Demineralization of tooth enamel following radiation therapy; An in vitro microstructure and microhardness analysis

Objective: The objective of this study is to evaluate the effects of radiotherapy doses on mineral density and percentage mineral volume of human permanent tooth enamel. Materials and Methods: Synchrotron radiation Xray microcomputed tomography (SRμCT) and microhardness testing were carried out on 8 and 20 tooth samples, respectively. Enamel mineral density was derived from SRμCT technique using ImageJ software. Microhardness samples were subjected to Vickers indentations followed by calculation of microhardness and percentage mineral volume values using respective mathematical measures. Data were analyzed using paired t-test at a significance level of 5%. Qualitative analysis of the enamel microstructure was done with two-dimensional projection images and scanned electron micrographs using μCT and field emission scanning electron microscopy, respectively. Results: Vickers microhardness and SRμCT techniques showed a decrease in microhardness and an increase in mineral density, respectively, in postirradiated samples. These changes were related to mineral density variation and alteration of hydroxyapatite crystal lattice in enamel surface. Enamel microstructure showed key features such as microporosities and loss of smooth homogeneous surface. These indicate tribological loss and delamination of enamel which might lead to radiation caries. Conclusions: Tooth surface loss might be a major contributing factor for radiation caries in head-and-neck cancer patients prescribed to radiotherapy. Such direct effects of radiotherapy cause enamel abrasion, delamination, and damage to the dentinoenamel junction. Suitable measures should, therefore, be worked out to protect nontarget oral tissues such as teeth while delivering effective dosages to target regions

Comparison of Treatment Outcome of Transforaminal and Caudal Epidural Steroid Injections for Radiating Low Back Pain

Introduction: Back pain is one of the most common reasonsfor the patients to seek emergency care. Caudal-ESI is both thesafest and the easiest epidural injection, and it does not alwaysrequire fluoroscopic guidance. Transforaminal ESI seems tobe more effective at reducing pain, improving functionality,and preventing spinal surgery, based on the data reported inprevious studies and systematic reviews. Hence; under the lightof above mentioned data the present study was undertaken forassessing and comparing the efficacy of Transforaminal andCaudal Epidural Steroid Injections Outcome for the treatmentin patients with chronic low back pain.Material and methods: A total of 20 patients with chroniclow back pain who underwent treatment with Transforaminalor caudal epidural steroid injection were enrolled in thepresent study. Patients belonged to the age group of 20-75years of age. All the patients were divided into two groupswith 10 patients in each group as follows: Group 1 includedpatients who were given injections through Transforaminalroute, while group 2 included patients who were giveninjections through caudal route. Pain relief after the epiduralsteroid injection using Visual analogue scale (VAS). Clinicalprofile of the subjects was obtained and details were filled in aproforma. All the results were summarized in Microsoft excelsheet and were analyzed by SPSS software.Results: Mean VAS at Pre-injection, Immediate Postinjection, Post-injection 1 month and Post-injection 3 monthfor subjects of group 1 was found to be 7.5, 4.3, 3.5 and 3.4respectively. Mean VAS at Pre-injection, Immediate Postinjection, Post-injection 1 month and Post-injection 3 monthfor subjects of group 1 was found to be 7.2, 5.1, 4.1 and 4.2respectively. While comparing the mean VAS among thepatients of both the study groups, at different post-treatmenttime intervals, significant results were obtained.Conclusion: Transforaminal approach demonstrated superioreffectiveness and should be performed with increasingfrequency.

To Study the Functional Outcomes of Proximal Fibular Osteotomy in Osteoarthritis Kee

Introduction: Knee osteoarthritis (OA), also known asdegenerative joint disease, is typically the result of wearand tear and progressive loss of articular cartilage leadingto radiologically decreased joint space. Proximal fibularosteotomy (PFO) is an alternative treatment to high tibialosteotomy (HTO). Hence; under the light of above mentioneddata, the present study was undertaken for assessing thefunctional outcomes of proximal fibular osteotomy inosteoarthritis knee.Material and methods: A total of 10 patients with OA ofknee were enrolled in the present study. The patients wereplaced in the supine position after administration of spinalanaesthesia. An approximately 5-cm longitudinal incisionwas made over the lateral aspect of the proximal fibula, andthe fibula exposed between the peroneus muscle and soleusmuscle. PFO was performed under the hands of skilled andexperienced orthopaedic surgeon. Knee pain was assessedusing a Visual analogue scale. Knee ambulation activitieswere recorded using the knee and function subscores of theAmerican Knee Society score (KSS). All the results wererecorded in Microsoft excel sheet and were analyzed by SPSSsoftware. Chi- square test and Mann Whitney U test were usedfor assessment of level of significance.Results: Mean KSS score at pre-operative, postoperative,postoperative 6 weeks and postoperative 9 months werefound to be 44.03, 53.50, 58.60 and 68.14 respectively.Significant results were obtained while comparing the meanKSS at different postoperative time intervals. In the presentstudy, mean VAS score at pre-operative, postoperative,postoperative 6 weeks and postoperative 9 months were foundto be 8.77, 6.96, 4.36 and 2.52 respectively. Significant resultswere obtained while comparing the mean VAS at differentpostoperative time intervals.Conclusion: PFO is a novel alternative method in themanagement of medial compartment arthritis of the knee.

Efficacy of Nanosilver with Collagen Matrix Vs Povidone Iodine in Healing of Lower Limb Ulcers

Background: Wounds expose a patient to serious hazards like wound infection, tissue destruction, disfiguring and disabling scars. Use of nanosilver with collagen matrix in infected wounds, ulcers, diabetic wounds, burns reduced morbidity and hospital stay with its early wound healing effect. To evaluate the effect of nanosilver with collagen matrix V/s povidone iodine on similar types of wounds. Methods: This prospective study included one hundred patients with different types of wounds who attended Department of Surgery, index medical college & hospital, indore from January 2015 to January 2017. The patients were divided into two groups. Group A where topical management and dressing was done using nanotrix and group B where topical management and dressing was done using povidone iodine. Results: A standard grading in terms of percentage decrease in wound size, peri wound oedema/ erythema, pus discharge and percentage increase in granulation, fibrin and epithelisation was noted in various types of wounds in both groups. Nanotrix treated wounds showed significant reduction in inflammation and earlier healing than those treated with povidon iodine. Conclusion: Nanotrix application was found to be safe having no pain and allergic manifestation.

Co-existing tubercular axillary lymphadenitis withcarcinoma breast can falsely over-stage the disease - Case series.

The synchronous occurrence of tuberculosis and carcinoma in breast is unusual. The simultaneous occurrence of both the diseases can complicate the neoplastic disease. The diagnosis and treatment of tuberculosis in a patient with cancer assumes importance as it can prevent high mortality in patients with co-existent disease and thereby create problems in treatment decision. Axillary lymph node enlargement in breast cancer patient is not always caused by metastatic tumour of the breast even in the ipsilateral axillary nodes. We present here six case reports as an example of tuberculous axillary lymphadenitis co-existing with invasive ductal carcinoma of the breast. Accurate diagnosis has helped in down-staging carcinoma of the breast and also in identifying curable disease.