal Fluid (CSF) leak. CONCLUSION: Vascular pedicle nasoseptal (Hadad) flaps are being widely used. MRI is a very useful tool in assessing the viability of the flap postoperatively and to evaluate for variations that may suggest potential flap failure.

Metastatic malignant peripheral nerve sheath tumour presenting as a spontaneous extradural haematoma - A case report.

Malignant peripheral nerve sheath tumours may arise from any cranial or somatic nerve. The median survival with best therapy is 49 months. The present case reports a patient with an MPNST that exhibited an unusually indolent behaviour. Besides this, the patient developed a dural metastasis from the lesion and presented with a spontaneous extra-dural haematoma. This has not been reported hitherto in literature.

Incidence of Potential Drug-Drug Interactions in a Limited and Stereotyped Prescription Setting - Comparison of Two Free Online Pharmacopoeias.

BACKGROUND: Drug-drug interactions (DDIs) are very common adverse events in health care delivery settings. The use of electronic pharmacopeias can potentially reduce the incidence of DDIs, but they are often thought to be cumbersome to use. This study is aimed at studying the incidence of potential DDIs in a surgical department, where a limited number of drugs are used in stereotyped combinations. We also compared two popular drug compendia in detecting potential DDIs. METHODS: The prescriptions of selected patients were entered into Epocrates® and Medscape® for Android smartphones. Potential DDIs were generated and their categories were noted. The warnings generated by Epocrates® were compared with those generated by Medscape® and an agreement index was calculated. RESULTS: Three hundred and thirty-one patients were included for analysis who had received a total of 2,878 drug orders. The incidence of potential DDIs was very high - 89% of all prescriptions. Phenytoin was the drug most commonly implicated, followed by furosemide. Of the DDIs detected, 0.14% were potentially serious and the drug combinations were contraindicated. There was a significant discrepancy between the categories of potential DDIs detected by Epocrates® and Medscape®. No clinically significant DDI was detected in any patient in this cohort. CONCLUSIONS: Despite routinely using only a limited number of drugs in stereotyped combinations, prescriptions in surgical departments may not be immune from a significant incidence of DDIs. The use of free apps could reduce the incidence of DDIs, enhance patient safety, and also aid in educating trainees.

The prevalence of mandibular incisive nerve canal and to evaluate its average location and dimension in Indian population.

AIM: The aim of this study was to find the prevalence of the mandibular incisive canal, evaluate its location and dimensions using cone beam computer tomography (CBCT) in Indian population. MATERIALS AND METHODS: CBCT scan images of 120 subjects were analyzed for the presence of the mandibular incisive canal, its location, size, and its length. The distance between the incisive canal and the buccal and lingual plate of the alveolar bone, and the distance from the canal to the inferior border of the mandible were also measured to position the canal in the mandible. RESULTS: About 71.66% of the CBCT scans of Indian subjects examined showed the presence of the Incisive canal, of which 48.33% exhibited canals bilaterally and 23.33% showed unilateral canals. 28.33% of the subjects CBCT scans did not exhibit the presence of incisive nerve canal. The average length of the incisive canal was 10.173 mm. The average diameter of the Incisive canal in the CBCT scans was 2.578 mm. The distance from the Inferior border of the mandible to (a) the origin of the Incisive canal was 9.425 mm and (b) to the apex of the Incisive canal was 9.095 mm. The distance from the buccal cortex of the mandible to (a) the origin of the incisive canal was 1.48 mm and (b) to the apex of the incisive canal was 4.476 mm. The distance from the lingual cortex of the mandible to (a) the origin of the incisive canal was 4.464 mm and (b) to the apex of the incisive canal was 5.561 mm. CONCLUSION: The presence, location, and dimensions of the mandibular incisive canal are an additional required data that needs to be elicited before planning an inter-foraminal placement of implants.

Assessment of perceptibility and acceptability of color variations between matched teeth among trainee dentist and lay person.

AIM: The aim of this study was to find the difference in perceptibility and acceptability of changes done to various color coordinates of matched teeth, between trainee dental surgeons, and lay person. MATERIALS AND METHODS: A photograph with a set of matched central incisor teeth was selected. In one of the central incisors, the color coordinates (hue, value, and chroma) were altered to a preset value. These pictures were presented to trainee dental surgeons and lay person and their level of perception of color change and acceptance of color change was registered and compared. RESULTS: It was found that trainee dental surgeons fared better in perceiving the color change and accepted less of the color changed specimens. The dimension of color that was more discerned both by lay person and trainee dental surgeons was value, hue, and last chroma. CONCLUSION: When compared to a lay person, dental surgeons are more acute in perceiving color changes and do not accept the color difference between teeth to a higher degree.

Acute onset of hemiparesis after gamma knife radiosurgery for arteriovenous malformation caused by hyperacute thrombosis of draining vein: a case report.

BACKGROUND: Complications after gamma knife radiosurgery (GKRS) have been attributed most commonly to radiation-induced damage to the brain. Early occlusion of the draining veins has been postulated as one of the rare causes of complications after GKRS, which often occurs at or beyond 6 months after GKRS. CLINICAL PRESENTATION: We present a very rare incidence of acute onset of hemiparesis caused by a draining vein occlusion within 24 hours after GKRS for arteriovenous malformation. The patient developed hemiparesis within one day after GKRS, which partially improved with steroids. Radiologic investigations revealed an early occlusion of a draining vein, resulting in occlusive hyperemia and neurologic deficit. CONCLUSION: Early draining vein occlusion is an important cause of postradiosurgery complications, and it can rarely occur within days.

Medical termination of pregnancy: a study of acceptor characteristics.

PIP: Characteristics of 616 Indian women who underwent therapeutic abortions between 1976-78 are described. The group is mostly young with the majority in the 25-34 age group followed by the 20-24 group. Parity is 2-3 with the majority having 2-3 living children. Women with middle or higher levels of education tended to have fewer living children than women with only primary or no education; the mean number of living children among the better educated urban women was 2.73 but 3.55 in those with no, or only primary, education. The number of living children was lower in the few women gainfully employed outside the home than in those who were housewives. Most of the abortions (about 82%) were carried out in the 1st trimester with a tendency for slightly later abortions in the rural sample; contraceptive failure was the reason in 22% of urban and 11% of rural cases while the mother's health was the reason in about 50% of all cases. The opportunity to accept family planning methods at the time of or after the pregnancy was rejected in about 17% but 54% of the urban and 62% of the rural accepted sterilization at the time of the abortion.^ieng

Contraception and the effectiveness of the ovulation method in India.

PIP: The Billings Ovulation Method was studied in India -- a method whereby a woman observes, records, and interprets her physiological sensations and symptoms during her menstrual cycle and thus is aware of the periods of her fertility or otherwise. The basis of the study was the evaluation of 3530 acceptors over the January 1975 through December 1977 period. The Centers participating in the study were located in several states of India, giving a varied picture of all cultures and socioeconomic classes. Evaluation of the program was carried out through aggregate and average woman months of use, net cumulative continuation rates and Pearl's pregnancy rates/life table pregnancy rates. 499 of the 3530 women discontinued the method at various points. The aggregate woman months of use was found to be 39,967 yielding an average of 11.3 months per woman. At the end of the 6th month, the continuation rate was 88.5, and at the cut-off point 80% of the women were continuing in the program. There were 176 pregnancies among the acceptors of this method during the study period. The Pearl's pregnancy rate was found to be 5.3 for all pregnancies. The life table pregnancy rate was found to be 5.7 at the end of 1 year.^ieng

Some demographic aspects of pregnancy histories of sterilized women in the Mission Hospitals of Karnataka.

This study deals with the pregnancy histories of 534 women whow were sterilized in the Mission Hospitals in Karnataka State (India) during 1974 and 1975. Fertility differentials prevailing in various sociocultural groups are indicated. The study highlights the prevalence of adolescent sterility and also emphasizes the need for spacing pregnancies to avoid fetal wastage. The differentials in the sex ratio at each birth order are described. the need for further investigation in this field of demography is emphasized.

A comparative study of oral acceptors in the three member mission hospitals of Mysore State.

PIP: A study of oral contraceptive usage in 3 hospitals of Mysore State, India, was undertaken to ascertain demographic characteristics of users, the continuation rate, and to develop indices for program evaluation. The study population consisted of 454 pill acceptors and their status as of December 31, 1971. The results show that the median age was 27.9 years and the mean parity was 4.0. Age, parity, and living children had no bearing on continuity or discontinuity. Average length of use was 5.6 woman months. 47% discontinued use of the pill, with 9% of this group dropping out because of side effects. 58% of the discontinued users were lost to follow-up studies. Accumulated months of participation totaled 221 months, and the average duration projection was 8.2 months. Indices for discontinuation, accumulated program participation, and duration projection were developed. The discontinuation index equals the number of new discontinuing participants divided by previous continuing persons multiplied by 100. Accumulated program participation equals the sum of previous continuing participants plus 1/2 the number of admissions minus 1/2 the number discontinuing. Finally the average duration projection is calculated by dividing the number of continuing persons by the average admitted persons.^ieng