Implication of photic sneeze reflex in ophthalmology.

Background: Photic sneeze reflex (PSR) also known as autosomal dominant compelling helioophthalmic outburst is a rare condition characterized by uncontrolled sneezing in response to bright light. The exact mechanism causing this is poorly understood. However, various hypotheses have been proposed. Ophthalmic examination involves exposing the patient to bright light like slit lamp, indirect ophthalmoscopy, and surgical microscope, which can trigger sneezing in PSR patients. Purpose: The purpose of this video is to draw light to this rare phenomenon and its implication in ophthalmic surgery. Synopsis: A 74-year-old male patient presented with diminution of vision in left eye. On routine slit lamp and IDO examination, patient had repeated sneezing. We diagnosed him to have photic sneeze reflex. He had pseudophakic bullous keratopathy in the right eye and senile immature cataract in the left eye. Taking into consideration his one eyed status and PSR, measures were taken accordingly and cataract surgery was performed uneventfully. We describe in this video the challenges encountered with this phenomenon and approach in such cases. Highlights: In this video, we tried to give an idea about photic sneeze reflex and its theories. Also, we tried to bring out the impact of PSR on ophthalmologic practice. Video link: https://youtu.be/KMZ_PC0hzhI.

Comparative Evaluation of Fracture Resistance of Endodontically Treated Bicuspids Instrumented With Hand Files, TruNatomy, ProTaper Next, ProTaper Gold, and WaveOne - An In vitro Study.

Aim: The study aims to compare and evaluate the fracture resistance of endodontically treated bicuspids instrumented with Hand Files, TruNatomy (TRN), ProTaper Next (PTN), ProTaper Gold (PTG), and WaveOne (WO). Materials and Methods: In total, 45 extracted single-rooted human premolar teeth were selected and sectioned at or below the cementoenamel junction to obtain roots 15 mm long. The samples were divided into four experimental groups and one control group (n = 9): instrumentation with nickel-titanium (NiTi) Hand Files (control group), instrumentation with TRN files, instrumentation with PTN files, instrumentation with PTG files, and instrumentation with WO files. The samples were obturated by lateral compaction technique using gutta-percha points and AH Plus sealer. A vertical load was applied to the tooth using the universal testing machine (Tecsol-TSI-BDS-2Kn-Sr No. 170710) for the fracture resistance test. Statistical analysis was performed. Results: The study reported that teeth instrumented with NiTi hand files exhibited the highest fracture resistance when compared to all the rotary and reciprocating file systems. Among rotary and reciprocating instruments, root prepared with TRN files showed the most significant resistance to fracture compared with PTN, PTG, and WO files. Conclusion: Within the limitations of this study, it can be concluded that minimally invasive instrumentation of the system preserves more pericervical dentin, which may increase the resistance to fracture. Results of this study and other studies support the use of minimally tapered instruments to improve the fracture resistance of endodontically treated teeth.

Comparative evaluation of shear bond strength of a bioactive material to composite resin using three different universal bonding agents: An in vitro study.

Background: Calcium silicate-based cements or bioceramics have revolutionized and simplified pulp-capping procedures due to its versatility and accessibility. Aim: This study aimed to assess the shear bond strength (SBS) of a bioceramic material to composite resin at two aging periods and with three universal adhesives. Materials and Methods: Forty-eight samples of Biodentine with a height of 2 mm and internal diameter of 4 mm were prepared. After 12 min of mixing, 24 samples were randomly selected and divided into four subgroups: Group I: Single Bond Universal, Group II: Palfique Universal Bond, Group III: G-Premio BOND, and Group IV: Control. Composite resin was restored over Biodentine after the application of universal adhesives using a cylindrical plastic mold of 2 mm height and 2 mm internal diameter. This process was repeated 24 h after mixing on the remaining 24 samples of Biodentine. The universal testing machine was used to measure the SBS of the fractured specimens, followed by stereomicroscopic evaluation. One-way ANOVA test and Bonferroni post hoc test were used to statistically analyze the data. Results: Highest SBS values were observed in Group III at 12 min and 24 h of the setting of Biodentine. Conclusions: Compared to the 12-min group, SBS was higher at 24 h. Group III exhibited higher bond strength than other subgroups.

The effects of recasting on the cytotoxicity of dental base metal casting alloys.

AIM AND OBJECTIVES: In dentistry, base metal casting alloys are extensively used for the fabrication of inlays, onlays, crowns, bridges, partial dentures, etc. During the casting of these alloys, excess amount of material used than needed will be collected as sprue buttons at the end, which is either added to the fresh alloy during casting and reused or disposed of. MATERIALS AND METHODS: The aim of the present in vitro experimental study was to investigate the effect of the complete recasting of four commercially available cobalt-chromium (Co-Cr) and nickel-chromium (Ni-Cr) base metal casting alloys on their cytotoxicity. During the study, four groups of alloys were subjected to complete recasting up to twenty times without the addition of new alloy. The cytotoxicity assessment of the selected alloys after recasting (Co-Cr and Ni-Cr alloys) was carried out using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. RESULTS: The results indicated that Co-Cr alloys exhibit superior cell viability compared to Ni-Cr alloys, and cytotoxic potential of the alloys increased with repeated casting and led to increased cell death. The recasting of alloys in the present study did not show high cytotoxicity even after the 20th recasting. CONCLUSION: From the results of the present study, it can be concluded that the alloys generated as a waste in the dental laboratory can be safely reused up to five times or at least once before they can be disposed, which reduces the cost of the treatment and also helps in conserving the natural resources.

Effect of bleaching agents having a neutral pH on the surface of mineral trioxide aggregate using electron microscopy and energy dispersive X-ray microanalysis.

AIM: To investigate the effect of bleaching agents having a neutral pH on the surface of mineral trioxide aggregate (MTA) used as a coronal seal material for nonvital bleaching, beneath the bleaching agent, with the help of energy dispersive X-ray microanalysis and scanning electron microscopy (SEM). MATERIALS AND METHODS: Six samples of plastic tubes filled with white MTA (Angelus white) were kept in 100% humidity for 21 days. Each sample was divided into 2 and made into 12 samples. These were then divided into three groups. Group A was exposed to Opalescence Boost 40% hydrogen peroxide (HP) (Ultradent). Group B to Opalescence 10% carbamide peroxide (Ultradent) and Group C (control group) not exposed to any bleaching agent. After recommended period of exposure to bleaching agents according to manufacturers' instructions, the samples were observed under SEM with an energy dispersive X-ray microanalysis system (JSM-6380 LA). RESULTS: There were no relevant changes in color and no statistically significant surface structure changes of the MTA in both the experimental groups. CONCLUSION: The present findings suggest that even high concentration HP containing bleaching agents with neutral pH can be used on the surface of MTA without causing structural changes. The superior sealing ability of MTA and the high alkalinity would prevent cervical resorption postbleaching.

Human Papilloma Virus Associated Squamous Cell Carcinoma of the Head and Neck.

Oral cancer is one of the commonest causes for mortality and morbidity with squamous cell carcinoma being the sixth most frequent malignant tumour worldwide. In addition to tobacco and alcohol, human papilloma virus (HPV) is associated with a proportion of head and neck cancers. As in cervical cancers, HPV types 16 and 18 are the cause of malignant transformation. HPV-positive cancers of head and neck have unique characteristics such as occurrence in a younger age group, distinct clinical and molecular features, and better prognosis as compared to HPV-negative carcinomas. They also possess the potential for prevention by using vaccination. The present review describes in detail the salient features of HPV associated oral squamous cell carcinoma (OSCC), its differences from HPV-negative OSCC, diagnostic features, and recent strategies in prevention and management.

Sudden neuropathological deaths: An autopsy study.

BACKGROUND: Sudden or unexpected death can occur from unnatural causes, such as violence or poisoning, as well as from natural causes. Second to cardiac causes, neuropathology is one of the main causes of sudden natural death. In spite of the increasing incidence of neuropathological deaths, few studies have been conducted in Asia - hence the reason for the present study. METHODS: A 10-year (January 2003 to December 2012) retrospective study was conducted at the MS medico-legal institute in a metropolitan city of southern India. All the cases of sudden natural death, where the cause of death was opined to be due to a neuropathology after meticulous medico-legal autopsy and chemical analysis, were included. RESULTS AND CONCLUSIONS: A total of 7520 reported deaths were investigated. These included 291 sudden natural deaths, amongst which the death was attributed to neuropathology in 43 cases (14.7%). Of these 43 cases, 69.7% were male and 30.3% were female. The majority of cases (25.5%) were in those aged ≥60 years. Causes of neuropathology were due to subarachnoid haemorrhage in 48.8% of cases, stroke in 30.2%, meningitis in 14% and tumours in 7%. There was history of hypertension in 46.5% of cases, diabetes in 32.5% of cases and cardiac disease in 18.6% of cases.

Levels of Serum Calcium and Magnesium in Pre-eclamptic and Normal Pregnancy: A Study from Coastal India.

BACKGROUND: Pre-eclampsia is one of the major causes of maternal and fetal morbidity and mortality. Though the aetiology is obscure, recent studies indicate that serum levels of calcium and magnesium may have a role in pre-eclampsia. AIM: The aim of this study was to find out the relationship of serum levels of calcium and magnesium in pre-eclamptic pregnancies compared to normal pregnancies in women from southern coastal India. SETTINGS AND DESIGN: This study was done in a medical college hospital in southern coastal India. MATERIALS AND METHODS: The blood samples from 60 pre-eclamptic women and an equal number of controls were analysed for calcium and magnesium levels. Data on Body Mass Index, maternal and gestational ages, serum calcium and magnesium were compared between the two groups. Outcome of pregnancy was analysed in both the groups and compared. STATISTICAL ANALYSIS: Data was expressed as Mean ± Standard Deviation. Data analysis was done by SPSS version 20. Comparison of serum levels of the elements between the two groups was performed by Independent t-test and Chi-square test and P-value of < 0.05 was considered as statistically significant. RESULTS: The serum calcium concentration was significantly lower in the pre-eclamptic group compared to normotensives (7.84 ± 0.87 mg/dl Vs 8.97± 0.69 mg/dl, p<0.001) whereas the levels of serum magnesium showed a marginal difference in both the groups. (1.43± 0.55 mg/dl Vs, 1.57 ± 0.72 mg/dl P 0.257) The study also showed that pre-eclamptic women were older, their BMI was higher and birth weight of babies lower compared to normotensives. CONCLUSION: According to the results of our research, intake of supplements, mainly calcium may help in the reduction of incidence of pre-eclampsia especially in a population of a developing country like ours where the nutrition is poor. Not many studies have been done in developing countries to assess the role of these elements in pre-eclampsia. The actual role of magnesium and calcium supplements needs further investigation.

Comparative evaluation of antibacterial activity of total-etch and self-etch adhesive systems: An ex vitro study.

AIM: The aim of this ex vivo study was to compare the antibacterial activity of total-etch and self-etch adhesive systems against Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus through disk diffusion method. MATERIALS AND METHODS: The antibacterial effects of Single Bond (SB) and Adper Prompt (AP) and aqueous solution of chlorhexidine 0.2% (positive control) were tested against standard strain of S. mutans, L. acidophilus, and A. viscosus using the disk diffusion method. The diameters of inhibition zones were measured in millimeters. Data was analyzed using Kruskal-Wallis test. Mann-Whitney U test was used for pairwise comparison. RESULT: Of all the materials tested, AP showed the maximum inhibitory action against S. mutans and L. acidophilus. Aqueous solution of chlorhexidine 0.2% showed the maximum inhibitory action against A. viscosus. Very minimal antibacterial effect was noted for SB. CONCLUSION: The antibacterial effects observed for the tested different dentin bonding systems may be related to the acidic nature of the materials.

Death due to coronary artery insufficiency following blunt trauma to the chest.

There have been numerous reports of sudden cardiac death following blunt trauma to the chest, but there is lack of such references in forensic literature. It is the court of law which makes decision about trauma precipitating natural events. The forensic pathologist is scientifically trained in the medical field and would be in a better position to give clear picture about the victim's general status at the time of death, exact nature and severity of the illness he is suffering from if any. He can also assess the nature and severity of injuries sustained, and thus, his opinion as to the possible role played by the traumatic event in bringing about the death is valuable. This paper will discuss the mechanism of cardiac injury or possible cardiac injury and sudden death of an apparently healthy 36-year-old male following blunt chest trauma sustained during alleged assault by his neighbor.

Ovarian Gonadoblastoma with Dysgerminoma in a Young Girl with 46, XX Karyotype: A Case Report.

Gonadoblastoma is a rare gonadal tumour consisting of a mixture of germ cells and sex cord stromal derivatives resembling immature granulosa and Sertoli cells. It usually arises in various types of gonadal dysgenesis containing Y chromosome like pure or mixed gonadal dysgenesis. Occurrence in phenotypically and chromosomally normal women is very rare. We report here a case of gonadoblastoma with dysgerminoma in a 14-years-old girl who presented with a huge tumour, virilisation and normal 46XX karyotype. Association of dysgerminoma is seen in 50% cases of gonadoblastomas. Elevated tumour markers like hCG and alpha Fetoprotein may make the diagnosis challenging.

Diagnostic value of acetic acid comparing with conventional Pap smear in the detection of colposcopic biopsy-proved CIN.

AIM: To assess the role of visual inspection with acetic acid as an alternative to Pap smear and in screening program for cervical cancer in low resource settings. MATERIALS AND METHODS: A total of 225 women in the reproductive age group attending the Department of Gynecology were enrolled in the study. A Papanicolaou smear and visual inspection of the cervix with acetic acid was done. All patients who tested positive on screening then underwent a colposcopy-guided biopsy. The Pap smear of a low-grade squamous intraepithelial lesion (LSIL) and above was taken as abnormal. The statistical test used was the chi-square test and results were computed using Statistical Package for the Social Sciences (SPSS) version 12.0. RESULTS: Out of 225 patients, acetic acid (VIA) was positive in 27 (12%) patients and the Pap smear was abnormal in 26 (11.7%). There were 15 LSIL, 6 high grade squamous intraepithelial lesions (HSIL) and 5 were squamous cell carcinoma. On biopsy, there were 15 mild dysplasia, 2 moderate dysplasia, 4 severe dysplasia, and 3 squamous cancers. The Pap smear had a sensitivity of 83%, specificity of 98%, and positive predictive value of 80% and negative predictive value of 97.9%. VIA had a sensitivity of 70.8%, specificity of 95%, and positive predictive value of 62.9% and negative predictive value of 96.5%. CONCLUSION: Since diagnostic values of VIA is comparable to Pap smear, and it performs well in detecting a high grade lesion, we conclude that VIA can be used as a screening modality for cervical cancer in low resource settings.