Efficacy and safety of oral cyclophosphamide versus mycophenolate mofetil in childhood nephrotic syndrome: an open-label comparative study.

INTRODUCTION: There is a scarcity of research comparing the efficacy of cyclophosphamide and mycophenolate mofetil in childhood nephrotic syndrome. The aim was to evaluate the efficacy and safety of oral cyclophosphamide (CYC) and mycophenolate mofetil (MMF) in children with steroid-sensitive nephrotic syndrome in terms of the proportion of children who have been off steroids for at least 6 months without proteinuria (responders). METHODS: This open-label retrospective-prospective comparative study was conducted in a pediatric nephrology clinic of a referral center for children between 1 and 18 years of age with FR/SD nephrotic syndrome. Group A consisted of patients who received oral cyclophosphamide (100, 25% female) at a dose of 2-2.5 mg/kg once daily for a period of 8-12 weeks. Group B consisted of patients who received oral mycophenolate mofetil (n = 61, 18% female) (dose: 800-1200 mg/m2) for at least 12 months. Responders were defined as children who were off steroids for at least 6 months along with absence of proteinuria. RESULTS: In the CYC group, 50% of the patients were responders, whereas 54% of the patients in the MMF group were responders (p = 0.614). The time to first relapse with CYC was 7 months (IQR 5.25-11) compared to 7 months (IQR 3.5-12) with MMF (p = 0.092). The relapse rate in the CYC group was 1.77 relapses per patient-year compared to 1.295 relapses per patient-year in the MMF group. The difference in relapse rate was significant (-0.474; 95% CI, 0.09 to 0.86 relapses/person-year) (p value = 0.009). Multivariate analysis revealed that an age of less than 5 years at the start of treatment was a significant factor for a better response to MMF (p value = 0.039, OR = 2.988, CI -1.055-8.468). CONCLUSIONS: The efficacy of MMF was similar to that of CYC in terms of response (6 months without steroids) in children with FR/SD nephrotic syndrome. MMF showed a favorable response in terms of the frequency of relapse and treatment failure. REGISTRATION OF THE STUDY WITH CLINICAL TRIALS REGISTRY OF INDIA: ( http://ctri.nic.in ;CTRI/2021/06/034421) (Dt: 28/06/2021).

Efficacy of vitamin D supplementation in asthmatic children with vitamin D deficiency: A randomized controlled trial (ESDAC trial).

BACKGROUND: Vitamin D supplementations for asthma control had shown inconsistent results. We aimed to study efficacy and safety of vitamin D supplementation in asthmatic children who were vitamin D deficient. METHODS: This double-blind, randomized controlled trial enrolled asthmatic children of 4-12 years of age who had 25-hydroxyvitamin D [25(OH)D] levels <20 ng/mL. The participants were randomized to receive either vitamin D orally 1000 IU/d for 9 months or similar-looking placebo. The primary outcomes were the proportion of children having the Childhood Asthma Control Test (CACT) score of ≥20 at the end of the treatment and adverse effects. RESULTS: The trial included 250 children (125 in each group) with a mean age of 8.1 ± 2.3 years and 180 boys. The baseline parameters were similar between the groups, including CACT score (21.7 ± 4.2 vs 21.9 ± 3.6, vitamin D vs placebo). At the end of the study, the proportion of asthmatic children who had CACT score ≥ 20 was similar between vitamin D and placebo group (93.6% vs 92.0%, P = .625). The number of exacerbations of asthma and side effect profile was also identical between the groups. 25(OH)D levels increased significantly in the vitamin D group (18.06 ± 7.11 vs 12.03 ± 5.98 ng/mL, P < .001). The results did not change when we did subgroup analysis for children with baseline CACT score < 20 and 25(OH)D levels at the end of the study ≥20 ng/mL. CONCLUSION: Vitamin D supplementation in asthmatic children with vitamin D deficiency did not improve control of asthma.

Conservative Management of Dislocated Pediatric Unilateral Condylar Fracture Using Orthodontic Treatment and Guiding Elastics.

Introduction: Mandibular fractures in children, when compared to adults, are quite less common. Treatment approaches for mandibular fracture differ in children due to their growth and developing dentition. Minimal manipulation of bony architecture is done to achieve a stable position. Case description: An 8-year-old girl with right-side condylar fracture with dislocation reported to the emergency trauma unit, Post Graduate Institute of Dental Sciences, Rohtak. Result: The case was well managed by a conservative approach whereby orthodontic treatment along with guiding elastics was used in the reduction of unilateral condylar fractures. How to cite this article: Goel N, Jha S, Singhal R, et al. Conservative Management of Dislocated Pediatric Unilateral Condylar Fracture Using Orthodontic Treatment and Guiding Elastics. Int J Clin Pediatr Dent 2024;17(2):184-186.

Modified Cap Splint: A Novel Approach to Treating Delayed Mandibular Fracture in Pediatric Patients.

Mandibular fractures in children, when compared to adults are quite less common. The treatment approaches for mandibular fractures differ in children due to their growth and developing dentition. Minimal manipulation of bony architecture is done to achieve a stable position. Thus a closed reduction is preferred in children. This article presents a case of an 8-year-old boy, mandibular left parasymphysis fracture with displacement of the left dentoalveolar segment which was managed by a novel treatment approach using a unilateral cap splint with interelastic traction. How to cite this article: Jha S, Singhal R, Goel N, et al. Modified Cap Splint: A Novel Approach to Treating Delayed Mandibular Fracture in Pediatric Patients. Int J Clin Pediatr Dent 2023;16(4):645-648.

Comparative Evaluation of Effectiveness of TheraCal LC, MTA, and Calcium Hydroxide in Direct Pulp Capping in Primary Molars: Randomized Clinical Study.

Introduction: This study was performed to evaluate the clinical and radiographic effectiveness of TheraCal light cured (LC) comparison to mineral trioxide aggregate (MTA) and calcium hydroxide in direct pulp capping of primary molars over a period of 9 months. Materials and methods: A total of 90 primary molars from children aged between 5 and 8 years were included in this randomized clinical study based on inclusion and exclusion criteria and were randomly divided into three groups-group I, TheraCal LC; group II, MTA; and group III, calcium hydroxide. Direct pulp capping (DPC) was performed in noncontaminated pulpal exposure with hemostasis achieved within 2-3 minutes followed by restoring the tooth using glass ionomer cement (GIC). Subjects were followed up at 3, 6, and 9 months for clinical and radiographic evaluations. Results: At 9 months of follow-up, the overall success rate of direct pulp capping in groups I, II, and III were 60%, 72.41%, and 48.14%, respectively. Intergroup comparison showed nonsignificant differences (p >0.05). Conclusion: The outcomes of this study suggest the limited success of direct pulp capping in primary molars. However, among the three materials used in this study, MTA comparatively had better results. How to cite this article: Jha S, Namdev R, Singhal R, et al. Comparative Evaluation of Effectiveness of TheraCal LC, MTA, and Calcium Hydroxide in Direct Pulp Capping in Primary Molars: Randomized Clinical Study. Int J Clin Pediatr Dent 2023;16(S-2):S213-S219.

Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study.

Introduction: The study was performed to evaluate and compare the clinical and radiographic efficacy of chlorhexidine (CHX) polymer scaffold, 3Mixtatin, and formocresol for vital primary pulp therapy-a randomized clinical study. Materials and methods: A total of 120 primary molars were included from children aged between 6 and 8 years in this randomized clinical study based on inclusion and exclusion criteria and were randomly allocated into three groups (group I-CHX polymer scaffold, group II-3Mixtatin, and group III-formocresol. Pulpotomy was performed in a vital cariously exposed primary tooth with healthy periodontium where their retention is more beneficial than extraction. Subjects were followed up at 1, 3, and 6 months for clinical and radiographic evaluations. Results: At 6 months of follow-up, the overall success rate of pulpotomy in groups I, II, and III was 56.41, 71.05, and 60.52% in each group, respectively. Nonsignificant difference (p > 0.05) was seen during intergroup comparison. Conclusion: However, among the three materials used in this study, 3mixtatin comparatively had better results. How to cite this article: Goel N. Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study. Int J Clin Pediatr Dent 2023;16(3):478-482.

Prevalence of dental fluorosis and dental caries in fluoride endemic areas of Rohtak district, Haryana.

Objectives: This study investigates the estimation of the fluoride concentration in drinking water in Rohtak district, Haryana, and quantifies its effect on the prevalence of dental fluorosis and dental caries. Materials and Methods: A cross-sectional survey was conducted among 1262 school children in endemic fluoride areas of Haryana. Using simple random sampling, thirty villages from five blocks of Rohtak districts were selected, and children 6-12 years of age were examined. A questionnaire survey form was filled out to record the demographic details of the samples. Dental caries was recorded according to DMFT (D = Decayed, M = Missing due to caries only, F = Filled, T = Teeth)/deft index (d = decayed, e = extracted due to caries, f = filled, t = teeth). Assessment of Dental Fluorosis was done according to Dean's Fluorosis index, modified in 1942. The data were analyzed using SPSS version 19, and nonparametric tests were used to assess the significance. Results: The study participants included 615 males and 647 females among which Mean DMFT in the area of study ranged from 0.32 to 1.90. Mean deft in the area of study ranged from 0.34 to 1.91. The fluoride concentrations in groundwater are in the range of 0.532-8.802. Out of 1262 children examined, 655 (51.90%) children were having dental fluorosis. 607 (48.10%) of the subjects were free from fluorosis. 16.09%, 13.39%, 9.11%, and 8.16% and 5.15% were having questionable, very mild, mild, moderate, and severe form of fluorosis, respectively. Conclusion: It can be concluded that in Rohtak district, the fluoride levels in drinking water and the prevalence of dental fluorosis are high, so requiring an urgent need to improve the quality of water and institute de-fluoridation of drinking water in affected areas to lower the burden of dental fluorosis in the community.

An Update on Newer Pulpotomy Agents in Primary Teeth: A Literature Review.

Primary molars with asymptomatic reversible pulpitis are commonly treated by pulpotomy procedure. Different pulpotomy materials used so far for pulpotomy that have been mentioned in the literature have been included in this article. This literature review includes all medicaments including natural alternatives. Many significant medicaments with their success rates have been mentioned in this paper. To increase the therapeutic success of pulpotomy procedure, it is necessary to identify a novel effective and preferably natural pulpotomy medicament.

Molar Incisor Hypomineralization: Clinical Characteristics with Special Emphasis on Etiological Criteria.

Molar incisor hypomineralization (MIH) is an entity to describe the enamel defects of the first permanent molars with the involvement of one or more incisors due to an underlying systemic cause. It is a frequently encountered challenge by dentists in a dental clinic and dental complications affecting patient's quality of life. Early diagnosis is the key to protect and prevent the deterioration of the condition. This article aims to highlight different aspects of etiology to treatment options in young patients related to MIH.

Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID-19 (MIS-C).

OBJECTIVE: To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. Methods: This comparative cross-sectional study was done at a tertiary care teaching institute. We enrolled all hospitalized children aged 1 month - 18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. RESULTS: During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. MIS-C with shock was seen in 15 cases (44%), MIS-C without shock in 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients [100.2 (85.1) vs 16.9 (29.3) mg/dL] (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Mean hospital stay (patient days) was longer in MIS- C compared to dengue fever (8.6 vs 6.5 days; P=0.014). CONCLUSION: Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.