International journal of dental and medical specialty

2-4

Authors: Isha Gupta , Bimal Kumar Agrawal , Anand Jindal

The giant goiter is enormously a common endocrine abnormality and the interesting phenomenon of enlarged thyroid gland almost exclusively confined to regions of endemic goiter. Goiters can result from biosynthetic defects, iodine deficiency, autoimmune disease or nodular diseases and if left untreated can lead to some symptoms of dyspnea, dysphagia and hoarseness by compressing the trachea, esophagus, and recurrent laryngeal nerve respectively. A majority of patients with giant goiter frequently desire surgical excision for structural distortion (cosmetic) and social reasons. Some of them, however, experience repeated attacks of intercurrent respiratory tract infection which can complicate the postoperative prognosis and cure. About a fifth of giant goiter patients frequently present with acute respiratory distress that requires emergency surgical intervention like tracheostomy. The peri-operative management of this endocrine disease is both formidable and hazardous. The operative time is not merely larger than for a standard thyroidectomy but mortality can also be unacceptably high. Here, we present a case report of a giant euthyroid goiter found in a 70-year-old female patient. The patient underwent fine-needle aspiration cytology examination.

9-14

Authors: Majumder M I, Harun M A S I

Background: Osteoporosis is imposing public health burden especially in postmenopausal women and elderly population. It is leading cause of morbidity and mortality in postmenopausal women. Among multiple modalities of osteoporosis diagnosis, bone mineral density (BMD) is considered as a gold standard by WHO. Aim: Evaluate the alveolar bone changes in osteopenic and osteoporosis condition of postmenopausal women. Materials and Methods: Totally 1315 postmenopausal women were included in this study. All patients were evaluated by dual-energy X-ray absorptiometry for BMD and dental radiograph such as orthopantomography and radiovesiography. Among those women 72 were normal, 276 were osteopenic and 967 were osteoporotic. Mandibular cortical index (MCI), pixel intensity (PI), mandibular alveolar bone mass (MABM), and Alveolar bone resorption pattern (ABRP) were evaluated from the dental radiograph. Calculation of mean and standard deviation, as well as correlation and difference, were performed using SPSS 11.5 for Windows (Windows XP). Results: The changes in the MCI (C2 and C3) were more in osteoporotic condition (87.48%) rather than osteopenic (31.34%) and normal (12.50%). The numbers of presenting teeth were more in normal and osteopenic women rather than osteoporotic women. PI and MABM were significantly different from normal vs. osteopenic and osteoporosis, osteopenic versus osteoporosis. Horizontal ABRP was more in osteoporosis women (91.21%). Conclusion: Changes in postmenopausal alveolar bone were strongly correlated with the BMD of systemic skeletal bone. This combined relationship can be used as an easy diagnosis tool for innovations in osteoporotic condition.

19-23

Authors: Rajnish Nagarkar, Shirsendu Roy, Mohammad Akheel, Vijay Palwe, Nayana Kulkarni, Prakash Pandit

Aim: Thyroid disorders are common endocrine disorders encountered in the African continent. Environmental and nutritional factors are often implicated in the occurrence of most thyroid disorders that occur in the most part of the world. This is a narrative review that seeks to document the pattern, prevalence, and management of thyroid disorders in the continent. To find the incidence and prevalence of thyroid disorders from total body malignancies at our cancer center. Objective: Implementation of thyroid screening camps among the general population. In India, thyroid disorders in childhood and adolescence have not been sufficiently studied. Where studies are available, they were either conducted decades ago or they involved only adults. The objectives of this study are to describe the pattern of thyroid disorders in each individual seen in our hospital and to highlight the management challenges encountered. Materials and Methods: This is a retrospective medical record analysis performed in our tertiary care cancer center in Nasik, Maharashtra for a period of 6 years from January 2008 to December 2014. The clinical examination, biochemical studies, serological and histological parameters were used to characterize and evaluate the patients of thyroid disorders. Investigations done, surgical treatment type, types and complications of thyroid disorders, incidence according to age, sex and prognosis were all documented in this analysis. Results: Of 16933 cancer patients, 128 patients suffered from thyroid disorders and the prevalence was 0.8%. The prevalence of thyroid disorders was significantly higher in females than males (33.6% vs. 66.4%, χ2 = 27.56, P < 0.001). The prevalence of thyroid disorders was significantly higher in higher aged (≥31 years) patients as compared to lower aged (≤30 years) patients (14.1% vs. 85.9%, χ2 = 132.30, P < 0.001). Of total thyroid disorders, 99 (77.3%) patients had cancers with highest prevalence of follicular cancer (58.6%). Of total thyroid disorders, 79 (61.7%) patients underwent surgery with no postoperative complications and were discharged on 3rd day of surgery. The mortality rate was 4.6%. Conclusion: There are a high risk and burden of thyroid disorders in India due to lack of nutrition and unavailability of proper therapeutic resources. There are a lack and paucity of data on the epidemiology of thyroid disorders. Due to lack of resources, complete screening for thyroid diseases in the general population is not cost-effective. There must be complete family screening with all genetic relatives in all patients with juvenile autoimmune thyroiditis.

28-31

Authors: Shah A, Shah R, Tyagi R, Botchu R

Plasmacytomas occur in bone marrow or in extramedullary sites, typically in the head and neck. Intramuscular plasmacytoma is rare and reported occurring in the orbits and upper limbs. We report a rare case of intramuscular extramedullary plasmacytoma (EMP) occurring in the gluteus medius muscle. In this case, an elderly lady with known multiple myeloma, presented with a lump in her right buttock. Subsequent imaging demonstrated a non-specific intramuscular mass in the right gluteus medius. Treatment is traditionally surgical resection plus/or adjuvant chemotherapy or autologous stem cell transplant. Plasmacytoma was considered among the differentials, despite the non-specific imaging features, and atypical location. It allowed for a rapid multi-disciplinary team discussion about the risks and benefits of a biopsy. Unfortunately, the patient died before treatment could be started. The purpose of this report is to remind clinicians to include plasmacytoma as a differential for soft tissue masses, even in atypical locations. We also discuss the relevant imaging features and management of EMPs.

2-6

Authors: Marin Cristian Eugeniu, Costea Radu, Popescu Vlad

Aim: The aim of this clinical study over 310 patients is to evaluate the success rate using Chlorhexidine (CHX) as a cleaning solution and lubricant during the endodontic treatment, compared with sodium hypochlorite (NaOCl). Materials and Methods: Group A consisted of 169 teeth, from which 78 were in a pulpitis stadium and 69 in a gangrenous stage. They were treated with CHX solution during endodontic dental procedures. The Group B consisted of 76 pulpits and 65 gangrenous teeth irrigated with NaOCl. Biostatistical analyzes using t-test with IBM SPSS 22.0 were applied to validate the results for P < 0.05. Results: The results show a success rate of 97% and a treatment success rate 3.5 times higher when using CHX in a much shorter time of treatment. 38.5% of cases were completed in the fi rst session of treatment, 42.5% in the second session and only 19% of cases being completed in the third treatment session. In Group A was obtained 100% success in pulpitis and 94.5% from gangrene was successfully cured, compared with 88% average success rate in Group B (6.5% failure rate in the pulp disease and 24% in gangrene). Conclusions: The advantages of using CHX instead of NaOCl in endodontic treatment proved by this study, in conjunction with results published since the early 80’s, show the supremacy of CHX solution in endodontic treatment.

14-17

Authors: Prasad Uma, Prasad Usha, Sushma J, Rema Nair Sarkar

Meckel–Gruber syndrome (MGS) is an rare lethal autosomal recessive genetic disorder, characterized by a unifi cation of renal cysts or cystic renal dysplasia, developmental anomalies of the central nervous system, hepatic dysgenesis and postaxial polydactyly. MGS (MS) is a rare and lethal syndrome characterized by a triad of occipital cephalocele, postaxial polydactyly and dysplastic cystic kidneys. It is a rare syndrome with the highest incidence in Gujarati Indians and Finnish population. We report a case of MGS in non-Gujarati Indian, which was diagnosed on fetal autopsy. The incidence of MGS ranges from 1 in 13,250 to 1 in 40,000 live birth.

24-29

Authors: Rajnish Nagarkar, Shirsendu Roy, Mohammad Akheel, Vijay Palve, Prakash Pandit, Nayana Kulkarni

Aim: The aim was to perform a retrospective audit of rare vascular neoplasm - Carotid body tumor (CBT) in our cancer center. Materials and Methods: An institutional retrospective audit was performed in Curie Manavata Cancer Centre, Nasik, India from 30th June 2013 to 30th June 2014. Total of 5 patients were diagnosed with CBT in a period of 6 months. Results: Out of 5 patients who were diagnosed with CBT, 2 (40%) were males and 3 (60%) were females with a ratio of 1:1.5. The types of CBT were familial in 2 patients (40%), sporadic in 2 patients (40%) and hyperplastic in 1 patient (20%). The clinical presentation of the 5 cases was, 3 patients (60%) had a painless, progressive swelling, 2 patients (40%) had pre-auricular pain, and 1 patient (20%) was identifi ed in routine follow-up. All patients underwent surgical excision of CBT with no need to pre-operative embolization. 40% of patients had cranial nerve injury and hematoma formation. 1 out of 5 patients received post-operative adjuvant radiotherapy due to large tumor size and lymphatic spread. No recurrence was found after a follow-up of 6 months. Conclusion: Surgical management of CBT remains a challenge for head and neck surgeon. Despite a reduction in stroke and mortality, there can be a signifi cant morbidity associated inadvertent adjacent cranial nerve injuries. However, our audit shows these tumors can be managed well with meticulous planning and execution of the surgery.

2-6

Authors: Anjaneya Dube, Girish Rao, Amogh Tanwar

Aim: The aim of the research was to determine and analyze the pattern of maxillofacial (MF) injury associated with head injury at a neurosurgical center (NIMHANS, Bangalore). Methodology: This is a descriptive analytical study of trauma patients at NIMHANS Bangalore in which the medical records of 250 patients who were referred for MF injury may or may not be associated with head and neurological injury were analyzed during a period of 6 month. Results: Road Traffic Accidents (RTA) were the most common cause and contributed to 77% of the injuries. A total of 229 males were affected in comparison to only 21 females. 85 patients (34%) were under the influence of alcohol. About 44.8% of the patients had MF injury. Midfacial injuries accounted for 73.2% of the total fractures. The soft tissue lacerations were distributed predominantly over middle and upper third of the face. Preponderance of patients had mild head injury and was handled conservatively in the present group. Operative instructions for maxillo-facial fractures were displaced facial bone fractures or pan facial trauma. Conclusion: Adult males were the typical frequent victims in MF trauma, and RTA were responsible for the majority of cranio- MF trauma. Most of the referred trauma patients sustained mild head injuries and were managed conservatively.

11-19

Authors: Swati Arora

Background: Acne vulgaris is the most common skin disease of the youth especially in puberty age. One of the most common complications of acne is scarring. It has been found to have a significant impact on their psychological well-being and has been associated with depression and suicide ideation. Acne causes emotional upset and impact to the patient by disfiguring face and scarring skin. Multiple surgical treatments are available for acne scars, which include dermabrasion, microdermabrasion (MDA), laser treatments, and dermal fillers. Aims: The aim of this study is to evaluate the efficacy of MDA in facial acne scars in terms of results and patient satisfaction. Materials and Methods: A total number of 50 patients with acne scars, who visited the hospital outdoor patient department, were included in this study. All patients were treated with MDA for 10 sittings, 2 weeks apart. Analysis: Patients were evaluated and analyzed after 10 sittings or before (if the complete response occurred before 10 sittings), both objectively and subjectively (in term of patient satisfaction). Result and Conclusion: Of a total of 50 patients, 25 patients (50%) had moderate scarring and of these 21 (84%) showed good response, 3 (12%) showed fair response and 1 (4%) showed excellent response.

25-26

Authors: Narendra Sharma, Sunita Shrivastav, R. H. Kamble, P. V. Hazarey, Preethi Sharma

The buccal archwire used in the pre-adjusted edgewise appliances technique is anchored to the brackets by means of ligatures made of soft stainless steel wire of about 0.010 inch diameter. These ligatures are seated under the flanges of the brackets. Various methods have been advocated seating and tying the ligatures. The performed ligatures used in this method differ from those conventionally used in that they can easily and quickly be formed on a jig constructed from available orthodontic material.

33-37

Authors: Ruchit Khanna, Anand Kumar, Ruchika Khanna

When nutrients are isolated from whole foods, they do not always act the same. Several nutrients found in fruit and vegetables show an inverse association with oral cancer. Nutrition has enhanced more bring into focus on the levels of biochemical sequences through which ingredients are digested, and other living organic structure are converted from one form to another via metabolism and metabolic pathways. Nutrition also centers on in what way diseases, conditions, and dilemmas can be averted or diminished with a healthy diet. Cancer is preceded by pre-cancerous lesions. Numerous investigations have attempted to determine whether consuming particular food increases or decreases a person’s chance of acquiring cancer. Sadly, various thoughts have conflicted issues, so it is troublesome to understand what impact foods or dietary supplements have on cancer risk. In summation, nutrition includes recognizing how particular disorders, conditions or dilemmas may be generated by dietary factors, such as inadequate food (malnutrition), food allergies, metabolic diseases, etc.

2-5

Authors: I. N. Ikhajiangbe Happy1, D. N. Ezejindu2, N. Ezeokafor Emmanuel1

Aims: The aim of this study is to compare the effect of bitter leaf (Vernonia Amygdalina) and glibenclamide in the treatment of diabetes in Alloxan-induced diabetic albino wistar rats. Materials and Methods: A total of 24 adult albino rats were used for the study. The rats were grouped into three groups of eight animals per group. Group A received 0.5 ml of distilled water and served as the control. Group B received 10 mg/kg/body weight of glibenclamide. Group C received 100 mg/kg/ body weight of bitter leaf extract. Effect of bitter leaf and glibenclamide were observed at every 2 days for up to 2 weeks. Results: The result showed that the extract caused a decrease in blood glucose level on the fourth day but this was not statistically signifi cant. Also, glibenclamide caused a decrease in the blood glucose level on the third day; this decrease was not statistically signifi cant but slightly signifi cant on the fourth day. On the sixth day, the extract caused a slightly signifi cant decrease but when compared with the sixth day of glibenclamide, the decrease was very signifi cant. From the eight day to the fourteenth day, the decrease in the blood glucose levels for group B and C became very signifi cant. However, group C (glibenclamide) showed highly signifi cant decrease when compared with group B (extract). Glibenclamide showed signifi cant (p<0.05 or p<0.01) decrease in mean blood glucose level from day 8 to till end (day 14) as compared to bitter leaf extract. Conclusion: The work suggests that glibenclamide has a more potent hypoglycemic effect in alloxan-induced diabetic wistar rats when compared with the extract and may be more effective in the treatment of diabetics.

10-13

Authors: Chaithra Kalkur, Anusha Rangare Lakshman, Mohammed Farhan, B. S. Kiran Kumar

Facial talon cusp (Dens evaginatus) is a very rare developmental anomaly of unclear etiology and significance can also be seen associated with some syndromes. Here the present report describes a 10-year-old female with facial talon cusp on mandibular permanent right central incisors. This rare anomaly requires careful dental and physical examination of the affected patient since its finding can be of clinical and genetic significance

18-20

Authors: Ruchika Khanna, Ruchit Khanna, P. M. L. Khanna

Cone beam computed tomography is a three-dimensional imaging modality and more accurate when compared to digital radiographs. The recent advancement in this technology has reduced the cost as well as the dose to the patients. The advanced software design and powerful computer system have permitted its use in dentistry. Its varied indications in practically all the branches of dentistry have made this progress all the more versatile. Through this review we have tried to highlight the basis of this technology, its advantages and applications, wherefore proving it to have an edge over the others

25-27

Authors: Ruchika Khanna, Ruchit Khanna

Osseous choristoma being a benign lesion is an entity rarely seen in the oral cavity. These are usually well-circumscribed proliferations of histologically normal tissue found in abnormal locations. They are usually composed of compact bone with harvesian systems. The etiology is considered to be developmental malformation or reactive. The most common site being the tongue and other sites being buccal mucosa as well. Through this article, we have tried to highlight various features that would aid in correct diagnosis and treatment planning of this rare lesion.