Rare coexistence of hypopituitarism with osteogenesis imperfecta - A double-trouble for bone.

Osteogenesis imperfecta (OI) commonly involving defects in COL1A1 and COL1A2 is a rare hereditary disease of bone fragility affecting 6-7 per 100,000 population. On the other hand, hypopituitarism is a separate entity that manifests with reduced levels of pituitary hormones. The cooccurrence of these two is seldom reported previously in literature as a deviation from Occam's razor. Here, we reported a case of pathological fracture in a 31-year-old male who had blue sclera and secondary adrenal insufficiency, hypogonadotropic hypogonadism, and growth hormone deficiency along with primary autoimmune hypothyroidism. Diagnosis of OI was suggested by heterozygous missense variant in exon 40 of the COL1A2 gene (chr7: g.94423092G > A; Depth: 99×) that resulted in the amino acid substitution of Serine for Glycine at codon 847. Replacement of glucocorticoid, levothyroxine, and testosterone was started along with antiresorptive therapy for better bone health outcomes.

Intra-operative drug level monitoring of pre-operative antibiotic for surgical prophylaxis in the patients of elective spinal surgery.

OBJECTIVES: Single dose prophylaxis is good enough for general surgery with low risk patients. However, the evidence for the effectiveness of single dose anti-microbial prophylaxis (AMP) is not conclusive in high risk patients and spinal surgeries requiring instrumentation or the use of implants in particular. No studies have explored the various concentration of ceftriaxone in plasma and tissue as well during an ongoing spinal surgery. Therefore, the objective of study was to correlate the serum and tissue concentrations of ceftriaxone with the SSI and identify patients with increased risk of SSI. METHODS: It was an open label prospective study in 50 consecutive patients who underwent elective spine surgery under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by high pressure liquid chromatography during the ongoing surgery. RESULTS: Subjects were observed for any post-operative complications including SSI. Serum (p=0.002) and tissue (p=0.012) concentrations of ceftriaxone at the closure of spinal surgery were associated with SSI. Duration of the surgery (p=0.04) and use of implants (p=0.02) were also important surgery related risk factors. CONCLUSIONS: Serum and tissue concentrations of ceftriaxone at the closure and duration of surgery and instrumentation or use of implants in the spinal surgery are good predictors of SSI.

Suprascapular nerve block is faster and as effective as hydrodistension in relieving frozen shoulder-associated pain and disability: A prospective, single-blind observational study with a follow-up of 24 weeks.

Background and Aims: Hydrodistension (HD) and suprascapular nerve block (SSNB) have been shown to reduce pain and improve shoulder function in frozen shoulder (FS). The aim of this study was to compare the efficacy of HD and SSNB in the treatment of idiopathic FS. Material and Methods: This was a prospective observational study. A total of 65 patients with FS were treated with SSNB or HD. The functional outcome was evaluated by Shoulder Pain and Disability Index (SPADI) score and active shoulder range of motion (ROM) measured at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Parametric data were analyzed using an independent sample T-test. Nonparametric data were analyzed using the Mann-Whitney test and Wilcoxon test. A P value less than 0.05 was considered significant. Result: At the end of 24 weeks, the two-group improved significantly from the baseline and the improvement was comparable between the two groups. ROM also improved significantly in both groups. At 2nd week, SPADI score was significantly less in SSNB group (P < 0.05). About 43% of patients considered HD extremely painful. Conclusion: Both HD and SSNB are almost equally effective in reducing pain and improving shoulder function. However, SSNB leads to a faster improvement.

Comparative analysis of stress distribution around CFR­PEEK implants and titanium implants with different prosthetic crowns: A finite element analysis.

BACKGROUND: Polyetheretherketone (PEEK) is a new material that was introduced for the fabrication of implants and their superstructure along with other available materials. It is not yet known whether the carbon fiber-reinforced polyetheretherketone (CFR­PEEK) material can be used as an implant and its superstructure in place of titanium (Ti). OBJECTIVES: The study evaluated stress distribution around CFR­PEEK implants and Ti implants with 5 different prosthetic crowns. MATERIAL AND METHODS: A three-dimensional (3D) model of a bone block was created to represent the right maxillary premolar area with a bone-level implant system with 100% osseointegration, using the Ansys Workbench software, v. 15.0. In total, 10 3D finite element analysis (FEA) models were created. The models were divided into 2 groups according to the type of implant: the CFR­PEEK group (n = 5); and the Ti group (n = 5). Each group was subdivided to imitate 5 different restorative crown materials (PEEK, zirconia, porcelain fused to metal (PFM), metal, and acrylic resin). Each implant model was loaded vertically (200 N) and obliquely (100 N). Stress distribution in the implants, the abutments, the cement layers, and the crowns was evaluated using the von Mises stress analysis. Maximum and minimum principal stress analyses were used to determine the stress generated in the bone. RESULTS: The CFR­PEEK implants bore more stress in vertical and oblique loading as compared to the Ti implants. The stress generated in the bone with the CFR­PEEK implants was similar to that generated with the Ti implants under vertical loading. Under oblique loading, less stress was transferred to the bone with the CFR­PEEK implants as compared to the Ti implants, showing better adaptation of the CFR­PEEK implants to lateral stress. CONCLUSIONS: In this FEA study, the amount of stress generated within the bone in the case of the CFR­PEEK implants with different restorative crowns was smaller in comparison with the Ti implants in oblique loading. This could help reduce lateral stress on implants as well as crestal bone loss.

Predictors of discogenic pain in magnetic resonance imaging: a retrospective study of provocative discography performed by posterolateral approach.

BACKGROUND: Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD. METHODS: Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out. RESULTS: A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11. CONCLUSIONS: In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.

Prevalence of Spaced and Non-Spaced Dentition and Occlusal Relationship of Primary Dentition and its Relation to Malocclusion in School Children of Davangere.

BACKGROUND: The aim of the current study was carried to determine the relation of spacing, closed dentition, and occlusal relation with malocclusion in the primary dentition in children during deciduous dentition period among school children of Davangere. MATERIALS AND METHODS: A total of 945 school children all having deciduous teeth were included in the study. Informed consent for the child's participation is taken from the school principal. The dentition was examined under natural daylight, and the data was recorded. All the school children were screened for spaced and non-spaced dentition, molar and canine relationship. RESULTS: The results concluded that most of the children showed spaced dentition (82.1%) when compared to non-spaced dentition (17.9%) with males shown more spaced dentition than compared to females. Among all children examined for molar and canine relation, flush terminal molar relation (65%) showed highest among all molar relation followed by mesial step (31%) and distal step (4%), and Class I canine relation (90%) was significant followed by Class II (6%) and Class III canine relation (4%). No significant difference was seen between right and left side. CONCLUSION: The study concludes that determining the malocclusion and its correction at an early age helps in preventing a future complication in permanent dentition since stable primary occlusion leads to ideal occlusion in permanent dentition. Spacing, i.e., primate and physiologic space with the terminal molar relation in primary dentition indicates proper alignment of the permanent dentition.

Total Salivary Anti-oxidant Levels, Dental Development and Oral Health Status in Childhood Obesity.

BACKGROUND: The objectives of this study were to assess the total antioxidant levels, dental development, and oral health status in childhood obesity. MATERIALS AND METHODS: A total of 120 children aged 6-12 years consisting of both genders from different school along Coastal Karnataka, India were part of the study and were categorized into obese/overweight, and normal children based on body mass index for age and sex. Total antioxidant capacity (TAC) levels determined by phosphomolybidic acid and spectrophotometric method were considered. Oral hygiene index-simplified, modified gingival index and dentition status index were used to analyze oral health status. Dental development was assessed using a clinical method and correlated with standard chronology of human dentition. RESULTS: Levels of the total salivary antioxidants were increased in the study group which is very highly significant when compared with control group, oral health status in both the study group and control group was good. Number of children in study group showing accelerated dental development is relatively less when compared with control group, but is not statistically significant. CONCLUSION: Salivary TAC was significantly high in overweight and obese children than their normal counterparts. Prevalence of dental caries was high in obese/overweight children when compared to normal children.

Comparison of different caries diagnostic thresholds under epidemiological and clinical settings among 7-15 year old school children from Bangalore city.

AIM: The aim of this study is to compare the different caries diagnostic thresholds under epidemiological and clinical settings among 7-15 year old school children. MATERIALS AND METHODS: A cross-sectional study was undertaken among 7-15 years old school children of Bangalore city. Total 738 children were enrolled in the study. General information was collected regarding oral hygiene practice and personal habits of the schoolchildren. Subsequently, examination was done under both the settings to record Decayed, missing and filled surfaces index for permanent teeth (DMFS) and Decayed, missing and filled surfaces index for deciduous teeth (dmfs) using the World Health Organization (WHO) and WHO + IL criteria. RESULTS: The present study showed that both the settings (clinical and epidemiological) and diagnostic thresholds (WHO and WHO + IL), could influence the detection of carious lesions. Mean Ds under WHO + Initial lesions (IL) criteria (3.92 + 3.49) was nearly double of WHO criteria (1.88 + 2.73,) and the influence observed was more in 14 years of age, where mean Ds under WHO + IL criteria (5.43 + 2.5) which was more than double of WHO criteria (2.02 + 1.9). CONCLUSION: The choice of a diagnostic threshold (WHO and WHO + IL) and the conditions of examination (epidemiological and clinical) are important for the detection of caries.