Role of Gene Xpert in the Detection of Genital Tuberculosis in Endometrial Tissue among Women with Infertility.

OBJECTIVE: The objective of the study is to evaluate the clinical utility of Gene Xpert compared with other available diagnostic modalities in prompt diagnosis of female genital tuberculosis (TB) causing infertility. MATERIAL AND METHODS: This was a prospective, cross-sectional analytical study. Premenstrual endometrial biopsy specimens were collected from 176 infertile women of reproductive age group suspected of having genital TB. Samples were processed for acid-fast bacilli, culture, histopathology, polymerase chain reaction (PCR), and Gene Xpert. Patients detected positive on Gene Xpert and PCR were subjected to laparoscopy to look for affirmative findings of genital TB. The results were analyzed using composite gold standard consisting of patients positive with culture, histopathology, and laparoscopy. RESULTS: A total of 18 patients were found positive using composite gold standard. Laparoscopy was positive in 15 patients, whereas culture and histopathology were positive in three and two patients, respectively. Gene Xpert was positive in two patients. None of them was detected with rifampicin resistance. The sensitivity of Gene Xpert was 11.11% whereas the specificity was 100%. CONCLUSION: Since genital TB is a paucibacillary disease, multiple diagnostic modalities are needed for diagnosis. Gene Xpert appears to be a useful modality in diagnosis of genital TB, owing to its high specificity, and can be recommended in conditions where microscopy, culture, and histopathology are negative; however, further randomized studies are required to support our hypothesis.

Primary Adenocarcinoma of the Fallopian Tube: A Rare Entity.

Primary fallopian tube carcinoma is an uncommon gynaecologic malignancy usually seen in postmenopausal females. We present a case of a 66-year-old postmenopausal female who presented with complaint of blood mixed vaginal discharge on and off for past one month. Workup of the patient revealed no abnormality other than presence of atypical squamous cells on Papanicolaou (PAP) smear. MRI showed mildly bulky cervix with around 4cc fluid in endometrial cavity. As the patient remained symptomatic and fluid in endometrial cavity persisted, total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. On histopathological examination, fimbrial end of left tube had features of poorly differentiated papillary serous adenocarcinoma. Postoperatively, she was given chemotherapy and is doing well with more than 3 years of follow up. This case highlights the importance of high suspicion in postmenopausal women with bleeding per vaginum, where there is little to suggest clinically or radiologically.

Non-syndromic multiple supernumerary premolars: Clinicoradiographic report of five cases.

Hyperdontia or supernumerary teeth in both arches without any syndromic manifestation are extremely rare. Supernumerary teeth are commonly associated with Gardner's syndrome, cleft lip and palate, cleidocranial dysplasia and trichorhinopha-langeal syndrome. Five cases of non-syndromic multiple premolars of maxillary and mandibular arches in Indian patients are presented here. This case series reports three cases with multiple (9 in maximum), bilaterally impacted and erupted supernumerary teeth and two cases with supernumerary premolars in non-syndromic cases from Indian patients. Supernumerary teeth can be present in any region of the oral cavity. Although the occurrence of maxillary para-premolars is rare, radio-logical investigations play a major and decisive role in determining the management of such cases.

Oral Health Knowledge, Attitudes and Practice Behaviour among Secondary School Children in Chandigarh.

INTRODUCTION: Oral health knowledge is considered to be an essential prerequisite for health-related practices and better oral health. Healthy practices adopted at young age are more sustainable. AIM: Present cross-sectional exploratory study was planned to assess oral health knowledge and practices of secondary school students in Chandigarh, India. MATERIALS AND METHODS: A cross-sectional survey was under-taken amongst 1027 secondary level school students, in Chandigarh, India. After obtaining informed consent subjects were administered pretested self administered questionnaire addressing demographics, knowledge, attitude and practice behaviour of participants. Frequency analysis was done using descriptive statistics. RESULTS: Survey revealed that only 40% subjects brushed twice daily. About 17% reported use of dental floss and 20% used either mouthwash or tongue cleaner as adjuncts. A total of 58% had knowledge that infrequent brushing led to dental caries, staining of teeth, dental plaque and bleeding from gums. Most of them knew sweets (92.7%) and soft drinks (67.8%) affected dental health. Only 12.9% visited dentist regularly after every 6-12 months. CONCLUSION: Efficacy of dental health education can be increased only if health programs are tailored to directly impinge on attitudes of targeted population, especially school children in whom healthy practices can be inculcated easily and be sustained for long times.

GSTM1 null polymorphism prevalence in tobacco users, oral leukoplakia and oral squamous cell carcinoma patients in South Indian population: A polymerase chain reaction study.

CONTEXT: Tobacco abuse is a well-known risk factor for potentially malignant disorders as well as oral squamous cell carcinoma. Factors that influence tobacco-exposed individuals developing a malignancy may include the combination of total tobacco exposure and genetic susceptibility. AIM: This study was undertaken to determine the prevalence of the glutathione S-transferase M1 (GSTM1) null polymorphism in oral leukoplakia and oral squamous cell carcinoma patients in South Indian population. SETTINGS AND DESIGN: This case-control study was conducted in hospital setting on South Indian population. MATERIALS AND METHODS: About 280 subjects with history of tobacco use, oral leukoplakia, oral squamous cell carcinoma were included in this study. Three milliliter of blood was collected and transported under cold cycle and taken for evaluation of GSTM1 null polymorphism using multiplex polymerase chain reaction. RESULTS AND DISCUSSION: On comparing the prevalence of GSTM1 null polymorphism among the group with subjects with habits and no oral lesions, oral leukoplakia, and oral squamous cell carcinoma, it was observed that there was a statistically significant association between GSTM1 null polymorphism and the different groups (P < 0.01). CONCLUSION: The lack of GSTM1 activity would make the oral tissues more susceptible to action of tobacco carcinogens and to the development of a high-grade level of dysplasia in oral leukoplakia and thereby increases the susceptibility of lesion to undergo malignant changes.

Prevalence of glutathione S-transferase M1 null polymorphism in tobacco users, oral leukoplakia and oral squamous cell carcinoma patients in South Indian population: A polymerase chain reaction study.

CONTEXT: Tobacco abuse is a well-known risk factor for potentially malignant disorders as well as oral squamous cell carcinoma (SCC). Factors that influence tobacco-exposed individuals developing a malignancy may include a combination of total tobacco exposure and genetic susceptibility. AIM: This study was undertaken to determine the prevalence of the glutathione S-transferase M1 (GSTM1) null polymorphism in oral leukoplakia and oral SCC patients in South Indian population. SETTINGS AND DESIGN: This case-control study was conducted in hospital setting on South Indian population. MATERIALS AND METHODS: Totally, 280 subjects with a history of tobacco use, oral leukoplakia, oral SCC were included in this study. Three milliliter of blood was collected and transported under cold cycle and taken for evaluation of GSTM1 null polymorphism using Multiplex Polymerase Chain Reaction. RESULTS AND DISCUSSION: On comparing the prevalence of GSTM1 null polymorphism among the group with subjects with habits and no oral lesions, oral leukoplakia and oral SCC, it was observed that there was a statistically significant association between GSTM1 null polymorphism and the different groups (P < 0.01). CONCLUSION: The lack of GSTM1 activity would make the oral tissues more susceptible to action of tobacco carcinogens and to the development of a high-grade level of dysplasia in oral leukoplakia and thereby increases the susceptibility of lesion to undergo malignant changes.

Impacted stapler pin in fractured maxillary central incisor with open apex: Advanced endodontic management using biodentine as innovative apical matrix.

The presence of foreign objects in the pulp chamber of fractured permanent teeth is a rare phenomenon and often diagnosed accidently .These foreign bodies are most commonly self inflicted by young patients and remain impacted within the pulp canal thereby acting as potential source of infection and painful conditions. In the present case report, we present successful endodontic management of stapler pin lodged in fractured maxillary central incisor with challenge of open apex in young patient using biodentine as a novel apical matrix.

Masseteric cysticercosis: an uncommon appearance diagnosed on ultrasound

Introduction: Cysticercosis occurs when man is infested by the larvae of Taenia solium. Cysticercosis involving the maxillofacial region is not only an uncommon event, but also represents a difficulty in clinical diagnosis. Objective: The present manuscript highlights masseteric cysticercosis as a differential diagnosis of chronic maxillofacial swellings and the role of high resolution sonography as an important noninvasive and non-ionizing imaging modality. Case report: We present a case of masseteric cysticercosis in an eight year old Indian boy, its clinical features, the imaging modalities required and adequate management of the case. Conclusion: Cysticercosis should always be a part of the differential diagnosis of maxillofacial swellings. A thorough case history, clinical examination, proper investigations and conservative treatment forms the mainstay for management of affected patients.

Is letrozole superior to clomiphene for ovarian stimulation prior to intrauterine insemination?

OBJECTIVE: To compare the efficacy of letrozole with clomiphene citrate for ovarian stimulation prior to intrauterine insemination. METHODS: A total of 272 patients underwent 362 cycles of stimulation prior to IUI from January 2009 to May 2011. One hundred and twenty-six patients (170 cycles) received letrozole 5 mg and 146 patients (192 cycles) received clomiphene citrate 100 mg for 5 days starting on day 3 of the cycle. Intrauterine insemination was done 36 ± 4 h after hCG injection in 99 patients (131 cycles) in the letrozole group and 115 patients (136 cycles) in the clomiphene group. The number of mature follicles and serum E2 levels was monitored on the day of hCG. Endometrial thickness was noted on the day of hCG and IUI as well. The pregnancy rate, the miscarriage rate, and other parameters were evaluated only for patients who underwent IUI. RESULTS: The mean number of mature follicles was significantly more in the clomiphene group (1.66 ± 1.69 vs. 1.41 ± 1.53) than in the letrozole group. No significant difference in endometrial thickness on the day of hCG administration was found; however, endometrial thickness was statistically significantly higher in the clomiphene group on the day of IUI (9.28 ± 1.43 vs. 8.77 ± 1.34). Serum E(2) levels on the day of hCG were statistically significantly higher in the clomiphene group (501.09 ± 2.45 vs. 214.79 ± 2.43 pg/ml). Pregnancy rate was 9.2 %/cycle and 12.12 %/patient in the letrozole group, and 8.1 %/cycle and 9.5 %/cycle in the clomiphene group; these differences were not statistically significant. CONCLUSION: This study found no superiority of letrozole over clomiphene when used for ovarian stimulation and IUI.

Primary tuberculosis: an unusual finding in the oral cavity.

The unusual involvement of the oral cavity in tuberculosis and the non-specific nature of its presentations mean that diagnosis of tuberculosis is often delayed and is an unexpected finding. The aim of this paper is to present a case of primary tuberculosis and discuss the implications of the manifestations and diagnosis of oral tuberculosis. This paper presents an unusual case of a painless, papillary, erythematous lesion in the anterior region of a maxillary edentulous ridge. When the patient concerned was first seen by the author, the lesion had been present for six months. There was cervical lymphadenopathy and it was diagnosed initially as a malignant lesion. Eventually, after biopsy and ultrasound examination, the diagnosis of primary oral tuberculosis was reached. The patient was managed solely by anti-tubercular drug therapy.

Orofacial manifestations of achondroplasia.

Achondroplasia (Online Mendelian Inheritance in Man [OMIM] 100800), is considered as a form of skeletal dysplasia dwarfism that manifests with stunted stature and disproportionate limb shortening. Achondroplasia is of special interest in the field of dentistry because of its characteristic craniofacial features which include relative macrocephaly, depressed nasal bridge and maxillary hypoplasia. Presence of large head, implanted shunt, airway obstruction and difficulty in head control requires special precautions during dental management. The current case report highlights the orofacial manifestations of Achondroplasia in a young pediatric patient, along with the multidisciplinary treatment (including the dental treatment) done for the patient which also might help the general practitioners in better understanding of the condition.

Malignant mixed Mullerian tumor of broad ligament with synchronous ovarian and endometrial carcinoma: a rare association.

Extragenital malignant mixed Mullerian tumor (MMMT) is a rare tumor in females, and it is even more rarely encountered among the multiple genital malignancies. There are some reports of extragenital MMMTs associated with synchronous or metachronous gynecologic tumors of Mullerian duct origin. We recently encountered an MMMT of broad ligament which is associated with papillary serous cystadenocarcinoma of the ovary and endometrioid adenocarcinoma arising in atypical polypoid adenomyoma endometrium in a 76-year-old woman. This case is presented for its rarity and unique presentation. To our knowledge, ours is the first reported case of this unique combination of multiple synchronous genital malignancies.

Ultrasound versus tactile cannulation in the treatment of proximal tubal obstruction.

OBJECTIVE: To compare the therapeutic effects of cannulation guided by ultrasound or tactile sensation in women with proximal tubal obstruction. METHOD: This prospective randomized study reports on outcomes for 50 women treated as outpatients, 25 by the ultrasound-guided method and 25 by the tactile sensation method. RESULTS: Of the 50 fallopian tubes in each group, 42 tubes (84%) were successfully cannulated by the ultrasound-guided method and 32 (64%) by the tactile sensation method; and of the 50 patients, 8 (16%) conceived in the 6 months following cannulation. The difference in pregnancy rates between the 2 groups was not statistically significant. CONCLUSION: Whether guided by ultrasound or tactile sensation, cannulation can be offered as a first-line outpatient procedure to women with proximal tubal obstruction.