The time lag prior to the rise in glucose requirements to maintain stable glycaemia during moderate exercise in a fasted insulinaemic state is of short duration and unaffected by the level at which glycaemia is maintained in Type 1 diabetes.

AIMS: To determine the duration of the low hypoglycaemia risk period after the start of moderate-intensity exercise performed under basal insulinaemic conditions and whether this period is affected by the level at which glycaemia is maintained under these conditions. METHODS: This was a prospective, randomized counterbalanced study. Eight participants with Type 1 diabetes (mean ± sd age 21.5 ± 4.0 years) underwent either a euglycaemic (5-6 mmol/l) or hyperglycaemic clamp (9-10 mmol/l) on separate days and were infused with insulin at basal rates and [6,6-2 H]glucose while cycling for 40 min at 50% maximum oxygen consumption rate. The main outcome measures were the glucose infusion rates required to maintain stable glycaemia and glucoregulatory hormone levels, and rates of glucose appearance and disappearance. RESULTS: During the first 20 min of exercise, the glucose infusion rate did not increase significantly, irrespective of the level at which glycaemia was maintained, but increased acutely between 20 and 25 min under both conditions. Maintaining higher glycaemia resulted in higher glucose infusion rate during, but not early post-exercise. With the exception of epinephrine, the glucoregulatory hormone levels and rates of glucose appearance and disappearance were similar between conditions. CONCLUSION: Irrespective of the levels at which glycaemia is maintained, there is a 20-min low exogenous glucose demand period during which the exogenous glucose requirements to maintain stable glycaemia do not increase during moderate exercise performed at basal insulin level.

Early presentation of ruptured post-traumatic hepatic artery pseudoaneurysm.

Visceral artery aneurysms (VAA) are an uncommon but well recognized condition. Hepatic artery aneurysms (HAA) represent 14-20% of all visceral artery aneurysms. Post traumatic hepatic artery pseudoaneurysm is an uncommon delayed complication of blunt liver trauma. Here we present a case of a 27 year old male with blunt abdominal trauma who developed a post traumatic pseudoaneurysm of the hepatic artery just proximal to its bifurcation into the left and right branches. The pseudoaneurysm ruptured within 12 hours of injury and he required double ligation of the hepatic artery as well as right and left hepatic arteries . However, the bleeding continued through the retrograde flow from the gastroduodenal artery and hence, ligation of gastrodudenal artery was also done. The decision of complete devasularisation of liver was taken as an emergency lifesaving procedure. The patient recovered and was discharged without sequel.

A 10-second sprint does not blunt hormonal counter-regulation to subsequent hypoglycaemia.

AIM: To investigate whether a 10-second (s) sprint impairs the counter-regulatory response to subsequent hypoglycaemia. METHODS: Nine people (five male, four female) with Type 1 diabetes, aged 21.1 ± 4.5 years, performed a 10-s rest or a 10-s maximum-effort sprint in random order on different days, while subjected to an euinsulinaemic-euglycaemic clamp. This was followed by a hyperinsulinaemic-hypoglycaemic glucose clamp 2.5 h later to induce hypoglycaemia for 40 min. At timed intervals, the counter-regulatory hormonal responses to hypoglycaemia were measured. Blood pressure, heart rate and hypoglycaemic symptoms were also assessed. RESULTS: During the hypoglycaemic clamp, epinephrine, norepinephrine, growth hormone and cortisol levels increased significantly from baseline, and their responses were similar after both rest and sprint conditions. In particular, plasma epinephrine rose eightfold, from 197 ± 103 pmol/l to 1582 ± 1118 pmol/l after the rest condition, and from 219 ± 119 pmol/l to 1900 ± 898 pmol/l after the sprint condition. CONCLUSION: A 10-s sprint is unlikely to blunt the subsequent hormonal counter-regulation to hypoglycaemia in individuals with Type 1 diabetes.

Differential expression of glutathione s-transferase enzyme in different life stages of various insecticide-resistant strains of Anopheles stephensi: a malaria vector.

BACKGROUND & OBJECTIVES: Interest in insect glutathione s-transferases (GSTs) has primarily focused on their role in insecticide resistance. These play an important role in biotransformation and detoxification of many different xenobiotic and endogenous substances including insecticides. The GST activity among 10 laboratory selected insecticide resistant and susceptible/control strains of Anopheles stephensi was compared using the substrates 1-chloro-2,4-dinitrobenzene (CDNB). The difference in the GST activities of different life stages of diverse insecticide resistant strains was compared and presented. METHODS: About 100 larvae, pupae, adult males, adult females and eggs (100 µg in total weight) were collected and used for the experiment. The extracts were prepared from each of the insecticide-resistant strains and control. Protein contents of the enzyme homogenate and GST activities were determined. RESULTS: Deltamethrin and cyfluthrin-resistant strains of An. stephensi showed significantly higher GST activity. Larvae and pupae of DDT-resistant strain showed peak GST activity followed by the propoxur-resistant strain. On contrary, the GST activity was found in reduced quantity in alphamethrin, bifenthrin, carbofuran and chloropyrifos resistant strains. Adults of either sexes showed higher GST activity in mosquito strain resistant to organophosphate group of insecticides namely, temephos and chloropyrifos. INTERPRETATION & CONCLUSION: The GST activity was closely associated with almost all of the insecticides used in the study, strengthening the fact that one of the mechanisms associated with resistance includes an increase of GST activity. This comparative data on GST activity in An. stephensi can be useful database to identify possible underlying mechanisms governing insecticide-resistance by GSTs.

A novel music based tooth brushing system for blind children.

OBJECTIVES: To assess the Oral Health Status (OHS) of visually impaired children in South India, to devise and implement a specially designed Oral Health Education (OHE) program for them and to assess its efficacy in improving their OHS. STUDY DESIGN: OHS of 98 institutionalized visually impaired children aged 6 to 14 years were evaluated at the start of the study (Pre-OHE level) using the Modified Gingival Index (MGI), the Turesky-Gilmore-Glickman modification of the Quigley Hein Plaque Index (MQHPI) and Streptococcus mutans colony count. Oral Health Education was imparted with the help of specially designed models and tooth-brushing taught with specially formulated music aided instructions in a song format. These parameters were re-evaluated after a period of reinforced (two weeks and one month) and non-reinforced (two months) tooth-brushing. RESULTS: Mean values of MGI and MQHPI showed a statistically very highly significant drop from the Pre-OHE level to the end of both the periods of reinforcement and non-reinforcement. There was a significant decrease in the S. mutans counts from the Pre-OHE levels to the period of non-reinforcement (p < 0.0005). CONCLUSION: The OHE program specially formulated for the visually impaired children was effective in improving their OHS significantly

Knowledge of care providers regarding the oral health care of visually impaired children.

OBJECTIVE: To assess the awareness of care providers of visually impaired children regarding their oral hygiene. METHOD: A simple pre-structured questionnaire was given to the care providers and the awareness regarding their oral health was assessed. RESULTS: There was a general lack of awareness among the care providers of these children regarding dental diseases and its prevention. Furthermore, the importance of oral hygiene was found to be very low. CONCLUSION: The results obtained showed that most of the caretakers were unaware of the difficulties faced by these children in the maintenance of their oral health.

Intraoperative evaluation of the resected bone margin in mandibular cancers using a trephine drill and frozen section analysis.

The objective of this study was to evaluate the accuracy and feasibility of intraoperative frozen section analysis of samples harvested with a trephine drill from the bone resection margins to identify malignancy. Thirty-five patients who were diagnosed with locally advanced oral squamous cell carcinoma involving the mandible were included in this study. After tumour resection, bone samples were collected from the resection margin of the specimen using a trephine drill. Sampling yielded a cylindrical specimen of bony tissue that included both cortical and cancellous areas. A second sample was obtained from the area where bone invasion was evident; this was used as a positive control. Frozen section analysis was performed intraoperatively to check for malignancy. The sensitivity of this technique was found to be 81.8%, with specificity of 87.5%, a positive predictive value of 75%, negative predictive value of 91.3%, and accuracy of 85.7% when compared to standard histopathology as the gold standard. In conclusion, the evaluation of bone margins using the trephine drill technique and frozen section analysis proved to be fast and reliable.

Three-dimensional finite element analysis of strength, stability, and stress distribution in orthodontic anchorage: a conical, self-drilling miniscrew implant system.

INTRODUCTION: The aims of this study were to analyze the stress distribution and displacement patterns that develop in an orthodontic miniscrew implant and its surrounding osseous structures for 2 implant materials under horizontal and torsional loading, with no ossseointegration. METHODS: A numeric approach was adopted. The finite element method was used to determine the stress and displacement of the various components at a given time after miniscrew implant application, when, due to viscoelastic relaxation effects, the only remaining stress field was from the application of the orthodontic load. RESULTS: Stress distribution was not significantly different between the 2 types of implant material. Increased stress values were located at the necks of the implants and the surrounding cortical bone. Bending of the titanium miniscrew was observed in the neck region under horizontal traction. CONCLUSIONS: The differences between the values of stress and displacement we obtained for the 2 types of miniscrew were too small to be clinically significant. Optimization of the miniscrew implant composed of the titanium alloy might be achieved by increasing the bulk (quantity) of the material in the neck region. The miniscrew implant can be immediately loaded and used for group movement of teeth.

Cephalometric comparison of vertical changes between Begg and preadjusted edgewise appliances.

The purpose of this retrospective study was to quantify and compare the vertical dimensional changes in bialveolar dental protrusion patients undergoing extraction of all four first premolars between the preadjusted edgewise appliance (PEA) and the Begg appliance. The cephalometric records of 55 patients (14 males and 41 females) with Class I bimaxillary protrusion were selected and divided into two groups based on the appliance used, i.e Begg or PEA mechanotherapy. To minimize the effects of growth, the subjects were at least in stage VI of skeletal maturation. The mean age was 18.25 ± 3.2 years for the Begg group and 18.03 ± 3.5 years for the PEA group. Skeletal and dental changes were analysed in both groups on lateral cephalograms taken pre- (T1) and post- (T2) treatment. A Student's t-test was used to analyse the treatment changes. Within group results showed a significant increase in face height and extrusion and mesial movement of the upper and lower molars for both groups. However, no significant differences were observed when the groups were compared. A significant correlation was found between the change in lower molar to mandibular plane angle and lower anterior face height for both groups. No significant difference was found when the Begg mechanotherapy was compared to the PEA technique on vertical dimensional changes. It can be speculated that mesial movement of the molars tended to keep pace with their extrusion and negated any bite opening effect with both mechanotherapies.

Nitric oxide metabolites in sera of patients across the spectrum of leprosy.

Leprosy, a chronic infectious disease, caused by Mycobacterium leprae infection, manifests itself as a clinical spectrum depending on the patients' immunological response, finally leading to peripheral nerve damage and deformities in the patients. Nitric oxide (NO) which is known to contribute to pathogenesis of several neurological diseases has been detected in tissues and urine of leprosy patients. This is the first study assessing NO as its stable end products, nitrites and nitrates, in sera of patients across the spectrum of the disease as a possible parameter of prognostic value. Comparison of NO metabolites showed a significant increase in multibacillary patients and patients with type I reactions as compared to healthy control individuals. These levels reduced significantly after treatment. This study has further borne out the utility and reliability of the cadmium-reduction method of estimation of NO metabolites--a relatively inexpensive procedure that lends itself to large-scale screening and follow-up of patients.

Minimally-invasive anterior maxillary distraction technique in patients with cleft lip and palate and maxillary deficiency: an evaluation of 106 patients.

Our aim was to evaluate the feasibility of a minimally-invasive surgical technique for anterior maxillary distraction osteogenesis to correct maxillary hypoplasia in patients with clefts. A modified Y distractor was placed intraorally in 106 patients with cleft- associated maxillary deficiency to facilitate protraction of the maxilla. Subsequently the patients had an anterior maxillary osteotomy through a minimally invasive incision, followed by activation of the appliance at the rate of 0.8mm/day until positive overjet was achieved. The patient's lateral cephalograms were evaluated preoperatively (T1), after activation (T2), and one year postoperatively (T3). Collected data were assessed with the paired t test, and probabilities of < 0.001 were accepted as significant. A mean (SD) of 10.4 (2.58) mm anterior maxillary advancement was obtained in all patients after 10-13 days of distraction. The sella-nasion-point A (SNA) angle increased from 75.37° to 83.01°. When we compared the cephalometric variables at T1 and T2, the mean maxillary length and overjet at T2 were significantly higher (p<0.001). The comparison of mean values at T2 and T3 was not significant. Minimally invasive anterior maxillary distraction with the modified Y distractor resulted in changes after activation that were consistent one year postoperatively, making it a conservative, less traumatic, and effective treatment of cleft-related maxillary deficiency.

Adenomatoid odontogenic tumor - hamartoma or true neoplasm: a case report.

Adenomatoid odontogenic tumor (AOT) is an uncommon tumor of odontogenic origin with a relative frequency of 2.2 - 7.1%. As the histogenesis of AOT is still uncertain, it is sometimes categorized as a hamartomatous lesion rather than a true neoplasm. We report a case of AOT in the right maxillary anterior region in a 20-year-old woman. The tumor showed some unusual and aggressive features that suggested it was a true neoplasm.

Observations from a 'special selective drive' conducted under National Leprosy Elimination Programme in Karjat taluka and Gadchiroli district of Maharashtra.

The special selective drive (SSD) was conducted on a request from the Joint Director of Health Services (Leprosy and TB) Government of Maharashtra. The study team comprised the Foundation for Medical Research (FMR), assisted by a member of the Acworth Leprosy Hospital Society for Research, Rehabilitation and Education in Leprosy and two from Kushtrog Nivaran Samiti (KNS). The drive was conducted in select villages covered by 6 primary health centers (PHCs) in Karjat taluka of Raigad district and 45 PHCs in Gadchiroli district from March to May 2009 and had the cooperation of the district and PHC level staff. The aim was to train and deploy community level workers (CWs) for early leprosy case detection and through them, to create leprosy awareness in the community. A total of 1053 CWs (126 in Karjat taluka, 927 in Gadchiroli district) were given intensive training by the team. The CWs then carried out a one-day house-to-house leprosy awareness drive in their areas and listed persons such 'suspects' in both Karjat taluka (no. = 514) and Gadchiroli district (no. = 1325). Around 40% of 'suspects' presented themselves at the PHCs for examination by the medical team; of these 38 (29%) and 281 (45%) respectively turned out to be previously undetected definite cases of leprosy. The PHC-wise NCDR ranged from 5 - 27/10,000 in Karjat (14/10,000) and 2 - 35/10,000 in Gadchiroli (average 13/10,000), both rates being much higher than the reported State average of 1.1/10,000. There was a high proportion of child cases (14 and 24% respectively) and grade 2 disability (18% and 12% respectively) which indicate continued transmission of leprosy and delayed diagnosis of cases. The study also notes poor diagnostic skills among the PHC staff. Significant shortage and irregular disbursement of MDT from district store PHCs, combined with transport problem which probably contributed to delay in treatment in over 50% of the cases confirmed by the team.

Promotional literature: how do we critically appraise?

There has been a tremendous increase in the number of new and generic drugs coming into the market. The busy practitioner obtains the information from various sources, of which promotional literature forms an important source. The promotional literature provided by the pharmaceutical companies cannot be entirely relied upon; moreover, very few physicians are equipped with the skills of critically appraising it. The new drug should be relevant to the clinician's practice in terms of population studied, the disease and the need for new treatment. The methodology of the study should be carefully judged to determine the authenticity of the evidence. The new drug should be preferred over the existing one if it offers clear advantages in terms of safety, tolerability, efficacy and price. Critical appraisal of promotional literature can provide valuable information to the busy physician to practice evidence-based medicine.

Detection and classification of leprosy: future needs and strategies.

This paper focuses on the obstacles and dilemmas in detection and classification of leprosy cases and suggested strategies for the same. This review attempts to raise some cardinal issues within leprosy diagnosis and the need for capacity building at clinical and field level in light of research conducted. It also recommends strategies to overcome these obstacles.

Ellis-van Creveld Syndrome (chondro-ectodermal dysplasia) in two siblings.

Two male siblings aged 12 and 15 years (Figure 1) presented with growth retardation, limb abnormalities and, defective teeth and nail since childhood. There was no history of similar defects in other family members. On examination their height was 114 cm and 130 cm (expected height; 169 cm and 150 cm) respectively. There were hypoplastic and dystrophic nails, and microdontia and hypodontia on dental examination. There were post-axial polydactyly in both the hands and left foot. Skeletal survey revealed short forearms, legs & distal phalanges (Acromesomelia). Cardiac or other organ system defects were not noticed on clinical examination or echocardiogram. Clinical picture was suggestive of a diagnosis of Chondroectodermal dysplasia (Ellis van Creveld syndrome). These cases have been reported for their rarity and for the presence of some rare features of this syndrome.

Evaluation of a polymorphism in MYBPC3 in patients with anthracycline induced cardiotoxicity.

Cardiotoxicity is the most serious side effect of anthracyclines (doxorubicin, daunorubicin or epirubicin). The incidence of anthracycline induced late cardiac toxicity (AIC) that is overt clinically is 3-5% in the Indian population. Polymorphism in intron 32 (deletion of 25bp) of MYBPC3 has been shown to be present exclusively in Asians and more so in South India (3-8%). The frequency of the polymorphism is significantly higher (13%) in patients with cardiomyopathy in India. Fifteen patients were identified to have cardiac dysfunction following treatment for malignant lymphoma with doxorubicin containing regimens. Peripheral blood DNA from control, amplified by polymerase chain reaction yielded a 467bp fragment while in the presence of the 25bp deletion only a 442bp fragment was detected. To confirm the presence or absence of the polymorphism, amplified DNA was restricted using Bgl1 in all samples. Bgl1 restricted amplified DNA only if the 25bp deletion was absent. A 467 base pair band was observed in all the 15 samples, which suggested the absence of polymorphism in MYBPC3. In a sample of DNA from a patient with a deletion in exon 33 (confirmed by sequencing) a 442bp fragment was detected. Amplified DNA from this patient was not restricted with Bgl1. Wild type MYBPC3 when amplified gave a distinct restriction banding pattern consisting of two bands of 401bp and 66bp. Amplified DNA from all peripheral blood samples restricted with Bgl1 suggesting the absence of the polymorphism. In this preliminary report, MYBPC3 does not seem to play a role in anthracycline induced cardiotoxicity.

Evaluation of antimicrobial and physical properties of orthodontic composite resin modified by addition of antimicrobial agents--an in-vitro study.

INTRODUCTION: This study was designed to investigate the antimicrobial and physical properties of orthodontic composite resin modified by the addition of antimicrobial agents. METHODS: Unite bonding adhesive (3M Unitek, Monrovia, Calif), a chemically cured composite resin, modified by the addition of benzalkonium chloride (BAC), chlorhexidine, and triclosan in concentrations of 0.1 wt%, 0.2 wt%, and 0.3 wt%, respectively, was formed into tablets for testing. The tablets of each group and a control group were subjected to the agar plate diffusion test to measure the zone of bacterial inhibition. In addition, they were incubated for 24 hours in tryptic soy broth inoculated with Streptococcus mutans and examined for bacterial growth. A total of 80 extracted premolars were collected and divided into 2 sets of 40 teeth each. Stainless steel Begg brackets were bonded by using control and experimental composites. A universal testing machine was used to determine shear bond strength. The first set of teeth was tested after 24 hours and the second set after 25 days of storage in distilled water. Time-dependent release of antimicrobial agents from the modified composites was monitored spectrophotometrically. RESULTS AND CONCLUSIONS: The findings indicated that (1) addition of BAC to the orthodontic composite resin enhanced its antimicrobial properties, (2) there was no significant difference in the bond strengths of the control and the experimental resin tested after 24 hours and 25 days, and (3) maximum release of BAC from the modified resin was higher than that of chlorhexidine or triclosan, and was much higher than the minimum inhibitory concentration level.

Henoch-Schönlein purpura as a rare cause of an acute abdomen.

A 52-year-old man presented with a purpuric rash affecting his legs and hypertension. He was diagnosed with Henoch-Schönlein purpura and discharged with non-steroidal anti-inflammatory drugs. Three weeks later, he presented again with loss of appetite and vomiting before developing abdominal pain with pyrexia of 38.5°C and rigors. On examination, he was hypotensive with a distended abdomen and a national early warning score of 6. Computed tomography revealed enteropathy of Henoch-Schönlein purpura. The patient deteriorated and went for an emergency laparotomy, where 30cm of ischaemic small bowel was resected.