Dermatoglyphics: Prediction for Prevention: An Innovative Tool in our Stash!

Background: Early childhood caries (ECC) has created pandemonium worldwide and so in India which is alarming and accentuates the need to foster novel and effective preventive strategies that are synergistic with the current one. There are different methods to diagnose ECC. Nonetheless, up until now, there has been no method to predict ECC. Dermatoglyphics could be considered a noninvasive and early predictor of dental caries in children, as ECC is a multifactorial disease with the influence of genetic patterns. Aim: The present study was undertaken to find out a possible relation between some quantitative and qualitative dermatoglyphic variables, ECC, and salivary bacteria. Materials and methods: The study was carried out on 200 children within the age-group of 36-72 months. The study population was divided into four groups comprising 50 individuals each based on decayed, missing and filled teeth (dmft) score and gender; group I-caries male (dmft ≥ 5), group II-caries free male (dmft score 0), group III-caries female (dmft≥ 5), and group IV-caries free female (dmft score 0). Dermatoglyphic patterns of all 10 palmar digits were recorded and assessed qualitatively and quantitatively. Results: The caries group showed maximum occurrence of whorls, which were more prevalent in females and decreased frequency of loops when compared to caries free group. There was a significant association of the whorl pattern with the microbial counts of Streptococcus mutans (S. mutans) and Lactobacillus. Conclusion: There is explicit variation in dermatoglyphic patterns between the ECC and caries-free group indicating a correlation between dermatoglyphic patterns and dental caries. How to cite this article: Shah SG, Kaul B, Gupta A, et al. Dermatoglyphics: Prediction for Prevention: An Innovative Tool in our Stash! Int J Clin Pediatr Dent 2023;16(S-1):S101-S108.

Forensic Odontological Parameters as Biometric Tool: A Review.

Human identification by virtue of dental identification is on the increase in the past few years and has served as a major adjunct in the identification process. The science associated with the dealing of evidences from dental, oral, and paraoral structures-Forensic Odontology, is a boon in itself. It has been seen that the role of forensic odontology has increased as most of the times teeth and other orally associated structures remain the only means of identification in the worst of scenarios where the conventional biometrics such as fingerprint, iris scan, palm print, etc., may be lost and are therefore not reliable enough to resolve the purpose of identification. There are various important aspects in forensic odontology which are associated with the study of tooth prints, i.e., ameloglyphics, radiographs, the study of palatal rugae patterns, i.e., rugoscopy, cheiloscopy, i.e., the study of lip patterns, tongue prints which can serve as an important biometric tool to aid in the human identification process. Dental biometrics helps to determine several parameters that serve in the interest of forensics such as type of specimen, population affinity, sex, age, stature, race, and various other individualization factors. So, comparative dental identifications with the help of a biometric recognition system will play a major role in identifying deceased individuals in disasters, crimes, or any other mass tragedies. How to cite this article: Kaul B, Vaid V, Gupta S, et al. Forensic Odontological Parameters as Biometric Tool: A Review. Int J Clin Pediatr Dent 2021;14(3):416-419.

Association of SUMOylation Pathway Genes With Stroke in a Genome-Wide Association Study in India.

OBJECTIVE: To undertake a genome-wide association study (GWAS) to identify genetic variants for stroke in an Indian population. METHODS: In a hospital-based case-control study, 8 teaching hospitals in India recruited 4,088 participants, including 1,609 stroke cases. Imputed genetic variants were tested for association with stroke subtypes using both single-marker and gene-based tests. Association with vascular risk factors was performed with logistic regression. Various databases were searched for replication, functional annotation, and association with related traits. Status of candidate genes previously reported in the Indian population was also checked. RESULTS: Associations of vascular risk factors with stroke were similar to previous reports and show modifiable risk factors such as hypertension, smoking, and alcohol consumption as having the highest effect. Single-marker-based association revealed 2 loci for cardioembolic stroke (1p21 and 16q24), 2 for small vessel disease stroke (3p26 and 16p13), and 4 for hemorrhagic stroke (3q24, 5q33, 6q13, and 19q13) at p < 5 × 10-8. The index single nucleotide polymorphism of 1p21 is an expression quantitative trait locus (p lowest = 1.74 × 10-58) for RWDD3 involved in SUMOylation and is associated with platelet distribution width (1.15 × 10-9) and 18-carbon fatty acid metabolism (p = 7.36 × 10-12). In gene-based analysis, we identified 3 genes (SLC17A2, FAM73A, and OR52L1) at p < 2.7 × 10-6. Eleven of 32 candidate gene loci studied in an Indian population replicated (p < 0.05), and 21 of 32 loci identified through previous GWAS replicated according to directionality of effect. CONCLUSIONS: This GWAS of stroke in an Indian population identified novel loci and replicated previously known loci. Genetic variants in the SUMOylation pathway, which has been implicated in brain ischemia, were identified for association with stroke.

The Epiphany of Post-COVID: A Watershed for Pediatric Dentistry.

Coronavirus disease-2019 (COVID-19) has spread as a pandemic throughout the world, posing a serious public health threat. Dentists appear to have a higher risk of COVID-19 exposure amongst Healthcare workers. This danger is even more magnified in pediatric dentistry since infected children typically have an asymptomatic, mild, or severe clinical viral infection and so can considerably contribute to community-based COVID-19 transmission. These are unprecedented times that require unprecedented efforts with dynamic protocols to be adopted. It is very challenging, but also an amazing opportunity to UNLEARN, RELEARN, AND REORGANIZE our approach of dental practice, so as to adapt and come at par to the emerging "NEW NORMAL". Coronavirus-" THE ENFORCER" has enforced upon us, screening of patients for COVID-19, utilization of stringent disinfection & sterilization protocols, be attired with personal protection such as PPE, N95 Mask, face shield, etc., to minimize chances of contraction or cross-contamination with social distancing and appropriate hygiene practices as a new norm. It has further enlightened the concept of "Non-aerosol" or "Minimally invasive techniques" that will possibly guide our therapeutic choices not only in the immediate future but also in the long term. The purpose of this review is to offer a compendious abridgment of literature available on COVID-19 to give an insight on recommendations that have been published about pediatric dental practice during COVID-19 and lays a concrete emphasis on the paradigm shift in the actual in-practice treatment options, to adapt to the changing circumstances during the pandemic and the times to follow, opening scenarios of prevention and cure that are more sustainable, safe, and efficient. HOW TO CITE THIS ARTICLE: Gupta A, Shah SG, Kaul B, et al. The Epiphany of Post-COVID: A Watershed for Pediatric Dentistry. Int J Clin Pediatr Dent 2021;14(6):802-811.

Emulating Odontolegal Practice: A Paradigm Shift in the Dental Practice Laying More Emphasis on Dental Records-A Perspective and Contemporary Study with a Reality Check.

AIM: This study was conducted to evaluate the knowledge and the awareness on odontolegal practice with more emphasis on significance of maintaining dental records by the oral health professionals. MATERIALS AND METHODS: A cross-sectional study was carried out among 120 dental practitioners of Jammu and Kashmir, Himachal Pradesh, Delhi, Punjab, Gujarat, and Odisha. A questionnaire was designed to assess their practice and knowledge regarding the importance of maintenance of dental records and the knowledge about dental jurisprudence. Total 120 questionnaire samples were distributed among dental health professionals, and the data obtained were studied and formulated for significance of dental records. RESULTS: Feedback obtained was then analyzed. Seventy percentage of the dentists are not maintaining clinical records of their patients and 20% of the dentists acknowledged that they are not keeping or maintaining dental records like X-rays and cast models of their patients. Eighty percentage of dentists were not known to the ethical importance of dental record, i.e., for how long they have to maintain records of their patients and other details. CONCLUSION: This study concludes that the oral health professionals lacked the knowledge and awareness about odontolegal aspects and the significance of maintaining dental records. It was observed that there was insufficient knowledge about medicolegal systems and there is a need to bring awareness and knowledge of the same in the dental fraternity. CLINICAL SIGNIFICANCE: With the increasing use of medical insurance and subsequently mediclaims, negligence suits, scientific evaluation, and research purposes, and health planning, etc., the "dental records itself have evolved as a separate science and therefore needs to be considered in the curriculum for dental students as this would introduce the concept for application in their future practice, thus avoiding legal complications in the future." HOW TO CITE THIS ARTICLE: Kaul B, Gupta S, Vaid V, et al. Emulating Odontolegal Practice: A Paradigm Shift in the Dental Practice Laying More Emphasis on Dental Records-A Perspective and Contemporary Study with a Reality Check. Int J Clin Pediatr Dent 2020;13(3):217-220.

Effect of Parental Employment and Family Status (Nuclear-Joint) on the Child's Oral Health in Jammu Population: A Cross-sectional Study.

This study was conducted to assess or evaluate the influence of parental employment on the child's oral and dental health. AIMS AND OBJECTIVES: This study aims to assess the repercussions of working parents in Jammu belonging to nuclear and joint families on the oral and dental health of children aged 2-14. MATERIALS AND METHODS: A cross-sectional study was conducted in which a total of 1,848 children were examined from March 01, 2012, to February 28, 2014, who came to seek treatment in the Department of Pediatric and Preventive Dentistry, Indira Gandhi Govt. Dental College and Hospital, Jammu, along with the accompanying parents. Assessment was based on the following parameters: dental caries, eruption status of teeth, and orthodontic status. RESULTS: Age-wise distribution of the patients was done in four groups, 2-5 years (33%), 5-8 years (30%), 8-11 years (21%), and 11-14 years (16%), and were examined as per the above-mentioned criteria. The results were compiled and statistically analyzed using Chi-square test. Children of working parents exhibited more incidence of dental caries which was statistically analyzed (p value = 0.111) and was found insignificant and when analyzed as per the retained deciduous teeth and orthodontic anomalies (p value <0.05) was found to be highly significant. Also, children belonging to the nuclear families whether employed or unemployed were found to be more affected by the above-mentioned dental diseases. CONCLUSION: It was seen that the children whose both parents were working had more incidence of dental caries, over-retained deciduous teeth, and were possessing habits that lead to orthodontic anomalies. HOW TO CITE THIS ARTICLE: Kaul B, Mahajan N, Kotwal B, et al. Effect of Parental Employment and Family Status (Nuclear-Joint) on the Child's Oral Health in Jammu Population: A Cross-sectional Study. Int J Clin Pediatr Dent 2020;13(5):504-507.

Association of cutaneous adverse drug reactions due to antiepileptic drugs with HLA alleles in a North Indian population.

PURPOSE: Aromatic antiepileptic drugs (AEDs) are frequently implicated in cutaneous adverse drug reactions (cADRs), a few of which are associated with certain human leukocyte antigen (HLA) alleles in some populations. We aimed to find HLA-associations with AED-related cADRs among North Indians. METHODS: North Indian subjects with cADR due to an AED, and those who were AED-tolerant were recruited as cases and controls, respectively. Genotyping for HLA-A, B and DRB1 were performed. Statistical analysis to compare carrier-rates and allele-frequencies between cases and controls (and healthy population, where necessary), was done for HLA-alleles occurring more than twice in either group. RESULTS: 120 cases {11 - Lamotrigine (LTG), 14 -Valproic acid (VPA), 8 -Levetiracetam (LEV), 35 -Carbamazepine (CBZ) and 52 - Phenytoin (PHT)}, and 250 controls were recruited. Presence of HLA-A*31:01 and HLA-B*51:01 were found to increase the risk of Maculopapular exanthema (MPE) due to CBZ and PHT (OR = 6.38; 95% CI: 1.46-27.75; OR = 4.60; 95% CI: 1.54-13.72, respectively). Among the severe cADRs, HLA-B*57:01(OR = 11.00 95% CI: 1.41-85.81) and HLA-DRB1*07:01 (OR = 7.25; 95% CI: 1.09-48.18) were noted to be significantly associated with CBZ-induced Stevens Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN); HLA-B *51:01 was associated with drug reaction eosinophilia and systemic symptoms (DRESS) caused by PHT (OR = 6.90; 95% CI: 1.38-34.29). CONCLUSIONS: We found significant associations of some HLA alleles with specific cADRs to CBZ and PHT in North Indians, which may need to be tested before AED-initiation; only screening for HLA-B*15:02 may not help in this population.

Lateralizing value of unilateral relative ictal immobility in patients with refractory focal seizures--Looking beyond unilateral automatisms.

PURPOSE: Ictal motor phenomena play a crucial role in the localization of seizure focus in the management of refractory focal epilepsy. While the importance of unilateral automatisms is well established, little attention is paid to the contralateral relatively immobile limb. In cases where automatisms mimic clonic or dystonic movements and in the absence of previously well-established signs, unilateral relative ictal immobility (RII) is potentially useful as a lateralizing sign. This study was carried out to examine the lateralizing value of this sign and to define its characteristics among patients of refractory focal epilepsy. METHODS: VEEGs of 69 consecutive patients of refractory focal epilepsy who had undergone epilepsy surgery at our center over last four years were reviewed and analyzed for the presence of RII. Unilateral RII was defined as a paucity of movement in one limb lasting for at least 10s while the contralateral limb showed purposive or semi-purposive movements (in the absence of tonic or dystonic posturing or clonic movements in the involved limb). The findings were seen in the light of VEEG, radiological and nuclear imaging data, and with post-surgical outcome. RESULTS: Unilateral RII as a lateralizing sign was found in 24 of 69 patients (34.78%), consisting of both temporal and extra temporal epilepsy, with 100% concordance with VEEG and MRI data. All patients demonstrating this sign had a good post-surgical outcome. CONCLUSION: RII, when well characterized is a frequent and reliable lateralizing sign in patients of refractory focal epilepsy.

Parkinsonian syndromes presenting with circadian rhythm sleep disorder- advanced sleep-phase type.

BACKGROUND: Circadian rhythm sleep disorder-advanced sleep-phase type is a relatively uncommon disorder, mostly seen among the elderly population. Impaired circadian rhythms have been reported in neurodegenerative conditions; however, there are no reports of any circadian rhythm sleep disorder among patients with Parkinsonian syndromes. We report two patients who presented with this circadian rhythm disorder, and were then diagnosed with a Parkinsonian syndrome. The cases. A 65-year-old retired man presented with history of abrupt change in sleep schedules, sleeping around 6.30-7 p.m. and waking up around 3-4 a.m. for the last 2 months. On detailed examination, the patient was observed to have symmetrical bradykinesia and cogwheel rigidity of limbs. A diagnosis of multiple system atrophy was made, supported by MRI findings and evidence of autonomic dysfunction. Symptoms of change in sleep-wake cycles resolved over the next 1 year, while the patient was treated with dopaminergic therapy. A 47-year-old man, who was being evaluated for presurgical investigation for refractory temporal lobe epilepsy, presented with complaints suggestive of dysarthria, bradykinesia of limbs and frequent falls for 5 months. Simultaneously, he began to sleep around 7 p.m. and wake up at about 2-3 a.m. Examination revealed severe axial rigidity, restricted vertical gaze and bradykinesia of limbs. A diagnosis of progressive supranuclear palsy was made. CONCLUSION: This is the first report of Parkinson's plus syndromes presenting with a circadian rhythm sleep disorder-advanced sleep-phase type. More prospective assessment for circadian sleep disorders may introduce useful insights into similar associations.

Bidirectional ventricular tachycardia of unusual etiology.

Bidirectional ventricular tachycardia (BDVT) is a rare form of ventricular arrhythmia, characterized by changing QRS axis of 180 degrees. Digitalis toxicity is considered as commonest cause of BDVT; other causes include aconite toxicity, myocarditis, myocardial infarction, metastatic cardiac tumour and cardiac channelopathies. We describe a case of BDVT in a patient with Anderson-Tawil syndrome.

The syndrome of pit of the lower lip and its association with cleft palate.

The Van der Woude syndrome is a rare autosomal dominant developmental malformation usually associated with lower lip pits, cleft lip and palate. These congenital lip pits appear, clinically, as a malformation in the vermilion border of the lip, with or without excretion. Obligate carriers of this dominant mutation may have lip pits alone, cleft(s) alone, clefts and pits or neither. Here, we present a case report of a 10 year-old male patient with Van der Woude syndrome and a brief literature on its treatment modalities.

Paroxysmal occipital discharges suppressed by eye opening: spectrum of clinical and imaging features at a tertiary care center in India.

BACKGROUND: Paroxysmal occipital discharges (PODs) demonstrating the phenomena of fixation-off sensitivity have classically been described in childhood epilepsies with occipital paroxysms. AIM: We attempted to delineate the demographic, clinical and imaging characteristics of patients whose interictal electroencephalograms (EEGs) showed occipital discharges with fixation-off sensitivity at our center. MATERIALS AND METHODS: During the period between 2003 and 2005, patients whose interictal EEGs showed PODs were included in the study. A detailed history, clinical examination and EEG findings along with imaging characteristics were analyzed. RESULTS: Of the 9,104 interictal EEGs screened during the study period, 11 patients (6 females and 5 males) aged between 5 and 17 years were identified to have PODs with fixation-off sensitivity. Five had history of generalized tonic-clonic seizures. Three patients could be classified under Panayiotopoulos syndrome; the remaining 8 (72.2%) patients had symptomatic epilepsy. CONCLUSION: This study suggests that the phenomenon of fixation-off sensitivity is found not only in patients of idiopathic focal epilepsies, but also in a substantial number of patients of symptomatic epilepsy. The high proportion of symptomatic epilepsy with phenomenon of fixation-off sensitivity may be related to the referral pattern.

Iron deficiency masquerading as idiopathic intracranial hypertension.

A 13-year-old female presented with complaints of headache, vomiting, diplopia and progressive blurring of vision developing sequentially over 1 month. Examination revealed marked pallor and bilateral lateral rectus palsy with a visual acuity of 6/12 and 6/36 in the left and the right eye, respectively. Fundus examination showed late stage papilloedema in both eyes. Investigation for anaemia revealed severe iron deficiency. MRI of the brain was normal. The cerebrospinal fluid opening pressure was markedly raised at 320 mm of water but fluid analysis did not reveal any abnormality. Thus, a diagnosis of iron deficiency anaemia with idiopathic intracranial hypertension was made. The patient responded dramatically to intravenous iron treatment. Physicians must be aware of this rare presentation of the common problem of iron deficiency, the rapid correction of which plays an instrumental role in salvaging the patient's vision and preventing a recurrence of disease.

Extensive medium-vessel vasculitis with SLE: an unusual association.

Systemic lupus erythematosus (SLE) is a multisystem disease of autoimmune origin. Vasculitis is often seen with SLE, but is usually limited to small vessels alone. The primary pathology in SLE-related vasculitis is leukocytoclastic vasculitis. Medium- and large-vessel vasculitis in association with SLE is distinctly uncommon and is limited to occasional case reports only. In addition, reports of medium-vessel vasculitis with SLE generally describe involvement of a single vessel bed. We report a rare case of extensive vasculitis involving medium-sized vessels in a patient with SLE. Our patient presented with classic signs and symptoms of SLE and satisfied a majority of the American College of Rheumatology criteria for SLE. She also had toe gangrene at presentation and developed paraplegia during the hospital stay. Radiologic studies showed evidence of diffuse medium-sized vessel vasculitis. The patient was treated with monthly pulse cyclophosphamide and high-dose prednisolone. Follow-up showed no new features of vasculitis and improvement in the signs and symptoms of SLE. Her paraplegia showed no response to treatment. This case stresses that medium-sized vessel occlusion anywhere in the body can occasionally occur due to vasculitis in a patient with SLE.