Diagnosis and Treatment of a Rare Case of Tubercular Gingival Enlargement.

Granulomatous inflammation is a distinctive variant of the chronic inflammatory response. The orofacial tissues may be affected by a wide range of granulomatous diseases. The lesions range from infections, immunological, and reactive, to foreign body granulomas. As is common knowledge, tuberculosis (TB) is a chronic infectious disease that can affect any region of the body, including the mouth. It may involve the tongue in the mouth and have quite peculiar features and forms. Therefore, while uncommon, oral lesions are crucial for the early detection and treatment of primary TB. We discuss a possible instance of gingival TB that manifested as an enlarged gingiva. The patient received a test dose of antituberculous therapy for one month. The antituberculous therapy was completed for the following five months after one month of treatment showed progress. This case report for dentists emphasizes how crucial it is to consider TB in the differential diagnosis of various types of gingival enlargements.

Esthetic Management of Multiple Gingival Recession - A Case Report and Review of Literature.

The importance of esthetics is increasing for the patients as well as for the dentist. With a high incidence that rises with age and a complicated soft-tissue pathology caused by a wide variety of factors, gingival recessions are a common but troublesome dental problem. They are characterized by the exposure of the root surface of the teeth due to the apical migration of the gingival border beyond the cemento-enamel junction, and they cause both functional and cosmetic disruptions. Many different surgical approaches have been offered over the years to address gingival recession, all with the goal of providing enough root coverage and achieving aesthetically pleasing results. No matter the amount of defects, Zucchelli's method is beneficial in terms of root coverage and keratinized tissue gain when treating many neighboring recessions. In this case study, Zucchelli's coronally advanced flap is used to treat numerous neighboring gingival recessions.

Oral Pyogenic Granuloma at Different Spots: A Series of Case Reports.

Pyogenic granuloma is an inflammatory non-neoplastic lesion of the oral cavity. Chronic, mild, local irritation, trauma, hormonal variables, and certain medications are typical causes of pyogenic granulomas. Women have a higher prevalence than men. The risk is greatest in the second to fifth decades of life. Clinically, the lesion appears smooth, with soft to firm consistency and nontender with a pedunculated or sessile base. Various modalities have been proposed for the treatment of lesion, which include the conventional approach, the use of laser, cryotherapy, and electrocauterization. This case series discusses three cases of pyogenic granuloma in female patients at different locations in the oral cavity. The lesion was subsequently treated with electrosurgery and surgical convention methods. No recurrence of the lesion has been seen in either of the cases.

Efficacy of Topical Vitamin C Application on Healing After Gingival Depigmentation by Scalpel: A Case Series.

Every person expresses their blissful moments through a smile. The elegance of the smile depends majorly on the colour of the gingiva. One of the factors that determines the colour of the gingiva is the amount of melanin pigment in the gingival epithelium. The intensity of melanin pigmentation differs from one person to another, and it is prevalent among all ethnicities. Most people are aesthetically concerned and widely prefer pink gingiva, leading to a demand for gingival depigmentation. There are various suggested treatment modalities for gingival depigmentation, like scalpel, electrosurgery, LASER, cryosurgery, etc. However, the recurrence of pigmentation is common in the depigmentation procedure. The current study attempts to determine the post-operative healing of gingival tissues following split-thickness epithelial excision with and without topical application of Vitamin C (ascorbic acid).

Management of Chronic Inflammatory Gingival Enlargement: A Short Review and Case Report.

Inflammatory gingival enlargement, sometimes referred to as gingival hyperplasia or gingival hypertrophy, is an abnormal proliferation of gingival tissues caused by underlying inflammation. It might also be related to long-term periodontitis. Herein, we discuss the case of a young, otherwise healthy male patient wherein the anterior regions of both the upper and lower arches were affected by long-standing gingival growth. The overgrowth was removed, and an excellent aesthetic outcome was achieved, using a surgical procedure termed gingivectomy. After a 15-day follow-up period, the healing process was satisfactory and no negative effects were found.

Establishment of Cephalometric Norms using Tetragon Analysis in Bengali Population.

Introduction: The traits of craniofacial skeleton varies with race, ethnicity, and culture. Tetragon cephalometric analysis, first given by J Fastlight, et al. in 2000, consist of simple and efficient method of measuring the maxillomandibular relationship and their relation with cranial base. Aims of the Study: urpose of study is to establish cephalometric norms for tetragon analysis in the Bengali population and differences between Bengali males and females. Materials and Methods: A sample of 100 cephalometric radiographs of class I non-orthodontic subjects aged between 18 and 25 years were traced manually and parameters were statistically analyzed by independent t-test using SPSS software. Results: When compared to Fastlicht's Caucasian norms, the upper and lower jaws of the Bengali people are more prognathic and their incisors are relatively proclined. Both jaws were convergent in Bengali population (horizontal growth pattern). Bengali females had a more protrusive upper jaw, proclined anterior teeth, and vertical growth pattern when compared to Bengali males. Conclusion: Tetragon analysis is an efficient tool to quickly assess the dentoalveolar and jaw relations to formulate treatment goals and to compare treatment outcomes.

Diagnosis and Management of Papillon-Lefevre Syndrome: A Rare Case Report and a Brief Review of Literature.

Papillon-Lefevre syndrome (PLS) manifests as an autosomal recessive disorder caused by a mutation in the cathepsin C (CTSC) gene. This genetic alteration results in palmoplantar hyperkeratosis, rapid onset of periodontitis, and premature shedding of both primary and permanent teeth. The major etiological factor responsible for the development of this disorder appears to be variations in the CTSC gene, which is responsible for the production of the cathepsin C enzyme in the body. The multifactorial aetiology of the syndrome is influenced by immunologic, genetic, or microbial factors. This case report presents a clinical picture of a 21-year-old Indian male patient with oligodontia and mobile teeth accompanied by palmoplantar keratosis and a history of recurrent infection. The detailed family history of the patient revealed genetic relevance with PLS. This article will discuss in detail the diagnosis, evaluation and treatment modalities involved in the management of the case.

Physiological impact of personal care product constituents on non-target aquatic organisms.

Personal care products (PCPs) are products used in cleaning, beautification, grooming, and personal hygiene. The rise in diversity, usage, and availability of PCPs has resulted in their higher accumulation in the environment. Thus, these constitute an emerging category of environmental contaminants due to the potential of its constituents (chemical and non-chemical) to induce various physiological effects even at lower concentrations (ng/L). For analyzing the impact of the PCPs constituents on the non-target organism about 300 article including research articles, review articles and guidelines were studied from 2000 to 2023. This review aims to firstly discuss the fate and accumulation of PCPs in the aquatic environment and organisms; secondly provides overview of environmental risks that are linked to PCPs; thirdly review the trends, current status of regulations and risks associated with PCPs and finally discuss the knowledge gaps and future perspectives for future research. The article discusses important constituents of PCPs such as antimicrobials, cleansing agents and disinfectants, fragrances, insect repellent, moisturizers, plasticizers, preservatives, surfactants, UV filters, and UV stabilizers. Each of them has been found to display certain toxic impact on the aquatic organisms especially the plasticizers and UV filters. These continuously and persistently release biologically active and inactive components which interferes with the physiological system of the non-target organism such as fish, corals, shrimps, bivalves, algae, etc. With a rise in the number of toxicity reports, concerns are being raised over the potential impacts of these contaminant on aquatic organism and humans. The rate of adoption of nanotechnology in PCPs is greater than the evaluation of the safety risk associated with the nano-additives. Hence, this review article presents the current state of knowledge on PCPs in aquatic ecosystems.

Fibrinogen as a Predictor of Early Neurological Deterioration in Acute Ischemic Stroke - Evidence From the Indian Population.

Background: Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen - a key component of the coagulation pathway, is controversial. Objective: To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke. Design: Single-centre prospective observational study. Methods: 141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome. Results: Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], P = .046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], P < .001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], P < .001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], P < .001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], P = .020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], P = .038). Conclusion: The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions.

Acantholytic Squamous Cell Carcinoma: a Diagnostic Pitfall on Cytology.

Acantholytic squamous cell carcinoma is an infrequent subtype of squamous cell carcinoma. This tumour variant being rare in itself has been rarely described at the penile location, thus leading to a limitation on information of pathological and immunohistochemical findings and prognosis. Clinical observations indicate an aggressive biologic behaviour. The cytological features on fine-needle aspiration cytology samples have rarely been described in literature. It is imperative for pathologists to be aware of the cytological features so as to allow the distinction of this variant from conventional squamous carcinoma. Here, we explore an intriguing case of a metastatic tumour to inguinal lymph node with the primary lesion at the penis which constituted a diagnostic challenge on cytological examination.

The Association Between Serum Lactate Concentration, Base Deficit, and Mortality in Polytrauma Patients as a Prognostic Factor: An Observational Study.

Introduction In polytrauma patients, it is crucial to identify the severity of the injuries to ensure patient safety and survival. Polytrauma leads to hypotension and hypoperfusion, which results in an anaerobic metabolism with acidosis and a decrease in base excess. Thus, blood lactate levels above a certain threshold indicate the existence of global tissue hypoxia, which is a precursor to shock and multiple organ dysfunction syndrome (MODS). The serum lactate and base deficit (BD) levels are used in polytrauma patients as measures of damage severity and resuscitation endpoints and as a way to evaluate therapy efficacy and to predict outcomes. Thus, arterial blood gas analysis is of great value in assessing the status and prognosis of patients with polytrauma. There are few comparative studies on the predictive values of these markers in trauma patients. To determine which measure can more accurately predict the prognosis of polytrauma patients, the present study investigated the predictive values of mortality of these indicators for mortality within 48 hours of admission to the emergency room (ER) in patients with polytrauma. Methods This prospective study was designed for a single tertiary care center in northern India. We included 90 patients with polytrauma who were between the ages of 18 and 70 years, with the exception of pregnant women, who presented to the ER within six hours of injury with an injury severity score (ISS) >16, serum lactate level >2.0 mmol/L, and BD -4.0 mEq/L at the time of admission. If the patient's ISS was >16 at the time of ER presentation, arterial blood samples were drawn to determine the serum lactate and BD level at the time of admission and at 12, 24, and 48 hours intervals after ER admission. The primary outcome was the change in serum lactate and BD level in polytrauma. The secondary outcomes were an association of serum lactate and BD with mortality and the correlation between serum lactate with the BD and ISS with mortality of polytrauma patients. The timing of all outcome assessments was at 48 hours after each patient's ER admission. Results Lactate clearance from 0-12 hours (t = 2.28, p <0.05), 0-24 hours (t = 6.01, p <0.001), and 0-48 hours (t = 7.98, p <0.001) and a correction in BD from 0-24 (t = 2.68, p <0.01 ) and 0-48 hours (t = 5.46, p <0.001) were significantly higher in nonsurvivors as compared with survivors. In survivors and nonsurvivors, mean serum lactate levels (2.46 ± 1.46 versus 4.15 ± 2.99, t = 3.31, p <0.001, 95%Cl) and mean BD (-3.17 ± 2.58 versus -6.5 ± 4.91, t = 3.86, p <0.001, 95%CI) had a statistically significant difference. The serum lactate and BD levels at time of ER admission (r L0, BD0 = -0.765, p <0.01) and 48 hours after ER admission (r L48, BD 48 = -0.652, p <0.001) were highly negatively correlated. Conclusion In polytrauma patients, serum lactate and BD are simple, quick, and independent biochemical predictors of 48-hour mortality, and this single arterial blood test would thereby improve decision-making for resuscitation effectiveness. Prolonged lactate and BD normalization time were associated with higher mortality. Serum lactate and BD are negatively correlated. A higher ISS at admission was associated with a higher incidence of mortality in polytrauma patients.

Advances in biological methods for the sequestration of heavy metals from water bodies: A review.

Pollution is a major concern of the modern era as it affects all the principal aspects of the environment, especially the hydrosphere. Pollution with heavy metals has unequivocally threatened aquatic bodies and organisms as these metals are persistent, non-biodegradable, and toxic. Heavy metals tend to accumulate in the environment and eventually in humans, which makes their efficient removal a topic of paramount importance. Treatment of metal-contaminated water can be done both via chemical and biological methods. Where remediation through conventional methods is expensive and generates a large amount of sludge, biological methods are favoured over older and prevalent chemical purification processes because they are cheaper and environment friendly. The present review attempts to summarise effective methods for the remediation of water contaminated with heavy metals. We concluded that in biological techniques, bio-sorption is among the most employed and successful mechanisms because of its high efficacy and eco-friendly nature.

Correlation between Chest CT and RT-PCR Testing in India's Second COVID - 19 Wave: A Retrospective Cohort Study.

A novel coronavirus, later designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was found to be responsible for a cluster of pneumonia cases originating in Wuhan City, Hubei province, China and the clinical disease caused by it came to be known as COVID-19. Tests in use for diagnosing COVID-19 infection in India included molecular based tests - RT-PCR, TrueNat and CBNAATAs. As COVID-19 primarily targets the lungs, Chest Computed Tomography (CT) would play a crucial role in the diagnosis, evaluation, and management of the disease. Study was done to assess the diagnostic accuracy of chest computed tomography (CT) in clinically suspected COVID - 19 patients using RT-PCR as the reference standard and establish the correlation between CT Severity Score (CTSS) and RT-PCR results. Material: A single centre tertiary care hospital based retrospective cohort suty was performed on 112 clinically suspected COVID - 19 patients between 1st April 2021 and 31st May 2021. Chest CT and RT-PCR tests were performed for all patients at a time interval of no longer than 7 days between the two tests. Patients with prior chronic respiratory illnesses were excluded. The diagnostic performance of Chest CT was evaluated using RT-PCR as the reference standard. The CTSS was calculated for all patients with positive Chest CT findings, and it was correlated with results of the RT-PCR assay. The primary outcome measures were determination of the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of Chest CT using RT-PCR as the standard of reference. The correlation between CTSS and RT-PCR was the secondary outcome. Observation: 85/112 (76%) patients tested positive on the RT-PCR whereas 91/112 (81%) had chest CT findings typical of SARS-CoV2 infection. Chest CT had a sensitivity of 90.6% [95% CI, 82.3% - 95.8%], a specificity of 48.1% [95% CI 28.7% - 68.0%], a PPV of 84.6% [95% CI, 79.2% - 88.8%], a NPV of 61.9% [95% CI, 43.0% - 77.8%] and an accuracy of 80.4% [95% CI, 71.8% - 87.3%]. There was a significant correlation between the CTSS and RT-PCR positivity (p value = 0.003) Conclusion: Chest CT has a good sensitivity in detecting COVID-19 pneumonia and is useful for moderate to-severe COVID-19 cases in resource limited settings, where RT-PCR testing is cumbersome due to lack of personnel, time, and diagnostic kits.

Correlation between chest CT and RT-PCR testing in India's second COVID-19 wave: a retrospective cohort study.

OBJECTIVES: To assess the diagnostic accuracy of chest CT in clinically suspected patients with COVID-19 using reverse transcriptase PCR (RT-PCR) as the reference standard and establish the correlation between CT Severity Score (CTSS) and RT-PCR results. DESIGN AND SETTING: Retrospective cohort study. Single-centre tertiary care hospital-based study. PARTICIPANTS: We enrolled 112 clinically suspected patients with COVID-19 between 1 April 2021 and 31 May 2021. Chest CT and RT-PCR tests were performed for all patients at a time interval of no longer than 7 days between the two tests. Patients with prior chronic respiratory illnesses were excluded. The diagnostic performance of chest CT was evaluated using RT-PCR as the reference standard. The CTSS was calculated for all patients with positive chest CT findings, and it was correlated with results of the RT-PCR assay. MAIN OUTCOME MEASURES: The primary outcome measures were determination of the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of chest CT using RT-PCR as the standard of reference. The correlation between CTSS and RT-PCR was the secondary outcome. RESULTS: 85/112 (76%) patients tested positive on the RT-PCR whereas 91/112 (81%) had chest CT findings typical of SARS-CoV-2 infection. Chest CT had a sensitivity of 90.6% (95% CI 82.3% to 95.8%), a specificity of 48.1% (95% CI 28.7% to 68.0%), a PPV of 84.6% (95% CI 79.2% to 88.8%), an NPV of 61.9% (95% CI 43.0% to 77.8%) and an accuracy of 80.4% (95% CI 71.8% to 87.3%). There was a significant correlation between the CTSS and RT-PCR positivity (p value=0.003). CONCLUSION: In our experience, chest CT has a good sensitivity and provides a reliable diagnostic tool for moderate-to-severe COVID-19 cases in resource limited settings.

Imperative role of electron microscopy in toxicity assessment: A review.

Electron microscope (EM) was developed in 1931 and since then microscopical examination of both the biological and non-biological samples has been revolutionized. Modifications in electron microscopy techniques, such as scanning EM and transmission EM, have widened their applicability in the various sectors such as understanding of drug toxicity, development of mechanism, criminal site investigation, and characterization of the nano-molecule. The present review summarizes its role in important aspects such as toxicity assessment and disease diagnosis in special reference to SARS-COV2. In the biological system, EM studies have elucidated the impact of toxicants at the ultra-structural level in various tissue in conformity to physiological alterations. Thus, EM can be concluded as an important tool in toxicity assessment and disease prognosis.

Modified RURS Elbow Guard: An Alternative Approach for Thumb Sucking.

Digit sucking or thumb sucking is one of the most common habits usually seen in children. These habits habitually lapse in mid-childhood. The continued persistence of these habits will bring about harmful unbalanced pressures to alveolar ridges, changes in the position of teeth, and occlusion which may result in abnormality if they are continued for a long time. This case report presents a case of a 5-year-old male child patient with a habit of thumb sucking that was successfully ceased by a modified RURS elbow guard appliance. How to cite this article: Anand S, Jyoti D, Shukla JN, et al. Modified RURS Elbow Guard: An Alternative Approach for Thumb Sucking. Int J Clin Pediatr Dent 2021;14(4):590-592.

Giant multiple vesical calculi: A case report.

Giant multiple vesical calculi are rare entities in modern urological practice. Very few cases of vesical calculi of more than 100 g has been reported in English literature. Largest vesical calculus was of weight 6294 g by Arthur et al. Bladder stones may be asymptomatic and discovered as incidental finding. However, when symptoms occur, these include lower abdominal pain, difficult urination, frequent urination, painful urination and blood in urine. Our CASE report demonstrated two vesical calculi weighing 194 g and 292 g which is a rare finding in today's urological practice.

Influence of Implant Neck Design on Crestal Bone Loss: A Comparative Study.

BACKGROUND: The success rate of dental implants depends on the amount of crestal bone around the implants. Crestal module is the transosteal region of implant that is designed to receive the prosthetic component. The design of crestal module influences the crestal bone loss around implants. AIM: The purpose of this study was to evaluate and compare the crestal bone loss around implants with smooth collar and implants with micro threaded rough collar design. MATERIALS AND METHODS: A total of 150 individuals received 100 dental implants. Each individual received one implant with smooth collar design (Group-A) and one implant with microthreaded rough collar design (Group-B) in the posterior edentulous region. All the 100 implants were prosthetically loaded after a healing period of 3 months. Crestal bone loss was measured on mesial, distal, buccal, and lingual side of each implant using periapical radiographs before loading (baseline), immediately after loading, 6, and 12 months after loading. RESULTS: The average crestal bone loss 12 months after loading the implants in Group A and Group B was 3.75 mm and 3.23 mm, respectively, the value being statistically significant (P < 0.05). In both Group A and Group B, the average crestal bone loss was maximum on the lingual side followed by buccal, distal, and mesial sides. CONCLUSION: Crestal bone loss around rough-surfaced microthreaded neck implants was significantly lower than smooth-surfaced neck implants.