Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19).

Coronavirus has emerged as a global health threat due to its accelerated geographic spread over the last two decades. This article reviews the current state of knowledge concerning the origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). Historically, it has caused two pandemics: severe acute respiratory syndrome and Middle East respiratory syndrome followed by the present COVID-19 that emerged from China. The virus is believed to be acquired from zoonotic source and spreads through direct and contact transmission. The symptomatic phase manifests with fever, cough and myalgia to severe respiratory failure. The diagnosis is confirmed using reverse transcriptase PCR. Management of COVID-19 is mainly by supportive therapy along with mechanical ventilation in severe cases. Preventive strategies form the major role in reducing the public spread of virus along with successful disease isolation and community containment. Development of a vaccine to eliminate the virus from the host still remains an ongoing challenge.

Comparative evaluation of arch form among the Nepalese population: A morphological study.

Aims: The study aims to identify sexual dimorphic features in the arch patterns based on tooth arrangement patterns and the maxillary and mandibular arches using Euclidean Distance Matrix Analysis (EDMA). Settings and Design: A total of 96 Nepalese subjects, aged 18 to 25 were assessed using casts and photographs. Materials and Methods: Thirteen landmarks representing the most facial portions of the proximal contact areas on the maxillary and mandibular casts were digitised. Seventy-eight possible, Euclidean distances between the 13 landmarks were calculated using the Analysis ToolPak of Microsoft Excel®. The male-to-female ratios of the corresponding distances were computed and ratios were compared to evaluate the arch form for variation in the genders, among the Nepalese population. Statistical Analysis Used: Microsoft Excel Analysis ToolPak and SPSS 20.0 (IBM Chicago) were used to perform EDMA and an independent t-test to compare the significant differences between the two genders. Results: The maxillary arch's largest ratio (1.008179001) was discovered near the location of the right and left lateral incisors, indicating that the anterior region may have experienced the greatest change. The posterior-molar region is where the smallest ratio was discovered, suggesting less variation. At the intercanine region, female arches were wider than male ones; however, at the interpremolar and intermolar sections, they were similar in width. Females' maxillary arches were discovered to be bigger antero-posteriorly than those of males. The highest ratio (1.014336113) in the mandibular arch was discovered at the intermolar area, suggesting that males had a larger mandibular posterior arch morphology. At the intercanine area, the breadth of the arch form was greater in males and nearly the same in females at the interpremolar and intermolar regions. Female mandibular arch forms were also discovered to be longer than those of males from the anterior to the posterior. Conclusions: The male and female arches in the Nepalese population were inferred to be different in size and shape. With references to the landmarks demonstrating such a shift, the EDMA established objectively the presence of square arch forms in Nepali males and tapering arch forms in Nepalese females.

Prevalence and Severity of Amlodipine-induced Gingival Enlargement.

BACKGROUND: The administration of several classes of drugs; anticonvulsants, immunosuppressants, and calcium channel blockers can cause gingival enlargement. The aim of the present study was to evaluate the frequency and severity of gingival enlargement in patients taking calcium channel blocker drug amlodipine. METHODS: This descriptive cross-sectional study was conducted on 250 patients who visited the dental hospital at Nepal Medical College between November 2021 to April 2022. Using the Bokenkamp and Bornhorst Index, the patients who had been on amlodipine for at least three months were examined for gingival enlargement. Along with gingival and plaque index, medication dosage and duration were also assessed. RESULTS: The prevalence of gingival enlargement was 37%. Grade 1 gingival enlargement was present in 18% while grade 3 was seen in only 2%. Both individuals taking amlodipine alone and in combination with other antihypertensive drugs showed the same level of gingival enlargement. The dose and duration of amlodipine ingestion showed a significant correlation with the enlargement. The gingival and plaque index also showed a strong correlation with overgrowth. CONCLUSIONS: The physicians prescribing amlodipine should well inform the patients about the potential side effects. In such cases, the maintenance of oral hygiene should be prioritized from the beginning. In severe cases, substitution of the drugs followed by oral therapeutic measures should be considered for complete regression.

Type I Lip Patterns among Medical Students of a Medical College.

Introduction: Identity and identification have long been a source of interest and concern in forensic dentistry, whether in the context of a criminal investigation or the identification of a deceased person. Lip print has demonstrated a high level of potential as one of the best options, as well as its usage as supporting evidence. The aim of this study was to find out the prevalence of Type I lip patterns among medical students of a medical college. Methods: This descriptive cross-sectional study was done among medical students of a medical college from 30 December 2021 to 30 February 2022 after obtaining ethical approval from the Institutional Review Committee. The lipstick was applied in a thin layer uniformly, and the impression was taken with the help of the cellophane tape. The specimens were analyzed and classified based on Tsuzuki and Tsuchihashi's classification. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 120 medical students, the prevalence of type I lip pattern was 48 (40%) (31.23-48.77, 95% Confidence Interval). Among them, 26 (54.17%) were males and 22 (45.83%) were females. Conclusions: The prevalence of Type I lip pattern among medical students was higher than in other studies done in similar settings. Keywords: biometric identification; forensic science; lips; medical students; photography.

Application of the London Atlas of Tooth Development and Eruption in Panoramic Xrays for the Age Estimation.

BACKGROUND: The age estimation of the individual by the forensic experts ascertains the chronological age of an individual. The possibility that the person being examined may be younger or older than a certain age threshold makes this process crucial, as it will establish whether or not the person is an adult under the law. The aim of this study was to test the applicability of the London Atlas of tooth development and eruption in Nepalese subset population. METHODS: The London Atlas for age estimation was tested in 350 digital panoramic radiographs from the patients between four and twenty-four years visiting Tribhuvan University Teaching Hospital, Institute of Medicine, Nepal. RESULTS: The mean values of the estimated age were higher in both the sexes, which was statistically not significant. Both the sexes showed an excellent positive correlation, and was significant with a p value of <0.001. The age estimation upto 10 years group classification was nearly accurate with less than 1 and 2.5 years variation in males and females respectively. The accuracy was good in 16-18 years group with maximum deviation of ±2.5 years. The accuracy was poor in more than 18 years group, as the variability was more than 5 years. CONCLUSIONS: The London Atlas method was best suited for less than 18 years of age and was not very accurate in the age group of 13-14 and 14-15 years where most of the polymorphisms were noted.

Analysis of smiling photograph; Operation US-Bangla Air Crash.

Human identification may be difficult when there is no antemortem data available. A photograph of the deceased may be valuable in such cases. Digital advancement and inclusion in the lives of ordinary people makes it easier to retrieve clear, high-resolution photos from social media accounts and other places. This paper describes three cases of forensic dental identification from a US-Bangla plane crash in Nepal in which a charred body was positively identified from a smiling photograph provided by the deceased's family. Each case is unique and their identification rests on the availability of pre- and post-mortem information. Thus, the number of concordant points may vary from single to multiple; there is no defined criteria for minimum number of concordance for a positive dental identification.

Oval Type of Human Mandibular Condyle in Panoramic Radiographs of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Mandibular condyle is a prominent structure in the mandible, which forms the temporomandibular joint. An oval-shaped condyle is considered to be present with a normal temporomandibular joint and any morphological variation of the condyle is assumed to be pathologic in temporomandibular disorders. The aim of the study was to find out the prevalence of oval shaped mandibular condyle among orthopantomogram radiographs of patients visiting the tertiary care centre. Methods: A descriptive cross-sectional study was performed among 752 condyles visiting a tertiary care center from November 29, 2021 to April 1, 2022. The ethical approval was taken from the Institutional Review Committee (Reference number: 184 (6-11) 078/079) before conducting the study. Convenience sampling was done. The radiographs were first examined and the observed morphological type of mandibular condyle was noted. Data analysis was done using Statistical Package for the Social Sciences version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The prevalence of oval shaped mandibular condyles out of 752 condyles was 416 (55.32%) (51.77-58.87 at 95% Confidence Interval). The oval-shaped condyle on the right side was 205 (54.52%) and on the left side was 211 (56.12%). Conclusions: The prevalence of oval shaped condyles among patients in this study was similar to the studies done in similar settings. Keywords: condyle; mandible; Nepal; X-ray.

Operation makalu air crash: influence of cognitive and human factors on decision-making.

Two onboard crew members lost their lives in the fatal Makalu Air Cessna Grand Caravan 208B domestic cargo flight crash on May 16, 2018. The Disaster Victim Identification (DVI) procedure comprises external examination, photography, DNA collection, fingerprint collection, postmortem examination, antemortem information collection from the family members, and reconciliation. The major challenge of this operation was dealing with cognitive bias. The antemortem dental information of one of the deceased was revealed to the forensic experts just before the postmortem examination. This influenced the testing strategies. There was a tendency to neglect the complete dental examination presuming the identification was established. Later, during a thorough examination, the forensic odontologist realised that the initial decision was erroneous. Furthermore, there are few experience-based resources available to resolve cognitive bias issues. The authors begin by summarising complicated operations in which they have been involved, followed by a discussion of the key sources of cognitive bias along with the solution to resolve these issues in DVI preparedness planning.

Mean Mesiodistal Width of Canine in Patients Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: The measurement of the teeth is one of the most reliable method of identification. The teeth represent the most durable, resilient, and chemically stable part of the skeleton. The comparison of tooth dimensions is one of the tools of sex determination. Canines, in particular, are found to have the greatest degree of sexual dimorphism. The aim of the study was to determine the mean mesiodistal width of canines in patients visiting a tertiary care centre. Methods: This descriptive cross-sectional study was done among patients visiting a tertiary care centre from 25 August 2021 to 28 December 2021. The ethical approval was taken from the Institutional Review Committee [Reference number: 61 (6-11)E2 078/079]. The maximum mesiodistal width of the permanent maxillary canine was measured by a digital vernier caliper. The formula given by Garn and Len was used to calculate sexual dimorphism. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 104 maxillary casts studied, the mean mesiodistal width of the maxillary canine was 7.85±0.45 mm (7.76-7.93, 95% Confidence Interval). The mean mesiodistal width of the right maxillary canine in males and females were 7.90±0.48 mm and 7.83±0.45 mm respectively and that of the left maxillary canines in males and females were 7.92±0.44 mm and 7.75±0.45 mm respectively. The sexual dimorphism in the right and left maxillary canine was seen in 10 (0.96%) and 22 (2.12%) respectively. Conclusions: The mean mesiodistal width of the maxillary canine was similar to other studies done in similar settings. Keywords: canine teeth; maxillary bone; sexual dimorphism.

A dental perspective on the successes and limitations of the disaster victim identification response to the Nepal earthquake.

This article describes the forensic odontological analysis of the events of the 2015 Nepal earthquake. It identifies the problems encountered in the aftermath, lessons learned, and prospective future advances aimed at reducing the subjectivity in disaster victim identification (DVI). During a crisis, dental practitioners, particularly forensic odontologists, can make a substantial contribution to DVI, as highlighted in this article. It also promotes best practices in forensic dentistry that may be used by anyone in situations with few resources or people to deal with comparable scenarios.

Association between Hypodontia and Angle's Malocclusions among Orthodontic Patients in Kathmandu, Nepal.

Background: Disturbances during the early tooth development stages may result in the congenital absence of teeth. The purpose of this study was to assess the relationship between hypodontia and Angle's malocclusions. Materials and Methods: The sample comprised 601 orthodontic patients' pretreatment records (242 men and 259 women), selected from the achieved orthodontic records. Developmental anomalies of teeth affecting the number were examined on dental panoramic radiographs. Based on Angle's classification, pretreatment dental casts were assessed and classified into different classes of malocclusion. The relationship between hypodontia and different classes of malocclusion was evaluated using the chi-square test. Results: The prevalence of tooth agenesis was 7.48%, that is, 45 out of 601 samples. There were a total of 72 (0.42%) missing teeth, excluding the third molars. The most frequent missing tooth was the maxillary lateral incisor (35, 48.61%), followed by the mandibular lateral incisor (14, 19.44%), the mandibular central incisor (6, 8.33%), the mandibular second premolar (5, 6.294%), and the maxillary second premolar (4, 5.55%). Hypodontia was more common in the upper jaw. Although hypodontia was mostly seen in Class I malocclusion patients (7.87%), followed by Class II malocclusion patients (6.99%) and least in Class III malocclusion patients. However, there was no significant difference in hypodontia among different classes of malocclusions (p = 0.352). Conclusion: The most frequently missing tooth was the maxillary lateral incisor, followed by lateral and central mandibular incisors and mandibular second premolars, while excluding the third molars. The present study did not find any association between various types of malocclusions and hypodontia.

Morphometric anlaysis of mandibular coronoid, condyle and sigmoid shape using panoromic view for personal identification in south Indian population.

Objective: The shape of the condyle, coronoid, and the intervening sigmoid notch is unique due to attachments and direction of pull of temporalis muscle, different chewing habits, hormones, etc. So morphometric variation of these mandibular landmarks can be used in individual identification. Material And Methods: The study was carried out on 500 panoramic view images. Visual tracing assisted assessment of thousand sides (left and right) was done. Sexual dimorphism of left and right mandibular ramus parts (sigmoid notch bordered by coronoid and condylar process). The shape of coronoid process, condyle, and sigmoid notch were interpreted. Results: The most prevalent shape of sigmoid notch was wide variant (41.2%), condyle was convex type (50%) and coronoid was round (53.4%). Condyle and coronoid showed asymmetry between right and left with p-value 0.001 and 0.019, respectively. This study has illustrated that triangular-shaped coronoid was more in females (p-value 0.012). Conclusion: Sexual dimorphism is observed in the shape of the mandible due to masticatory activity at the point of insertion of temporalis muscle, biting force, hormones, and various genetic reasons. The results have exemplified that the morphometric variation of condyle, coronoid and sigmoid notch can be used as a tool for personal identification.

Is manual reduction adequate for intraoperative control of occlusion during fixation of mandibular fractures? A systematic review and meta-analysis.

The aim of this systematic review was to find out if manual intraoperative control of occlusion is adequate for the reduction of mandibular fractures in comparison with intermaxillary fixation (IMF). We searched PubMed, Embase, the Cochrane Library and Clinical Trials Registry, and the references of included trials. Our primary outcomes of interest were the reduction of fracture anatomically and radiographically, occlusal disturbances, and the incidence of revision procedures due to poor occlusion or reduction. Our secondary outcomes of interest were operating time and infective complications. Of the 257 studies retrieved (manual reduction = 136, IMF = 121), four were included. The studies had an unclear risk of bias. Nevertheless, the overall effect was statistically significant and in favour of manual reduction, with a lower number of adverse events in the manual reduction group (n = 43) than in the IMF group (n = 78), odds ratio 0.42 (95% CI 0.27 to 0.64). An absolute reduction in adverse events was seen in occlusion disturbances (120 fewer/1000), revision procedures (164 fewer/1000), and infective complications (178 fewer/1000). The evidence to support manual reduction over IMF for the intraoperative control of fracture fragments and occlusion was derived from few studies with an unclear risk of bias, and the quality was low. The results were not different when condylar fractures were present. The overall certainty of evidence was moderate. Clinicians should select the appropriate technique based on the injury pattern, and the treating surgeon's experience and available resources.

The Morphological Variation of the Soft Palate in Hospital Visiting Patients.

BACKGROUND: The soft palate anatomy of individuals can have a range of morphologies. Cephalometric analysis is a low-cost approach to analyze the soft palate in patients with or without developmental abnormalities. METHODS: The lateral cephalogram of the patients visiting Tribhuvan University Teaching Hospital, Institute of Medicine for various dental treatment purposes was evaluated. The soft palate was delineated on the radiographs by sketching the soft palate's contour along its radiolucent outline using the curve lines and connectors of Microsoft PowerPoint. The soft palate was then categorized according to the study by You M et al. Results: The different types of soft palate morphology observed in the study were rat tail (42.4%), leaf-like (40.8%), butt-like shape (8.9%), straight-line (4.7%), s-shaped (1.9%), and crooked (0.9%). The males had rat-tail (44.4%), leaf-like (41.1%), butt-like shape (8.4%), straight-line (3.9%), s-shaped (1.3%), and crooked (0.6%), whereas the females had rat-tail like (40.6%), leaf-like (40.6%), butt-like shape (9.5%), straight-line (5.6%), s-shaped (2.5%), and crooked (1.2%) types of soft palate. CONCLUSIONS: The rat-tail form of the soft palate was the most prevalent, followed by the leaf-like in both sexes. The least common type was the crooked form. This study found no evidence of sexual dimorphism.

Perceived Barriers to Publication in Scholarly Journals by Faculty from Maharajgunj Medical Campus.

BACKGROUND: Due to multiple reasons, the faculty members in Nepal devote less than expected time to research and publication. This could be attributable to various challenges unique to each faculty member and their institution. The present study aims to evaluate the potential barriers to publication faced by the faculty of Maharajgunj Medical Campus, Kathmandu, Nepal. METHODS: This cross-sectional observational questionnaire-based study was conducted among the 139 faculty members representing various departments of MMC.  Results: The significant barriers were: difficult coordination (43.2%), the response time of the reviewer (48.2%), overburdened with work (39.6%), lack of funds for research (44.6%), limited submission skills (33.8%), poor writing skills (35.3%), difficulties in starting to write (42.4%), lack of time to submit a paper (43.9%), and family commitment (36.7%).  Conclusions: The findings of this study could be used to advocate for a prospective change in the work module to produce competent medical researchers generating high-quality publications.

Age Estimation Using Monoradicular Teeth by comparing Pulp/Tooth Area Ratios between Bucco-lingual and Mesio-distal Periapical Radiographs.

BACKGROUND: Age estimation is an integral tool in identification of the victims when visual identification is not possible. Secondary dentin deposition is a regular ageing process and can be utilized in dental age estimation when development and eruption parameters cannot be utilized. METHODS: In total, 38 monoradicular teeth of Nepalese subjects were assessed for tooth pulp ratio. Intraoral periapical radiographs of these teeth were taken, and pulp tooth ratio was calculated and dental age was estimated. RESULTS: The mean chronological age was 46.79 years and the mean estimated age was 44.32 years. The pulp/tooth area ratios calculated were in the range of 0.012 to 0.195, and 0.052 to 0.256 for mesio-distal and bucco-lingual planes respectively. CONCLUSIONS: Pulp tooth ratio of maxillary lateral incisors and mandibular lateral incisors showed the highest correlation with values of 90% and 76% respectively. Mesio-distal assessment was more accurate in dental age estimation than bucco-lingual view.

Dental Age Assessment using Demirjian's Eight Teeth Method and Willems Method in a Tertiary Hospital.

INTRODUCTION: Age estimation is an important aspect in forensic anthropology, as it can aid in the identification of the deceased, and can be used in cases of immigration, child abuse and criminal prosecution in living individuals. Dental age estimation is considered reliable and accurate, since tooth development is least affected by environmental factors compared to somatic growth. METHODS: In total, 150 pre-orthodontic treatment radiographs from healthy individuals were assessed. These individuals were aged between 8 to 19 years. Dental age for these individuals was calculated by two methods: Demirjian's eight teeth method and Willems method. For Willems method, seven teeth on the left side of mandible (except the third molar) were staged according to Demirjian's staging, and for Demirjian's eight teeth method, all eight teeth were staged. RESULTS: The mean chronological ages were 13.6961±1.94384 years in males and 13.9204±2.63541 years in females. The mean estimated ages by Demirjian's eight teeth method were 12.1856±1.73478 years and 11.7906±2.32344 years in males and females respectively. Similarly, the mean estimated ages by Willems method were 12.8958±1.46838 years in males and 12.6926±2.27807 years in females. CONCLUSIONS: Willems method and Demirjian's eight teeth method underestimated the chronological age in the given population. Both methods showed excellent correlation with chronological age indicating their applicability in dental age estimation, with development of population specific scores.

Identification of Deceased Children of Nepal Airlines Crash through Dental Age Estimation.

Identification of victims in a disaster is a challenging process and requires use of both primary and secondary identifiers. Development of teeth is one of the routinely used methods of age estimation and helps in establishing deceased biological profile. Two children who lost their lives in 2014 in Nepal Airlines crash, were looked for the dental developmental status. One of the children had primary dentition, while the other had mixed dentition. This helped us in estimating age of these individuals reconciled with the chronological age provided by the relatives. This led to the identification of both the children, thus, emphasizing teeth as important means of identification in any disaster.

Application of Ultraviolet Light in Dental Identification of Avalanche Victims.

In any disaster, it becomes important to identify the deceased for ethical, social and legal causes.Out of the numerous methods of identification, dental comparison is considered to be one of the scientific methods in a Disaster Victim Identification process. The two victims of avalanche in Nepal were identified using dental comparison. The two bodies brought for examination were unidentifiable visually. To aid identification of tooth coloured restorations, ultraviolet light was used. The ultraviolet light made the tooth coloured restorations appear distinct from the adjacent tooth structure in one of the cases. This helped in post-mortem charting of dental examination with greater accuracy. When the ante-mortem dental records and the post-mortem dental findings were compared, positive identification was made for both the cases. The bodies were then handed over to their respective kin. These cases highlighted the importance of ultraviolet light in post-mortem dental examination and the significance of forensic dentistry in identification process.