Outcomes of Deep Inferior Epigastric Artery Perforator (DIEP) Flap in Indian Population-A Prospective Single-Institute Study.

Introduction Breast reconstruction has become integral part of breast cancer treatment. Deep inferior epigastric perforator (DIEP)-based flap is considered the gold standard in autologous breast reconstruction. Aims and Objectives The aim of this study was to evaluate the patient satisfaction and the incidence of complications in DIEP flaps in an Indian setup for breast reconstruction. Materials and Methods This is a prospective, nonrandomized study at a single institute-Manipal Hospitals, Old Airport Road, Bangalore. Eligible patients were women aged between 28 and 60 years with primary breast cancer requiring mastectomy and radiotherapy, who consented for DIEP flap reconstruction. Results The study includes subjects who had autologous breast reconstruction after mastectomy with DIEP flap between January 2019 and August 2021 that included 31 patients with a minimum follow-up of 2 years. Four flaps were turbocharged and 17 flaps were superdrained primarily. The average operative time for the whole procedure by adopting a two-team approach is 353.8 ± 43.793 minutes. About 94.1% patients had excellent aesthetic score results. Six patients developed mastectomy flap necrosis, one had fat necrosis that was managed conservatively, whereas one patient had donor site re-exploration for hematoma. We had no DIEP flap necrosis, seroma, flap site hematoma, or flap failure. Physical well-being module of Breast-Q indicated an average of 83 points, psychosocial well-being module indicated 80 points, whereas sexual scores reverted an average of 77 points. Among satisfaction module, aesthetic outcomes for breast showed an average of 94 points, whereas the donor site had 96 points. Satisfaction with information, surgeon, medical staff each gained more than 87 points. Conclusion Breast reconstruction with DIEP flap yields good aesthetic outcomes and quality of life in Indian population. The incidence of fat necrosis, flap and donor site complications is less over time and will enhance the patient satisfaction score further.

Effectiveness of nanosilver fluoride in arresting dental caries in children with one- year follow-up - a systematic review.

OBJECTIVE: This systematic review assesses the effectiveness of nanosilver fluoride in arresting dental caries in children, with one-year follow-up. METHODOLOGY: Multiple databases were searched for RCTs (randomized controlled trials) according to specified inclusion-exclusion criteria. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) reporting guidelines were followed to conduct the systematic review. Nanosilver fluoride was compared against silver diamine fluoride varnish or topical fluoride varnish or placebo. The primary outcome was effectiveness in arresting dental caries. The Cochrane risk of bias tool was used to assess the risk of bias. DATA SOURCES: Articles were searched in the following databases: PubMed, Ovid, Web of Science, Wiley Online, Proquest and Cinahl. DATA SELECTION: The initial search yielded a total of 3660 hits. After deduplication, a total of 2507 articles were obtained. After screening the title and abstract, 11 studies were included. After the full-text screening, a total of three articles that fulfilled the eligibility criteria were included in the analyses. DATA EXTRACTION AND DATA SYNTHESIS: All the three studies were RCTs carried out in school children, and involved application of the material in primary teeth with a follow-up of one year. RESULTS: In two studies, nanosilver fluoride varnish group showed significantly higher arrest of dental caries compared to placebo group. In the study comparing nanosilver fluoride and silver diamine, both the groups showed arrest of dental caries and there was no significant difference between the groups. One study showed high risk of bias for allocation concealment. CONCLUSION: The included studies in the final review effectively demonstrated the benefit of using nanosilver fluoride in the arrest of dental caries.

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.

Lung transplantation in an 18-month-old with donor specific antibodies - The use of intraoperative, targeted plasma exchange.

BACKGROUND: Sensitised patients undergoing Human Leukocyte Antigen-incompatible transplantation are at increased risk of hyperacute rejection and may be predisposed to antibody-mediated rejection, chronic lung allograft dysfunction and higher mortality. CASE: We present a case of primary lung transplantation in the setting of late identification of donor specific antibodies treated with intraoperative target plasma exchange. The patient was treated with fresh human plasma to a final volume of 1.5 times the patient's systemic circulation. From a pre-transplant mean fluorescence intensity of 5002, donor-specific antibodies were undetectable following plasma exchange on single antigen bead assay. CONCLUSIONS: This method represents a potential desensitisation technique for use in the intraoperative period.

Effective atomic number and electron density of some biologically important lipids for electron, proton, alpha particle and photon interactions.

X-ray, γ-ray and charged particle interaction parameters of biomolecules are useful in medical diagnosis and radiation therapy as exposure to radiations can cause energy of photons and charged particles to be deposited in body through various interaction processes. With this in view, the effective atomic number (Zeff) and electron density (Neff) of some biologically important lipids for X-ray, γ-ray and charged particle interactions were studied in the energy range 10 keV-500 MeV using logarithmic interpolation method. A non-monotonic variation in Zeff values was observed for protons and alpha particles in low and intermediate energy regions respectively whereas a sudden increase in Zeff was observed for electron interaction in higher energy region. Zeff values were maximum in higher energy region for total electron interactions whereas maximum values of Zeff for total alpha particle interactions were at relatively lower energies. Highest Zeff values were found at lower energy region of photoelectric absorption dominance for photon interactions. Variation in Neff seems to be similar to variation in Zeff as they are inter-related.

A maxillofacial prosthetic obturator using precision attachments.

The majority of maxillary defects can be rehabilitated with pedicled flaps. However, when there are very large resections of the maxilla and flap success is questionable, then the defect may be obturated with a conventional hollow bulb clasp retained obturator or implant retained obturator prosthesis. However, inadequate retention, stability and support may be associated with the use of a conventional obturator and in case of recurrence the success of implant is questionable. A precision attachment becomes the silver lining. They have been used to retain obturator for some time. The use of precision attachments in a dentate maxillectomy patient can yield significant functional improvement while maintaining the obturator's aesthetic advantages. This clinical report describes the successful prosthetic rehabilitation of maxillary defects with an obturator retained using two different extracoronal resilient precision attachments. Attachment retained prosthesis provides a successful closure for the defect but also better esthetics, retention, better tolerability and better mastication and speech.

Assessment of malocclusion status, dentition status, and treatment needs among 15-year-old school children of Mangalore.

BACKGROUND AND OBJECTIVES: Dental caries and malocclusion are common dental public health problems. Surveys provide us with an insight into the oral health status and treatment needs and also help in proper treatment planning. Hence, the objective of this study was to assess the malocclusion status, dentition status, and treatment needs of 15-year-old school children of Mangalore. METHODOLOGY: A cross-sectional study of 1001 school children aged 15-year-old was conducted in Mangalore. Their malocclusion status, dentition status, and treatment needs were recorded using the WHO oral health assessment pro forma. Statistical analysis was done using Statistical Package for Social Sciences version 17. Descriptive statistics was obtained and Chi-square test was used. The level of significance was set at 0.05. RESULTS: Decayed teeth were prevalent in 45.5% of the study subjects. Malocclusion was present in 30% of the study subjects. Teeth missing due to caries and those requiring extraction and prosthetic rehabilitation were significantly higher in government schools (P < 0.05). Malocclusion and treatment need was significantly higher in government schools (P < 0.05). CONCLUSION: From the present study, we can conclude that the school children aged 15 years of Mangalore had varied malocclusion status, dentition status, and treatment needs with significantly higher treatment needs and malocclusion among children of government school.

An In vitro Study to Compare the Effect of Different Types of Tea with Chlorhexidine on Streptococcusmutans.

INTRODUCTION: Tea is the second most commonly consumed beverage in the world after water. The leaf and bud of the plant Camellia sinensis produces tea. The different forms of tea are 'non-fermented' green tea, 'semi-fermented' oolong tea and 'fermented' black tea according to the manufacturing process. Streptococcus mutans is the main causative organism in dental caries and plaque formation. AIM: The present study was undertaken to determine the antibacterial effectiveness of aqueous and ethanol extracts of green tea, black tea and oolong tea against S. mutans in comparison with 0.2% chlorhexidine. MATERIALS AND METHODS: An in vitro study was conducted to compare the effectiveness of aqueous and ethanol extracts of green tea, black tea and oolong tea with 0.2% chlorhexidine against S. mutans. Chlorhexidine 0.2% commercially available as mouthwash was used as such for comparison. The antimicrobial activity was determined using agar well diffusion method. About 50 µl of the aqueous and ethanol extracts of tea and 0.2% chlorhexidine were inoculated into the wells prepared on blood agar plates smeared with S. mutans. The agar plates were incubated for 24 hours after which the diameter of the zone of inhibition was measured. Analysis of Variance (ANOVA) followed by Tukey's post hoc test were used for statistical analysis. RESULTS: The mean zone of inhibition of the aqueous extracts of green tea, black tea, oolong tea and chlorhexidine was found to be 16.33 mm, 10.33 mm, 19.66 mm and 22 mm respectively. The mean zone of inhibition of the ethanol extracts of green tea, black tea, oolong tea and chlorhexidine was found to be 14 mm, 9 mm, 20.66 mm and 22 mm respectively. The study result state that the inhibitory effect of chlorhexidine is almost similar to that of oolong tea followed by green tea and black tea. CONCLUSION: From the present study, it can be concluded that the aqueous and ethanol extracts of oolong tea showed highest antimicrobial activity compared to green tea and black tea.

Anticandidal efficacy of denture cleansing tablet, Triphala, Aloe vera, and Cashew leaf on complete dentures of institutionalized elderly.

With an increase in the number of dependent elderly, there is a need to introduce few natural products for denture cleansing, which are easily and economically available. Hence the aim of this study was to compare the anticandidal efficacy of denture cleansing tablet (sodium bicarbonate and sodium perborate monohydrate), Triphala (Phyllanthus emblica, Terminalia chebula and Terminalia belerica fruits powders in equal proportion), cashew leaf, Aloe vera and water (control) on complete dentures of institutionalized elderly. Study population consisted of 50 institutionalized elderly of Mangalore, Karnataka, with 10 in each group. Swabs were collected from the dentures before and after the use of denture cleansing tablet, Triphala, cashew leaf, Aloe vera, and water (control). Thereafter, the swabs were cultured on Sabouraud dextrose agar and the total candida counts were determined. Denture cleansing tablet and Triphala Churna showed a statistically significant reduction in Candida counts (P < 0.05). Denture cleansing tablet and Triphala Churna were found to be more effective.