A Systematic Review on Sleep Related Disorders and Periodontal Disease

BACKGROUND: Periodontitis has been implicated in many systemic diseases such as diabetes, cardiovascular diseases, hypertension, stroke, Obesity, Kidney disorders. Recent scientific evidence has revealed a relationship between sleep related breathing disorders (SRBDs) and periodontal diseases. There has been a recent scientific evidence on population based studies reflecting an association between periodontal diseases and OSA.  AIM: The tenet of the study was to find out interconnect between obstructive sleep apnea and periodontal disease. METHODS: A systematic review of clinical trials assessing the relationship between OSA and periodontitis was carried out. An electronic search based on internet search sites (From 2000-2016) by PubMed, MEDLINE, SCOPUS, EMBASE, Google scholar, CINAHL, and Web of Science (WoS) were used. Studies which met the inclusion criteria were further analysed to find out the outcome of the study. RESULTS:  A total of 174 potentially qualifying studies were screened. Out of them 10 studies  fulfilled the inclusion criteria which were further analysed. In our study 10 studies (2000-2016) from Jordan, Tokyo, Turkey, Saudi Arabia, India, USA, South Korea, Taiwan, Australia were shortlisted. Out of them 5 were cross sectional studies, 4 were case control, and 1 was meta-analysis. The sample size in the studies ranged from 66 to 30,120 adult falling in age range of 18 to 75.  The indicators for OSA used were as positive Epsworth sleepiness scale (ESS), Berlin Questionnaire, STOP-bang questionnaire, Apnea-Hypopnea index, Polysomnography (PSG). And the indicators for periodontal disease were Plaque index (PI), Clinical attachment level (CAL), Pocket Probing Depth (PPD), Gingival Bleeding Index (GBI). Majority of studies showed positive correlation between OSA and periodontal disease. CONCLUSION: Recent evidence and literature suggests that there exist a strong  interconnect between OSA and periodontal disease. Dentist play a pivotal role in diagnosis and timely management of OSA cases so as to halt progression of sleep apnea and periodontitis

Optimal management of hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler–Weber–Rendu syndrome, is a group of related disorders inherited in an autosomal dominant fashion and characterized by the development of arteriovenous malformations (AVM) in the skin, mucous membranes, and/or internal organs such as brain, lungs, and liver. Its prevalence is currently estimated at one in 5,000 to 8,000. Most cases are due to mutations in the endoglin (HHT1) or ACVRLK1 (HHT2) genes. Telangiectasias in nasal and gastrointestinal mucosa generally present with recurrent/chronic bleeding and iron deficiency anemia. Larger AVMs occur in lungs (~40%–60% of affected individuals), liver (~40%–70%), brain (~10%), and spine (~1%). Due to the devastating and potentially fatal complications of some of these lesions (for example, strokes and brain abscesses with pulmonary AVMs), presymptomatic screening and treatment are of utmost importance. However, due to the rarity of this condition, many providers lack an appreciation for the whole gamut of its manifestations and complications, age-dependent penetrance, and marked intrafamilial variation. As a result, HHT remains frequently underdiagnosed and many families do not receive the appropriate screening and treatments. This article provides an overview of the clinical features of HHT, discusses the clinical and genetic diagnostic strategies, and presents an up-to-date review of literature and detailed considerations regarding screening for visceral AVMs, preventive modalities, and treatment options

Role of Transvaginal Sonographic Parameters in Predicting Outcomes of Induction of Labour: A Prospective Observational Study

Introduction: Induction of labour is an artificial method of initiating uterine contractions before the onset of spontaneous labour, which leads to progressive cervical dilatation and effacement followed by delivery. Bishop score is the most commonly used method for assessing the favourability of the cervix. However, this method is subjective and less accurate. Transvaginal ultrasonography (TVS) has been demonstrated to be more sensitive than the Modified Bishop score in predicting successful labour induction in recent years as it avoids interobserver variations. Aim: To know the role of TVS parameters in predicting the outcome of induction of labour and to compare with the predictive power of the Modified Bishop score. Materials and Methods: This was a prospective observational study conducted between October 2019 to April 2021 in the Department of Obstetrics and Gynaecology, ESIC PGIMSR, Basaidarapur, New Delhi, India. The study was conducted on 124 pregnant women. Preinduction TVS was performed using a transvaginal probe of 6 MHz and a transabdominal probe of 3.75 MHz. Ultrasound was used to determine cervical length, posterior cervical angle and foetal head position. Following the ultrasonographic examination, a digital examination of the cervix was done, and a score was assigned based on the Modified Bishop score. The induction of labour was performed as per hospital protocol. For the purpose of this study, the successful outcome was taken as a vaginal delivery within 24 hours from the start of induction. Data analysis was done by Statistical Package for Social Sciences (SPSS) version 25.0. McNemar’s test was used to compare sensitivity and specificity. Qualitative variables were correlated by the Chi-square test/Fisher’s exact test. Results: A total of 124 patients were selected, who underwent induction of labour. Out of these 92 (74.2%) patients who delivered vaginally, 81 patients delivered within 24 hours of induction and 11 patients delivered after 24 hours of induction, rest 32 patients delivered by caesarean. So, the unsuccessful outcome was in 8.87% the of study population. Modified bishop score, TVS cervical length, posterior cervical angle and foetal head position, all were found significant in predicting the successful induction of labour. Cervical length measured by ultrasonography can be used as a significant predictor of the successful induction of labour (p<0.001) with an optimum cut-off of <3.65 with sensitivity and specificity of 99.1% and 79.5% respectively. The posterior cervical angle can also be used as a significant predictor of successful induction of labour. Modified bishop score can be used as a significant predictor of successful induction of labour (p<0.001) with an optimum cut-off of >2 with sensitivity and specificity of 98.13% and 82.35% respectively. Although, all ultrasound parameters when combined and compared with the Bishop score were found to be more significant in predicting successful induction of labour. Conclusion: TVS parameters when combined were found to be more specific and sensitive as compared to the Modified Bishop score in predicting successful labour induction

Nasal septal angle deviation: effect on lateral wall in nasal obstruction

Background: Deviation of the nasal septum (DNS) refers to the convexity of the septum to one side disturbing the nasal physiology with obstructed nasal breathing leading to lateral nasal wall abnormalities and paranasal sinuses (PNS) mucosal disease. Knowledge of nasal morphological parameters plays an important role in planning successful nasal surgery. Our aim was to evaluate the angle of septal deviation (ASD) on CT scan and study its influence on the lateral nasal wall abnormalities and PNS mucosal disease.Methods: A prospective cross-sectional observational study was conducted on 130 patients with clinical evidence of DNS and chronic sinusitis. The direction and severity of DNS was recorded on CT scan along with evaluation of lateral nasal wall and sinus mucosal abnormalities.Results: Increasing ASD had statistically significant correlation with the lateral nasal wall abnormalities, most commonly, contralateral middle and inferior turbinate hypertrophy (p-value <0.0001). No significant association was found with the incidence of ipsilateral or contralateral osteomeatal complex (OMC) obstruction and sinus mucosal disease.Conclusions: The direction and severity of septal deviation has significant impact on contralateral middle and inferior turbinate hypertrophy. The analysis of these ancillary pathologies can be of great help to the surgeon in better management of patients with nasal obstruction

Semi-leptonic Octet Baryon Weak Axial-Vector Form Factors in the Chiral Constitutent Quark Model

The weak vector and axial-vector form factors have been investigated for the semi-leptonic octet baryon decays in the chiral constituent quark model with configuration mixing (\chiCQM_{config}). The effects of SU(3) symmetry breaking and configuration mixing have also been investigated and the results are not only in good agreement with existing experimental data but also show improvement over other phenomenological models.Comment: 5 pages, 2 tables. Presented at the 18th International Spin Physics Symposium, University of Virginia, USA, October 6-11, 200

Relationship between grey scale sonographic grades of fatty liver and shear wave elastographic values: an observational study

Background: Due to the growing public health menace of metabolic syndrome, the Non-Alcoholic Fatty Liver Disease (NAFLD) has been recording a burgeoning global rise. The prognosis of NAFLD is largely depends upon its histological stage. Simple steatosis has a fairer prognosis, while Non-Alcoholic Steatohepatitis (NASH) has a poorer prognosis with tendency to progression into fibrosis and end stage liver disease. Until now, the diagnosis of varying grades of NAFLD has been dependent upon liver biopsy, which is indisputably the most reliable tool to distinguish between simple steatosis, steatohepatitis, and end stage liver disease. The sonographic grading of NAFLD is primarily based on subjective findings, the results of which may vary between different observers. Hence, there is a need to identify a reliable non-invasive objective substitute. To compare the sonographic grades of fatty liver on gray scale with liver stiffness (Kpa) values of shear wave elastography. Also, an attempt to establish objective criteria for grading of fatty liver with improved accuracy and increased specificity.Methods: Cross sectional, observational study comprising of 240 adults referred for routine abdominal sonography. All patient underwent gray scale sonography and shear wave elastography and results were analysed.Results: A significant positive correlation was found between various grades of NAFLD as assessed subjectively on grey scale sonography to the liver stiffness in kilopascal (Kpa) using shear wave elastography.Conclusions: Shear wave elastography being an objective imaging tool is a reliable modality compared to grey scale sonography in diagnosis of NAFLD and has the capacity to carry out quantitative evaluation of liver parenchyma in vivo

Effectiveness Of 1.2% Simvastatin Gel as an Adjunct to Non-Surgical Therapy in The Treatment of Chronic Periodontitis: A Split Mouth Randomized Controlled Trial

BACKGROUND: Periodontitis is an inflammatory disease that results in bone resorption creating bony defects, which may cause tooth loss. AIM: The present study aimed to evaluate the effectiveness of 1.2% Simvastatin gel as an adjunct to non-surgical therapy to treat chronic periodontitis (CP). MATERIALS AND METHOD: 25 patients with 50 sites were categorized into two treatment groups: Scaling and Root Planing plus 1.2% Simvastatin, and Scaling and Root Planing with placebo. Clinical parameters; site-specific plaque index, modified sulcus bleeding index (mSBI), pocket probing depth (PD), and relative attachment level (RAL) were recorded at baseline, 3, 6, and 9 months. RESULTS: Mean PD reduction and mean RAL gain was found to be greater in Simvastatin group than the placebo group, at 3, 6, and 9 months. CONCLUSION: Locally delivered Simvastatin was found to be effective in the treatment of chronic periodontitis (CP)

Atypical exophytic liver mass: Giant pedunculated hepatic haemangioma masquerading as a gastrointestinal stromal tumour of the gastric wall

Haemangioma is the most common benign tumour of the liver. However, an exophytic hepatic haemangioma, especially the pedunculated form, is very rare. Giant pedunculated haemangiomas are prone to complications because of the narrow size of the pedicle. A large number of lesions can potentially present as exophytic liver masses, and accurate diagnosis can sometimes be challenging. We report a case of an incidentally discovered asymptomatic giant pedunculated liver haemangioma in the region of the lesser sac in a prospective renal donor, which was initially suspected to be a gastrointestinal stromal tumour of the stomach wall. Multiphasic computed tomography and confirmatory magnetic resonance imaging scans ultimately revealed the true nature of the lesion, which turned out to be an exophytic pedunculated hepatic haemangioma from the left lobe of the liver. The lesion was then surgically resected and histopathologically confirmed to be a haemangioma. The patient subsequently underwent successful renal donation as planned. Being a benign lesion with characteristic imaging features, accurate radiological diagnosis is absolutely essential for the appropriate management of such atypical haemangiomas