Effectiveness of Tofacitinib in Ulcerative Proctitis Compared to Left Sided Colitis and Pancolitis.

BACKGROUND: Ulcerative proctitis (UP), though associated with high symptom burden and poor quality of life, is excluded from most of the randomized controlled trials in UC, including the OCTAVE trials. We aimed to analyse the effectiveness of tofacitinib in UP, and compare it to that in left sided colitis (LSC) and pancolitis (PC). METHODS: This was a prospective cohort study. Patients with either steroid-dependent or refractory ulcerative colitis, who received tofacitinib, were divided into three groups based on the disease extent [UP, LSC and PC]. The primary outcome was comparison of proportion of patients in clinical remission in the three groups, at weeks 8, 16 and 48. Safety outcomes were reported using incidence rate per patient year of exposure. RESULTS: Clinical remission was achieved in 47%(15/32), 24%(23/94), and 43%(23/54) of patients at week 8, 56%(18/32), 37%(35/94), and 56%(30/54) of patients at week 16, and 59%(19/32), 38%(36/94), and 24%(13/54) of patients at week 48 in groups UP, LSC and PC, respectively. Corticosteroid-free clinical remission rates were significantly higher in patients in groups UP at week 48. Five (15%) patients with UP were primary non-responders to tofacitinib at week 16, while three (9%) patients had secondary loss of response at week 48. The probability of sustained clinical response was highest in patients with UP. Patients with UP had the lowest incidence of adverse effects. CONCLUSION: The effectiveness of tofacitinib in inducing and maintaining clinical remission is greater in patients with UP compared to LSC and PC.

Recent Trends in Palliative Care Utilization in Patients With Decompensated Liver Disease: 2016-2020 National Analysis.

Background: Patients with end-stage liver disease (ESLD) have a poor quality of life, which often worsens as disease severity increases. Palliative care (PC) has emerged as a management option in ESLD patients, especially for those who are not candidates for a liver transplant. Objective: To assess the associated factors and trends in PC utilization in recent years. Design: We used the 2016-2020 National Inpatient Sample (NIS) database of the United States to identify patients with decompensated cirrhosis who suffered in-hospital mortality. Information regarding patient demographics, hospital characteristics, etiology and decompensations, Elixhauser comorbidities, and interventions was collected. The multivariate regression model was used to identify factors associated with PC use. Results: Out of 98,160 patients, 52,645 patients (53.6%) received PC consultations. PC utilization increased from 49.11% in 2016 to 56.85% in 2019, with a slight decrease to 54.47% in 2020. Patients with PC use had decreased incidence of blood transfusions (28.85% vs. 36.53%, p < 0.001), endoscopy (18% vs. 20.26%, p 0.0001), liver transplantation (0.28% vs. 0.69%, p < 0.001), and mechanical ventilation (46.22% vs. 56.37%, p < 0.001). African American, Hispanic, and Asian/Pacific Islander patients had 29%, 27%, and 23% lower odds of receiving PC than White patients. Patients in the two lowest income quartiles had 12% and 22% lower odds of receiving PC compared with the highest quartile. Conclusions: PC utilization in patients with ESLD is associated with decreased invasive procedures, shorter lengths of stay, and lower hospitalization charges. Minorities, as well as patients in the lower income quartiles, were less likely to receive PC.

Vaccine-Preventable Illness Leads to Adverse Outcomes in Liver Transplant Recipients.

BACKGROUND: Liver transplant recipients (LTR) and patients with chronic liver disease (CLD) are at an increased risk of infections. AIMS: The objective of our study was to assess the incidence, and impact of vaccine preventable illness (VPI) on outcomes in LTR. METHODS: National Inpatient Sample (NIS) 2016-2020 was used to identify adults (age > 18) hospitalized LTR using ICD-10 codes. Data were collected on patient demographics, hospital characteristics, etiology of liver disease, hepatic decompensations and outcomes. Patients were stratified into two groups based on the presence or absence of VPI. Multivariate logistic regression analysis was performed to identify the association between VPI and outcomes. RESULTS: Out of 170,650 hospitalized LTR, 13.5% of the patients had VPI. The most common VPI was noted to be influenza (10.7%), followed by pneumococcal infection (2.7%). Incidence of mortality (6.9% vs. 1.6%, p < 0.001), ICU admissions (14.3% vs. 3.4%, p < 0.001), and acute kidney injury (AKI) (43.7% vs 37.35%, p < 0.001) was higher in the VPI group. CONCLUSION: More than 13% of the LT hospitalizations had concomitant VPI. VPI in LTR was associated with worse outcomes. Our data suggests the need to identify factors associated with reduced vaccination rates and identify strategies to improve vaccination rates and responses in these patients.

Clinical and magnetic resonance imaging spectrum of complex perianal fistulizing Crohn's disease: A cohort study from northern India.

BACKGROUND: Fistulizing perianal Crohn's disease (CD) is a debilitating condition associated with significant morbidity and reduction in the quality of life. Magnetic resonance imaging (MRI) of the pelvis is the preferred imaging modality for the comprehensive assessment of the perianal fistula. There is a paucity of data from India on the MRI spectrum of complex perianal fistula in CD. METHODS: A single-centre cross-sectional analysis of patients with fistulizing perianal CD, who underwent pelvic MRI between January 2020 and December 2021, was performed. The clinical (age, sex, disease duration, disease location and behavior, disease activity [Perianal Disease Activity Index, PDAI] and treatment received) and radiological (number and location of fistulae, extensions, number and location of internal and external openings, fistula activity, presence or absence of perianal abscess and associated proctitis) characteristics of complex perianal fistula (defined according to the American Gastroenterological Association classification) were recorded. RESULTS: Of total 175 patients with CD who attended the gastroenterology clinic during the study period, 27 (15.42%) (mean age 42±15.5 years, 62.96% females and median disease duration four years) had complex perianal fistula and were included in the analysis. The mean PDAI was 5.48±2.53. The median Van Assche Index was 17 (interquartile range [IQR] 13-19). A majority (96.29%) of the fistulae were trans-sphincteric and four (14.81%) fistulae extended into the supralevator space. All fistulae were active on MRI. Concomitant perianal abscess and proctitis were seen in 59.26% (n=16) and 62.96% (n=17) of patients, respectively. Combination therapy with biologics and antibiotics/immune-suppressants were the most commonly prescribed medical therapy. Six (22.22%) patients underwent combined medical and surgical (non-cutting seton, fistulectomy, fecal diversion) treatment. CONCLUSION: The cumulative risk of the development of fistulizing perianal CD in a northern Indian cohort was similar to the western populations. Complex perianal fistulae were predominantly trans-sphincteric and commoner in females. MRI evaluation is pivotal for the delineation of fistula anatomy, assessment of disease extent and activity and the evaluation of concomitant perianal abscess and other complications.

Frailty as a risk-stratification tool in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS).

Objectives: The concept of frailty has gained importance, especially in patients with liver disease. Our study systematically investigated the effect of frailty on post-procedural outcomes in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). Methods: We used National Inpatient Sample(NIS) 2016-2019 data to identify patients who underwent TIPS. Hospital frailty risk score (HFRS) was used to classify patients as frail (HFRS>=5) and non-frail (HFRS<5). The relationship between frailty and outcomes such as death, post-procedural shock, non-home discharge, length of stay (LOS), post-procedural LOS, and total hospitalization charges (THC) was assessed. Results: A total of 13,700 patients underwent TIPS during 2016-2019. Of them, 5,995 (43.76%) patients were frail, while 7,705 (56.24%) were non-frail. There were no significant differences between the two groups based on age, gender, race, insurance, and income. Frail patients had higher mortality (15.18% vs. 2.07%, p<0.001), a higher incidence of non-home discharge (53.38% vs. 19.08%, p<0.001), a longer overall LOS (12.5 days vs. 3.35,p<0.001), longer post-procedural stay (8.2 days vs. 3.4 days, p<0.001), and higher THC ($240,746.7 vs. $121,763.1, p<0.001) compared to the non-frail patients. On multivariate analysis, frail patients had a statistically significant higher risk of mortality (aOR-3.22, 95% CI-1.98- 5.00, p<0.001). Conclusion: Frailty assessment can be beneficial in risk stratification in patients undergoing TIPS.

Impact of Aspirin Use on Outcomes in Patients With Hepatocellular Cancer: A Nationwide Analysis.

Background: Despite the use of new immunotherapies, hepatocellular carcinoma (HCC) has a poor survival rate. Through multiple molecular mechanisms, aspirin (ASA) has demonstrated a reduced incidence of HCC, however, the impact of long-term ASA use on in-hospital outcomes has not been studied. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2020 to identify patients with HCC. Patients were stratified into two groups, based on long-term ASA use. Information was collected regarding patient demographics, Elixhauser comorbidities, interventions, etiology, and decompensations of liver disease. Outcomes studied included sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and in-hospital mortality. The association between long-term ASA use and outcomes was studied using multivariate analysis. Results: A total of 224,735 patients were included in the study. Of them, 18,835 (8.4%) patients were on long-term ASA. The majority of the patients with ASA use were White (61.3%), men (78.2%), and aged > 65 years old (68.8%). Patients in the ASA group had a higher incidence of non-alcoholic steatohepatitis (NASH) and decreased rates of hepatic decompensation than those not on ASA. Patients with ASA use had lower incidence of sepsis (2.76% vs. 3.54%), shock (4.86% vs. 8.23%), AKI (30.9% vs. 33.4%), ICU admission (3.88% vs. 7.4%) and in-hospital mortality (5.18% vs. 9.87%). After adjusting for confounding factors, ASA use was associated with a 30% lower risk of in-hospital mortality (adjusted odds ratio (aOR): 0.70, 95% confidence interval (CI): 0.60 - 0.82, P < 0.001). ASA users also had 21% lower odds of developing shock (aOR: 0.79, 95% CI: 0.67 - 0.94, P = 0.007) and 31% lower odds of requiring ICU admission (aOR: 0.69, 95% CI: 0.54 - 0.78, P < 0.001). Conclusions: Our study noted that patients on long-term ASA use had better in-hospital outcomes such as mortality, shock, and ICU admissions compared to non-ASA users. These findings are of interest, and further randomized clinical trials confirming the benefits of ASA in improving outcomes in HCC patients need to be conducted.

Understanding the Dynamics of Blast Resistance in Rice-Magnaporthe oryzae Interactions.

Rice is a global food grain crop for more than one-third of the human population and a source for food and nutritional security. Rice production is subjected to various stresses; blast disease caused by Magnaporthe oryzae is one of the major biotic stresses that has the potential to destroy total crop under severe conditions. In the present review, we discuss the importance of rice and blast disease in the present and future global context, genomics and molecular biology of blast pathogen and rice, and the molecular interplay between rice-M. oryzae interaction governed by different gene interaction models. We also elaborated in detail on M. oryzae effector and Avr genes, and the role of noncoding RNAs in disease development. Further, rice blast resistance QTLs; resistance (R) genes; and alleles identified, cloned, and characterized are discussed. We also discuss the utilization of QTLs and R genes for blast resistance through conventional breeding and transgenic approaches. Finally, we review the demonstrated examples and potential applications of the latest genome-editing tools in understanding and managing blast disease in rice.

Covid-19 Rehabilitation Therapy: A novel strategy to reduce Covid-19 respiratory complications and significantly improve lung function.

Navi Mumbai Municipal Corporation, Covid-19 DCHC and ICU, Navi Mumbai COVID- 19 pandemic has become a leading cause of morbidity and mortality worldwide since the emergence of novel coronavirus SARS-CoV-2 in December 2019. The patterns of imaging abnormalities and data from prior coronavirus outbreaks suggest that patients with severe COVID-19pneumonia are at increased risk of progression to interstitial lung disease and chronic pulmonary vascular disease.We have devised an effective,inexpensive approach for Covid-19 recovering patients to reduce the incidence and severity of these pulmonary complications. MATERIAL: This cross sectional study was conducted across two centres-largest government-run DCHC,Vashi, Navi Mumbai and private tertiary care hospital in Airoli, Navi Mumbai from Nov'20 to Feb'21. IEC approval, consent was obtained.472 patients were enrolled. Demographic,clinical,radiological data was collected.Adults >18yrs who tested Covid-19 RTPCR/ Rapid Antigen Positive, HRCTSS of >10, required home oxygen of 4lts/min and above, ABG established hypoxia,oxygen saturation of 82% to 94%RA, with/without existing comorbidities were included in the study.Covid Rehabilitation Therapy included six alternate day OPD based sessions over twelve days starting three days after the day of discharge from the hospital.Each session included clinical assessment,15 minute intensive chest physiotherapy and breathing exercises followed by 6 minutes of nebulisation with Levosalbutamol+Ipratropium bromide and Budesonide,followed by high flow humidified oxygen therapy of 10lts/min via non breathable mask for 90 minutes along with breathing variation of inhalation:exhalation of 1:2. Oxygen Saturation, Pulse,BP, RR were established at the beginning of every session and the end of the session.6MWT,Chest Xray was obtained at first and sixth session.These factors were used to determine outcome measures in Covid Rehabilitation Therapy. OBSERVATION: Of 472patients, 218(46.2%) were females, 254(53.8%) were males, 179(38%) had baseline saturation 82-85% on RA, 186(40%) had 85-90%, 107(22.6%) had 90-94% RA. 78% have improved to saturation of 98% at the end of last session of therapy,8%improved to 97%,10% to 96%,4% to 95%. 354(75%) patients showed 3/4th resolution of fibrosis on Chest Xray, 70(14.8%) showed 1/2 resolution,48(10.2%) have 1/4 resolution on CXR. 82% patients showed complete normalcy on 6MWT,15% showed partial improvement and 3% have showed no change.82% patients were able to come off home oxygen within 4 days,12% within 10 days and 6% within 21 days of completing therapy.369 patients reported significant reduction in dyspnea,chest pain.The results of therapy are remarkable and we had 0 defaulters.These patients as compared to the ones who didn't opt for the therapy did not have any complications after 1month on follow up versus those who presented with intermittent dyspnea and fatiguability after one month of Covid. CONCLUSION: Covid-19 Rehabilitation Therapy is cost effective,easy and convenient approach to reduce and prevent related pulmonary complications and must be advocated.

Deciphering the role of microRNAs during Pi54 gene mediated Magnaporthe oryzae resistance response in rice.

The broad-spectrum resistance gene Pi54 confers resistance to multiple isolates of Magnaporthe oryzae in rice. In order to decipher the molecular mechanism underlying the Pi54 mediated resistance in rice line Taipei309 Pi54 (carrying Pi54), miRNAome study was performed at 24 h post-inoculation (hpi) with M. oryzae. A total of 222 known miRNAs representing 101 miRNA families were found in this study. Of these, 29 and 24 miRNAs were respectively up- and down-regulated in the resistant Taipei309 Pi54 . Defence response (DR) genes, like, NBSGO35, and OsWAK129b, and genes related to transcription factors were up-regulated in Taipei309 Pi54 line. The vast array of miRNA candidates identified here are miR159c, miR167c, miR2100, miR2118o, miR2118l, miR319a, miR393, miR395l, miR397a, miR397b, miR398, miR439g, miR531b, miR812f, and miR815c, and they manifest their role in balancing the interplay between various DR genes during Pi54 mediated resistance. We also validated miRNA/target gene pairs involved in hormone signalling, and cross-talk among hormone pathways regulating the rice immunity. This study suggests that the Pi54 gene mediated blast resistance is influenced by several microRNAs through PTI and ETI components in the rice line Taipei309 Pi54 , leading to incompatible host-pathogen interaction.

Characterizing the putative mitogen-activated protein kinase (MAPK) and their protective role in oxidative stress tolerance and carbon assimilation in wheat under terminal heat stress.

Wheat, being sensitive to terminal heat, causes drastic reduction in grain quality and yield. MAPK cascade regulates the network of defense mechanism operated inside plant system. Here, we have identified 21 novel MAPKs through gel-based proteomics and RNA-seq data analysis. Based on digital gene expression, two transcripts (transcript_2834 and transcript_8242) showing homology with MAPK were cloned and characterized from wheat (acc. nos. MK854806 and KT835664). Transcript_2834 was cloned in pET28a vector and recombinant MAPK protein of ∼40.3 kDa was isolated and characterized to have very high in-vitro kinase activity under HS. Native MAPK showed positive correlation with the expression of TFs, HSPs, genes linked with antioxidant enzyme (SOD, CAT, GPX), photosynthesis and starch biosynthesis pathways in wheat under HS. Wheat cv. HD3086 (thermotolerant) having higher expression and activity of MAPK under HS showed significant increase in accumulation of proline, H2O2, starch, and granule integrity, compared with BT-Schomburgk (thermosusceptible).

MAPK Enzymes: a ROS Activated Signaling Sensors Involved in Modulating Heat Stress Response, Tolerance and Grain Stability of Wheat under Heat Stress.

Mitogen-activated protein kinase (MAPK) signaling cascade is highly conserved across the species triggering the self-adjustment of the cells by transmitting the external signals to the nucleus. The cascade consists of MAPK kinase kinases (MAPKKKs), MAPK kinases (MAPKKs) and MAPKs. These kinases are functionally interrelated through activation by sequential phosphorylation. MAPK cascade is involved in modulating the tolerance and regulating the growth and developmental processes in plants through transcriptional programming. The cascade has been well characterized in Arabidopsis, Tobacco and rice, but limited information is available in wheat due to complexity of genome. MAPK-based sensors have been reported to be highly specific for the external or intracellular stimuli activating specific TF, stress-associated genes (SAGs) and stress-associated proteins (SAPs) linked with heat-stress tolerance and other biological functions especially size, number and quality of grains. Even, MAPKs have been reported to influence the activity of ATP-binding cassette (ABC) transporter superfamily involved in stabilizing the quality of the grains under adverse conditions. Wheat has also diverse network of MAPKs involved in transcriptional reprogramming upon sensing the terminal HS and in turn protect the plants. Current review mainly focuses on the role of MAPKs as signaling sensor and modulator of defense mechanism for mitigating the effect of heat on plants with focus on wheat. It also indirectly protects the nutrient depletion from the grains under heat stress. MAPKs, lying at pivotal positions, can be utilized for manipulating the heat-stress response (HSR) of wheat to develop plant for future (P4F).

Subclinical Hypothyroidism and Associated Cardiovascular Risk Factor in Perimenopausal Females.

BACKGROUND: Perimenopause refers to the period around menopause (40-55 years). This includes the period before menopause and the first year after menopause. Perimenopausal age is an important stage in a women's life. Many women are diagnosed with hypothyroidism at midlife. Hypothyroidism - both overt and subclinical are associated with increased risk of CVS diseases. Subclinical hypothyroidism is more important as this stage is usually ignored from treatment point of view and if early intervention is done in SCH worsening of metabolic derangement may be avoided. OBJECTIVES: The present study was aimed to know the prevalence of subclinical hypothyroidism and associated dyslipidemia in perimenopausal females. MATERIAL AND METHODS: In our retrospective study we took 100 perimenopausal females (40-55years) who were investigated for thyroid and lipid profile. Atherogenic indices like TC/HDL-c, LDL-c/HDL-c, TG/HDL-c ratios were calculated from the individual lipid profile parameters. The reference guidelines for lipid profile was according to NCEP ATP III. RESULT: Subclinical hypothyroidism was found to be present in 18% of perimenopausal females The mean TSH levels were found to be higher in SCH as compared to euthyroid females with a mean value of 7.56±3.54(µIU/ ml). Dyslipidemia was seen in patients with SCH. TSH levels were found to be positively correlated with total cholesterol. CONCLUSION: We conclude that subclinical hypothyroidism is present in 18% females of perimenopausal age group. Increased TSH levels are associated with hypertension, hypertriglyceridemia, and elevated TC/HDL-C ratio and non cholesterol HDL. In perimenopausal women the condition is usually underdiagnosed and ignored but subclinical hypothyroidism in these females should be screened and treated timely to decrease the risk of accelerated atherosclerosis and premature coronary artery disease in them.

Functional validation of the Pi54 gene by knocking down its expression in a blast-resistant rice line using RNA interference and its effects on other traits.

Rice blast disease caused by Magnaporthe oryzae is one of the major diseases affecting the rice (Oryza sativa L.) crop. A major blast resistance gene, Pi54, has already been cloned and deployed in different rice varieties. To understand the role of Pi54 in providing rice blast resistance, we used the RNA interferences (RNAi) approach to knock down the expression of this gene. We showed a high frequency of Agrobacterium tumefaciens-mediated transformation of rice line Taipei 309 containing a single gene (Pi54) for blast resistance. Pi54 RNAi leads to a decreased level of Pi54 transcripts, leading to the susceptibility of otherwise M. oryzae-resistant rice lines. However, among the RNAi knockdown plants, the severity of blast disease varied between the lines. Histochemical analysis of the leaves of knockdown plants inoculated with M. oryzae spores also showed typical cell death and blast lesions. Additionally, Pi54 RNAi also showed an effect on the Hda3 gene, a florigen gene playing a role in rice flowering. By using the RNAi technique, for the first time, we showed that the directed degradation of Pi54 transcripts results in a significant reduction in the rice blast resistance response, suggesting that RNAi is a powerful tool for functional validation of genes.

Correlation of Parathyroid Hormone Levels with Mineral Status in End-stage Renal Disease Patients.

Parathyroid hormone (PTH) is the main regulator of calcium, phosphate, magnesium, sodium, and potassium homeostasis. Therefore, this study was conducted to evaluate the relationship between PTH and aforementioned minerals in end-stage renal disease (ESRD) patients. AIM: The aim of this study was to estimate serum intact parathormone (iPTH) and other biochemical parameters in ESRD patients and to find correlation between serum iPTH and biochemical parameters in the study group. RESULTS: This cross-sectional study included 60 clinically diagnosed patients of ESRD of age (>18 years), either sex. Disordered mineral metabolism is common complications of ESRD patients. The mean value of calcium, phosphorus, and magnesium was 7.90 ± 1.16 mg/dL, 6.44 ± 1.72 mg/dL, and 2.57 ± 0.62 mg/dL, respectively, indicating hypocalcemia, hyperphosphatemia, and hypermagnesemia in ESRD patients. To compensate the deranged mineral status, increased levels of PTH were seen in ESRD patients with mean value of 173.93 ± 62.62 pg/mL. There was a statistically significant positive correlation found between PTH and S. creatinine (P ≤ 0.001; r = 0.596), whereas the statistically significant negative correlation found between PTH and eGFR (P ≤ 0.001; r = -0.525). A significant positive correlation found between PTH and phosphorous (P = 0.003; r = 0.378) and potassium (P ≤ 0.001; r = 0.421). On the other hand, significant negative correlation found with calcium (P ≤ 0.001; r = -0.805) and corrected calcium (P = <0.001; r = -0.769). But nonsignificant association was found with magnesium, sodium, and calcium × phosphorous (P > 0.05). CONCLUSION: It was concluded that PTH is playing crucial role in mineral metabolism; it should be frequently assessed in order to prevent any untoward mineral decompensation and to prevent complications like bone disease and extra skeletal calcification, and decrease cardiac disease risk in ESRD patients.

Status and Prospects of Next Generation Sequencing Technologies in Crop Plants.

The history of DNA sequencing dates back to 1970s. During this period the two first generation nucleotide sequencing techniques were developed. Subsequently the Sanger's dideoxy method of sequencing gained popularity over Maxam and Gilbert's chemical method of sequencing. However, in the last decade, we have observed revolutionary changes in DNA sequencing technologies leading to the emergence of next-generation sequencing (NGS) techniques. NGS technologies have enhanced the throughput and speed of sequencing combined with bringing down the overall cost of the process over a time. The major applications of NGS technologies being genome sequencing and resequencing, transcriptomics, metagenomics in relation to plant-microbe interactions, exon and genome capturing, development of molecular markers and evolutionary studies. In this review, we present a broader picture of evolution of NGS tools, its various applications in crop plants, and future prospects of the technology for crop improvement.

Ameloblastoma: A retrospective analysis of 31 cases.

AIMS AND OBJECTIVE: To evaluate the surgical treatment given and do a regular follow up to study the recurrence rate and complications of ameloblastoma in our institution. MATERIALS AND METHODS: A total of 31 cases of various subtypes of ameloblastoma, treated with different modalities, in the Department of OMFS, were recalled for a follow up & radiographs were taken along with the clinical examination for any recurrence or complications such as fracture/exposure of the reconstruction plate, loosening of the screw, infection of the graft, any draining sinus/signs of infection. RESULTS: Two of our patients had fractured reconstruction plate, one patient developed infection, one patient complained of screw exposure and two other patients had infection of the iliac graft. CONCLUSION: We conclude that an adequate resection with a safe margin could be a treatment option and can be undertaken depending on the extent, location of the lesion and histopathologic variant.

Distraction osteogenesis in the treatment of temporomandibular joint ankylosis with mandibular micrognathia.

AIMS: The aims of the study were to evaluate the efficacy of simultaneous interpositional arthroplasty with distraction osteogenesis (DO) as a single procedure and to give the patient acceptable functional rehabilitation with correction of the gross facial asymmetry. MATERIALS AND METHODS: Nine patients of temporomandibular joint (TMJ) ankylosis with micrognathia were treated with interpositional arthroplasty and simultaneous DO and followed for a period of minimum 3 years. Preoperative, immediate postoperative, at the end of distraction, at 6 months and 3 years postdistraction consolidation radiographs were taken along with the clinical examination for mouth opening, deviation, length of the mandible and ramus, midline shift, occlusal cant, and occlusion. RESULTS: The results showed an increase in the mouth opening, length of the mandible and ramus height, correction of deviation, occlusion, and midline shift. Relapse was not seen in any case, rather one patient developed infection at the distractor site and two patients had fracture of the roots of the teeth at the osteotomy site. There was an overall improvement in the facial asymmetry. CONCLUSION: Simultaneous interpositional arthroplasty with DO should be used to correct TMJ ankylosis associated with facial asymmetry/micrognathia, as it reduces the need for second surgery, thereby saving the trauma of a second surgery and difficulty in intubation, increases the length of the mandible, corrects the deformity, thereby resulting in an acceptable facial esthetics and function.