Development of difficulty index for management of impacted maxillary canine: A CBCT-based study.

BACKGROUND: The aim of this study was to propose an Impacted Canine Treatment Difficulty Index using Cone-beam Computed Tomography (CBCT) imaging to assess difficulty anticipated during the alignment of impacted maxillary canine and further validate the index in clinical set up. METHODS: Pre-treatment CBCT of 15 patients with unilateral or bilateral impacted maxillary canine aged between 12 and 30 years were selected. All the following five factors were assessed on CBCT image: 1) angulation, 2) vertical position, 3) bucco-palatal position, 4) horizontal position and 5) rotation. Two orthodontists evaluated the pre-treatment CBCT for the selected five factors and allocated a total difficulty score. To validate the proposed difficulty index in clinical settings, a team of oral and maxillofacial surgeons were included in the study to grade the difficulty encountered during surgical procedure. RESULTS: The distribution of difficulty score recorded by observer 1 was significantly associated with the difficulty score recorded by observer 2 (P-value < 0.001), with relatively higher level of linearly weighted Cohen's kappa value of 0.610. The distribution of difficulty score recorded by oral and maxillofacial surgeon was significantly associated with the difficulty score recorded by observer 1 (P-value < 0.01), with relatively higher level of linearly weighted Cohen's kappa value of 0.667. The distribution of difficulty score recorded by orthodontist was significantly associated with the difficulty score recorded by observer 1 (P-value < 0.001), with relatively higher linearly weighted Cohen's kappa value of 0.819. CONCLUSION: Impacted Canine Treatment Difficulty Index using CBCT imaging could be used to assess the difficulty that would be anticipated during the alignment of impacted maxillary cuspid.

Evaluation of Airway Dimensions Following Mandibular Setback with Surgery-First Orthognathic Versus Conventional Orthognathic Approach.

BACKGROUND: To evaluate changes in airway dimensions following mandibular setback with conventional orthognathic approach (COA) and surgery-first orthognathic approach (SFOA). MATERIALS AND METHODS: Treatment records of 20 patients who underwent mandibular setback with SFOA/COA were divided into two groups (COA and SFOA, ten patients in each group). Acoustic pharyngometry values were obtained at T0 (01 week prior to surgery), T1 (01-month post-surgery) and T2 (01-year post-surgery). Percentage change in mean volume and area was obtained at T1 (T1-T0) to evaluate airway changes and at T2 (T2-T1) to compare relapse of airway changes in both groups. Changes in airway per mm setback at T1 (T1-T0) and T2 (T2-T1) were also obtained in both groups. RESULTS: For both parameters, SFOA showed greater reduction at T1 and greater relapse at T2 as compared to COA. The reduction in airway volume at T1 was 0.56 mm/mm setback in COA compared to 1.06 mm/mm setback in SFOA (P-value > 0.05). The relapse in airway volume at T2 was 0.15 mm/mm setback in COA compared to 0.25 mm/mm setback in SFOA (P-value > 0.05). The reduction in area at T1 was 0.062 mm/mm setback in COA compared to 0.110 mm/mm setback in SFOA (P-value > 0.05). The relapse in area at T2 was 0.016 mm/mm setback in COA compared to 0.034/mm setback in SFOA (P-value < 0.05). CONCLUSION: In setback cases, SFOA has greater airway reduction immediate post-surgically and greater relapse at 01-year follow-up. Predicting these changes at diagnostic and treatment planning stage may prevent potential adverse events on airway.

Evaluation of Nasal Patency Among Patients With Unilateral Cleft Lip and Palate: Cleft Versus Non-Cleft Side.

OBJECTIVE: To evaluate the nasal patency using acoustic rhinometry (AR) in patients with unilateral cleft lip and palate (UCLP) and to ascertain the rhinological importance of the same. METHODS: Eccovision Acoustic Rhinometer system was used for assessment of nasal cross-sectional area (CSA) and volume in 15 patients with UCLP. The CSA1, CSA2, and CSA3, which represent the CSA at the nasal valve area and anterior end of the inferior turbinate, the anterior half of the inferior turbinate and the anterior end of the middle turbinate, and the region of middle portion of middle turbinate, respectively, were compared on the cleft and non-cleft side. RESULTS: The mean ± SD of CSA1, CSA2, and CSA3 as well as the overall nasal CSA were significantly higher on non-cleft side compared to cleft side (P value < .001). The mean ± SD of nasal volume was also significantly higher in non-cleft side compared to cleft side (P value < .001). CONCLUSIONS: The nasal patency among patients with UCLP demonstrates a range of impairments that can be objectively measured using acoustic rhinometry. The orthodontic, orthopedic, or orthosurgical management of maxillary deficiency in these patients can affect the nasal area and volume and can have an impact on breathing, speech, and sleep. The pretreatment assessment may be useful to identify patients who are at potential risk of deterioration of nasal patency and airway post-intervention. Taking into consideration the multiple diagnostic procedures in the course of long-term multidisciplinary treatment of patients with cleft lip and palate, a noninvasive investigation technique such as AR may be the preferred mode of investigation to ascertain nasal patency.

A radiographic study of external apical root resorption in patients treated with single-phase fixed orthodontic therapy.

BACKGROUND: External apical root resorption (EARR) is one of the most common iatrogenic consequences of orthodontic tooth movement. Many factors like gender, duration, orthodontic force and duration of orthodontic treatment have been implicated to cause EARR. METHODS: Pre- and post-treatment OPGs of 60 orthodontic patients (30 males and 30 females) who had undergone treatment with a single phase of fixed orthodontic therapy were randomly selected from institutional archives. The root apices were evaluated for EARR by a single operator on an radiograph viewing box at a standardized source of light using a four-grade ordinal scale. Anterior EARR was measured on the maxillary and mandibular canines. Posterior EARR was measured on premolars, mesiobuccal and distobuccal roots of maxillary first molars and mesial and distal roots of mandibular first molars. The results were compiled and subjected to statistical analysis. RESULTS: The cases in which the patients underwent therapeutic extraction had a relatively higher amount of EARR compared to the cases in which the patients were treated by non-extraction therapy (P < 0.001). Odds ratio indicated that extraction cases had two-fold increased risk of EARR than non-extraction cases (P < 0.001). No statistically significant difference was observed in the distribution of EARR based on gender or duration of orthodontic treatment (P > 0.05). CONCLUSION: Therapeutic extraction is an important determinant of post-treatment EARR. Gender and duration of orthodontic treatment may not be important variables in the causation of EARR according to the findings of this study. However, longitudinal studies with larger sample size are required to validate the results of this study.

Recommendations for Vaccination Against Seasonal Influenza in Adult High Risk Groups: South Asian Recommendations.

Influenza is a global public health problem and concern especially in high risk people. Prevention plays a key role in avoiding complications of influenza related illnesses. Despite the existing prevalence of influenza, and documented importance of vaccination, the uptake of influenza vaccine is very poor. This document provide recommendations for influenza vaccination in high-risk individuals and help implement best practices in the South Asian region and improve coverage of influenza vaccination to achieve better outcomes in this population.

Therapeutic efficacy of a hybrid mandibular advancement device in the management of obstructive sleep apnea assessed with acoustic reflection technique.

Obstructive sleep apnea (OSA) is one of the most common forms of sleep-disordered breathing. Various treatment modalities include behavior modification therapy, nasal continuous positive airway pressure (CPAP), oral appliance therapy, and various surgical modalities. Oral appliances are noninvasive and recommended treatment modality for snoring, mild to moderate OSA cases and severe OSA cases when patient is not compliant to CPAP therapy and unwilling for surgery. Acoustic reflection technique (ART) is a relatively new modality for three-dimensional assessment of airway caliber in various clinical situations. The accuracy and reproducibility of acoustic rhinometry and acoustic pharyngometry assessment are comparable to computerized tomography and magnetic resonance imaging. This case report highlights the therapeutic efficacy of an innovative customized acrylic hybrid mandibular advancement device in the management of polysomnography diagnosed OSA cases, and the treatment results were assessed by ART.

Pharyngeal airway analysis in obese and non-obese patients with obstructive sleep apnea syndrome.

BACKGROUND: Sleep disorders are a group of disorders characterized by abnormalities of respiration during sleep. OSA (Obstructive Sleep Apnea) is characterized by the repetitive episodes of complete or partial collapse of the upper airway during sleep, causing a cessation or a significant reduction of airflow. METHOD: The study population consisted of 30 control patients (AHI ≤ 5) events per hour, 74 patients with OSAS, including 34 Obese (BMI ≥ 27) and 40 non-obese (BMI ≤ 27). Polysomnography and measurements of 21 cephalometric variables were carried out for all patients with OSAS. RESULTS: Obese patient with OSAS showed significant difference in following cephalometric parameters: (1) PAS (2) MPT (3) MPH (4) PNS-P (5) SAS. In addition, obese patient had longer tongue (TGL), more anteriorly displaced hyoid bones (H-VL) and more anterior displacement of mandible (G-VL) when compared with control groups. The findings of non-obese patients when compared to controls showed all the findings of obese patients and in addition to that narrow bony oropharynx were significant. Step wise regression analysis showed the significant predictors for all patients were MPH, PNS-P, bony nasopharynx (PNSBa), MPT, and palatal length (ANS-PNS) for AHI. The significant predictors for obese OSA (obstructive sleep apnea) group were MAS while for non-obese OSA group ANS-PNS was significant predictor for AHI (apnea-hypopnea index). CONCLUSION: Craniofacial landmarks such as increase in hyoid distance, longer tongue and soft palate with increased thickness and narrowing of superior pharyngeal, oropharyngeal and hypopharyngeal airway space may be important risk factors for development of OSAS.

Strychnine inhibits inflammatory angiogenesis in mice via down regulation of VEGF, TNF-α and TGF-ß.

Strychnine is known to possess anti-inflammatory and antitumour activity, but its roles in tumour angiogenesis, the key step involved in tumour growth and metastasis, and the involved molecular mechanism are still unknown. We aimed to investigate the effects of strychnine on key components of inflammatory angiogenesis in the murine cannulated sponge implant angiogenesis model. Polyester-polyurethane sponges, used as a framework for fibrovascular tissue growth, were implanted in Swiss albino mice and strychnine (0.25, and 0.5 mg/kg/day) was given through installed cannulas for 9 days. The implants collected at day 9 postimplantation were processed for the assessment of haemoglobin (Hb), myeloperoxidase (MPO), N-acetylglucosaminidase (NAG) and collagen used as indexes for angiogenesis, neutrophil and macrophage accumulation and extracellular matrix deposition, respectively. Relevant inflammatory, angiogenic and fibrogenic cytokines were also determined. Strychnine treatment attenuated the main components of the fibrovascular tissue, wet weight, vascularization (Hb content), macrophage recruitment (NAG activity), collagen deposition and the levels of vascular endothelial growth factor (VEGF), tumour necrosis factor (TNF)-α and transforming growth factor (TGF-ß). A regulatory function of strychnine on multiple parameters of main components of inflammatory angiogenesis has been revealed giving insight into the potential therapeutic underlying the actions of strychnine.

Patterns and determinants of dyslipidaemia in 'Young' versus 'Not so Young' patients of coronary artery disease: a multicentric, randomised observational study in northern India.

AIMS: The aims of the study were to ascertain difference in lipid levels of 'Young' onset of coronary artery disease (CAD) (≤ 45 years) vs. 'Not so Young' onset of CAD (≥ 55 years) among north Indians and also to investigate determinants of 'dyslipidaemia' in CAD patients. METHODS: This was a prospective, multicentric, randomised, observational study carried in eight centres of UP, India. All blood investigations were performed employing a central laboratory. RESULTS: Out of a total 435 patients studied, 218 were in the 'young group' (YG) and 235 were in the 'Not so Young Group' (NSYG). Dyslipidaemia was more common in YG as evident by significantly higher levels of total cholesterol, triglycerides, low- and very low-density lipoprotein cholesterol as compared to NSYG. Diabetes, hypertension, urban lifestyle, and family history of CAD were found to be important determinants of dyslipidaemia in YG. CONCLUSION: We conclude that lipid levels among north Indians are significantly higher in younger patients with CAD when compared with elderly.

Perindopril protects against streptozotocin-induced hyperglycemic myocardial damage/alterations.

High blood pressure, obesity, abnormal lipid profile, which often coexist with diabetes, tend to be associated with preclinical cardiovascular abnormalities and may contribute to the association of diabetes with cardiovascular events. Many studies have proved that streptozotocin (STZ) is responsible for type-2-diabetes-induced cardiovascular complications. Long-term perindopril therapy in patients with hypertension and diabetes has been observed to correct carotid remodeling by reducing hypertrophy. We studied the effect of perindopril (1 mg/kg/d orally [po]) on cardiovascular complications in neonatal model of rats, which was induced by administering STZ (90 mg/kg, intraperitoneally [ip]), in 5-d-old wistar rats and cardiac hypertrophy induced by isoprenaline (ISO; 5 mg/kg, ip) for 10 d. Various biochemical, cardiac, and hemodynamic parameters were measured at the end of 8 weeks of treatment in diabetes model and 10 d in hypertrophy model. STZ produced hyperglycemia, hyperinsulinemia, dyslipidemia, hypertension, bradycardia, increased creatinine kinase (CK-MB), lactate dehydrogenase enzymes (LDH) and C-reactive protein (CRP) levels, cardiac hypertrophy, and oxidative stress. Chronic treatment with perindopril significantly prevented STZ-induced hyperglycemia and hyperinsulinemia and controlled dyslipdemia in diabetic rats. Further, perindopril produced a significant reduction in elevated levels of CRP, LDH, and CK. STZ-induced hypertension and bradycardia were also prevented by perindopril treatment. Perindopril also produced beneficial effect by preventing cardiac hypertrophy as evident from cardiac hypertrophy index and left ventricular hypertrophic index. Perindopril also prevented STZ-induced oxidative stress. Similar results were obtained in ISO-induced cardiac hypertrophic model, which confirms the beneficial role of perindopril in cardiac hypertrophy. In conclusion, our data from both studies suggest that perindopril produced beneficial effect on cardiac complications.

TB control in India--efforts, challenges and priorities.

TB control is a long battle. Since after the discovery of Mycobacterium tuberculosis by Robert Koch in 1882, endeavours have been made at different levels in the form of control measures like establishment of open-air sanatorium in Tilonia (Ajmer) in 1906, Tuberculosis Dispensary in Mumbai (1917), Tuberculosis Association of India (1939), Mass BCG campaign (1951), Establishment of Chemotherapy centre (TRC Chennai), National Sample Survey (1955-58), National Tuberculosis Institute Bangalore (1961), Developments of National Tuberculosis Programme (1962), Review of NTP by GOI, SIDA & WHO (1992), pilot testing of RNTCP (1993), implementation/expansion of RNTCP across the country (1997-2006). Shopping for health, marketing for TB diagnosis and treatment, MDR-TB, XDR-TB, TB-HIV combination and partnership related challenges are crucial and needs to be addressed .Universal access to DOTS for cutting the chain of transmission of bacilli, reducing the morbidity and mortality and reversing the TB epidemic in line with Millennium Development Goals, surveillance of notification, drug resistance, TB/HIV coinfection, operation researches, development of vaccines, immune therapeutic agents against tuberculosis and expansion of package of care to MDR-TB and XDR-TB would be the priorities for eradicating TB as a public health problem.

Can IMA-RNTCP stop TB by 2050?

Tuberculosis has been with mankind since time immemorial. No other disease has so much sociological, economic and health significance as tuberculosis. In the poorly functioning tuberculosis control programme, the ratio of incidence to prevalence may be as high as 1: 3.5. Experience and observations from both developed and developing countries have demonstrated that if case detection and cure rates in smear positive cases are consistently achieved to 70 % and 85 % respectively, the incidence would decline to 5% annually while prevalence decline very rapidly, being reduced to less than half of its previous level within three years. Since RNTCP India is based on scientific principles of DOTS strategy, its effective clinical and public health management, committed and co-ordinated efforts of public and private partners (IMA) would certainly lead to decline the prevalence (already declined from 586/1,00,000 in 1990 to 185/1,00,000 population in 2008 - 68 % reduction), mortality rate from 42/ 1,00,000 in 1990 to 21/1,00,000 in 2015 (already reduced to 24/1,00,000 in 2008 - 43 % reduction) as target set under indicator 23 of TB-related Millennium Development Goal. This kind of impact would result in halting and reversing TB Incidence to pave way for future effective control of TB, which may not remain a public health problem by 2050. Thus, TB control is a winnable battle.

Peptide bound hypohydroxyprolinuria in Handigodu Disease: a familial syndrome of spondylo epi(meta)physeal dysplasia.

Handigodu Disease (HD) is disorder of the osteoarticular system prevalent in few villages of two districts of the state Karnataka in southern India. 24 hrs urinary excretions of proline (Pro) and 4-hydroxyproline (Hyp) were analyzed by HPLC. Decreased peptide bound Hyp excretions (mumole/24 hrs) were found in patient group when compared with controls (Nonaffected; 113.02 +/- 67.96, Type-I; 36.22 +/- 20.76, Type-II; 45.74 +/- 14.95, Type-III; 40.46 +/- 22.68) and without significant difference in Pro excretions. Significant increased peptide bound Pro to Hyp ratio were found in patient group compared to control (Nonaffected n=63: 2.02 +/- 1.65, Type-I n=18: 3.144 +/- 1.42, Type-II n=28: 4.21 +/- 1.95, Type-III n=8: 8.60 +/- 6.55). 24 hrs urinary excretions of deoxypyridinoline (DPD) crosslinks were found without significant difference among affected and control, hence HD ruled out from general bone reduction. These results suggest hypohydroxyprolinuria may be because of reduced bone turnover or defective hydroxylation of prolyl residues during post translational modification of collagen biosynthesis.

Prevention of homozygous beta thalassemia by premarital screening and prenatal diagnosis in India.

AIM: To determine the feasibility and acceptability of premarital screening for beta thalassemia/related hemoglobinopathies followed by prenatal diagnosis in India. MATERIALS AND METHODS: Premarital testing for thalassemia carrier state was carried out in (1) extended family members (EFM) of diagnosed cases of thalassemia/hemoglobinopathies, (2) unmarried adult cases of anemia attending the hospitals' outpatient department (OPD) and (3) adult college students (CG). Hemoglobin, red cell indices were measured by a cell counter and hemoglobin fractionation was carried out by high performance liquid chromatography (HPLC). In cases with HbA2>3.5%, or with variant hemoglobin, mutation screen was done by amplification refractory mutation system polymerase chain reaction (ARMS-PCR). In high-risk prospective couples, premarital genetic counseling was done and prenatal diagnosis possibilities were explained. RESULTS: The yield of carriers from EFM, OPD and CG groups was 78.17% (308/394), 19.51% (263/1348) and 4.04% (38/939), respectively. The number of prospective high-risk couples detected were 154, 48 and 2 from EFM, OPD and CG, respectively. As much as 99% of prospective carrier couples married even after knowing their high-risk status and opted for prenatal diagnosis. The program averted the birth of 33 thalassemic children; 28 in EFM group (by screening of 394 individuals), 4 in the OPD group (by screening 1348 anemic patients), and 1 in CG group (by screening of 939 students). CONCLUSION: Premarital screening in extended family members, followed by prenatal diagnosis is acceptable and the most effective strategy for control of thalassemia in developing countries like India.