Evaluation of Efficacy of 10% Dextrose Prolotherapy in Management of Temporomandibular Joint Disorders: A Prospective Study.

The aim of this study was to assess the efficacy of 10% dextrose prolotherapy in the management of temporomandibular joint disorder. Thirty patients aged between 18 and 62 years, diagnosed with Temporomandibular Disorders (TMDs) persisting for more than six months and unresponsive to other conservative treatments, were enrolled in the study. Over four subsequent visits, spaced six weeks apart, each patient received injections of 3 ml of 10% dextrose solution into the temporomandibular joint space. Parameters assessed included pain levels, frequency of luxations/dislocations, episodes of locking per month, maximal mouth opening, and clicking, evaluated every six weeks for a duration of three months. All patients exhibited improvements in Temporomandibular Disorders (TMDs), manifested as reduced pain, clicking sounds, locking episodes, and increased maximal mouth opening, following prolotherapy treatment. These improvements were found to be statistically significant (p-value < 0.05). Dextrose prolotherapy is a treatment method with broad applications and should be considered prior to resorting to long-term pharmacotherapy or surgical interventions. The use of 10% dextrose prolotherapy presents a promising treatment modality for temporomandibular joint disorders, as evidenced by its therapeutic benefits.

Recurrence and Prognosticators of Recurrence in Odontogenic Keratocyst of the Jaws.

Introduction: The incidence of recurrence of OKC varied from 2.5 to 62%. Studies have linked recurrence to treatment methods and also clinical and pathological features. The aim of this study was to evaluate the 5-year recurrence and the factors associated with recurrence in odontogenic keratocysts of the jaws. Methods: A retrospective review of records was done from the Institute's Medical Records Directory from 2010 to 2021. The following data were obtained of the lesion; age at presentation, gender, site, subsite, radiographic presentation (locularity), radiographic borders, presence or absence of satellite cysts, inflammatory infiltrate, and treatment rendered presence or absence of cortical perforation and soft-tissue extension and presence or absence of recurrence. Kaplan Meir estimator was used to evaluate recurrence rate and log rank test was used to compare the survival amongst groups. Cox regression analysis was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval. Results: In our study cohort, 27.2% of patients had recurrence. Posterior maxillary lesions, multilocular lesions, lesions with scalloped borders, presence of soft-tissue extension and cortical perforation, presence of satellite cysts and inflammatory infiltrate and enucleation with peripheral ostectomy were significantly associated with recurrence. However, soft-tissue extension, cortical perforation, multilocular lesions and presence of satellite cysts were independent risk factors. Conclusion: There is still debate on the best treatment modality for the management of OKCs. More studies are required to quantify the results.

Lethal Self-Administration of Atracurium: A Rarely Reported Case with Review of Literature.

ABSTRACT: Atracurium besylate is a nondepolarizing skeletal muscle relaxant first introduced in 1980. It is used during endotracheal intubation. It causes muscle relaxation during surgery or mechanical ventilation. When people consider suicide, they employ drugs found in their surroundings but not usually injectable muscle relaxants, which are not widely available. Studies on their use in suicide are rarely reported worldwide. This was a case of a 34-year-old male nursing staff, working in the general surgery department's operation theater complex, who was found unconscious in bed in his room in the morning with an empty syringe by the bedside. He was declared dead when brought to the emergency department. Forensic autopsy was conducted, and during the external examination, a needle puncture wound was found over the left cubital fossa. No other external other injuries were observed throughout the body. The toxicological analysis report indicated the presence of laudanosine in the vitreous humor, blood, urine, and skin from the puncture site and underneath vein. Also, the toxicological analysis of the empty syringe found at the crime scene revealed the presence of atracurium, confirming that the victim had administered a lethal dose of atracurium.

Enhancing Wound Healing With Sprayable Hydrogel Releasing Multi Metallic Ions: Inspired by the Body's Endogenous Healing Mechanism.

In the pursuit of new wound care products, researchers are exploring methods to improve wound healing through exogenous wound healing products. However, diverging from this conventional approach, this work has developed an endogenous support system for wound healing, drawing inspiration from the body's innate healing mechanisms governed by the sequential release of metal ions by body at wound site to promote different stages of wound healing. This work engineers a multi-ion-releasing sprayable hydrogel system, to mimic this intricate process, representing the next evolutionary step in wound care products. It comprises Alginate (Alg) and Fibrin (Fib) hydrogel infused with Polylactic acid (PLA) polymeric microcarriers encapsulating multi (calcium, copper, and zinc) nanoparticles (Alg-Fib-PLA-nCMB). Developed sprayable Alg-Fib-PLA-nCMB hydrogel show sustained release of beneficial multi metallic ions at wound site, offering a range of advantages including enhanced cellular function, antibacterial properties, and promotion of crucial wound healing processes like cell migration, ROS mitigation, macrophage polarization, collagen deposition, and vascular regeneration. In a comparative study with a commercial product (Midstress spray), developed Alg-Fib-PLA-nCMB hydrogel demonstrates superior wound healing outcomes in a rat model, indicating its potential for next generation wound care product, addressing critical challenges and offering a promising avenue for future advancements in the wound management.

Abdominal stab wound with an unusual presentation: A case report.

The forensic literature has described unusual wounds of entry into fatal stab wounds that are rarely found in autopsies. Stab wounds are considered fatal injuries when they occur in vital organs. Many authors have suggested that the description of the wound track helps recreate the crime scene. Still, many say that the recreation of a crime scene is a static event, whereas the actual event is dynamic. We received the dead body of a 25-year-old male for postmortem examination. During autopsy, we found a wedge-shaped stab wound in the epigastric region. Interestingly, when we dissected the skin and subcutaneous tissue without disturbing the wound, we observed two separate wedge-shaped wounds over the rectus sheath. A knife can produce an atypical appearance after plunging into the body. With a single external primary stab wound, two different wound tracks can be made internally. Thus, examining only the wound track made it impossible to comment on the circumstances of violence.

Enhancing trauma evaluation: Comparative analysis of post-mortem computed tomography and autopsy findings in abdominal stab wounds.

In cases of traumatic deaths, accurate assessment of injuries is essential for both legal and medical purposes. This case report compares the findings of post-mortem computed tomography with conventional autopsy methods in assessing abdominal stab wounds. A 34-year-old woman with multiple stab wounds in the abdomen underwent post-mortem examination, including computed tomography imaging. Computed tomography revealed specific breaches in the skin's continuity and internal injuries, including perforation of the stomach. A conventional autopsy confirmed the presence of multiple stab wounds and associated injuries to internal structures. However, additional injuries to major blood vessels, such as the abdominal aorta and inferior vena cava, were only detected during manual exploration of the peritoneal cavity. This case highlights the complementary roles of post-mortem computed tomography and conventional autopsy in evaluating traumatic injuries. While computed tomography imaging offers non-invasive visualisation of injuries, manual examination remains essential for identifying certain injuries, particularly those affecting major blood vessels. The integration of computed tomography imaging with traditional autopsy methods enhances the accuracy and reliability of forensic assessments in cases of traumatic deaths, particularly in complex cases involving multiple injuries. Understanding the strengths and limitations of these techniques is crucial for improving forensic investigations and ultimately enhancing medico-legal outcomes.

Legal Complexities of Adolescent Relationships: A Study of Protection of Child Sexual Offense Cases in India.

Introduction The Protection of Children from Sexual Offences (POCSO) Act in India prohibits sexual engagement among individuals under 18 years old. However, societal variables also affect many teenagers' consensual sexual activities. Little research has been conducted on the legal ramifications for consenting to sexual action under the POCSO Act. This study examined consensual sexual assault cases under the POCSO Act and their possible outcome. Methodology Five years of medicolegal records from a tertiary hospital were analyzed for sexual assault victims aged <18 years. Descriptive statistics were used to analyze victim demographics, literacy, sexual acts, reporting patterns, and accused-victim relationships. Result A total of 410 instances of sexual assault were recorded, and 29% involved victims between the ages of 16 and 18. Most victims (73.9%) in this age range were literate, and 85.7% provided consent for sexual relations. Parents or guardians reported all cases, and most of the accused were victims' friends. Discussion The POCSO Act offers legal safeguards for sexual abuse and exploitation. However, their use in adolescent sexual consent has raised concerns. The Law Commission of India's refusal to reassess the POCSO Act's age barrier for sexual consent emphasizes the need for a child-centric approach to negotiating complex teenage relationships. Conclusion Balancing legal obligations and developmental needs is essential to addressing consensual sexual acts under the POCSO Act. While sensitively implementing the law, stakeholders must focus on their children's best interests and healthy development. Child-friendly environments and support systems empower victims and reduce trauma in teenage relationships.

Insight Study of Trace Elements in PM2.5 During Nine Years in Delhi, India: Seasonal Variation, Source Apportionment, and Health Risks Assessment.

This study investigated the concentrations, seasonal variations, sources, and human health risks associated with exposure to heavy elements (As, Al, Pb, Cr, Mn, Cu, Zn, and Ni) of PM2.5 at an urban location of Delhi (28° 38' N, 77° 10' E; 218 m amsl), India, from January 2013 to December 2021. The average mass concentration of PM2.5 throughout the study period was estimated as 127 ± 77 µg m-3, which is exceeding the National Ambient Air Quality Standards (NAAQS) limit (annual: 40 µg m-3; 24 h: 60 µg m-3). The seasonal mass concentrations of PM2.5 exhibited at the order of post-monsoon (192 ± 110 µgm-3) > winter (158 ± 70 µgm-3) > summer (92 ± 44 µgm-3) and > monsoon (67 ± 32 µgm-3). The heavy elements, Al (1.19 µg m-3), Zn (0.49 µg m-3), Pb (0.43 µg m-3), Cr (0.21 µg m-3), Cu (0.21 µg m-3), Mn (0.07 µg m-3), and Ni (0.14 µg m-3) exhibited varying concentrations in PM2.5, with the highest levels observed in the post-monsoon season, followed by winter, summer, and monsoon seasons. Six primary sources throughout the study period, contributing to PM2.5 were identified by positive matrix factorization (PMF), such as dust (paved/crustal/soil dust: 29.9%), vehicular emissions (17.2%), biomass burning (15.4%), combustion (14%), industrial emissions (14.2%), and Br-rich sources (9.2%). Health risk assessments, including hazard quotient (HQ), hazard index (HI), and carcinogenic risk (CR), were computed based on heavy elements concentrations in PM2.5. Elevated HQ values for Cr and Mn linked with adverse health impacts in both adults and children. High carcinogenic risk values were observed for Cr in both adults and children during the winter and post-monsoon seasons, as well as in adults during the summer and monsoon seasons. The combined HI value exceeding one suggests appreciable non-carcinogenic risks associated with the examined elements. The findings of this study provide valuable insights into the behaviour and risk mitigation of heavy elements in PM2.5, contributing to the understanding of air quality and public health in the urban environment of Delhi.

Role of procalcitonin, interleukin-6 and interleukin-10 as a predictive marker for the use of perioperative steroid in maxillofacial trauma patients.

Maxillofacial trauma often brings significant challenges for surgeons in terms of preoperative oedema. Steroids offer oedema reduction, yet potentially increase the risks of postoperative infection. This study explores procalcitonin (PCT), as a marker for bacterial infection risk, and interleukins IL-6 and IL-10, which respectively signify pro-inflammatory and anti-inflammatory responses, as potential indicators of infection and inflammation in these trauma cases and thereby aid in refining perioperative guidelines for the use of steroids. A prospective study was conducted at a tertiary public hospital in India from 2019 to 2022 on patients >18 years with facial trauma. After specific exclusions, patients were randomised into steroid (Group A) and non-steroid (Group B) groups. Various parameters including oedema, PCT, IL-6, and IL-10 levels were measured and analysed using SPSS software. Out of 80 patients, 44 were in Group A and 36 in Group B. Post-24 hours, Group A showed significant oedema reduction, with 25 patients displaying a decline to mild oedema, versus 10 patients in Group B (p = 0.034). However, Group A witnessed a higher infection risk, with 20 patients showing positive wound cultures versus three in Group B. Subgroup analysis revealed a link between higher PCT levels and infections (p = 0.039). Additionally, Group A showed less intraoperative bleeding and reduced operating time. While perioperative steroids mitigate swelling, they might increase postoperative infection risk. Elevated PCT levels indicate potential wound infections, suggesting those patients should avoid perioperative steroids. IL-6 and IL-10 trends during perioperative phases can predict pronounced oedema outcomes.

Determinants of malaria prevention and control at household level in Assam: An analysis of data using composite index.

Background: Malaria prevention and control is a major public health problem of tropical countries including India. Usage of insecticide-treated bed nets, and early treatment especially in high-risk areas are the crucial factors for the malaria prevention at household levels. This study aimed to determine the crucial factors associated with malaria prevention at households' level such as household's characteristics, education, knowledge and awareness, insecticide treated bed nets usage, early treatment etc. Methods: Data of 1989 households was used from the cross-sectional survey of malaria-endemic areas of Assam. Principal component analysis and multinomial logistic regression model were used to compute the composite scores of malaria awareness and prevention practices, and to estimate the associated factors with malaria prevention practices, respectively. Results: The average age of household respondents were 41.1 ± 12.0 years and among them 71% were males. Almost 47% respondents were illiterate, and 38.6% of the respondents were farmers and 35% were employed. Multinomial logistic regression analysis indicates that malaria prevention practices are associated with age, education, religion, type of house and occupation of household heads and their level of malaria awareness among them. The prevention practices were significantly five times associated [Adjusted Rates Ratio (ARR): 5.0, 95% CI: 2.7-9.4] with the high level of malaria awareness compared with the low level of awareness. Overall, the level of prevention awareness, education, occupation, and house type related to the standard of living was significantly associated with the malaria prevention practices. Conclusion: Malaria awareness and education are the key factors of malaria prevention practices that need to be accelerated for effective control of malaria. Malaria education and increasing awareness of people have a high impact on malaria prevention practices and their control.

Color Doppler Ultrasound Indices as Predictors of Propranolol Response in Infantile Hemangioma: A Prospective Study.

OBJECTIVE: To evaluate the utility of color Doppler ultrasonography in assessing infantile hemangioma response to treatment with oral propranolol. METHODS: A prospective study was conducted between January, 2016 and December, 2022, wherein children with symptomatic (ulceration, bleeding, pain and scarring) infantile hemangioma were given oral propranol (2 mg/kg per day in three divided doses) as outpatient therapy. The clinical response was assessed three months post-initiation of treatment (intermediate clinical response) and three months post-completion of treatment (final clinical response, FCR). The primary outcome measurement was a clinical and radiological response (resistivity index (RI), pulsatility index (PI) and peak systolic velocity) to treatment. The secondary outcomes assessed were the complications related to treatment. RESULTS: Out of 601 patients who were started on propranolol, 99 developed severe adverse effects and were excluded from analysis. At FCR assessment, out of 502 participants, 64.3% (n = 323) showed excellent response, 17.7% (n = 89) showed partial, and 17.9% (n = 90) were non-responders. A significant increase in RI and PI values was noted in all children following propranolol treatment for six months. An increase > 7.5% in RI could identify responders with 92% sensitivity, 91% specificity and area under the curve (AUC) of 0.963. An increase of > 11.5% in PI could identify responders with 86% sensitivity, 91% specificity and AUC of 0.896. Patients initially showing no response but later becoming excellent responders had significantly higher RI and PI values. CONCLUSIONS: Color Doppler ultrasonography is a valuable tool in predicting the treatment outcome of infantile hemangioma using propranolol.

Current Evidence for the Management of Edentulous Atrophic Mandible Fractures: A PRISMA-SWiM Guided Review.

Study Design: PRISMA-SWiM guided systematic review. Objective: 1. Provide consistent evidence regarding the management of atrophic mandible fractures; 2. To search, evaluate and validate existing guidelines if any for the management; 3. Provide evidence regarding specific management of condylar fractures in the atrophic mandible; 4. To address the clinical applicability of bone grafts. Methods: A systematic review was conducted using the PRISMA-SWiM protocol. PROSPERO ID: CRD42021235111. Studies with adequate data on outcome, treatment methods were selected. Isolated case reports, case series, and non-human studies were excluded. Quality assessment was done using Newcastle -Ottawa scale. The level of evidence was assessed using Oxford Level of Evidence. Results: Mandibular body was the most common type of fracture. Self falls and RTA were the most common etiologies. Condylar fracture was most commonly managed conservatively with ORIF employed in few studies. For the mandible compression and non-compression osteosynthesis were used. Bone grafts were used in cases with segmental defects or cases requiring augmentation. Conclusions: There is lack of proper evidence to definitely conclude any single treatment modality. However, the consensus is towards ORIF. Reconstruction plates are preferred by many authors. However, unilateral fractures may be managed by miniplates. Bilateral fractures require more rigid fixations. Open reduction and internal fixation of condylar fracture is indicated in cases with displacement or low-level fractures.

Kite String (Manjha) Injuries Among Children: Single Center Experience Over Four Years.

We reviewed hospital records for kite-string injuries among children over four years (2017-2022). Of 42 affected children, mortality was 9.5%. The mean (SD) Pediatric Trauma Score (PTS) was 8.02 (2.66), with passively involved children facing greater severity [mean (SD) PTS, 5.58 (2.23)]. Kite-string injuries, alarmingly, endanger even bystanders, urging stricter preventive strategies.

An update on lipid-based nanodrug delivery systems for leishmaniasis treatment.

Lipid-based nanodrug delivery systems hold considerable promise in therapeutic intervention for leishmaniasis by enhancing drug solubility and targeted delivery.

Polyester nanomedicines for visceral leishmaniasis treatment.

Tweetable abstract Unveiling the power of polyester nanomedicines in revolutionizing visceral leishmaniasis treatment with enhanced drug loading and precise targeting.

Outcome of Mandibular Reconstruction with Fibula free Flaps: Retrospective Analysis of Complications.

Rationale: Fibula free flap has become the workhorse for head and neck reconstruction. In this retrospective study we aimed at determining the outcomes of mandibular reconstruction with fibula free flaps. Methods: Any patient who underwent a mandibulectomy and reconstructed with vascularised fibula flap was included in the study. The predictor variables were age, sex, type of lesion, tobacco and alcohol use, tracheostomy, neck dissection, post operative radio and chemotherapy. Flap failure, fistulas, dehiscence, bone exposure and hardware complications were the outcomes. A P value of < 0.05 was considered statistically significant. Results: 242 patient records were selected for evaluation. PORT, CRT, neck dissection, no. of segments were the factors significantly associated with every complication. Malignant lesion was significantly associated with every complication except for plate fracture. Plate fracture although occurred more frequently with malignant diseases, the association was insignificant. Tobacco consumption was significantly associated with increased incidence of post -operative complications. Alcohol consumption was significantly associated with plate fracture, screw loosening, fistulas, bone exposure and flap failure. Conclusion: Overall the fibula free flap has a success rate of 90.0% with fistulas being the most significant complication. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03344-2.

Development of chemically synthesized hydroxyapatite composite with reduced graphene oxide for enhanced mechanical properties.

A successful attempt has been made to improve the mechanical properties of Hydroxyapatite (HAp) and reduced graphene oxide (rGO) composite nanoparticles (NPs). Various proportions of HAp and rGO were synthesized to improve the mechanical properties. HAp NPs were prepared using the wet precipitation method and further calcined to form crystalline particles. The physicochemical characterization of the HAp NPs revealed that the crystalline size and percentage of crystallinity were calculated to be 42.49 ± 1.2 nm and 44% post calcination. Furthermore, the rGO-HA composites were prepared using ball milling and obtained in the shape of pellets with different ratios of rGO (10, 20, 30, 40, 50% wt.). The mechanical properties have been evaluated through a Universal testing machine. Compared to calcined HAp (cHAp), the strength of variants significantly enhanced with the increased concentration of rGO. The compressive strength of HA-rGO with the ratio of the concentration of 60:40% by weight is a maximum of about 10.39 ± 0.43 MPa. However, the porosity has also been bolstered by increasing the concentration of rGO, which has been evaluated through the liquid displacement method. The mean surface roughness of the composites has also been evaluated from the images through Image J (an image analysis program).

Bleomycin-triamcinolone sclerotherapy in the management of propranolol resistant infantile hemangioma of the maxillofacial region: A single arm prospective evaluation of clinical outcome and Doppler ultrasound parameters.

INTRODUCTION: Propranolol has emerged as a first line agent in the management of hemangiomas. With increased use of propranolol, studies have also focused on relapses following propranolol therapy. Our current study evaluates the role of bleomycin triamcinolone sclerotherapy for the management of propranolol resistant Infantile Hemangioma (IH). We also evaluated the role color Doppler USG for response assessment of sclerotherapy. METHODS: Patients with Propranolol resistant (Non- responders/ Partial responders) IHs were included in the study. Patients received intralesional bleomycin at a dose of 0.5 IU/kg followed by intralesional injection of triamcinolone at a dose of 2mg/kg body weight. Clinically patients were grouped into excellent, partial and non responders. Doppler parameters; Resistivity index (RI), Pulsatility index(PI) and Peak systolic velocity (PSV) were used to evaluate the response to sclerotherapy. These parameters were evaluated prior to sclerotherapy and 3 months following completion of therapy. The clinical responses of the patients were compared with the change in Doppler parameters before and after treatment. RESULTS: A total of 115 participants were considered for analysis; 60.86% had excellent response, 32.17% had partial response and 6.95% had poor response. There was a significant change in terms of RI, PI and PSV in patients who were either excellent or partial responders. Poor responders did not have a significant change in Doppler parameters. CONCLUSION: Combined bleomycin- triamcinolone sclerotherapy is an effective therapy for the management of propranolol resistant IHs. Doppler parameters RI, PI and PSV are reliable indicators of response in the management of IH.

Management of Maxillary Sagittal Fracture by using Pre-activated Rapid Maxillary Expansion (RME).

Introduction: Different techniques of the management of sagittal maxillary fractures have been described with different advantages and disadvantages. We herein present our experience and results of managing these cases by reversing pre-activated maxillary expanders and evaluation of its efficacy. Patient and Methods: A prospective study was conducted from April 2016 to February 2020 including all the patients managed for sagittal palatal fractures using the modified technique. The patients were evaluated for healing, occlusion and complications. Results: A total of five patients with sagittal palatal fracture were managed. The mean Glasgow Coma (GCS) score and injury severity score (ISS) of patients were 11.6 ± 2.4 and 15.2 ± 4.3, respectively. Both had a significant strong negative correlation with a correlation coefficient of - 0.889 (p = 0.44). The median duration for initiating the treatment for facial fractures was 2 days (range 2-12 days). All patients achieved satisfactory outcomes and tolerated this technique well. No obvious complications were found. Conclusion: This method could produce enough transversal force to reduce fractured fragments and then serve as an external fixator to maintain stability for bony healing.

Adenomatous Hyperplasia of Palatal Minor Salivary Gland and Angiolipoma of the Floor of Mouth: The First Documented Case Report in a Neonate.

Adenomatous hyperplasia of the salivary glands usually affects the parotid gland. Within the oral cavity, palate is the most common site. However, this lesion occurs in adults and till date no case has been documented in neonates. Angiolipomas are a variant of congenital lipomas which undergoes vascular proliferation. Angiolipomas of the oral cavity have not been documented till date among neonates. We herein report the first case of combined angiolipoma of the floor of the mouth with adenomatous proliferation of the minor salivary glands in a neonate. The case was managed through surgical excision, and the follow-up was uneventful. Histopathology confirmed the diagnosis.