COVID-19 Reinfection in the Face of a Detectable Antibody Titer.

Coronavirus disease 2019 (COVID-19) reinfections are now reported from many countries with different coronavirus strains. Detectable immunoglobulin G (IgG) levels are thought to impart protective immunity to reinfection in that individual. Here, we discuss a case report of a young, healthy, type 2 diabetic patient who suffered reinfection even after four times upper normal circulating IgG antibody specific to a COVID-19 spike protein. The first time was a clinical diagnosis when he self-isolated himself and was diagnosed later by COVID-19-specific symptoms with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2)-specific IgG antibody titer.

Physicians' Dilemma of False-Positive RT-PCR for COVID-19: a Case Report.

Coronavirus disease 2019 (COVID-19) has played havoc on this world's health and economics since its outbreak in December 2019. Reverse transcription-polymerase chain reaction (RT-PCR) has been the gold standard to diagnose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Still, few false-positive reports are emerging up that add to the physicians' dilemma and maintenance of health statistics.

Role of Preoperative Ureteric Stenting in Optimization of Patients with Retroperitoneal Tumors Associated with Obstructive Uropathy.

Retroperitoneal tumors can cause ureteric obstruction leading to obstructive uropathy. Early preoperative ureteric stenting helps to improve renal function and also helps in identifying ureters and prevent ureteric injury during surgery. This study was aimed at assessing the outcome of preoperative stenting in optimizing such patients. A total of 24 cases were enrolled. Of these, 15 patients who had obstructive uropathy were taken for ureteric stenting preoperatively and other 9 patients have undergone surgery without stenting. Twelve patients were stented successfully but 3 patients could not be stented (underwent percutaneous nephrostomy). All 24 patients underwent laparotomy, and of the 12 stented patients, 11 underwent successful resection and one had unresectable tumor. The patient's serum creatinine was assessed initially and then twice after stenting (48 h and 5 days). Serum creatinine was also estimated 24 h after excision of the tumor. In the successfully stented and operated patients, mean initial creatinine was 7.85. The mean creatinine at 48 h and 5 days after stenting was 4.29 and 1.19 respectively. The mean creatinine 24 h after resection of the tumor was 1.04. Of the non-stented patients, 3 had ureteric injury during surgery. We conclude that preoperative ureteric stenting is helpful for optimization of patients with retroperitoneal tumors with obstructive uropathy.

COVID-19 Reinfection: Myth or Truth?

The novel coronavirus disease (COVID-19) has posed a large problem to this world and has exposed the skeleton of healthcare system all over. There have been reports of patients getting reinfected with COVID-19 as they tested positive for the virus again after discharge. We try to address the issue of this reinfection and want to clarify whether this entity actually exists or is it just a myth.

Ventricular Arrhythmia Risk Based on Ethnicity in COVID-19 Patients on Hydroxychloroquine and Azithromycin Combination: Viewpoint.

There are many reports available now, which are mostly observational or registry trial outcomes having varied results on coronavirus 2019 (COVID-19) patients put on hydroxychloroquine and azithromycin combination. Some are showing increased in-hospital mortality and ventricular arrhythmia increase, while some are showing overall benefit with significant viral RNA load reduction. Everyday things are getting more complicated with the publication of these different outcomes. This needs to be addressed.

Epidemiological Determinants of COVID-19-Related Patient Outcomes in Different Countries and Plan of Action: A Retrospective Analysis.

Current development around the pandemic of novel coronavirus disease 2019 (COVID-19) presents a significant healthcare resource burden threatening to overwhelm the available nationwide healthcare infrastructure. It is essential to consider, especially for resource-limited nations, strategizing the coordinated response to handle this crisis effectively and preparing for the upcoming emergence of calamity caused by this yet-to-know disease entity. Relevant epidemiological data were retrieved from currently available online reports related to COVID-19 patients. The correlation coefficient was calculated by plotting dependant variables - the number of COVID-19 cases and the number of deaths due to COVID 19 on the Y-axis and independent variables - critical-care beds per capita, the median age of the population of the country, the number of COVID-19 tests per million population, population density (persons per square km), urban population percentage, and gross domestic product (GDP) expense on health care - on the X-axis. After analyzing the data, both the fatality rate and the total number of COVID-19 cases were found to have an inverse association with the population density with the variable - the number of cases of COVID-19 - achieving a statistical significance (p-value 0.01). The negative correlation between critical care beds and the fatality rate is well-justified, as intensive care unit (ICU) beds and ventilators are the critical elements in the management of complicated cases. There was also a significant positive correlation between GDP expenses on healthcare by a country and the number of COVID-19 cases being registered (p-value 0.008), although that did not affect mortality (p-value 0.851). This analysis discusses the overview of various epidemiological determinants possibly contributing to the variation in patient outcomes across regions and helps improve our understanding to develop a plan of action and effective control measures in the future.

Clinical Case Series of Decrease in Shear Wave Elastography Values in Ten Diabetic Dyslipidemia Patients Having NAFLD with Saroglitazar 4 mg: An Indian Experience.

BACKGROUND: Diabetes and other metabolic abnormalities including high triglycerides (TGs) are commonly seen comorbid conditions in patients having nonalcoholic fatty liver disease (NAFLD). There is no approved pharmacotherapy for NAFLD, and life-style therapy plays a major role. Saroglitazar, the world's first approved dual PPAR α/γ agonist, is approved in India for the treatment of diabetic dyslipidemia. The objective of this case series analysis was to evaluate the safety and effectiveness of saroglitazar 4 mg once daily in reducing liver stiffness in patients having diabetic dyslipidemia associated NAFLD. METHOD: In this retrospective case series analysis, we identified 10 patients with diabetic dyslipidemia (type 2 diabetes and triglycerides >200 mg/dL at baseline) and NAFLD who were treated with saroglitazar 4 mg once daily and the follow-up data were available for 9 months after saroglitazar treatment. At baseline, all patients were on stable antidiabetic and statin therapy. Liver stiffness was measured by using 2D shear wave elastography at baseline and at 9-month follow-up. RESULTS: At 9-month follow-up after saroglitazar treatment, significant improvement was observed in shear wave velocity (SWV) and serum transaminases levels. Serum TG level was significantly reduced after 9-month treatment with saroglitazar. No major adverse event was reported. CONCLUSION: In this case series of 10 patients with diabetic dyslipidemia and NAFLD, saroglitazar improved liver stiffness along with reduction observed in liver enzymes and TG values. Long-term randomized controlled clinical trial is required to further establish the safety and efficacy of saroglitazar in treatment of NAFLD.

Severe OSA Leading to Long Pauses in 24-h Holter ECG Reversed with CPAP.

INTRODUCTION: Sleep-related problems like sleep apnea are increasing tremendously mostly owing to the disordered lifestyle the present generation is leading which is added like a topping on the base of obesity and metabolic syndrome. The burden on the society is huge taking into consideration the work-time loss and health-related financial issues arising out of these sleep disorders with obstructive sleep apnea (OSA) leading the way. Early diagnosis can prevent several complications of OSA. Cardiovascular diseases, including various arrhythmias, arising due to OSA, are described previously. CASE PRESENTATION: Herein, an interesting case of OSA, whose pacemaker installation to rectify the long pause could be avoided by simple correction of his OSA using continuous positive airway pressure, is presented. This 49-year-old male patient was diagnosed with severe OSA by using polysomnography and all his significant sinus pauses (highest one with 7.8 sec) during holter ECG monitoring were found to be occurring at night and correcting his OSA with continuous positive airway pressure (CPAP) treatment reverted all those sinus pauses and the need for any further intervention with pacemaker was discarded. DISCUSSION: OSA is caused by either partial or complete obstruction of the upper airway, and there is the simultaneously attenuated upper airway dilator muscle tone while the patient is sleeping. The gold standard test designed for the assessment of OSA is polysomnography, as approved by the American Academy of Sleep Medicine and CPAP has been found to be universally beneficial in treating OSA related complications. Physiologically, the ACC/AHA guidelines recommend pacing only in patients with prolonged asymptomatic pauses occurring during wakefulness. This case report proved the above mentioned claim of CPAP treatment.

Switch-over Study with Fast-acting Insulin Aspart Showing Lower Glycemic Variability in Type 2 Diabetics with Stage 4 Chronic Kidney Disease: A Case Series.

Background Despite conventional insulin treatment being considered an effective approach for glycemic regulation during renal dysfunction, there is still a major clinical need for better insulin therapy to stabilize fluctuations in glucose levels. Aim The aim of this study was to assess the impact of mealtime fast-acting insulin aspart therapy on glycemic variability as compared to regular human insulin therapy in advanced chronic kidney disease (CKD) patients with type 2 diabetes (T2D). Methods Data from eight patients were retrospectively collected after analyzing 57 patients' data between July 2019 and October 2019. All T2D patients with stage 4 CKD were switched to mealtime fast-acting insulin aspart on account of recurrent hypoglycemic events. The continuous glucose monitoring data of the first four days were analyzed to calculate the mean amplitude of glucose excursions (MAGE) as well as five other glycemic variability indices, namely, standard deviation, mean, continuous overall net glycemic action, average daily risk range, and J index. Results The primary endpoint of 24-h MAGE significantly decreased from 7.01 ± 2.59 to 4.19 ± 1.06 mg/dL (p = 0.012) when short-acting regular human insulin (RHI) therapy was replaced with mealtime fast-acting insulin aspart therapy. However, no significant change was observed in 24-h mean glucose levels and other indices of glucose variability. Significant reduction in 24-h and night-time hypoglycemic events was reported in patients after therapy switch during the four-day follow-up period. Conclusions The present study demonstrated an improvement in glycemic variability with the administration of fast-acting insulin aspart as compared to RHI, suggesting that modern bolus insulin replacement might prove to be a useful therapeutic strategy in type 2 diabetes patients with advanced CKD. Further clinical studies will be required to confirm the benefits of this therapeutic approach. Relevance for patients The safety and effectiveness of fast-acting insulin aspart in CKD patients have not yet been established. The clinical effectiveness and better safety profile of newer mealtime insulin therapy may prompt a reconsideration of its use in patients with an advanced stage of renal dysfunction, leading to better adherence and improved quality of life.

Significant Reduction of Elevated Triglycerides and Liver Fibrosis in Diabetic Dyslipidemia with Saroglitazar: A Case Report.

Metabolic disorders are characterized by pathologies like visceral adiposity, hypertension, type 2 diabetes mellitus (T2DM), dyslipidemia, impaired glucose tolerance, fatty liver, and so on, with insulin resistance being the main contributing factor. Insulin resistance and diabetes mellitus are commonly associated with elevated triglyceride levels. Among the available medications for treating metabolic disorders, only Saroglitazar has a dual peroxisome proliferator-activated receptor ɑ + γ action that can reduce high triglycerides and improve insulin sensitivity. This medication may also reduce liver fibrosis content. The present case report illustrates the efficacy of Saroglitazar in reducing hypertriglyceridemia and liver stiffness as assessed by shear wave elastography.

A Cross-sectional Retrospective Analysis of Glycemic Burden and Nephropathy in an Indian Population and Formulation of a New Plan Using eGFR/HbA1c Grid Formation.

Background Diabetes is a metabolic, non-communicable disease (NCD) that represents one of the major causes of morbidity and mortality worldwide. India has a huge burden of chronic kidney disease (CKD) that is associated with diabetes. Materials and methods Cross-sectional data were collected for a total of 241 patients from the authors' clinic record. A new approach for the management of patients with diabetes was proposed using a grid system, where we need to consider the Hemoglobin A1C (HbA1c) and estimated glomerular filtration rate (eGFR) values of the patient and assign a zone (green, blue, orange or red) and subsequently decide an appropriate treatment according to the assigned zone. Results We found that 20.73% of patients had decreased eGFR and only 31.12% of patients achieved target HbA1c level. A high prevalence of diabetic nephropathy (20.73%) was observed in this study population. A statistically significant difference among the four groups (zones) with respect to age (p <0.001), duration of diabetes (p = 0.024), HbA1c (p <0.001), and eGFR (p <0.001) was found. Conclusion The burden of diabetes and nephropathy is high in low-income countries and can be easily assessed by applying simple tools such as the newly proposed HbA1c/eGFR grid system to identify high-risk and medium-risk patients and adopting treatment according to the assigned zone.

A Retrospective Study to Examine the Correlation of Bioelectrical Impedance Analysis with Shear-wave Elastography in Indian Patients with Non-alcoholic Fatty Liver Disease and Diabetes on Background Sodium-glucose Cotransporter-2 Inhibitor Therapy.

Background Patients with non-alcoholic fatty liver disease (NAFLD) are often insulin resistant. Several recent studies show NAFLD to be associated with cardiovascular risk. Bioimpedance analysis (BIA) is a common approach for body composition measurements and is a noninvasive, low-cost modality. Shear-wave elastography (SWE) works using an acoustic radiation force pulse sequence that generates shear-waves that estimates the liver stiffness. Objectives The primary objective was to assess the correlation between SWE values and BIA values in an Indian population. The hypothesis is that with the increase in BIA value measuring visceral fat percentage, the SWE value measuring liver stiffness should increase. Materials and methods We conducted a retrospective analysis of clinic data of 36 patients properly screened from July 2018 to December 2018, who matched our prespecified inclusion criteria. Statistical analysis was performed using GraphPad Insta Version 3.0® using regression analysis. Visceral fat percentage and skeletal muscle percentage of lower limbs were calculated using an Omron HBF 375® analyzer. SWE values for liver fat were measured using a Philips Affinity 70® using two-dimensional imaging and expressed in kilopascal (kPa) units. Results We found that 88.88% of the patients with diabetes had above normal SWE values (2.0 to 4.5 kPa), and a corresponding 83.33% of patients had above the high cut-off for BIA values (>10%) but without any positive correlation between the two parameters as evident from the p-value of 0.079. Conclusions This study found a high prevalence of fat burden amongst our patients with type 2 diabetes and NAFLD. This is the first of its kind of study where we searched for a correlation between the two commonly used parameters in assessing the fat burden and liver stiffness of an individual but found there was no significant correlation between the two parameters used.

Administration of Once-daily Canagliflozin to a Non-diabetic Patient in Addition to Standard Aerobic Exercise: A Case Report.

There is no Indian data at present on sodium-glucose cotransporter 2 (SGLT2) inhibitors' role on glycated haemoglobin A1c (HbA1c), weight, and blood pressure in non-diabetic individuals. This novel mechanism of action could assure us of sustained non-glycaemic benefits along with information on the negligible risk of hypoglycaemia. The aim was to observe the changes of various parameters using canagliflozin (300 mg) in a non-diabetic person suffering from hypertension and dyslipidaemia (on treatment for two years). Canagliflozin (300 mg) once-daily was administered for 13 weeks with a continuous glucose monitoring system (CGMS) installed to assess glycaemic changes and tests done at baseline: four, eight, and 13 weeks. A dyslipidaemic and hypertensive with a family history of type 2 diabetes (T2D) (mother) and hypertension (father), the patient was currently using antihypertensive and statin therapy for two years. Over a period of 13 weeks, there was a reduction in weight by 3.2 kg; body mass index (BMI) by 1 Kg/m2, visceral fat by 1.5%, waist circumference by 5 cm, uric acid level by 63.01%, and increase in bone mineral density (BMD) (as opposed to decrease seen with SGLT2Is in other studies). There was no episode of hypoglycaemia. Our study has given rise to certain critical issues regarding the early use of canagliflozin (although on an off-label basis) in patients who are at high risk of developing diabetes in the future.

Thrombopoietin Receptor Agonists: Can These Be the Future Answer to the Deadly Thrombocytopenia in Dengue Fever?

Dengue is considered the most prevalent mosquito-borne viral disease worldwide and sometimes turns out to be life-threatening. Thrombocytopenia is frequently observed in mild and severe cases of dengue. Severe thrombocytopenia, with a platelet count much below the normal range and hemorrhagic manifestation, is considered a fatal consequence of dengue that needs proper and timely management. The development of the dengue vaccine is quite challenging due to the existence of four different serotypes of the virus. Currently, neither a specific antiviral therapy nor a vaccine is available, and the common treatment modalities include fluid replacement therapy and platelet transfusions. Besides dengue, thrombocytopenia is correlated with many other diseases, particularly immune thrombocytopenic purpura (ITP). Thrombopoietin receptor (TPO-R) agonist, which is responsible for increasing platelet count, is a novel treatment option for chronic ITP patients. At present, two TPO-R agonists - eltrombopag and romiplostim - approved by the US Food and Drug Administration (USFDA) have been successfully used for the treatment of chronic ITP and other thrombocytopenic conditions. However, to date, only a single case study reported the use of romiplostim to enhance the platelet count in a myeloma patient suffering from dengue-associated thrombocytopenia. The objective of this review is to propose to the medical fraternity to consider using these TPO-R agonists to treat dengue hemorrhagic patients with thrombocytopenia and to conduct relevant researches to find out the usefulness of these molecules. This review is completely based on hypotheses and articles showing the positive response with romiplostim in dengue after going through a web-based search on various search engines. Furthermore, this review highlights the need for good-quality, randomized controlled trials and meta-analyses to detect the safety and efficacy of romiplostim and eltrombopag therapy for patients suffering from dengue-related thrombocytopenia.

Dental fluorosis and associated risk factors in early adolescents in India.

Background Dental fluorosis has a negative impact on the facial esthetics of adolescents and is a worldwide oral health concern. Objective To assess the prevalence and associated risk factors for dental fluorosis in early adolescents in India. Methods This was a cross-sectional study carried out on 800 adolescent school children selected from the Jhabua and Dhar districts of Madhya Pradesh, India. The children were in the of 12-15-year age group. A total of eight schools from both Jhabua and Dhar districts were included in the study. A self-administered questionnaire collected information on demographic characteristics, oral hygiene practices and various risk factors for dental fluorosis. Water samples were collected from each zone and sent to a laboratory for water fluoride estimation. Dental fluorosis was assessed using the Dean index. Chi-squared (χ2) and logistic regression analysis were performed. Results The overall prevalence of dental fluorosis was found to be 40.5% in early adolescents. The prevalence of dental fluorosis was found to be 45% in the Jhabua district and 36% in the Dhar district. The water fluoride content was found to be the strongest predictor for dental fluorosis followed by the method of water storage. Conclusion Dental fluorosis affects a large number of adolescents in both the Jhabua and Dhar districts of Madhya Pradesh. Effective policies focusing on oral health education and prevention of dental fluorosis need to be drafted.

Efficacy of oral steroids after optical internal urethrotomy in reducing recurrence of urethral strictures.

OBJECTIVE: Optical internal urethrotomy is a feasible modality of treatment for short segment bulbar urethral strictures. Recurrence is an important problem after urethrotomy. This study aimed at evaluating the efficacy of oral steroid (deflazocort) in reducing the recurrence of strictures after urethrotomy. Up to date, no study has evaluated the role of oral steroids after urethrotomy. MATERIAL AND METHODS: In this case-control study, patients undergoing urethrotomy (bulbar urethral strictures <2 cm) were divided into two groups according to patients receiving (Group 1) or not receiving (Group 2) oral steroid (deflazocort 6 mg tablets) after operation. Both groups were controlled at 1, 3 and 6 months after catheter removal (usually 5-6 days after operation) with uroflowmetry, and the flow rates were statistically compared. Deflazocort was given after catheter removal, at first 6 mg twice daily for two weeks, then 6 mg once daily for another two weeks (self-obturation was not performed). RESULTS: A total of 72 patients were selected for the study as per inclusion criteria. They were divided into 2 groups as those receiving (Group 1: deflazocort group; n=36) or not receiving (Group 2; n=36) deflazocort. Median postoperative maximum flow rates in the deflazocort group were 26.2, 22.3 and 18.2 mL/sec, and in the control group was 24.4, 17.1 and 13.7 mL/sec at postoperative 1., 3. and 6. months, respectively. Lesser patients in the deflazocort group had recurrence. The difference was statistically significant only at postoperative 3 (p value=0.03), and 6. months (p value=0.02) (p value=0.15). CONCLUSION: Oral steroids can be used after internal urethrotomy to reduce the recurrence of urethral strictures.

Influence of Lifestyle Factors on Oral Health-Related Quality of Life in Pregnant Women in Indore City.

BACKGROUND: Lifestyle factors affect the periodontal and oral hygiene status and, thus, may affect the Oral Health-Related Quality of Life (OHRQoL) in pregnant women. Thus, the aim of the study was to assess the OHRQoL and determine its relationship with lifestyle and other factors in pregnant women in Indore city. METHODS: This cross-sectional study was carried out on 400 pregnant women who were selected using stratified random sampling technique from eight private maternity centers located in Indore city. A questionnaire collected information on socio-demographic characteristics, oral hygiene practices, previous dental visit and past medical history. OHRQOL was assessed using Oral Health Impact Profile-14 questionnaire. Lifestyle factors were assessed using the Health practice Index. RESULTS: The lifestyle factors were the strongest predictor for poor OHRQOL. The pregnant women (OR = 3.22, P-value < 0.0001*) with poor lifestyle had significantly poor OHRQOL. Logistic regression analysis showed that poor socio-economic status (OR = 2.63, P-value = 0.025*), brushing frequency of less than or equal to once daily (OR = 2.02, P-value = 0.025*), and suffering from systemic diseases (OR = 2.11, P-value = 0.017*) were other important predictors for poor OHRQOL in pregnant women. CONCLUSIONS: Our findings showed that lifestyle factors significantly impact OHRQOL in pregnant women. Thus, it is recommended that effective policies should be drafted to improve lifestyle factors and OHRQOL in pregnant women.

Analysis of outcome of end-to-end and end-to-side internal iliac artery anastomosis in renal transplantation: Our initial experience with a case series.

INTRODUCTION: In renal transplantation, there is end-to-side anastomosis of renal artery to external iliac artery and end-to-end anastomosis of renal artery to internal iliac artery. The end-to-end internal iliac artery anastomosis can be associated with complications due to compromised distal vascular supply to limbs and penile erectile tissue. A method of end-to-side anastomosis can overcome them. Till date, there is no case series or trial that has studied the effect of end-to-side anastomosis. This study is aimed at comparing the outcome of end-to-side and end-to-end anastomosis, so as to evaluate the efficacy of end-to-side technique. MATERIALS AND METHODS: A total of 40 renal transplant recipients were taken, with internal iliac artery anastomosis, and were divided into two groups, 20 patients with end-to-end and 20 patients with end-to-side anastomosis. The cold ischemia time, arterial anastomosis time, post-operative bleeding and urine leak, claudication, saddle anesthesia and erectile dysfunction, and follow-up recipient creatinine and eGFR and Doppler to look for graft renal artery patency (at 6 months post-transplant) were compared between the two groups. RESULTS: The intraoperative cold ischemia time was slightly more in the group with end-to-end anastomosis, but it was statistically significant (P = 0.22). The arterial anastomosis time was comparable in both the groups (P = 0.65). In the end-to-end group, 15%, 20% and 15% patients had post-operative saddle anaesthesia, claudication and mild-to-moderate erectile dysfunction, which were absent in the end-to-side group. On follow-up, the mean recipient serum creatinine and eGFR were comparable in the two groups. Also, the graft renal artery patency on Doppler was comparable. CONCLUSION: The end-to-side technique can be definitely applied for renal transplantation, with some advantages over end-to-end technique, and without compromising efficacy.

A Profilometric Study to Assess the Role of Toothbrush and Toothpaste in Abrasion Process.

STATEMENT OF THE PROBLEM: Despite of many studies conducted on toothbrushes and toothpaste to find out the culprit for abrasion, there is no clear cut evidence to pin point the real cause for abrasion. PURPOSE: An in vitro assessment of the role of different types of toothbrushes (soft/ medium/hard) in abrasion process when used in conjunction with and without a dentifrice. MATERIALS AND METHOD: Forty five freshly extracted, sound, human incisor teeth were collected for this study. Enamel specimens of approximately 9 mm(2) were prepared by gross trimming of extracted teeth using a lathe machine (Baldor 340 Dental lathe; Ohio, USA). They were mounted on separate acrylic bases. The specimens were divided into three groups, each group containing 15 mounted specimens. Group 1 specimens were brushed with soft toothbrush; Group 2 brushed with medium toothbrush and Group 3 with hard toothbrush. Initially, all the mounted specimens in each group were brushed using dentifrice and then the same procedure was repeated with water as control. Profilometric readings were recorded pre and post to tooth brushing and the differences in readings served as proxy measure to assess surface abrasion. These values were then compared to each other. Kruskal Wallis and Mann-Whitney U test were performed. RESULTS: The results showed that brushing, with water alone, caused less abrasion than when toothpaste was added (p< 0.008). When brushed with water, the harder toothbrush caused more abrasion (higher Ra-value), but when toothpaste was added, the softer toothbrush caused more abrasion (p< 0.001). CONCLUSION: Besides supporting the fact that toothpaste is needed to create a significant abrasion, this study also showed that a softer toothbrush can cause more abrasion than harder ones. The flexibility of bristles is only secondary to abrasion process and abrasivity of dentifrice has an important role in abrasion process.

Mandibular canine index: A reliable predictor for gender identification using study cast in Indian population.

CONTEXT: Various methods are used for gender identification in anthropologic and forensic investigations. The canine tooth is widely used for gender determination because of its sexual dimorphism and durability in the oral cavity. Mandibular canine index (MCI) is one of the most reliable and valid predictor for gender identification. AIM: To assess the reliability of MCI in gender determination in Indian population. SETTINGS AND DESIGN: This was an experimental study involving the preparation of plaster models of 100 individuals residing in Udaipur, Rajasthan, India. Of these 45 were males and 55 were females. Both sexes were in the age group of 20-30 years. Study casts were prepared for all individuals and the measurements of mandibular canine teeth were taken. The MCI was calculated using standardized equation. In addition, the percentage of sexual dimorphism was calculated. STATISTICAL ANALYSIS USED: Independent sample t-test was used. P < 0.05 was considered statistically significant. RESULTS: There was a significant difference (P < 0.05) observed between inter-canine distance, right and left canine width and right and left MCI between males and females. Sexual dimorphism is more on left permanent mandibular canine teeth than right permanent mandibular canine teeth. The overall percentage of accuracy observed was 85.5%. CONCLUSIONS: Study findings reveal that MCI can be used a reliable predictor for gender determination in Indian population and can form the basis of anthropologic and forensic investigations.