Chrysosporium: A rare cause of allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) forms a significant group of patients presenting with the commonest health problem encountered in rhinology. Patients commonly present with typical symptoms of sinusitis, and the diagnosis is often made after imaging and/or intraoperatively. Infections caused by Chrysosporium species are very rare and are very rarely been reported to cause sinusitis in humans. Usually, human chrysosporial infections are mild and unmarked by symptoms. We report a rare case of allergic fungal sinusitis (AFS) caused by Chrysosporium species in a 41-year-old male with the history of diabetes mellitus.

Comparative Evaluation of Intranasal Dexmedetomidine Spray Versus Intranasal Normal Saline Spray in Patients Undergoing Transalveolar Extractions for Anxiety Reduction: A Randomized Control Study.

Background: Dexmedetomidine has dose-dependent selectivity for alpha 2 adrenoceptors. It is a good sedative with analgesic characteristics and good haemodynamic stability. Intranasal sedation is a non-invasive medication delivery method that is both safe and well accepted by both children and adults. One of the most common procedures in maxillofacial surgery is transalveolar extraction. In minor oral surgery, a painless transalveolar extraction with little post-operative pain would be ideal. Aim: To examine the effectiveness of intranasal dexmedetomidine spray against intranasal normal saline spray in patients undergoing transalveolar extractions for anxiety relief. Method: We compared sedation effect by Ramsay sedation scale, analgesia by visual analogue scale, monitored BP and pulse rate for anxiety, and spo2 levels for any complication in this prospective double-blinded randomized control study for two groups, A group with intranasal dexmedetomidine spray and the B group of intranasal NS spray for placebo effect at 0 min, 15 min, 30 min, and 45 min until transalveolar extraction. Result: As a result of the intranasal spray of dexmedetomidine, there were no related problems such as respiratory depression. There was a substantial difference in sedation and analgesia between group A and the placebo group, as well as a significant decrease in pulse rate and hypotension in the dexmedetomidine group to reduce anxiety. Conclusion: Intranasal injection of atomized dexmedetomidine (1.5 mcg/kg) for patient sedation having transalveolar extractions or other minor surgical operations in oral and maxillofacial surgery is clinically effective, convenient, lowers anxiety, and safe.Clinical Trial Registration: No. CTRI/2021/07/035181.

Increasing aggressive prostate cancer.

INTRODUCTION: To compare prostate biopsy (Pbx) characteristics, before and after the 2012 United States Preventive Services Task Force (USPSTF) prostate cancer screening guidelines in our practice. MATERIALS AND METHODS: We completed a retrospective comparative analysis of 1703 sequential patients that had a Pbx in 2010 to 2012 (3 years) with 1006 patients biopsied in 2018, 2019 and 2021 (3 years). Data from a total of 2709 Pbx was collected on patient age, race, prostate-specific antigen (PSA), digital rectal examination (DRE) and Gleason sum score (GSS). The data was analyzed to determine whether the 2012 USPSTF screening recommendations against prostate cancer screening may have affected prostate cancer characteristics. Two study groups were defined as Group A and Group B. Group A represents Pbx prior to the 2012 USPSTF screening guidelines (2010-2012) and Group B represents Pbx in 2018-19 and 2021. The patient population consisted of 76% Black, 14% White and 11% other. RESULTS: The number of patients that had a Pbx in Groups A vs. B: 567 patients/year vs. 335 patients/year. The annual positive Pbx rate for Group A vs. B: 134/year vs. 175/year. High grade prostate cancer (GSS 7-10) in Groups A vs. B: 51.5% vs. 59%. The proportion of patients with a PSA 10 ng/mL or greater in Groups A vs. B: 25.4% vs. 31%. The PSA 10 ng/mL and over and GSS 7-10 was higher in Group B for all age groups. In 2021, GSS 7-10 was present in 64% of 70-80 year olds. In Group B, GSS 6 decreased by 7.5% while GSS 7-10 increased by 7.5% compared with Group A. CONCLUSIONS: Our data through the year 2021 shows that after the 2012 USPSTF recommendations against prostate cancer screening, Pbx decreased and prostate cancer diagnosis and high grade (GSS 7-10) prostate cancer increased. As our patient population consists of 76% Black patients and 33% of men age 70-80 years old, our results support annual prostate cancer screening for US men 50-80 years old and especially high-risk patients that include Black men, men with a family history of prostate cancer and healthy men age 70-80 years old. Annual DRE- and PSA- based prostate cancer screening will likely markedly decrease prostate cancer morbidity, mortality and the cost of prostate cancer management.

A Trend Toward Aggressive Prostate Cancer.

To compare prostate biopsy (Pbx) characteristics before and after the 2012 United States Preventive Services Task Force (USPSTF) prostate cancer (PCa) screening guidelines, we completed a retrospective comparative analysis of 1703 sequential patients that had a Pbx in 2010 to 2012 (3 years) with 383 patients biopsied in 2018 and 310 patients biopsied in 2019. Data was collected on patient age, race, serum prostate specific antigen (PSA) level, digital rectal examination (DRE) results, total number of biopsies performed, and Gleason sum score (GSS). Data were analyzed to determine whether the 2012 USPSTF screening recommendations against PCa screening may have affected PCa characteristics. Three study groups were defined as Group A, Group B, and Group C. Group A represents Pbx prior to the 2012 USPSTF screening guidelines (2010-2012), Group B represents Pbx in 2018, and Group C represents Pbx in 2019. The patient population consisted of 73% Black men, 16% White men, and 11% men of other races. The number of patients that had a biopsy in Groups A through C, respectively, were 567 patients/year, 383 patients/year, and 310 patients/year. The annual positive Pbx rate for Group A through C was 134/year, 175/year, and 201/year, respectively. High-grade PCa (GSS 7-10) in Groups A through C was 51.5%, 60.5%, and 60.0%. The proportion of patients with a serum PSA level 10 ng/mL or greater in Groups A through C was 25.4%, 29.3%, and 33%. For patients age 70 to 80 years, there was an increasing trend for serum PSA levels 10 ng/mL and higher: 31%, 38%, and 39%, respectively. In this age group, high-grade tumors (GSS 7-10) occurred in 61%, 65%, and 68%, respectively. In 2019, Grade Group 3, 4, and 5 was present in 37.7% of 70- to 80-year-old men and 34.6% of Black men. More than 50% positive biopsy cores were present in 46.3% of 70- to 80-year old men and 36.6% of Black men. Our data through 2019 continued to show that after the 2012 USPSTF recommendations against PCa screening, PCa screening has decreased. We found decreased Pbx, increased PCa diagnosis, and increased high-grade PCa (GSS 7-10). As our patient population consisted of 73% Black patients and 33% of men age 70 to 80 years, our results support aggressive PCa screening for high-risk patients, which include Black men, men with a family history of PCa, and healthy men age 70 to 80 years.

Retrospective analysis on the outcome of open and closed reduction of mandibular condylar fractures at tertiary centre of Gujarat.

AIM: Aim of this study is to analyse the epidemiology, treatment modalities and complications faced in management of mandibular condylar fractures by surgical and conservative treatment, over period of five years at our centre. MATERIAL AND METHOD: Data of patients who were diagnosed with condylar fractures of mandible from 2013 to 2018 was collected, and were evaluated on the basis of Etiology, fracture pattern, age, sex, associated injuries, treatment modalities and complications. RESULTS: The sample size of 82 patients (total 204), 67 male (81.71%) and 15 female (18.29%) (Male: female = 4.5:1), commonly affected 21-40 years age group. RTA is the most common cause (67.07). Subcondylar fractures were significantly related to RTA under influence of alcohol (48.5%). Total 55 (67%) were treated conservatively and (30.59%) of this belonged to MacLennan I. MacLennan II and III were mostly treated surgically with retromandibular approach being the most common. CONCLUSION: The principal factors which determine the treatment plan are the level of the fracture and the degree of displacement. Most of undisplaced fractures can be managed by closed non surgical treatment. Open reduction is justified mostly in adults with undisplaced or displaced fractures associated with Malocclusion and patients requiring immediate function. Even after these guidelines many other factors like Medical condition, Patient acceptance & Cost can be a deciding factor.

A Case of Squamous Cell Carcinoma of the Anterior Urethra in a Man.

Squamous cell carcinoma (SCC) of the anterior urethra in men is rare, comprising less than 1% of all urologic cancers. The mean age at diagnosis is 60 years and it is nearly twice as common in black men compared with white men. We detail a case of SCC of the anterior urethra in a man presenting with an inguinal mass, meatal stenosis, and balanitis.

Comparative Evaluation of Efficacy of Conventional Arch Bar, Intermaxillary Fixation Screws, and Modified Arch Bar for Intermaxillary Fixation.

AIM: Comparative evaluation of efficacy of conventional arch bar, intermaxillary fixation screws, and modified arch bar with respect to plaque accumulation, time required for procedure, postoperative stability after achieving the intermaxillary fixation, mucosal growth, and complication encountered for intermaxillary fixation. MATERIALS AND METHODS: This study is a randomized clinical trial in which participants were divided into three groups of 10 each, and designated as Group A, Group B, and Group C. In Group A, intermaxillary fixation was achieved by the conventional method using Erich arch bar, fastened with 26-gauge stainless-steel wires. In Group B, intermaxillary fixation was achieved by the use of 2 mm × 8 mm 4-6 stainless-steel intermaxillary fixation screws. In Group C, intermaxillary fixation was achieved by modified screw arch bar. A conventional arch bar was modified by making perforations in the spaces between the winglets along the entire extension of the bar which was then adapted to the vestibular surface of the maxilla and mandible, close to the cervical portion of the teeth, and perforations were made in the inter-radicular spaces with a 1.1-mm bur, and after this, 1.5-mm screws were placed to fix the bar. RESULTS: In the present study, a total of 30 patients were analyzed. The average working time for Group A, Group B, and Group C were 110, 16, and 29 min respectively. Oral hygiene scores through modified Turskey Gilmore plaque index which was taken at immediate postoperative, 15, 30, and at 45 days. Maximum hygiene was maintained in intermaxillary fixation screw group followed by modified arch bar group and conventional arch bar group. Maximum stability was seen in the conventional arch bar group followed by modified arch bar group and intermaxillary fixation screw group. With respect to mucosal coverage, maximum mucosal growth was seen in intermaxillary fixation screws group. When complications were taken into consideration, maximum complications were reported in Group A followed by Group B and Group C. CONCLUSION: This study emphasizes that the use of modified arch bar is quick and easy method than conventional arch bar with least chances of glove puncture and needle stick injury to the operator. Oral hygiene maintenance is comparatively better in patients with modified arch bar than with conventional arch bars. Modified arch bar was significantly stable when compared with IMF screws, and therefore, for the patients who require long-term intermaxillary fixation, modified arch bars can be a viable option.

Prostate Biopsy Features: A Comparison Between the Pre- and Post-2012 United States Preventive Services Task Force Prostate Cancer Screening Guidelines With Emphasis on African American and Septuagenarian Men.

We compare prostate biopsy (Pbx) characteristics from 3 years prior to the 2012 United States Preventive Services Task Force (USPSTF) prostate cancer (PCa) screening guidelines with those of 2018, with a focus on African American (AA) men and healthy men aged 70 to 80 years. We completed a retrospective comparative analysis of 1703 sequential patients that had had a Pbx from 2010 to 2012 (3 years) with 383 patients biopsied in 2018. Data was collected on patient age, race, prostate-specific antigen (PSA), digital rectal examination (DRE), total number of biopsies performed, and Gleason sum score (GSS). The data was analyzed to determine whether the 2012 USPSTF screening recommendations affected PCa characteristics. Two study groups were defined as group A and B, Pbx prior to the 2012 USPSTF screening guidelines and that of 2018, respectively. The study population consisted of 71% high-risk AA patients. In Group A (pre-2012 USPSTF guidelines), 567 patients/year underwent a Pbx versus Group B, 383 patients/year, a 32% reduction post-USPSTF. The annual positive Pbx rate for Group A is 134/year versus Group B with 175/year, a 31% increase post-USPSTF. In Group B, there was a 94% relative increase in total positive biopsies. Group A had high-grade PCa (GSS 7-10) in 51.5% versus 60.5% in Group B, a 9% increase post-USPSTF. The proportion of patients with a PSA 10 ng/mL or higher was 25.4% in group A versus 29.3% in group B. The age group of 70 to 80 years demonstrated an increasing trend for patients with PSA 10 ng/mL and higher, 31% in Group A versus 38% in Group B; high-grade tumors (GSS 7-10) occurred in 61% in Group A versus 65% in Group B. After the 2012 USPSTF guidelines against PCa screening, our study shows decreased prostate cancer screening with decreased Pbx, increased PCa diagnosis, and increased high-grade (GSS 7-10) PCa. These trends were especially notable in the 70- to 80-year age group, which showed a larger proportion of total patients (compared with pre-2012 USPSTF guidelines), increased PCa grades, increased PSA levels, and a higher percentage of patients with greater than 50% positive cores. As our patient population consists of 71% AA patients, our results support aggressive PCa screening for high-risk patients, which includes AA men, men with a family history of PCa, and healthy men aged 70 to 80 years.

Evaluation of efficacy of intermaxillary fixation screws versus modified arch bar for intermaxillary fixation.

AIM: This study aimed to evaluate the efficacy of intermaxillary fixation (IMF) screws and modified arch bar. MATERIALS AND METHODS: This study is a randomized clinical trial in which all participants were divided into two groups of ten in each group and designated as Group A and Group B. In Group A, IMF was achieved by the use of four to six 2×8mm stainless steel IMF screws. In Group B, IMF was achieved by modified screw arch bar. RESULTS: In the present study, a total of twenty patients were analyzed. The average working time for Group A and Group B was 16 min and 29 min, respectively. Oral hygiene scores through modified Turesky Gilmore plaque index were calculated at immediate postoperative period and after 15 days, 30 days, and 45 days. Maximum hygiene was maintained in IMF screw group than modified arch bar group, but maximum stability was observed in the modified arch bar group than IMF screw group. CONCLUSION: This study emphasizes the use of IMF screws as a quick and easy method than modified arch bar. Oral hygiene maintenance was comparatively better in patients with IMF screws than those with modified arch bar. Modified arch bar was significantly stable when compared with IMF screws; therefore, for patients who require long-term IMF, modified arch bars can be a viable option, but the perforation in the original arch bar may lead to the weakening of the arch bar, and therefore the prefabricated modified arch bar would be a better option.

Prostate Biopsy Characteristics: A Comparison Between the Pre- and Post-2012 United States Preventive Services Task Force (USPSTF) Prostate Cancer Screening Guidelines.

To compare prostate cancer (PCa) characteristics diagnosed by prostate biopsy (Pbx) in the 3 years before and after the 2012 United States Preventive Services Task Force (USPSTF) recommendations for PCa screening, we completed a retrospective comparative analysis of 402 sequential PCa patients diagnosed from 2010 to 2012 (3 years) with 552 PCa patients diagnosed from 2015 to 2017 (3 years). Data was collected on patient age, race, total number of biopsies performed, prostate specific antigen (PSA), Gleason sum score (GSS), and digital rectal examination (DRE). The data was analyzed to determine whether the 2012 USPSTF screening recommendations affected PCa characteristics. Two study groups were defined, Group A and Group B, prior to and after the 2012 USPSTF screening recommendations, respectively. In Group A (pre- 2012 USPSTF recommendations), 567 patients/year underwent a Pbx versus Group B, 398 patients/year, a 30% reduction post-USPSTF. The annual positive Pbx rate for Group A is 134/year versus Group B 184/year, a 37.3% increase post-USPSTF. Group A had high-grade PCa (GSS 7-10) in 51.5% versus Group B in 60.1%, an 8.6% increase post-USPSTF. In Group B, the total number of positive biopsies was increased by 100%. This study shows that in Group B, the Pbx rate decreased by 30% but the annual PCa detection rate increased by 37%. High-grade GSS (7-10) PCa increased by 8.6%. Despite a reduction in the total number of prostate biopsies by 30%, there was a 100% increase in the total number of positive prostate biopsies.

Prevalence of Bifid Mandibular Canal Amongst Indian Population: A Radiographic Study.

BACKGROUND: Bifid mandibular canal (BMC) is a normal anatomical variation and has been less studied in the Indian population. This study was aimed at estimating the prevalence of BMC amongst Indian population. MATERIALS AND METHODS: The study sample comprised of 5800 digital orthopantomograms (OPGs) which were from four zones of India, i.e. North India, South India, East India, and West India (1700 OPGs from each zone). Any pathological or normal digital OPGs having age between 15 and 80 years in the format of jepg or jpg image were included, while OPGs of operated case of hemimandibulectomy and blurred in which mandibular canal was not traceable were excluded from this study. Each radiograph was assessed for BMC based on the classification given by RP Langlais. Four examiners (two Oral and Maxillofacial surgeons and two Oral and Maxillofacial Radiologists) individually assessed every OPG for the presence of BMC. BMC was considered present, if all the examiners detected it independently. RESULTS: There were 5800 OPGs examined, out of which 2576 were of women and 3224 were of men. Bifid mandibular canals were observed in 135 (2.3%) out of 5800 digital panoramic images. There was no statistically significant correlation found with regard to age. Bifid mandibular canals were found with a female-to-male ratio of 1:1.2. The most frequently encountered type of BMC was type II (1.34%) followed by type I (0.72%), type IV (0.15%), and type III (0.1%).