Intracranial Tubercular Subdural Empyema: A Case Report and Review of Literature.

Tuberculosis (TB) is a major health problem in developing countries. Approximately 1 million children became ill with TB in year 2016. Neurotuberculosis is associated with high mortality and morbidity. Intracranial tubercular subdural empyema is extremely rare in pediatric population. Authors report a case of 13-year-old male child who had presented with recurrent seizures and features of raised intracranial pressure. Neuroradiology of skull revealed intracranial subdural empyema. He was managed effectively with burr hole evacuation of the pus, postoperative neuroradiological assessment, and prompt empirical antitubercular therapy. Authors propose that high index of suspicion, neuroradiology, and prompt therapeutic interventions are necessary for good prognosis of this rare yet curable disease.

Salivary and Serum Aspartate Aminotransferases and Alanine Aminotransferases in Insulin-Dependent Diabetes Mellitus and Normal Children: A Comparative Study.

AIMS AND OBJECTIVES: The aim of the study was to estimate and compare aspartate aminotransferases (AST) and alanine aminotransferases (ALT) levels in saliva and serum of insulin-dependent diabetes mellitus (IDDM) and normal children, and the objective was to evaluate the significance of these enzymes in assessing the salivary gland injury in IDDM children. MATERIALS AND METHODS: The study group comprised of thirty children clinically and biochemically diagnosed for IDDM and thirty healthy children of similar age in the control group. Saliva and serum samples were collected and enzyme assay was performed by optimized ultraviolet test method (according to International Federation of Clinical Chemistry). The values obtained were subjected to statistical analysis using Mann-Whitney U-test for comparison of the variables and Karl-Pearson's coefficient test for correlation. The SPSS 16.0, (SPSS Inc., Chicago, USA) was used for statistical analysis. RESULTS: Higher values of AST (mean = saliva 91.60 IU/L) and ALT (mean = saliva 94.93 IU/L) were found in the saliva than in serum (AST serum = 15.83 IU/L) (ALT serum = 20.80 IU/L) among the patients and the differences were statistically highly significant (P = 0.001). A similar comparison in the control group did not show statistical significant difference (saliva - AST mean = 23.50 IU/L, ALT mean = 21.95 IU/L and serum - AST mean = 12.60 IU/L, ALT mean = 13.25 IU/L). On correlation between patient and normal group, greater values of AST and ALT were observed in saliva of patients and the difference was statistically highly significant ([AST-mean = patients 91.166 IU/L and controls = 23.500 IU/L] [ALT-mean = patients 94.933 IU/L and controls 21.950 IU/L]). The serum values of patients and controls did not show statistical difference. Although higher values of salivary ALT and AST were observed in patients with the disease for 0-5-year clinical duration (ALT mean = 100.21 IU/L and AST mean = 95.39 IU/L) than those with the disease for 6-10-year duration (ALT mean = 77.57 IU/L and AST mean = 77.28 IU/L), values were statistically nonsignificant. CONCLUSION: Elevated salivary AST and ALT levels in IDDM patients suggest the injury to salivary glands and could aid as a salivary marker for the involvement of salivary glands in IDDM.

A Novel Herbal Formulation versus Chlorhexidine Mouthwash in Efficacy against Oral Microflora.

AIMS AND OBJECTIVES: The aim of the study was to compare and to analyze the antimicrobial efficacy of 0.12% chlorhexidine and new formulated herbal mouthwash after using for 14 days. The objective was to signify whether the noval herbal combination could be a better alternative mouthwash to Chlorhexidine (CHX). MATERIALS AND METHODS: This is a double-blinded, random controlled research study conducted in the Department of Oral Pathology and Microbiology. A total of 200 dental students were selected randomly, comprising of two groups, 100 in each, aged between 18 and 22 years with gingival index of score II. The first group was advised to oral rinse with 0.12% chlorhexidine mouthwash and the second group with new formulated herbal mouthwash for 14 days. Saliva samples were collected on the day 0 (baseline), followed by day 7 and 14 and microbial colony count was performed. The data obtained was statistically analyzed using SPSS version 16. Student's t-test was applied for comparison of the mean microbial count between the two groups. Repeated measures analysis of variance followed by Tukey's post hoc test was applied to assess the changes from day 0 to day 7 to day 14. The statistical significance level was set at P < 0.05. RESULTS: Microbial colonies were reduced better in chlorhexidine group on the day 7 whereas, on day 14, greater reduction was observed in the herbal group in both gender groups with high statistical significance (P < 0.001). CONCLUSIONS: Herbal mouthwash formulation performed effectively well on long-term usage, could be used as an alternative mouthwash to overcome the disadvantages of chlorhexidine.

Child maltreatment: Cross-sectional survey of general dentists.

BACKGROUND: Child abuse continues to be a social menace causing both physical and emotional trauma to benevolent children. Census has shown that nearly 50-75% of child abuse include trauma to mouth, face, and head. Thus, dental professionals are in a strategic position to identify physical and emotional manifestations of abuse. AIM: A cross-sectional survey was conducted to assess knowledge and attitude of dental professionals on the exigent issue of child abuse. METHODOLOGY: With prior consent, a 20-question survey including both multiple choice and dichotomous (yes/no) questions was mailed to 120 state-registered general dentists and the data collected were subjected to statistical analysis. STATISTICAL ANALYSIS: The overall response rate to the questionnaires was 97%. Lack of knowledge about dentist role in reporting child abuse accounted to 55% in the reasons for hesitancy to report. Pearson's Chi-square test did not show any significant difference between male and female regarding the reason for hesitancy to report and legal obligation of dentists. RESULTS: Although respondent dentists were aware of the diagnosis of child abuse, they were hesitant and unaware of the appropriate authority to report. CONCLUSION: Increased instruction in the areas of recognition and reporting of child abuse and neglect should be emphasized.

Formulation and Evaluation of Sol-Gel Drug Delivery System for Intracanal pH Sensitive Controlled Delivery of Chlorhexidine.

INTRODUCTION: Persistence of viable micro-organisms even after thorough chemomechanical debridement has been cited as a major cause for endodontic failure. Chlorhexidine is a drug, which has shown marked efficacy against Enterococcus faecalis and Candida spp., which are mostly accounted for endodontic failure and it has demonstrated high degree of substantivity to dentin by adsorption. Another issue with chlorhexidine and other intracanal medicaments is the excessive or premature peaking of the drug leading to possible side effects. AIM: The objective of this experimental work undertaken was to formulate a pH sensitive sol-gel sustained drug delivery system containing chlorhexidine. MATERIALS AND METHODS: The formulations were prepared using different concentrations of GELRITE® (0.1% and 0.2%) and Chlorhexidine (0.1% and 0.2%). The prepared solutions were evaluated for pharmacological properties like sterility test, viscosity, drug content, drug release characteristics, drug excipient compatible study. RESULTS: The drug excipient compatibility studies showed no interaction between the excipient and the active constituent. The microbial analysis showed good efficacy against the test micro-organisms and Minimum Inhibitory Concentration (MIC) values against Candida albicans (ATCC® 14053™) was observed as 4 µl/ml for both formulation containing 0.1% and 0.2% of GELRITE® Gellan (polymer). Whereas, MIC values against Enterococcus faecalis was observed to be 3.2 µl/ml and 6 µl/ml for formulation containing 0.1% and 0.2% of GELRITE® Gellan (polymer) respectively. CONCLUSION: From the present study, it could be successfully demonstrated that sol-gel formulations can be simple, easy to administer mode of intracanal drug delivery system. Localized pH changes present within the canal can trigger sol-gel conversion thereby releasing the drug in sustained manner with less toxicity and side effects.

Influence of Smile Arc and Buccal Corridors on Facial Attractiveness: A Cross-sectional Study.

INTRODUCTION: Two aspects of the smile: the Smile Arc (SA) and Buccal Corridors (BC) have been the interest of the orthodontist in recent years. AIM: The present study was undertaken to evaluate the influence of the smile arc and buccal corridors on facial attractiveness as evaluated by orthodontists, general dentists and laymen. MATERIALS AND METHODS: Two subjects (one male & one female) were selected from the regional population fulfilling the criteria of an ideal smile arc and ideal buccal corridors. Frontal smile view photographs of these subjects were taken and modified by using adobe photoshop 7.0 to create combination of three smile arc variance and three buccal corridors variations respectively which were shown to 25 orthodontists, 25 general dentists & 25 laymen, to rate the facial attractiveness of each image on a rating scale. RESULTS: All the three groups (laypersons, dentists and orthodontists) showed significant difference in ratings, indicating that they had different perceptions on the facial attractiveness. CONCLUSION: Orthodontists were more precise in discerning the smile arc and buccal corridors compared to dentists and laypersons.

Oral Leukoplakia: Clinicopathological Correlation and Its Relevance to Regional Tobacco-related Habit Index.

INTRODUCTION: A case control study was carried out to evaluate the synergistic effects of habits quantified by habit index and its effect and severity on the clinicopathological features of oral leukoplakia in a cohort of 100 patients visiting Triveni Dental College, Bilaspur, Chhattisgarh, India. MATERIALS AND METHODS: One hundred patients indulging in tobacco-related habits (smoking and smokeless forms) were categorized into two groups: A case/experimental group consisting of 50 patients presenting with oral leukoplakia lesion and a control group consisting of 50 patients with no clinical signs of oral leukoplakia. Habit index was calculated in both groups. Case group was further subjected to incisional biopsy of the lesion followed by histopathological examination. All the variables in the study were statistically analyzed for the mean, standard deviation, i.e., value of central tendency, z-test, test of significance, and Pearson's correlation (r-test). RESULTS: For p < 0.05 bidi habit index was significantly higher in the case group. Higher bidi habit index was evident in the severe stages of lesion ice, p < 0.001 (highly significant). The degree of dysplasia was higher with advancing clinical stage of the lesion. CONCLUSION: Higher bidi habit index in the case group contributed significantly for severe stages of lesion and thereby indicates its probable progression toward malignancy. Nonhomogenous leukoplakia of the speckled subtype exhibited moderate and severe epithelial dysplasia. Hence, quantification of tobacco-related habits and the clinical appearance of the premalignant lesion predict the risk of subsequent malignant transformation of the disease.

Assessment of objective and subjective measures as indicators for facial esthetics.

BACKGROUND: The study mentioned was aimed to examine the contribution of the objective measures representing anterior-posterior (AP) and vertical characteristics, dental esthetics, or their combination that are used in daily orthodontic practice in the assessment of the facial esthetics. MATERIALS AND METHODS: A panel of 64 laypersons evaluated the facial esthetics of 32 boys and 32 girls, stratified over four different angle classes, on a visual analog scale. The relationship between the objective parameters and facial esthetics was evaluated by the backward multiple regression analysis. RESULTS: Dental esthetics, expressed by the esthetic component of the index of orthodontic treatment need (AC/IOTN), appeared to be the most vital indicator for facial esthetics. The horizontal sum, a variable for AP characteristics of the patient, could be a better variable when compared with the overjet. CONCLUSION: Addition of this newly defined parameter to the AC/IOTN improved the prognostic value from 25% to 35%.

Extra-axial medulloblastoma in the cerebellopontine angle: Report of a rare entity with review of literature.

With only 33 cases reported so far, a purely extra-axial position of medulloblastoma at cerebellopontine (CP) angle is quite exceptional. We report a case of extra-axial medulloblastoma in a 15-year-old male child located in the CP angle that was surgically treated with a provisional diagnosis of schwannoma. Histopathological diagnosis of medulloblastoma was made with the routine hematoxylin and eosin stain and immunohistochemical markers. This case report highlights the fact that although extremely rare, the possibility of an extra-axial mass being a medulloblastoma does exist.

Spectroscopic analysis of cinnamic acid using quantum chemical calculations.

In this present study, FT-IR, FT-Raman, (13)C NMR and (1)H NMR spectra for cinnamic acid have been recorded for the vibrational and spectroscopic analysis. The observed fundamental frequencies (IR and Raman) were assigned according to their distinctiveness region. The computed frequencies and optimized parameters have been calculated by using HF and DFT (B3LYP) methods and the corresponding results are tabulated. On the basis of the comparison between computed and experimental results assignments of the fundamental vibrational modes are examined. A study on the electronic and optical properties; absorption wavelengths, excitation energy, dipole moment and frontier molecular orbital energies, were performed by HF and DFT methods. The alternation of the vibration pattern of the pedestal molecule related to the substitutions was analyzed. The (13)C and (1)H NMR spectra have been recorded and the chemical shifts have been calculated using the gauge independent atomic orbital (GIAO) method. The Mulliken charges, UV spectral analysis and HOMO-LUMO analysis of have been calculated and reported. The molecular electrostatic potential (MEP) was constructed.

Shear punch strength evaluation of nanocomposite and compomer, post-conditioning in dietary solvents - An in-vitro study.

BACKGROUND: Perpetual research in esthetic dentistry has stupendously contributed in improving the mechanical and esthetic properties of restorative materials. Recently introduced nanocomposite claim to possess higher optimized esthetic and mechanical properties superior to other esthetic restorative materials in clinical use. It has been highlighted in many studies that intraoral degradation of composites is a consequence of both mechanical factors and chemical degradation. Thus, this in-vitro study was conducted to determine the strength of commonly used esthetic restorative materials after conditioning them in dietary solvents, thereby, simulating the intraoral environment. AIM: Evaluation of shear punch strength of nanocomposite and compomer, post-conditioning in dietary solvents. MATERIALS AND METHODS: Two test groups mentioned above, each containing sixty preconditioned samples, divided into four subgroups of fifteen samples each and conditioned in different dietary solvents, were subjected to shear punch test in custom designed shear punch apparatus in Universal Testing Machine. RESULTS: Among the dietary solvents, citric acid caused maximum decrease in the strength while conditioning in heptane showed increase in strength of the test restorative materials. CONCLUSION: Nanocomposite revealed to have higher strength, thereby indicating its better application universally.

Coronary vasospasm and myocardial infarction induced by oral sumatriptan.

Coronary vasospasm is well documented as a side effect of injectable subcutaneous forms of sumatriptan; only one such case has been reported so far with oral ingestion of sumatriptan in a patient with underlying coronary artery disease. This report describes a case of coronary vasospasm induced by oral sumatriptan even in normal coronary arteries. Physicians and patients should be aware of a small and unpredictable risk of the serious cardiac side effects of this drug.