A Cross-Sectional Multicentre Study to Validate Insulin Sensitivity Index Cut-Offs for Detection of Metabolic Syndrome in Indian Adolescents with Type-1 Diabetes.

Background: A previous study compared insulin sensitivity indices for the detection of double diabetes (DD) in Indian adolescents with type-1 diabetes (T1D) and derived a cut-off to predict future risk for the development of metabolic syndrome (MS) in adolescents with T1D. We conducted the current study with the aim to validate these cut-offs for detecting DD among Indian subjects with T1D from various geographical locations. Methods: This multicentric cross-sectional study included 161 Indian adolescents with T1D. Demographic, anthropometric, clinical, and biochemical data were collected using standard protocols. Insulin sensitivity (IS) was calculated using various equations developed to determine insulin sensitivity in subjects with T1D. Metabolic syndrome was diagnosed using International Diabetes Federation (IDF) Consensus Definition 2017. Results: We report 4.3% prevalence of MS in Indian adolescents with T1D with an additional 29.8% of study participants at risk of development of MS. Low High density lipoprotein (HDL) (23.6%) was the commonest abnormal component of the MS definition. Insulin sensitivity calculated by an equation derived by the SEARCH group was the most appropriate index to identify MS and metabolic risk in Indian adolescents with T1D. The proposed cut-off of 5.48 had high specificity, positive predictive value, and negative predictive value in identifying the risk of the development of DD. Conclusions: Insulin sensitivity calculated by the equation proposed by the SEARCH group together with cut-offs derived in earlier study may be used effectively to identify risk of development of MS/DD in Indian adolescents with T1D from various geographical locations.

Hepatoblastoma and Wilms' tumour in an infant with Beckwith-Wiedemann syndrome and diazoxide resistant congenital hyperinsulinism.

Beckwith-Wiedemann syndrome (BWS) can be associated with embryonal tumours and congenital hyperinsulinism (CHI). We present an infant with BWS who developed congenital hepatoblastoma and Wilms' tumour during infancy. The infant presented with recurrent hypoglycaemia requiring high intravenous glucose infusion and was biochemically confirmed to have CHI. He was resistant to diazoxide but responded well to octreotide and was switched to Lanreotide at 1 year of age. Genetic analysis for mutations of ABCC8 and KCNJ11 were negative. He had clinical features suggestive of BWS. Methylation-sensitive multiplex ligation-dependent probe amplification revealed hypomethylation at KCNQ1OT1:TSS-DMR and hypermethylation at H19 /IGF2:IG-DMR consistent with mosaic UPD(11p15). Hepatoblastoma was detected on day 4 of life, which was resistant to chemotherapy, requiring surgical resection. He developed Wilms' tumour at 3 months of age, which also showed poor response to induction chemotherapy with vincristine and actinomycin D. Surgical resection of Wilms' tumour was followed by post-operative chemotherapy intensified with cycles containing cyclophosphamide, doxorubicin, carboplatin and etoposide, in addition to receiving flank radiotherapy. We report, for the first time, an uncommon association of hepatoblastoma and Wilms' tumour in BWS in early infancy. Early onset tumours may show resistance to chemotherapy. UPD(11p15) is likely associated with persistent CHI in BWS. Learning points: Long-acting somatostatin analogues are effective in managing persistent CHI in BWS. UPD(11)pat genotype may be a pointer to persistent and severe CHI. Hepatoblastoma and Wilms' tumour may have an onset within early infancy and early tumour surveillance is essential. Tumours associated with earlier onset may be resistant to recognised first-line chemotherapy.

Speech aid prosthesis.

Velopharyngeal defects are common problem encountered in dentistry, different prosthetic designs can be used; however, the prosthesis should be comfortable and function properly. Surgical treatment is the treatment of choice, but there are few patients who are not able to receive the surgical intervention; in such cases prosthetic management is considered using speech bulb prosthesis to overcome nasal twang and nasal regurgitation.

Modified technique of soft liner application.

Soft liners are materials that can be advocated successfully to manage clinical situations like atrophic edentulous ridges with flabby displaceable tissues and in cases of severely resorbed ridges which adversely affect the retention and stability of complete dentures and further enhance bone loss. Soft liner provides a cushioning effect and distributes uniform occlusal forces to compromised residual ridges. In this paper a modified technique of soft liner application in mandibular denture has been discussed.

Comparative evaluation of vertical dimension at rest before extraction, after extraction and after rehabilitation with complete denture - A Cephalometric study.

INTRODUCTION: The determination of physiologic rest position of the mandible to the maxillae is of paramount importance in almost all fields of dentistry. The stability of vertical dimension at rest has been controversial if the rest position of mandible remains constant throughout life or not. Despite of several studies on the rest position of the mandible and facial vertical dimension, certain fundamental disagreements remain unresolved. The present study aims to compare the vertical dimension at rest, before and after extraction and after rehabilitation with complete denture. MATERIAL & METHODS: This study was conducted in a total of ten randomly selected patients, who had some natural teeth present with one or more opposing posterior teeth with vertical occlusal stops but were advised for extraction because of poor prognosis. Digital lateral cephalograms were done and measurements recorded at three stages: prior to extraction of remaining natural teeth, post extraction and after complete denture rehabilitation. RESULTS: Vertical dimension at rest was found to be greatest in post rehabilitation followed by pre-extraction than post extraction state. The differences in changes were found to be statistically significant. CONCLUSION: Vertical dimension at rest shows a decrease following extraction of natural teeth, the occlusal stops, and an increase on rehabilitation. It can be stated that vertical dimension at rest is not stable position and varies following extraction of natural teeth and rehabilitation.