Spinocerebellar ataxia 46 in a young female.

Spinocerebellar ataxias (SCAs) are a group of both clinically and genetically heterogeneous neurodegenerative disorders. SCA 46 is a rare autosomal dominant ataxia initially described in a Dutch family, clinically characterized by ataxia, peripheral neuropathy, cerebellar dysarthria, and varied oculomotor abnormalities. SCA 46 has recently been discovered to be associated with a mutation in phospholipase D 3 gene.

Calcium silicate biocomposites: effects of selenium oxide on the physico-mechanical features and theirin-vitrobiological assessments.

Bone tissue regenerative material serves as a prospective recovery candidate with self-adaptable biological properties of bio-activation, degradability, compatibility, and antimicrobial efficacy instead of metallic implants. Such materials are highly expensive due to chemical reagents and complex synthesis procedures, making them unaffordable for patients with financial constraints. This research produced an efficient bone tissue regenerative material using inexpensive naturally occurring source materials, including silica sand and limestone. The extracted SiO2and CaO particles (75:25 wt%) were subjected to hydrothermal synthesis (water treatment instead of chemical solvents) to produce the CaSiO3biomaterial (code: S). Selenium oxide was doped with calcium silicate at 3, 5, and 10 wt.% to enhance its properties, yielding biocomposite materials (i.e. S3, S5, and S10). The physico-mechanical properties of these materials were investigated with x-ray diffraction, Fourier transform infrared, FESEM-EDS, and micro-universal testing machine. The results revealed that the synthesized biocomposites have a crystalline wollastonite phase with a porously fused rough surface. From structural parametric calculations, we found that the biocomposites have reduced particle size and enhanced surface area due to the influence of selenium oxide. The biocomposite S10, having high SeO2content, attained the maximum compressive strength of 75.2 MPa.In-vitrostudies of bioactivity, biodegradability, biocompatibility, and antibacterial activity were performed. At 7 and 14 d of bioactivity, the synthesized biocomposites are capable of dissolving their ions into simulated body fluid (SBF) solution to precipitate hydroxyapatite and a required Ca/P ratio of 1.69 was achieved by S3. A comparative analysis has been performed on the degradation activity in Tris-HCl and the consequent pH changes during SBF treatment. The bio-analysis revealed that the biocomposite S3 shows enhanced bioactivity through a controlled degradation rate and secured cell viability of 88% at a concentration of 100 µg ml-1. It also offers significant bacterial inhibition potency againstE.coliandS.aureusbacteria.

Public Health Dentistry as a Career Choice - Attitude of Dental Undergraduate Students in Puducherry.

Background: To pursue further education in a particular specialty of dentistry, it is important for dental students to be aware of the "expectation" associated with any specific specialty in dentistry. Therefore students 'attitudes' towards 'expectations' of various specialties, to a large extent enables a meaningful understanding that facilitates appropriate planning in the dental sector for the community. Materials and Methods: A cross-sectional questionnaire based survey was conducted, which included, final year and dental interns studying in two dental institutions, in the State of Puducherry. It consisted of 27 questions that were graded using 5-point Likert scale. The responses for the attitude questions toward selecting Public Health Dentistry for post-graduation were categorized into three factors, negative attitude (includes score 0-21), neutral attitude (score 22-44), and positive attitude (score 45-64). Differences between groups were examined using t-test for proportions. The level of statistical significance was set at p < 0.05. Results: Among 221 respondents, 73 (33.0) were males and 148 (67.0) females. About (52.2%) of the respondents had positive attitude toward selecting Public Health Dentistry as their future career and (76.7%) had neutral attitude, around (5 %) had negative attitude towards the speciality for pursuing post-graduation in both the two institutions. Conclusion: Our study could highlight many factors namely gender, year of study etc which influence the attitude of students for selecting PHD as career choice. These specific factors could be kept in mind while course planning for government or private institutions so that maximum interest can be fetched among students.

Effectiveness of Leg Raise and Leg Fold Maneuver to Prevent Syncope During Extraction of Teeth: A Pilot Study.

Objectives The primary objective of this study is to evaluate the effectiveness of leg raise and leg fold maneuvers to prevent syncope during extraction procedures. Methods This study included 30 patients with a previous history of syncope and dental anxiety. Patients were randomly divided into two groups consisting of 15 patients each. Group I (test group) patients were educated about a few physical maneuvers, and instructions were given preoperatively about when to perform them. Group II (control group) underwent extraction conventionally. The blood pressure, saturation, pulse rate, and clinical signs and symptoms of the patients were assessed preoperatively, intraoperatively, and postoperatively. Informed consent was obtained from all the patients. Results There is a significant difference between the control and study groups in terms of the occurrence of syncope and patient comfort. This indicates that the leg raise and leg fold maneuvers reduce the occurrence of syncope during extraction. No participant in the test group experienced syncope post-treatment, while five subjects (33.3%) experienced syncope in the control group. Conclusion Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope. Leg raise and leg fold maneuvers improved the hemodynamics of the patients.

AMAN with Ophthalmoparesis: A Rare Presentation.

Acute motor axonal neuropathy (AMAN) is a variant of Guillain-Barré syndrome (GBS), characterized by acute areflexic flaccid quadriparesis with motor axonal changes and absence of demyelinating findings in electrophysiological studies. A 30-year-old man presented with acute onset flaccid type of weakness involving all four limbs, along with drooping of eyelids. Examination revealed ptosis with restricted horizontal and vertical eye movements. Spinomotor system examination revealed acute flaccid areflexic quadriparesis. Nerve conduction studies (NCS) showed features suggestive of motor axonal neuropathy changes. Cerebrospinal fluid (CSF) revealed albuminocytological dissociation. The diagnosis of AMAN was made, and the patient was treated with intravenous immunoglobulin (IVIg). His weakness gradually improved over 1 month, with partial improvement in ptosis and eye movements. This case highlights the occurrence of ophthalmoparesis in the AMAN variant of GBS. The presence of ophthalmoparesis and areflexia makes it necessary to exclude Miller-Fisher syndrome. But, the presence of axonal changes in nerve conduction study and the profound weakness with negative serum anti-GQ1b antibody profile, supports the diagnosis of AMAN. How to cite this article: Budumuru U, Muralidharan K, Sowmini PR, et al. AMAN with Ophthalmoparesis: A Rare Presentation. J Assoc Physicians India 2023;71(11):103-104.

Oral Hygiene Practices and Knowledge on Periodontal Diseases and Therapy: A Cross-Sectional Questionnaire Study on Gypsy Narikuravars in Puducherry.

Background: Gypsy "Narikuravars" constituted separate sociocultural groups having distinct cultures, customs, traditions, and lifestyles. Oral health-seeking behavior of this group remains to be an ignored part. This study aims to assess the oral hygiene practices and knowledge on periodontal diseases and therapy among Gypsy Narikuravars in Puducherry. Materials and Methods: The total study population consisted of 100 subjects, and a performed validated pro forma about oral hygiene practices and knowledge on periodontal diseases was used. Results: There is no significant association between sociodemographic factors and knowledge on periodontal disease and therapy. Majority (90%) of the participants have poor knowledge of periodontal disease and therapy. 56% of the participants used their fingers to clean the teeth, and very few subjects (13%) used toothbrush to clean their teeth, and most of the participants (92%) brushes once daily using manual method. Conclusion: The practice of poor oral hygiene and lack of knowledge on periodontal disease and therapy was observed. Hence, the implementation of oral health programs and provision of comprehensive health services for these Gypsy population should be a high priority.

Polyradiculopathy and Multiple Cranial Nerve Palsies - Rare Manifestations of Cerebral Venous Sinus Thrombosis.

We report about two young males who developed significant proximal weakness of all four limbs secondary to intracranial hypertension due to intracranial venous sinus thrombosis. Intracranial venous sinus thrombosis can manifest in a variety of ways which includes isolated intracranial hypertension, focal neurological symptoms or signs and acute or subacute encephalopathy. Various false localising signs have been reported to occur in patients with raised intracranial pressure including cranial nerve palsies and extensive radiculopathy. In a patient presenting with flaccid areflexic quadriparesis and papilledema, the possibility of a potentially reversible dysfunction of the cranial nerves and spinal nerve roots due to a marked rise in intracranial and intraspinal pressure must be recognised. Lumboperitoneal shunt to reduce the intraspinal pressure on the spinal nerve roots has been advocated to reverse the symptoms of extensive radiculopathy in such patients. Both of our patients showed remarkable improvement in symptoms and signs with medical treatment of CVT.

See-Saw Relationship and its Reversal after Immunotherapy in a Case of Graves' Disease with Coexisting Myasthenia Gravis.

The unique association of myasthenia gravis (MG) with Graves' disease in clinical practice emphasizes that one autoimmune disease can coexist with another or many. The relationship between these two entities has remained controversial till date. Some authors have reported a see-saw relationship between these two entities, MG waning with hyperthyroidism and waxing with treatment of hyperthyroidism. Treatment of both these disorders concurrently may be challenging at times as treatment for one entity may worsen the other. The use of beta-blockers and steroids for Graves' disease may worsen myasthenic weakness. Antithyroid drugs can worsen myasthenia probably by immunomodulatory effects. We report a case of Graves' disease coexisting with MG in a reciprocal relationship which was subsequently reversed after immunotherapy.

Neurofibromatosis Type 1 Associated with Hashimoto's Thyroiditis.

Hashimoto's thyroiditis is a common form of chronic autoimmune thyroid disease (AITD) and it often coexists with other autoimmune diseases, but Hashimoto's thyroiditis associated with an autosomal dominant neurofibromatosis type 1 is exceedingly rare. A 30-year-old woman presented with complaints of headache for 1 year on and off. Physical examination revealed nodular swelling in the neck, cafe-au-lait spots, and neurofibromas covering the entire surface of her body. Her thyroid hormones were within normal limits. Thyroid ultrasound revealed mild altered heterogeneous echo texture, multiple nodules of varying sizes, with hyper vascularity and ultrasound-guided fine needle aspiration cytology revealed lymphocytic infiltration of the gland, suggesting Hashimoto's thyroiditis. High levels of autoimmune antibodies such as antithyroglobulin and antimicrosomal antibodies confirmed the diagnosis. When encountering a patient with Neurofibromatosis type 1, the possibility of associated autoimmune diseases should be considered. So further studies of such patients having combination of neurofibromatosis type 1 and autoimmune thyroiditis will certainly provide better understanding of this link in the near future.