Post traumatic stress disorder following facial and dental trauma: preliminary findings from a study conducted in India.

This study was conducted to identify and study the prevalence of post traumatic stress disorder (PTSD) in patients, who had sustained traumatic facial and dental injuries along with other variables that may affect the psychological response. MATERIAL AND METHODS: 241 patients suffering from traumatic facial and dental injuries presenting to the Ahmadabad Municipal Dental College and Hospital were included in the study. 110 patients (males - 87, females - 23) suffered disfiguring injuries and/or loss of multiple front teeth (DF). 131 patients (males - 102, females - 29) suffered no disfigurement (NDF). Assessment was carried out on day of discharge (D.O.D), 1 month, and 6 months. Impact of Event Scale (I.E.S-R) was used to assess the presence of post traumatic stress disorder in the patients. RESULTS: Patients with DF injuries had statistically significant higher mean scores than patients suffering NDF injuries. Female patients had comparatively higher scores at D.O.D, 1 month, and 6 months. Patients treated with maxillomandibular fixation and between ages 18 and 40 years also had significantly higher scores. CONCLUSION: Patients with DF facial injuries including multiple anterior teeth loss had significantly higher mean (I.E.S-R) scores for PTSD in comparison with patients with NDF facial injuries.

Unicystic desmoplastic osteo-ameloblastoma of posterior mandible: Report of rarest of the rare case and review of literature.

Desmoplastic ameloblastoma (DA) is an epithelial odontogenic tumor and a rare variant of ameloblastoma. It was first described by Eversole in 1984. In the World Health Organization (WHO) classification of odontogenic tumors (2005), DA has been considered as a distinct entity from conventional/multicystic ameloblastoma. DA differs strikingly in its clinical, radiological, and histopathological presentation when compared to other variants of ameloblastoma. We report here an extremely rare "Hybrid DA" in a 50-year-old female patient with painless hard swelling involving right posterior mandible with detailed clinical history, an unusual radiographic and histopathological presentation. Histopathology revealed odontogenic epithelium in the form of follicles, ameloblastoma with cystic degeneration, and squamous metaplasia at places and elsewhere there were odosntogenic islands compressed by dense fibrocellular stroma suggestive of desmoplasia along with osseous tissue formation. Also review of the literature and possible explanation of etiopathogenesis of cystic change and osseous tissue formation in DA are discussed.

Basal Implants: An Asset for Rehabilitation of Atrophied Resorbed Maxillary and Mandibular Jaw - A Prospective Study.

INTRODUCTION: Conventional implants have great limitations in case of atrophic maxillary and mandibular ridges. Ultimately, patients who have severely atrophied jawbones paradoxically receive little or no treatment, as long as conventional implants are considered the device of first choice. Basal implants were developed with the goal to overcome the limitations of conventional implantology, primarily for atrophied ridges or inadequate bone with the protocol of immediate loading. However, studies regarding the rehabilitation followed by placement of screwable basal implants in atrophied ridges are limited. The purpose of the study was to conduct a prospective evaluation for the feasibility of placing strategic basal implants in clinical practice along with its merits and demerits. MATERIALS AND METHODS: A prospective study was designed to evaluate the protocol of immediate functional loading using the technology of strategic basal implants® for fixed complete arch prostheses and segmental teeth prostheses. A minimal of 10 patients selected in the age group of 20-80 years were restored with strategic basal implants irrespective of the quality and quantity of cancellous/alveolar bone following immediate functional loading protocols. RESULTS: About 157 various designs of basal implants were placed in 10 patients, out of which four failed with the survival rate of 97.5% of basal implants. DISCUSSION: The new concepts laid by basal implantology eliminate all drawbacks of conventional implantology and should be used as an adjunct to improve the quality of life of our patients. The concept of strategic implantology is innovative but reliable technique for patients in need of permanent rehabilitation.

Does an autogenous demineralized dentin (ADDM) graft has the ability to form a new bone?

AIM: This aimed to evaluate a new bone formation and to provide a single-stage treatment, i.e., extraction of tooth followed by autogenous dentin demineralized (ADDM) graft in the same extraction socket (ES) - for adult patients who require tooth extraction. MATERIALS AND METHODS: Two hundred teeth extractions were performed to investigate the efficacy of ADDM graft in the formation of new bone. After demineralization of dentin graft parameters such as exposure of graft, any signs of infections/pus/exudates, pain, and bone density were evaluated. RESULTS: On follow-up, exposure of graft was recorded in five sockets at 1 month and infection was recorded in four sockets. Pain was significantly high at postoperative day 1 and least with 3rd and 6th months. There was a highly significant bone formation (P < 0.01, 0.05) in the ES group at various time intervals, while there were no significant differences in the adjacent bone group. CONCLUSION: Using ADDM graft in providing a single-stage treatment plan, i.e., extraction of tooth followed by autogenous demineralized dentin graft in the same ES in adult patients - is an alternative for the immediate reconstruction of alveolar bone defects to facilitate the future prosthesis. It also saves the cost of other graft materials which are commercially available in market for the patient and also reduces the infective dental waste globally.

Dichloroacetate prevents TGFß-induced epithelial-mesenchymal transition of retinal pigment epithelial cells.

Proliferative retinopathies are associated with formation of fibrous epiretinal membranes. At present, there is no pharmacological intervention for the treatment of retinopathies. Cytokines such as TGFß are elevated in the vitreous humor of the patients with proliferative vitro-retinopathy, diabetic retinopathy and age-related macular degeneration. TGFß isoforms lead to epithelial-mesenchymal transition (EMT) or trans-differentiation of the retinal pigment epithelial (RPE) cells. PI3K/Akt and MAPK/Erk pathways play important roles in the EMT of RPE cells. Therefore, inhibition of EMT by pharmacological agents is an important therapeutic strategy in retinopathy. Dichloroacetate (DCA) is shown to prevent proliferation and EMT of cancer cell lines but its effects are not explored on the prevention of EMT of RPE cells. In the present study, we have investigated the role of DCA in preventing TGFß2 induced EMT of RPE cell line, ARPE-19. A wound-healing assay was utilized to detect the anti-EMT effect of DCA. The expressions of EMT and cell adhesion markers were carried out by immunofluorescence, western blotting, and quantitative real-time PCR. The expression of MAPK/Erk and PI3K/Akt pathway members was carried out using western blotting. We found that TGFß2 exposure leads to an increase in the wound healing response, expression of EMT markers (Fibronectin, Collagen I, N-cadherin, MMP9, S100A4, α-SMA, Snai1, Slug) and a decrease in the expression of cell adhesion/epithelial markers (ZO-1, Connexin 43, E-cadherin). These changes were accompanied by the activation of PI3K/Akt and MAPK/Erk pathways. Simultaneous exposure of DCA along with TGFß2 significantly inhibited wound healing response, expression of EMT markers and cell adhesion/epithelial markers. Furthermore, DCA and TGFß2 effectively attenuated the activation of MAPK/Erk/JNK and PI3K/Akt/GSK3ß pathways. Our results demonstrate that DCA has a strong anti-EMT effect on the ARPE-19 cells and hence can be utilized as a therapeutic agent in the prevention of proliferative retinopathies.

Mandibular Retromolar Foramen and Canal - A Systematic Review and Meta-Analysis.

INTRODUCTION: The retromolar fossa is a small triangular area posterolateral to 3rd molar region in the mandible. The retromolar fossa often contains the retromolar foramen (RMF) as an anatomical variant. When the RMF is present, the foramen is connected with the mandibular canal (MC) through another canal known as the retromolar canal (RMC). RMC contains neurovascular bundle, which gives additional supply to the mandible. Although few studies have been conducted in past, a lacunae in comprehensive review is lacking. Although, these variations posed challenging situations for the practicing surgeons, they have been quite neglected and not well presented in textbooks. Hence, we made an attempt to provide a comprehensive and consolidated review regarding RMF and RMC. MATERIALS AND METHODS: The relevant articles were selected by hand search and electronic media (Google scholar, PubMed, Science Direct, Medline, Embase and Cochrane) from 1987 to 2019. All the relevant articles were properly screened and findings were extracted from the articles. RESULTS: There seems to be wide variations in morphology and morphometry of RMF and RMC. DISCUSSION: Detailed knowledge of these anatomical variations is important in surgical procedure involving the retromolar area to protect the patient from complications such as unexpected bleeding, hematoma formation, and nerve damage. Furthermore, its knowledge makes us understand about the failed inferior alveolar nerve block, spread of infection, and metastasis in case of carcinoma. When there is any suspicious alteration in the MC, we suggest more accurate examination technique like CBCT.

ALK positivity on pleuroscopic pleural biopsy in lung adenocarcinoma.

Lung cancer is the leading cause of cancer deaths worldwide, and around 75% to 80% of lung cancers are detected in advanced stage. Multiple genetic mutations are identified and reported in adenocarcinoma of the lung. Various pulmonary samples can be tested for molecular mutations in lung cancer. However, feasibility of molecular profiling of pleuroscopic pleural biopsies in lung adenocarcinoma is not reported. We describe a case of advanced adenocarcinoma of lung with positive anaplastic lymphoma tyrosine kinase mutation on pleuroscopic pleural biopsy and improved with oral crizotinib. The current case highlights the feasibility of pleuroscopy.-guided pleural biopsies in molecular profiling of lung adenocarcinoma.

Percutaneous balloon pericardiotomy for the treatment of infected pericardial effusion with tamponade.

Percutaneous balloon pericardiotomy has been used as an alternative for surgically created pericardial window mainly for the management of malignant pericardial effusions in critically ill patients. We describe a patient with purulent pericardial effusion and cardiac tamponade who was treated successfully and without complications with percutaneous balloon pericardiotomy.

Gated SPECT perfusion imaging for the simultaneous assessment of myocardial perfusion and ventricular function in the BARI 2D trial: an initial report from the Nuclear Core Laboratory.

BACKGROUND: The BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial, a National Heart, Lung, and Blood Institute-sponsored study in type 2 diabetic patients with coronary artery disease, completed patient recruitment in March 2005. This trial had a nuclear substudy in addition to many other substudies. METHODS AND RESULTS: After patient enrollment, adenosine gated single photon emission computed tomography perfusion imaging is performed at years 1 and 3. The images are interpreted at the core laboratory. Among the objectives of the nuclear substudy are (1) to determine the impact of the mode of therapy on left ventricular function, extent of ischemia, and scar; (2) to determine the impact of therapy on the progression/regression of ischemia/scar and changes in left ventricular function between years 1 and 3; and (3) to determine the independent and incremental prognostic value of ischemia, scar, and left ventricular function on the primary and secondary endpoints of the trial in the entire patient population and specified subgroups such as women, elderly patients, and minorities. CONCLUSIONS: This article describes the methodology and the initial experience of the nuclear core laboratory in this large multicenter trial and provides a summary of variables that are available for future analysis by the working group.

Relation between effects of adenosine on brachial artery reactivity and perfusion pattern in patients with known or suspected coronary artery disease.

This study examined the changes in brachial artery diameter and flow velocity in response to intravenous adenosine and compared the results to cuff occlusion and single-photon emission computed tomographic (SPECT) images. The change in diameter was less with adenosine than with cuff occlusion. There was no correlation between the presence of abnormal SPECT images and the responses to adenosine or cuff occlusion in either diameter or flow velocity.