Severe Vitamin D Deficiency in Youth with Autism Spectrum Disorder During the COVID-19 Pandemic.

BACKGROUND: Decrease in sunlight exposure during periods of social distancing during the COVID-19 pandemic increased the risk of severe manifestations of vitamin D deficiency (VDD) in a particular "high-risk" population. Our objective was to highlight the importance of vitamin D screening in youth with autism spectrum disorder (ASD) and restrictive eating. CASE PRESENTATION: We describe 3 adolescent male patients with ASD who developed severe manifestations of VDD and hypocalcemia in late 2020 during the COVID-19 pandemic. All spent less time outdoors than in prior years because of isolation at home during the pandemic. Presenting symptoms included seizures and atraumatic fractures. All 3 were found to have hypocalcemia and severe VDD. Limited sun exposure because of isolation indoors during the COVID-19 pandemic was a likely contributing factor to the severity of VDD. All 3 were treated with intravenous calcium acutely, followed by oral calcium and vitamin D. Laboratory tests performed post-treatment showed biochemical resolution of hypocalcemia and VDD. CONCLUSION: These cases highlight the importance of screening "at-risk" youth for VDD. Clinicians should be cognizant that children and adolescents with ASD and restricted eating can have severe manifestations of hypocalcemia and VDD. Decreased sun exposure because of isolating indoors during the COVID-19 pandemic increased their risk for this.

Antimicrobial and catalytic activities of biosynthesized gold, silver and palladium nanoparticles from Solanum nigurum leaves.

The field of nanobiotechnology and nanomedicine paves way for the use of several nanoparticles. Especially, in biomedical applications, the silver nanoparticles (AgNPs), gold nanoparticles (AuNPs) and palladium nanoparticles (PdNPs) are found most vital and promising, among other nanoparticles. The biomedical activities of these particles mostly depend on their shape, size and distribution. Preparation of these particles in an eco-friendly method is an immediate need of the society. Herein, AuNPs, AgNPs and PdNPs (MNPS) were synthesized by Solanum nigrum Leaves (SNL) extract. The structural and morphological studies were carried out by using TEM, XRD and EDAX, while the optical and chemical properties were studied using UV-visible spectrum and FTIR spectroscopy. The particles obtained were found to possess a FCC (Face Centered Cubic) structure. TEM images of Ag, Au and PdNPs showed spherical well dispersed nanoparticles with average size of 3.46 nm, 9.39 nm and 21.55 nm respectively. The FTIR spectra confirmed polyphenols and antioxidants in SNL extract act as reducing and capping agents respectively in the synthesis of MNPs. The EDX technique confirmed the presence of silver, gold and palladium nanoparticles. Antimicrobial studies noted that the AgNPs have effective inhibition against E. coli. The complete reduction of 4-Nitrophenol and the formation of 4-Aminophenol with the presence of NaBH4 was chosen for the study of catalytic activities of the prepared MNPs. The reduction time of Au and Pd catalyst were smaller compared to that of Ag. This viable preparation method for producing small spherical shaped nanoparticles expected to the applied to the fields of nanomedicine.

Clinical profile of measles in children with special reference to infants.

This study was conducted to analyse the clinical characteristics of measles in infants and to compare them with those in older children. Clinical and sociodemographic details of all hospitalised children with suspected measles were recorded and confirmed cases were analysed further. Twenty-four infants and 34 children aged >1 year were included. Most infants were boys and 15 (62.5%) of them were aged <9 months. Early onset of rash (within three days of fever in 62.5% of cases) occurred in infants. The complications of measles in infants included bronchopneumonia (n = 17, 71%), acute diarrhoea (n = 8, 33%), meningitis (n = 1, 4%) and staphylococcal sepsis (n = 2, 8%). The number of infants with complications was significantly high (88% and 65%; P = 0.05). Measles in infants can have atypical presentations, a greater risk for complications and may occur before they are due to receive the conventional first dose of measles vaccine.

Evaluation of the lateral orbital approach in management of zygomatic bone fractures.

Zygomatic maxillary fractures, also known as tripod fractures, are usually the result of a direct blow to the body of the zygoma. Tripod fracture consists of (a) zygomatic arch fracture, (b) fracture of the lateral orbital wall, and (c) fracture of the inferior orbital floor. The purpose of this study is to evaluate the functional and esthetic outcome following this lateral orbital approach in the management of zygoma fracture. This study was carried out in VMS Dental College, Salem, and in a private hospital. This study was based on the experience gained from a retrospective study of the 30 lateral orbital approaches that were used in 30 patients with fractures of the zygomatic complex, which were conducted for a period of 8 years between January 2003 and January 2011. In the retrospective study, all the 30 patients were able to open the mouth completely; eyeball movements were normal; esthetically, all patients appeared normal. There were no sinusitis or visual problems in any of the studied patients. We conclude that the lateral orbital approach is an ideal option in reduction and treatment of zygomatic bone and arch fractures.

Significance of localization of mandibular foramen in an inferior alveolar nerve block.

BACKGROUND: The mandibular foramen (MF) is an opening on the internal surface of the ramus for divisions of the mandibular vessels and nerve to pass. The aim of this study is to determine the position of the MF from various anatomical landmarks in several dry adult mandibles. MATERIALS AND METHODS: A total of 102 human dry mandibles were examined, of which 93 were of dentulous and 9 were of edentulous. The measurements were taken from the anterior border of the ramus (coronoid notch) to the midportion of the MF and then from the midportion of the MF to the other landmarks such as internal oblique ridge, inferior border, sigmoid notch, and condyle were measured and recorded. RESULTS: The data were compared using Student's t-test. The MF is positioned at a mean distance of 19 mm (with SD 2.34) from coronoid notch of the anterior border of the ramus. Superio-inferiorly from the condyle to the inferior border MF is situated 5 mm inferior to the midpoint of condyle to the inferior border distance (ramus height). CONCLUSION: We conclude that failures in the anesthesia of the inferior alveolar nerve are due to the operator error and not due to the anatomical variation.

Clinical evaluation of the efficacy of a GTR membrane (HEALIGUIDE) and demineralised bone matrix (OSSEOGRAFT) as a space maintainer in the treatment of Miller's Class I gingival recession.

BACKGROUND: Periodontal plastic surgical procedures aimed at coverage of exposed root surface have evolved into routine treatment modalities. The present study was designed to evaluate the effectiveness and predictability of using a collagen barrier along with a demineralized bone matrix in the treatment of recession defects in a single surgical procedure. MATERIALS AND METHODS: Seventeen patients with Miller's class I recession were treated with a combination of a collagen barrier used along with a bone graft and coronally advanced flap technique. Clinical parameters were recorded at baseline, 3 months, 6 months, and 9 months. RESULTS: The study showed a highly significant reduction in the recession depth (70.29 ± 21.96%) at the end of the study. This study showed that the use of this technique for recession coverage is highly predictable and highly esthetic root coverage can be obtained.

Esthetic evaluation of the treated unilateral cleft lip using photographs and image analysis software: a retrospective study.

AIM: The aim of this study was to objectively evaluate the surgical outcome of unilateral cleft lip patients treated by Dr. Adenwalla's modification of Millards rotation advancement technique using image analysis software. METHOD: Of the unilateral cleft lip cases done by a single surgeon using Dr. Adenwalla's modification of Millard's rotation advancement technique, only 11 cases satisfied the photographic standardization criteria (frontal view with both ears visible to minimize rotation and least nostril show to minimize tilt) and were included in this study. These photographs were acquired into the imageJ Software and Farkas cleft-related landmarks were marked on the lip area. The values of treated cleft side and the normal side were used to work out a Cleft Lip Component Symmetry Index. A value of 100 would indicate perfect symmetry of the lip. A value of either less or more would mean a degree of asymmetry. RESULT: The horizontal lip length, vertical lip length from the top of the Cupid's bow to subnasale and nostril floor width were slightly increased on treated side of the lip and the vertical lip length from the top of the Cupid's bow to the alar base, the Cupid's bow width and vermilion length on the treated side were slightly decreased when compared to the normal side. Even though there were some differences, it was not statistically significant. The horizontal and vertical lip lengths, the Cupid's bow width, vermilion length and nostril floor width were almost symmetrical. CONCLUSION: Computer assisted anthropometric analysis of photographs using imageJ software demonstrates that Dr. Adenwalla's modification of Millard's rotation and advancement technique produces esthetic lip symmetry consistently.

Incidence and risk factors for neonatal hypoglycaemia in Kerala, India.

OBJECTIVES: To detect the incidence and risk factors that predicted the occurrence of neonatal hypoglycaemia and to identify neonates who require mandatory blood glucose screening during the first 48 h of life. DESIGN: Hospital based prospective study in a maternity centre in south India. SETTING: Labour room, postnatal wards and newborn nursery of the Institute of Maternal and Child Health, Medical College, Kozhikode, India. PATIENTS: Six hundred and four neonates were enrolled in the study by a systematic random sampling method from 1 August to 1 November 2002. INTERVENTION/MEASUREMENT: Random blood glucose levels were estimated by the standard glucose oxidase--peroxidase method on two occasions 24 h apart, during the first 2 days of life. Nineteen clinical characteristics of the mother-baby pair were analysed statistically in relation to the occurrence of hypoglycaemia. RESULTS: The incidence of neonatal hypoglycaemia in the present study group was 41/1000 live births. Eight variables strongly and independently predicted the risk of neonatal hypoglycaemia, at least one being present in 89.1% of the hypoglycaemic neonates. They included prematurity, low birthweight, maternal diabetes mellitus, delay in initiation of breastfeeding for more than 2 h postnatally, maternal pre-eclampsia and eclampsia, birth asphyxia, cold stress or hypothermia, and maternal oligohydramnios. CONCLUSIONS: Hypoglycaemia was a common problem in apparently normal asymptomatic babies. Apart from the classic 'text book risk factors', maternal oligohydramnios and a breastfeeding delay of more than 2 h after delivery predicted the risk of neonatal hypoglycaemia in this group. Mandatory blood glucose screening in babies with any one of the above mentioned risk factors serves as an easy and cost effective measure for the prompt identification of this condition.

Enhancement of computed tomography liver contrast using iomeprol-containing liposomes and detection of small liver tumors in rats.

RATIONALE AND OBJECTIVES: We evaluated iomeprol-containing liposomes (Lipiom), a new contrast medium for computed tomography (CT) liver scanning, in an animal model of chemically induced hepatocellular carcinomas and other liver tumors in rats. METHODS: Liver tumors were induced by administration of carcinogens to rats, either 0.55% (w/w) 1'-hydroxysafrole in the diet or induction by 3'-methyl-4-diethylaminoazobenzene followed by promotion with carbon tetrachloride. CT scanning was performed 1-3 hr after intravenous injection of iomeprol-containing liposomes. RESULTS: After injection of iomeprol-containing liposomes at a dose of 70 mg of liposome-entrapped iodine per kilogram of body weight, the normal liver parenchyma showed a contrast enhancement, in Hounsfield units, of more than 60% over the control value before bolus. Liver tumors with no or few Kupffer cells were not enhanced and appeared as dark areas within the normal parenchyma. Tumors and pretumoral lesions devoid of Kupffer cells, as small as 3 mm in diameter, could be distinguished using this non-invasive method. CONCLUSION: CT liver scanning after injection of iomeprol-containing liposomes appears to be promising method for detecting liver tumors and focal liver lesions.