Objective assessment of progressive increase in bite force post surgical correction of mandibular fractures using Nupai bite scan analyser

Background: Fracture of mandible is a common condition which is increasing in incidence in the trauma centers due to increasing motor vehicles and failure to abide by traffic regulations. Patients undergo surgical open reduction and internal fixation where post-operative occlusion and normal masticatory functions are targeted. Bite force can be taken as a guide of normal masticatory function of an individual which is dependent upon craniomandibular biomechanics. The aim of the study was to analyse bite force measurements post-operatively in patients who underwent open reduction and internal fixation for mandible fractures at different sites.Methods: Molar bite force was recorded in 31 post-operative patients who underwent open surgical procedure for fracture mandible in the department of plastic surgery from January 2018 to June 2019 by a pre-scale bite force recorder-Nupai bite force prescale system (FujiTM). Various parameters were recorded pre and post-operatively including age, gender, history, comorbidities, requirement of MMF, site and number of fractures and age of injury. Bite force were compared and improvement of bite force every 2 weeks was noted and analyzed upto 6 weeks postoperatively.Results: Bite force improvement was seen in all types of mandible fractures irrespective of the site and type of fractures over a period of 6 weeks post-operatively. This improvement was however not statistically significant. Decreased time interval form injury to surgery resulted in improved bite force measurements though not statistically significant.Conclusions: Although objective improvement in bite force could be demonstrated but extensive study involving more subjects and more patient variables would have statistical significance

MLH1-methylated endometrial cancer under 60 years of age as the “sentinel” cancer in female carriers of high-risk constitutional MLH1 epimutation

Objective. Universal screening of endometrial carcinoma (EC) for mismatch repair deficiency (MMRd) and Lynch syndrome uses presence of MLH1 methylation to omit common sporadic cases from follow-up germline testing. However, this overlooks rare cases with high-risk constitutional MLH1 methylation (epimutation), a poorly-recognized mechanism that predisposes to Lynch-type cancers with MLH1 methylation. We aimed to de-termine the role and frequency of constitutional MLH1 methylation among EC cases with MMRd, MLH1- methylated tumors.Methods. We screened blood for constitutional MLH1 methylation using pyrosequencing and real-time methylation-specific PCR in patients with MMRd, MLH1-methylated EC ascertained from (i) cancer clinics (n = 4, <60 years), and (ii) two population-based cohorts; Columbus-area (n = 68, all ages) and Ohio Colo-rectal Cancer Prevention Initiative (OCCPI) (n = 24, <60 years).Results. Constitutional MLH1 methylation was identified in three out of four patients diagnosed between 36 and 59 years from cancer clinics. Two had mono-/hemiallelic epimutation (similar to 50% alleles methylated). One with multiple primaries had low-level mosaicism in normal tissues and somatic second-hits affecting the unmethylated allele in all tumors, demonstrating causation. In the population-based cohorts, all 68 cases from the Columbus-area cohort were negative and low-level mosaic constitutional MLH1 methylation was identified in one patient aged 36 years out of 24 from the OCCPI cohort, representing one of six (similar to 17%) patients <50 years and one of 45 patients (similar to 2%) <60 years in the combined cohorts. EC was the first/dual-first cancer in three pa-tients with underlying constitutional MLH1 methylation.Conclusions. A correct diagnosis at first presentation of cancer is important as it will significantly alter clinical management. Screening for constitutional MLH1 methylation is warranted in patients with early-onset EC or syn-chronous/metachronous tumors (any age) displaying MLH1 methylation.(c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/)

A Case of De Novo CD5+ Disseminated Intravascular Large B-Cell Lymphoma Presenting as Multiorgan Failure

Intravascular large B-cell lymphoma is an extremely rare extranodal lymphoma that proliferates in the lumen of the blood vessels while sparing the organ parenchyma. It usually presents with CNS and skin involvement. A 65-year-old Caucasian female presented with fevers and chills of 3-4 months’ duration. Bone marrow biopsy done 3 months prior showed no significant myelodysplasia or lymphoid aggregates. The patient later died due to multiorgan failure. A bone marrow biopsy showed 20–30% CD5+ B cells consistent with infiltrative large B-cell lymphoma. An autopsy performed revealed diffuse intravascular invasion by lymphoma cells. Multiorgan involvement by intravascular B-cell lymphoma is very rare. Based on our literature review and to the best of our knowledge, there are only 5 case reports describing the presentation of this lymphoma with multiorgan failure. The immunophenotypic studies performed revealed that our patient had de novo CD5+ intravascular large B-cell lymphoma which is known to be aggressive with very poor prognosis. Although it is an extremely rare lymphoma, it should be considered as a potential cause of multiorgan failure when no other cause has been identified. A prompt tissue diagnosis and high-dose chemotherapy followed by ASCT can sometimes achieve remission

A comparative evaluation of efficacy of commercially available bleaching agents in non-vital teeth: An in vitro study

Aim : The aim of the study was to evaluate and compare the efficacy of commercially available three bleaching agents when used internally or by internal-external method in non-vital teeth. Materials and Methods: Seventy extracted single-rooted premolars were artificially stained with whole blood in centrifugal machine. Teeth were divided into six experimental groups (Group I-VI) and one control group (Group VII). Bleaching was carried out in all the experimental groups using either of three commercially available bleaching agents: In Group I and group IV, 35% carbamide peroxide was used. In group II and V, 21% carbamide peroxide was used. Teeth in Group III and VI were bleached using 35% hydrogen peroxide (H 2 O 2 ). In the first three experimental groups (Group I, II, III), internal bleaching was done and in other three groups (Group IV, V, VI), both internal and external application was done. The evaluation was done at 0, 7, and 14 days using VITA shade guide. Statistical Analysis: The results obtained were statistically analyzed using ANOVA, Paired t-test, and ANOVA with post hoc Tukey′s modification to evaluate the significant change and efficacy of the groups tested. Results: All bleaching agents showed effective shade reduction. The effects of 35% H 2 O 2 and 35% carbamide peroxide were statistically similar. The least reduction was seen with 21% carbamide peroxide groups. There was no difference between internal bleaching and internal-external methods. Conclusions: Within the limitation of the study, it could be concluded that 35% carbamide peroxide is an effective intracoronal bleaching agent similar to that of 35% H 2 O 2

Postavulsion complete loss of both lids with corneal injury and orbital floor fracture: A surgical challenge

Total upper and lower eyelid reconstruction remains a challenging task for plastic and reconstructive surgeons. Repair of full-thickness defects >50% of the horizontal length of the lids can be particularly complex. Here, we discuss a case of a 52-year-old male who presented to the emergency with avulsion of the right upper and lower eyelids associated with corneal injury and orbital floor fracture. Among all the possible choices of locoregional flap available, we chose the paramedian forehead flap for anterior lamella reconstruction of both upper and lower lids, and the posterior lamella was reconstructed with buccal mucosal graft while orbital floor reconstruction was carried out with prosthesis. This reconstructive modality resulted in satisfactory function and esthetic outcome

Laparoscopic inguinal hernia repair- Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: A comparative analysis

Background and Aim: Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are the two standardized laparoscopic techniques for inguinal hernia repair. Although several studies were conducted in the past, there are still no certain answers regarding the best laparoscopic approach for inguinal hernia repair. Therefore, our aim was to compare the outcomes of the TAPP versus TEP for inguinal hernia. Materials and Methods: This prospective study was conducted at Dayanand Medical College and Hospital, Ludhiana, from January 1, 2018 to March 31, 2019 and included 54 patients admitted with unilateral or bilateral uncomplicated inguinal hernia. Patients undergoing laparoscopic TEP or TAPP inguinal hernia repair were compared on various intraoperative and postoperative parameters. Results: Fifty-four patients were included in the study (TEP, 27; TAPP, 27). Both groups were comparable in terms of demographic profile and hernia characteristics. TEP had significantly less mean operative time compared to TAPP. Pain scores and injectable analgesics' requirement were significantly higher in TAPP compared to TEP. Postoperative stay was significantly higher in TAPP than TEP. Surgical outcome in terms of intraoperative and postoperative complications, hernia recurrence, and chronic pain for the two laparoscopic techniques was comparable. Conclusion: The lesser intraoperative duration of surgery with lesser postoperative pain scores and lesser postoperative hospital stay favor the use of TEP over TAPP for repair of inguinal hernia

Managing blisters in minor burns: Should they be deroofed?

Introduction: Management of burn blister has always been controversial. The options available are deroofing the blister, aspiration of fluid or leaving the blister intact. There is no set dressing protocol for managing blisters. Aims and objectives: To compare two treatment modalities i.e. deroofing and keeping the burn blister intact for the optimal management of minor superficial 2nd degree burns. Material and Methods: This prospective study was done on 27 patients who presented with minor superficial 2nd degree burns of upper limbs. Total of 50 blister wounds were randomly split into two categories of 25 each. One subset of blisters (Category 1) was deroofed and dressed every alternate day with silver alginate dressing. The other subset of blisters was left intact (Category 2) and dressed every alternate day. The parameters assessed and compared were pain at burn site, soakage of dressing and time to complete healing Statistical Analysis: Student t –test and Chi square (χ2) test . SPSS 21 software Results: The mean age of patients was 36 years. Category 1 wound patients had more pain (as assessed by Visual Analogue Scale) in comparison to Category 2 wounds. The time to wound healing was less by mean of 1.7days in Category 1 wounds compared to Category 2 wounds. Wound soakage was comparable in both subsets. Conclusion: De roofing a burn blister results in statistically significant decrease in time to wound healing and is recommended for management of minor superficial 2nd degree burns

Not Available

Not AvailableCamelpox is a wide-spread infectious viral disease of camelids. An outbreak of camelpox was reported in 15 adult male dromedary camels aged between 10 to 16 years of an organized herd in winter season. The infected camels showed clinical signs of fever, anorexia, lachrymation, pendulous lips, excessive salivation and pock lesions on the skin of head, neck, mouth, lips, extremities, thigh, abdomen, scrotum and inguinal region. Mortalities were recorded in three infected camels after 10–12 days of infection and showed systemic pox lesions characterized by vesicles, papules, ulcerations and raised pock lesions in the mucous membranes of the mouth, tongue, tracheal mucosa, lung, abomasum and liver. Histopathology study revealed characteristic pox lesions with intracytoplasmic eosinophilic inclusion bodies in tongue. Lung showed lesion of interstitial pneumonia (n ¼ 2) and bronchointerstitial pneumonia (n ¼ 1). Liver showed infiltration of mononuclear cells around central veins and degenerative changes of hepatocytes. The abomasum and intestine showed ulcerations, marked capillary congestion and areas of lymphocyte infiltration in mucosa and submucosa. The presence of camelpox virus (CMLV) was confirmed in viral DNA isolated from formalin fixed paraffin embedded (FFPE) tissues of tongue, lung, abomasum, liver, heart and intestine of infected camels by C18L gene PCR. The sequencing of viral DNAs showed phylogenetic relatedness with other CMLV isolates from India and other countries. Thus, our study confirmed the rare severe form of systemic camelpox outbreak in adult male dromedary camels hence future attention should be given for studies on virulence, strain identification and molecular epidemiology of CMLV for planning of effective preventive and control strategies.Not Availabl