Clinical characteristics and associated factors of cerebral palsy in pediatric population: a tertiary care centre clinicoepidemiological study

Background: Although, a highly prevalent disease, the etiology of cerebral palsy is still poorly understood thereby eluding a definitive prevention strategy. Our study aimed to evaluate the etiological, clinical and prognostic factors associated with cerebral palsy in children of western Rajasthan. Methods: All cases of non-progressive neurological disorder in the age group of 6 months to 14 years were enrolled in the present study. Detailed assessment, CNS examination and related neuroimaging were performed. Statistical analysis was done by standard statistical methods. Results: Maximum number of patients in current study were in the age group of 1-3 years. In our study according to sex, 40 (66.67%) were males and 20 (33.33) were females. Most of the patient in the present study were spastic quadriplegic type (40%) followed by spastic diplegia in 20% cases. As per gross motor function classification system (GMFCS) grading, maximum number of cases were 16 (26.67%) from grade 4. The most common sequelae in cerebral palsy were speech delay in 49 (81.66%) patients. Cortical atrophy was the most commonly (71.73%) seen abnormality on neuroimaging with CT-scan. Conclusions: Cerebral palsy is a non-progressive CNS disorder which has a major physical as well as psychological effects on the children as well as their families. The present study highlights the importance of understanding epidemiological and etiological aspects of the disease in Indian scenario

Non-syndromic multiple supernumerary premolars: Clinicoradiographic report of five cases

Hyperdontia or supernumerary teeth in both arches without any syndromic manifestation are extremely rare. Supernumerary teeth are commonly associated with Gardner’s syndrome, cleft lip and palate, cleidocranial dysplasia and trichorhinopha-langeal syndrome. Five cases of non-syndromic multiple premolars of maxillary and mandibular arches in Indian patients are presented here. This case series reports three cases with multiple (9 in maximum), bilaterally impacted and erupted supernumerary teeth and two cases with supernumerary premolars in non-syndromic cases from Indian patients. Supernumerary teeth can be present in any region of the oral cavity. Although the occurrence of maxillary para-premolars is rare, radio-logical investigations play a major and decisive role in determining the management of such cases

Ethnomedicine: Applications of Neem (Azadirachta indica) in dentistry

Ethnomedicine is the study of traditional medicines having relevant written sources (Ayurveda, traditional Chinese Medicine) as well as those whose knowledge and practices have been orally transmitted over the centuries. The Neem tree (Azadirachta indica) has been known as the wonder tree for centuries in the Indian subcontinent. It has become important in the global context today because it offers solutions to the multiple concerns faced by mankind. Each part of the Neem tree has some medicinal property and the broad range of biologic activities and pharmacologic actions of Neem tree are very well established. Although literature search reveals that Neem tree has multiple potential uses in dentistry, its application is limited in routine dental practice. The following manuscript is an attempt to throw light on the potential and immense uses of Neem tree products for oral care, which forms a critical issue in both developing countries where professional dental care is limited and in developed nations where populations are aging

A Rare Case of Tuberculous Pyometra in a Young Infertile Female Confirmed by mRNA-based RT-PCR

A 25-year-old female presented to the infertility OPD with complaints of secondary infertility and pain lower abdomen with watery discharge for the past five days. She had history of undergoing hysterosalpingography in a private hospital ten days back. The interventions included drainage of pyometra, endometrial biopsy for routine and AFB smear/ culture,  confirmation of diagnosis by mRNA-based RT-PCR for detection of M. tuberculosis-specific 85B antigen gene, anti-tubercular therapy. Pyometra and tubo-ovarian masses disappeared and patient resumed her normal period post-treatment. Genital tuberculosis was confirmed by mRNA-based RT-PCR and the disease resolved after anti-tubercular therapy. We conclude that a combination of high degree of clinical suspicion and ‘high-precision' gene detection methods (e.g. mRNA) in culture-negative cases may be useful in diagnosis of genital tuberculosis, particularly in infertile patients presenting with pyometra post-hysterosalpingography

Impacted stapler pin in fractured maxillary central incisor with open apex: Advanced endodontic management using biodentine as innovative apical matrix

The presence of foreign objects in the pulp chamber of fractured permanent teeth is a rare phenomenon and often diagnosed accidently .These foreign bodies are most commonly self inflicted by young patients and remain impacted within the pulp canal thereby acting as potential source of infection and painful conditions1. In the present case report, we present successful endodontic management of stapler pin lodged in fractured maxillary central incisor with challenge of open apex in young patient using biodentine as a novel apical matrix

Extensive Type III unicystic ameloblastoma: A case report with conservative management

Unicystic ameloblastoma is a distinct type of ameloblastoma that clinically and radiographically resembles a dentigerous cyst; however, on three-dimensional evaluation, it shows tumorous behavior and histopathologically shows ameloblastic epithelium. Compared to conventional ameloblastoma, it has a low recurrence rate after conservative treatment. We report a case of extensive unicystic ameloblastoma of mandible in a young male patient that showed tumorous characteristics on computed tomography (CT) and was treated conservatively by decompression. CT follow-up after 3 months showed significant bone formation. The lesion was then enucleated. Follow up at 8 months showed tremendous bone healing

Pitfalls in diagnostic imaging: A case report

The new millennium has witnessed a sea change in diagnostic imaging sciences and the unfortunate ′tilt′ toward ′over imaging′ and ′over relying′ on modern imaging needs to be relooked. This case report emphasizes the need to strengthen conventional diagnostic skills/acumen and the importance of case history taking in all its grandeur as a part of comprehensive patient work up. In this case report of a 7-year-old child, the entire prognosis and treatment outcome was fortuitous since the imaging findings and suspected diagnosis on magnetic resonance imaging were relegated to the findings of history and clinical examination

IS FIBROMYALGIA A SYNDROME OF HORMONAL IMBALANCE?

Objectives: The present study was conducted to estimate cortisol and thyroid-stimulating hormone (TSH) levels in patients with fibromyalgia syndrome (FMS) and to find correlation if any between hormone levels and pain duration in FMS.Methods: Plasma cortisol and TSH concentration were determined by electro chemiluminescence immunoassay in 89 female patients with FMS and 74 age-matched healthy women.Results: No significant difference in TSH level was observed between FMS and healthy subjects. Ten patients had higher cortisol levels than the standard reference range, 48 patients with reduced cortisol and 31 patients with normal cortisol levels. No significant correlation was observed between pain duration and levels of cortisol.Conclusion: The study has confirmed the equivocal data regarding cortisol/hypothalamic-pituitary-adrenal axis related dysfunction in FMS. To the best of our knowledge, it is the first Indian study on FMS which assessed the cortisol and TSH levels and their correlation with pain duration if any

Malignant mixed Mullerian tumor of broad ligament with synchronous ovarian and endometrial carcinoma: A rare association

Extragenital malignant mixed Mullerian tumor (MMMT) is a rare tumor in females, and it is even more rarely encountered among the multiple genital malignancies. There are some reports of extragenital MMMTs associated with synchronous or metachronous gynecologic tumors of Mullerian duct origin. We recently encountered an MMMT of broad ligament which is associated with papillary serous cystadenocarcinoma of the ovary and endometrioid adenocarcinoma arising in atypical polypoid adenomyoma endometrium in a 76-year-old woman. This case is presented for its rarity and unique presentation. To our knowledge, ours is the first reported case of this unique combination of multiple synchronous genital malignancies

CHRONIC TENSION-TYPE HEADACHE: MUSCLE OVERACTIVITY VERSUS DEFICIENT PAIN CONTROLS

Objective: The oscillating school of thought between the peripheral and central mechanisms of pain origin hinders the selection of appropriate therapy for chronic tension-type headache (CTTH). The aim of this study was to assess the role of central and peripheral pain mechanisms together in CTTH.Methods: In the present study, we compared surface electromyography (sEMG) amplitudes and nociceptive flexion thresholds in patients diagnosed with CTTH (n=30) with age-matched healthy controls (n=30). For central pain modulation with spinal and supraspinal influences on nociception, we recorded nociceptive flexion reflex (NFR) by stimulating the sural nerve and observing the biceps femoris muscle response. sEMG was done for the temporalis and trapezius muscles at rest, during mental activity and during maximum voluntary contraction to assess contribution from peripheral pain.Results: We observed a decreased NFR threshold in CTTH patients as compared to healthy controls, suggesting a hyperalgesic state due to central factors. Electromyographic activity of trapezius muscle was increased at rest in CTTH while both temporalis and trapezius showed an overactivity in patients during mental task.Conclusion: Central factors are important in the pathogenesis of CTTH while, peripheral factors, such as stress-related muscle spasm may also contribute to pain state