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1.  An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study 
The statistical profile reflects a global estimate of 5.1 million deaths in 2000, which was due to injuries that accounted for 10% of deaths due to all causes. Out of this, a quarter of injury-related deaths occurred in the South-East Asian region. Road Traffic Accident (RTA) is one among the top 5 causes of morbidity and mortality in South-East Asian countries. Most common cause of blunt abdominal trauma in India is road traffic accident followed by pedestrian accidents, abdominal blows, and fall from heights. Aims: To analyze the epidemiology and pattern of fatal thoraco-abdominal injuries in road traffic accidents.
Materials and Methods:
An autopsy-based cross-sectional study conducted. A purposive sampling technique was applied to select the study sample of 100 post-mortems of road traffic accident between November 2008 and May 2010 subjected to medico-legal autopsy at the department of Forensic Medicine, KIMS Hospital Bangalore.
The majority of the victims were aged 21 to 40 years, 50 (50.0%), most of the victims were male 92 (92.0%); and male/female ratio was 11.5:1. Commonest offending agents in heavy motor vehicles were 54 (54.0%). Bony cage sustained injuries were observed in 71; out of this, fractures of ribs were observed in 45 (63.3%) victims, clavicle in 14 (19.7%), sternum was 6 (8.4%), and vertebrae 6 (8.4%) of fatal road traffic accidents. Internal thoracic injuries were observed in 26 cases. Among internal thoracic injuries, lungs were the most commonly involved organ 24 (92.3%) followed by the heart 2 (7.6%). Lung sustained more lacerations 19 (79.1%) than contusions 5 (20.8%). Internal abdominal injuries were observed in 49 cases. In road traffic accidents, the most commonly injured abdominal organs were solid organs such as liver 16 (32.6%) followed by spleen 9 (18.3%).
Majority of the times in road traffic accidents, young and productive males were injured or lost their life. This study may help the planners to take safety measures, to implement strict traffic rules, to risk stratification in the susceptible population to educate the people, and the study of nature of offending agent in RTA can help the authorities to plan better availability of health care on roads.
PMCID: PMC4013727  PMID: 24812457
Abdominal injuries; Bangalore; road traffic accidents; thoracic injuries
2.  Psychological Morbidity Status Among the Rural Geriatric Population of Tamil Nadu, India: A Cross-sectional Study 
Mental health problems like depression, cognitive impairment, anxiety, sleep disorders, and so on, arising out of senility, neurosis, and living conditions are common in the geriatric population.
To study the psychiatric morbidity among the rural elderly.
Settings and Design:
A community-based, cross-sectional study.
Materials and Methods:
A study was conducted on 800 rural elderly subjects, aged 60 years and more, living in ten randomly selected villages, served by the Rural Health Training Center (RHTC), Valadi, in Tamilnadu state, India. Cognitive functioning was assessed by the Mini Mental Status Examination (MMSE), and the depression by the Geriatric Depression Scale — Shorter version.
Statistical Analysis:
The data was analyzed with SPSS 16 version statistical software using proportions, and the chi-square.
A majority of the subjects were widows / widowers, illiterates, living with family, and showing economic dependency. The prevalence of cognitive impairment was 43.25%, with a mean MMSE score of 23.32±4.4, and the depression was 47.0% and 6.16±3.4. Cognitive impairment, depression, and a disturbed sleep pattern were associated with female sex, age, illiteracy, poverty, loneliness, and the low socioeconomic status of the family.
The study showed a definite association between the sociodemographic factors and psychiatric morbidity. Encouraging the Non-governmental Organizations (NGOs) working for the elderly, running of separate geriatric clinics, and effective implementation of schemes like old age pension are some of the measures to be taken.
PMCID: PMC3573572  PMID: 23441084
Cognitive impairment; depression; geriatric; mini mental status examination
3.  Ibrutinib versus Ofatumumab in Previously Treated Chronic Lymphoid Leukemia 
The New England journal of medicine  2014;371(3):213-223.
In patients with chronic lymphoid leukemia (CLL) or small lymphocytic lymphoma (SLL), a short duration of response to therapy or adverse cytogenetic abnormalities are associated with a poor outcome. We evaluated the efficacy of ibrutinib, a covalent inhibitor of Bruton’s tyrosine kinase, in patients at risk for a poor outcome.
In this multicenter, open-label, phase 3 study, we randomly assigned 391 patients with relapsed or refractory CLL or SLL to receive daily ibrutinib or the anti-CD20 antibody ofatumumab. The primary end point was the duration of progression-free survival, with the duration of overall survival and the overall response rate as secondary end points.
At a median follow-up of 9.4 months, ibrutinib significantly improved progression-free survival; the median duration was not reached in the ibrutinib group (with a rate of progression-free survival of 88% at 6 months), as compared with a median of 8.1 months in the ofatumumab group (hazard ratio for progression or death in the ibrutinib group, 0.22; P<0.001). Ibrutinib also significantly improved overall survival (hazard ratio for death, 0.43; P = 0.005). At 12 months, the overall survival rate was 90% in the ibrutinib group and 81% in the ofatumumab group. The overall response rate was significantly higher in the ibrutinib group than in the ofatumumab group (42.6% vs. 4.1%, P<0.001). An additional 20% of ibrutinib-treated patients had a partial response with lymphocytosis. Similar effects were observed regardless of whether patients had a chromosome 17p13.1 deletion or resistance to purine analogues. The most frequent nonhematologic adverse events were diarrhea, fatigue, pyrexia, and nausea in the ibrutinib group and fatigue, infusion-related reactions, and cough in the ofatumumab group.
Ibrutinib, as compared with ofatumumab, significantly improved progression-free survival, overall survival, and response rate among patients with previously treated CLL or SLL. (Funded by Pharmacyclics and Janssen; RESONATE number, NCT01578707.)
PMCID: PMC4134521  PMID: 24881631
4.  Antioxidant mix: A novel pulpotomy medicament: A scanning electron microscopy evaluation 
Contemporary Clinical Dentistry  2014;5(4):428-433.
This study aims to evaluate the clinical, radiographic, and histological success rate of antioxidant mix as a new pulpotomy agent for primary teeth.
Settings and Design:
Commercially available antioxidants, namely Antioxidants plus trace elements (OXIn-Xttm, India) were used.
Materials and Methods:
This prospective study was carried out on 36 primary molar teeth in 32 children, with age that ranged from 6 to 9 years. Regular conventional pulpotomy procedure followed by placement of antioxidant mix over the radicular orifice was done. Recall was scheduled for 3, 6, and 9 months, respectively, after treatment.
Thirty-six pulpotomized primary molars were available for follow-up evaluations. Scanning electron microscopy analysis of samples showing convex shaped hard tissue barrier formation may be proof of the role of antioxidant material in localization and direction and morphology of the hard tissue barrier. One tooth which presented with pain was assessed as unsuccessful.
Quite promising clinical, radiographic, and histological results of antioxidants in the present study shows their potential to be an ideal pulpotomy agent.
PMCID: PMC4229747  PMID: 25395754
Antioxidants; pulpotomy; reactive oxygen species
5.  Analysis of Patterns and Treatment Strategies for Mandibular Condyle Fractures: Review of 175 Condyle Fractures with Review of Literature 
This study aims to evaluate incidence, patterns and epidemiology of mandibular condylar fractures (MCF) to propose a treatment strategy for managing MCF and analyze the factors which influence the outcome. One hundred and seventy-five MCF’s were evaluated over a four year period and their pattern was recorded in terms of displacement, level of fracture, age of incidence and dental occlusion. Of the 2,718 facial bone fractures, MCF incidence was the third most common at 18.39 %. Of 175 MCF 58.8 % were unilateral and 41.12 % were bilateral. 67 % of bilateral fractures and 43.8 % of unilateral fractures were associated with midline symphysis and contralateral parasymphysis fractures respectively. Most of the MCF was seen in the age group of above 16 years and 50 % of them were at subcondylar level (below the neck of the condyle). Majority of MCF sustained due to inter personal violence were undisplaced (72.7 %) and contrary to this majority of MCF sustained during road traffic accident were displaced. 62.9 % of total fractures required open reduction and rigid fixation and 37.1 % were managed with closed reduction. 80 % of MCF managed with closed reduction were in the age group of below 16 years. From this study it can be concluded that the treatment algorithm proposed for managing MCF is reliable and easy to adopt. We observed that absolute indication for open reduction of MCF is inability to achieve satisfactory occlusion by closed method and absolute contraindication for open reduction is condylar head fracture irrespective of the age of the patient.
Electronic supplementary material
The online version of this article (doi:10.1007/s12663-012-0428-9) contains supplementary material, which is available to authorized users.
PMCID: PMC3777042  PMID: 24431859
Mandibular condyle fractures; Temporomandibular joint; Dental occlusion; Age distribution of fractures; Treatment algorithm
6.  Real world experience with an indigenously manufactured stent Cobal C – A retrospective study 
Indian Heart Journal  2014;66(5):525-529.
Second generation bare metal stents made of cobalt chromium alloy are superior to first generation stain less steel stents. The thin struts are shown to reduce clinical and angiographic adverse outcomes.
To study the long term clinical and angiographic outcomes in patients who underwent coronary angioplasty with an indigenously made cobalt chromium bare metal stents with thin strut Cobal+C™ (Relisys).
A total of 268 consecutive patients who underwent coronary angioplasty with Cobal+C stents were studied retrospectively. Clinical follow up was done after a minimum period of nine months through telephonic interview and angiographic follow up was done in 80 patients chosen randomly. The end points analyzed included major adverse cardiac events (MACE) at nine months and the rate of binary restenosis at follow up angiogram done between 9 and 15 months post angioplasty.
Thirty four percent were diabetic and 33% had acute myocardial infarction. Females constituted 17%. Mean stent diameter was 2.88 ± 0.28 and mean stent length 18.8 ± 4.2. MACE at nine months was 4.5% with TLR 0.3%. The rate of binary restenosis was 21%. Patients with longer stent lengths and non-compliance with medications had significantly higher rates of binary restenosis.
The use of Relisys Cobal+C stents was associated with good long term clinical and angiographic outcomes as evidenced by low incidence of MACE and binary restenosis rates for a bare metal stent.
PMCID: PMC4223194  PMID: 25443606
Bare metal stent; Cobalt chromium stent; Restenosis; Cobalt+C stent
7.  Management of Recurrent Post-partum Pregnancy Tumor with Localized Chronic Periodontitis 
Pregnancy tumor is a benign, hyperplastic lesion of the gingiva, considered to be reactive or traumatic rather than neoplastic in nature. The term pyogenic granuloma is a misnomer as it is not filled with pus or granulomatous tissue histologically. It is multi factorial in nature, which shows an exaggerated response to stimuli such as low grade or chronic irritation, trauma or hormonal variations. Higher levels of sex hormones during pregnancy produce effects on sub gingival microflora, the immune system, the vasculature and specific cells of periodontium which in turn in the presence of local irritants exaggerate the lesion. Since the lesion is clinically indistinguishable from other type of hyperplastic conditions, histological findings are required for proper diagnosis. We present a case report of recurrent pyogenic tumor which showed the evidence of pre-existing localized periodontitis with extensive horizontal bone destruction. The lesion was excised by electrocautery combined with conventional flap procedure after parturition period. During 3 and 6 months follow-up period post-operative healing showed satisfactory results without recurrence.
PMCID: PMC4050686  PMID: 24932397
Gingival overgrowth; pregnancy tumor; pyogenic granuloma
8.  Gaint Epidermoid Cyst of External Ear– A Rare Case Report 
Epidermoid cysts are developmental, benign, cutaneous cysts which are commonly found on face followed by trunk and neck. They account for approximately 80% of follicular cysts of the skin. They are slow growing lesions and remain asymptomatic until or unless secondarily infected. They occasionally have tendency to develop into a malignancy. We describe a case of giant epidermoid cyst of posterior part of external ear, a location where very few cases have been reported in the literature. Since cyst was attached to the external ear, esthetics was also one of the important concern apart from the cyst getting infected, as they cause disfigurement of the face. The cyst was excised surgically. Histopathology confirmed the presumptive diagnosis of Epidermoid cyst. Two-years after the resection there was no recurrence. Due to the possibility of the cyst to transform into a malignancy and for appropriate diagnosis, histopathological examination remains a gold standard for confirmatory diagnosis.
PMCID: PMC3972548  PMID: 24701521
Epidermoid cyst; External ear; Retroauricular Cyst
9.  Substrate Directed Regioselective Monobromination of Aralkyl Ketones Using N-Bromosuccinimide Catalysed by Active Aluminium Oxide: α-Bromination versus Ring Bromination 
ISRN organic chemistry  2014;2014:751298.
Bromination of aralkyl ketones using N-bromosuccinimide in presence of active Al2O3 provided either α-monobrominated products in methanol at reflux or mononuclear brominated products in acetonitrile at reflux temperature with excellent isolated yields depending on the nature of substrate employed. The α-bromination was an exclusive process when aralkyl ketones containing moderate activating/deactivating groups were subjected to bromination under acidic Al2O3 conditions in methanol at reflux while nuclear functionalization was predominant when aralkyl ketones containing high activating groups were utilized for bromination in presence of neutral Al2O3 conditions in acetonitrile at reflux temperature. In addition, easy isolation of products, use of inexpensive catalyst, short reaction time (10–20 min), and safe operational practice are the major benefits in the present protocol.
PMCID: PMC4041026  PMID: 24955257
10.  Prevalence of recurrent aphthous ulceration in the Indian Population 
Objective: Patients with an oral ulcer may present initially to a general physician or a dental practitioner. Majority of the ulcers are benign and resolve spontaneously but small proportions are malignant. The aim of the present study was to determine the prevalence of recurrent aphthous ulcerations in the Indian population. Material and Methods: 3244 patients attending the Department of Oral Medicine and Radiology during the period from November, 2010 to December, 2012 with various complaints were examined. Of the patients examined 1669 were females and 1575 were males. Results: 705 patients presented with recurrent aphthous ulceration (21.7%). Females (56.3%) were more commonly affected than males (43.7%). Patients in the third and fourth decade were most commonly affected. Stress was the most common factor associated with recurrent aphthous stomatitis (386 patients). 54.5% patients did not take any medications and 72.9% patients opined that the condition needed no dental consultation. Conclusion: The results of the present study indicate that recurrent aphthous ulceration is a common mucosal disorder in the Indian population. The early and proper diagnosis of the ulcers will help the dental practitioner in providing information to the patient regarding awareness and management of the condition.
Key words:Recurrent aphthous ulcers, prevalence, Indian population.
PMCID: PMC3935903  PMID: 24596633
11.  Design and Synthesis of Metal Complexes of (2E)-2-[(2E)-3-Phenylprop-2-en-1-ylidene]hydrazinecarbothioamide and Their Photocatalytic Degradation of Methylene Blue 
The Scientific World Journal  2013;2013:828313.
The photocatalytic degradation has been considered to be an efficient process for the degradation of organic pollutants, which are present in the effluents released by industries. The photocatalytic bleaching of cationic dye methylene blue was carried out spectrometrically on irradiation of UV light using Cu(II), Ni(II), and Co(II) complexes of (2E)-2-[(2E)-3-phenylprop-2-en-1-ylidene]hydrazinecarbothioamide (HL). The effects of pH and metal ion were studied on the efficiency of the reaction. Cu(II) complex shows better catalytic activity and the highest percentage degradation (~88.8%) of methylene blue was observed at pH 12. A tentative mechanism has also been proposed for the photocatalytic degradation of methylene blue.
PMCID: PMC3865733  PMID: 24363623
12.  The Calmodulin-Binding Transcription Factor SIGNAL RESPONSIVE1 is a Novel Regulator of Glucosinolate Metabolism and Herbivory Tolerance in Arabidopsis 
Plant and Cell Physiology  2012;53(12):2008-2015.
The Arabidopsis Ca2+/calmodulin (CaM)-binding transcription factor SIGNAL RESPONSIVE1 (AtSR1/CAMTA3) was previously identified as a key negative regulator of plant immune responses. Here, we report a new role for AtSR1 as a critical component of plant defense against insect herbivory. Loss of AtSR1 function impairs tolerance to feeding by the generalist herbivore Trichoplusia ni as well as wound-induced jasmonate accumulation. The susceptibility of the atsr1 mutant is associated with decreased total glucosinolate (GS) levels. The two key herbivory deterrents, indol-3-ylmethyl (I3M) and 4-methylsulfinylbutyl (4MSOB), showed the most significant reductions in atsr1 plants. Further, changes in AtSR1 transcript levels led to altered expression of several genes involved in GS metabolism including IQD1, MYB51 and AtST5a. Overall, our results establish AtSR1 as an important component of plant resistance to insect herbivory as well as one of only three described proteins involved in Ca2+/CaM-dependent signaling to function in the regulation of GS metabolism, providing a novel avenue for future investigations of plant–insect interactions.
PMCID: PMC3516851  PMID: 23072934
Arabidopsis; AtSR1; Glucosinolates; Herbivory; Wound responses
13.  Schedule of Factors Influencing Access to Psychiatric Treatment in Persons with Schizophrenia: Validity and Pilot Testing 
A substantial proportion of patients with severe mental disorders remain untreated in India. Qualitative research has highlighted the complex interplay of multiple factors that preclude schizophrenia patients in rural Indian settings from accessing treatment.
(a) To establish the face and content validities of an interview schedule titled “Schedule of Factors Influencing Access (SOFIAc) to Psychiatric Treatment in Persons with Schizophrenia”, which comprehensively assesses the factors that prevent schizophrenia patients from accessing psychiatric treatment. (b) To assess the feasibility of its administration.
Materials and Methods:
SOFIAc contains 15 items. This schedule involves three phases of interviewing patients and family members. This was given to 12 experts. They used Likert scales (1=not at all satisfactory to 5=very much satisfactory) to rate each item of the schedule. In addition, the experts rated (the same way as above) the following five dimensions of the schedule (as a whole) separately: A (comprehensiveness of the factors), B (scoring system), C (interviewing method), D (general instructions given to the raters), E (overall schedule). Later on, 10 persons with schizophrenia were interviewed with SOFIAc to test the feasibility of administration.
Thirteen items were rated as either satisfactory (score=4) or very much satisfactory (score=5) by all 12 experts; remaining two were rated as 4 or 5 by 11 experts. Regarding comprehensiveness of the factors, scoring methods and general instructions given to the interviewers, all provided scores >4; regarding the method of interviewing, 11 provided the score of >4; with regard to overall interview schedule, all experts provided scores >4. Pilot testing revealed that it took 60 min to administer SOFIAc.
SOFIAc has satisfactory face and content validities. It is also feasible to administer SOFIAc.
PMCID: PMC3868087  PMID: 24379496
Access to psychiatric care; content validity; face validity; interview schedule; rural community
14.  Associated oral lesions in human immunodefeciency virus infected children of age 1 to 14 years in anti retroviral therapy centers in Tamil Nadu 
Contemporary Clinical Dentistry  2013;4(4):467-471.
To evaluate the prevalence of oral lesions status in human immunodeficiency virus (HIV) infected children of age 1 to 14 years in Anti Retro viral therapy (ART) centres in Tamil Nadu.
Materials and Methods:
A of total 326 HIV infected children, age 1 to 14 years of which 174 male children and 152 female children were examined for Oral lesions in the Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University in association with the ART centers in Villupuram, Vellore and HIV Homes in Thiruvannamalai, Trichy and Salem in Tamil Nadu towns.
Statistical Analysis:
Statistical Package for Social Science for Windows (version 11 code: 3000135939012345).
Of the total 326 children, 201 (61.65%) had oral lesions. (68 [20.86%] with Oral Candidiasis [OC], 54 [16.56%] with Angular Cheilitis, 27 [8.28%] with Necrotizing Ulcerative Gingivitis [NUG], 25 [7.66%] with Necrotizing Ulcerative Periodontitis [NUP], 18 [5.53%] with Linear Gingival Erythema [LGE] and 9 [2.76%] with Apthous Ulcer.) Conclusion Among the oral lesions in HIV infected children, OC 20.86% was the predominant oral lesion followed by Angular Chelitis 16.56%, NUG 8.28%, NUP 7.66%, LGE5.53% and Apthous Ulcer 2.76%.
PMCID: PMC3883325  PMID: 24403790
Oral lesions; prevalence; human immunodeficiency virus
15.  Estimation of prostaglandin E2 levels in gingival crevicular fluid in periodontal health, disease and after treatment 
Contemporary Clinical Dentistry  2013;4(3):303-306.
Background and Objectives:
Initial research has shown a positive correlation between the severity of periodontal disease (PD) and prostaglandin E2 (PGE2) concentrations in gingival crevicular fluid (GCF). However, there are no enough reports to correlate the PGE2 concentrations in GCF in periodontal health, disease and after treatment. Hence, the present study is aimed to estimate the levels of PGE2 in GCF in periodontal health, disease and after periodontal therapy.
Materials and Methods:
A periodontal examination and collection of GCF by extracrevicular method was performed in 25 subjects selected randomly and categorized into three groups on the basis of plaque index, gingival index, probing pocket depth and clinical attachment level. Group I (healthy) consists of 10 subjects, Group II (chronic periodontitis) consists of 15 patients and Group III (after treatment group) consists of 15 patients of Group II. PGE2 levels were estimated in GCF samples by using the enzyme linked immunosorbent assay.
All clinical parameters improved significantly after therapy (P < 0.001). PGE2 was detected in all the samples. Highest mean PGE2 concentrations in GCF were obtained for Group II while the lowest concentrations were seen in Group I and Group III. Statistically significant difference was found between the levels of PGE2 at Group-II and Group-III (P < 0.05).
There is a substantial increase in the concentrations of PGE2 as PD progresses. Since PGE2 levels in GCF are positively correlated with gingival index, plaque index, probing pocket depths and clinical attachment levels, PGE2 may be considered as a Novel Biomarker in PD progression. However, controlled, longitudinal studies are needed to confirm this possibility.
PMCID: PMC3793549  PMID: 24124294
Gingival crevicular fluid; periodontal disease; prostaglandin E2; root planing; scaling
16.  Comparison of matrix metalloproteinase-3 and tissue inhibitor of matrix metalloproteinase-1 levels in gingival crevicular fluid in periodontal health, disease and after treatment: A clinico biochemical study 
Dental Research Journal  2013;10(4):434-439.
Considering the role of matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in the pathogenesis of periodontitis, the present study is to estimate the levels of MMP-3 and TIMP-1 in gingival crevicular fluid (GCF) in periodontal health, disease and to evaluate the effect of periodontal therapy on MMP-3 and TIMP-1 concentrations in GCF.
Materials and Methods:
A periodontal examination and collection of GCF by extra-crevicular method was performed in 30 subjects selected randomly and categorized into 3 groups. Group I consists of 10 subjects Group II consists of 20 patients and Group III consists of 20 patients of Group II. Non surgical periodontal therapy was performed, and GCF was collected after 8 weeks from the same site of 20 chronic periodontitis patients who are considered as Group III. MMP- 3 and TIMP-1 levels were estimated in GCF-samples by using enzyme-linked immunosorbent assay. The findings were analyzed using the software and descriptive statistical methods such as Mann- Whitney U-test and Kruskal-Wallis test. P value < 0.001 was considered significant.
MMP-3 and TIMP-1 was detected in all samples. Highest mean MMP-3 concentrations in GCF were obtained for Group II (7.490 ng/ml) while the lowest concentrations were seen in Group I (0.344 ng/ml) and Group III (2.129 ng/ml). This suggests that MMP-3 levels in GCF increases proportionally with the progression of periodontal disease and decreases after treatment. Lowest mean TIMP-1 concentrations in GCF were obtained for Group-II (1.592 ng/ml), while the highest concentrations were seen in Group-I (8.78 ng/ml) and Group-III (6.40 ng/ml). This suggests that TIMP-1 levels in GCF decreases proportionally with progression of periodontal disease and increases after treatment.
There is a substantial increase in the concentrations of MMP-3 and decrease in TIMP-1 as periodontal disease progress. Since MMP-3 and TIMP-1 levels in GCF are positively correlated with gingival index, probing pocket depth, and clinical attachment loss, MMP-3, and TIMP-1 may be considered as a Novel Biomarkers in periodontal disease. However, controlled, longitudinal studies are needed to confirm this possibility.
PMCID: PMC3793404  PMID: 24130576
Gingival crevicular fluid; matrix metalloproteinase-3; periodontal disease; scaling and root planning; tissue inhibitor of matrix metalloproteinase-1
17.  Identification of a novel heterozygous mutation in exon 50 of the COL1A1 gene causing osteogenesis imperfecta 
A 19-year-old woman was diagnosed with osteogenesis imperfecta (OI). She had sustained numerous low-trauma fractures throughout her childhood, including a recent pelvic fracture (superior and inferior ramus) following a low-impact fall. She had the classical blue sclerae, and dual energy X-ray absorptiometry (DEXA) bone scanning confirmed low bone mass for her age in the lumbar spine (Z-score was −2.6). However, despite these classical clinical features, the diagnosis of OI had not been entertained throughout the whole of her childhood. Sequencing of her genomic DNA revealed that she was heterozygous for the c.3880_3883dup mutation in exon 50 of the COL1A1 gene. This mutation is predicted to result in a frameshift at p.Thr1295, and truncating stop codon 3 amino acids downstream. To our knowledge, this mutation has not previously been reported in OI.
Learning points
OI is a rare but important genetic metabolic bone and connective tissue disorder that manifests a diverse clinical phenotype that includes recurrent low-impact fractures.Most mutations that underlie OI occur within exon 50 of the COL1A1 gene (coding for protein constituents of type 1 pro-collagen).The diagnosis of OI is easily missed in its mild form. Early diagnosis is important, and there is a need for improved awareness of OI among health care professionals.OI is a diagnosis of exclusion, although the key diagnostic criterion is through genetic testing for mutations within the COL1A1 gene.Effective management of OI should be instituted through a multidisciplinary team approach that includes a bone specialist (usually an endocrinologist or rheumatologist), a geneticist, an audiometrist and a genetic counsellor. Physiotherapy and orthopaedic surgery may also be required.
PMCID: PMC3922149  PMID: 24616757
18.  Acquired acid resistance of human enamel treated with laser (Er:YAG laser and Co2 laser) and acidulated phosphate fluoride treatment: An in vitro atomic emission spectrometry analysis 
Contemporary Clinical Dentistry  2013;4(2):170-175.
Dental caries is essentially a process of diffusion and dissolution. If the aspect of dissolution can be curtailed some degree of prevention can be achieved.
The present study was carried out to evaluate and compare the effect of Er:YAG laser and Co2 laser irradiation combined with acidulated phosphate fluoride treatment on in vitro acid resistance of human enamel.
An in vitro study was carried out on 30 human premolars to evaluate the enamel's acid resistance using an atomic emission spectrometry analysis.
Materials and Methods:
A total of 60 enamel specimens were prepared from 30 human premolars and were randomly assigned to 6 groups: (1) Untreated (control); (2) 1.23% acidulated phosphate fluoride (APF) gel application alone for 4 min; (3) Er:YAG laser treatment alone; (4) Co2 laser treatment alone; (5) Er:YAG laser + APF gel application; (6) Co2 laser + APF gel application. The specimens were then individually immersed in 5 ml of acetate buffer solution (0.1 mol/L, pH 4.5) and incubated at 37°C for 24 h, and the acid resistance was evaluated by determining the calcium ion concentration using the atomic emission spectrometry.
Statistical Analysis:
An ANOVA model was constructed (P value of 0.05), followed by Tukey's test for multiple pair wise comparisons of mean values.
Significant differences were found between the control group and the test groups (P < 0.001).
Combining acidulated phosphate fluoride with either Er:YAG or Co2 laser had a synergistic effect in decreasing the enamel demineralization more than either fluoride treatment or laser treatment alone.
PMCID: PMC3757877  PMID: 24015004
Acidulated phosphate fluoride; acid resistance; Co2 laser; Er:YAG laser
19.  Atraumatic surgical extrusion using periotome in esthetic zone: A case series 
Several techniques have been proposed for clinical crown lengthening procedures. Crown lengthening in esthetic zone can be classified in two basic types: Restorative and non-restorative cases after the crown lengthening is executed.
Atraumatic surgical extrusion using a specially designed instrument called periotome was performed in four cases on isolated teeth in esthetic zone.
The technique presented is an alternative approach to periodontal surgical procedures consisting orthodontic extrusion and osseous recontouring. It does not result in functional or esthetic deformities especially in the anterior esthetic zone.
PMCID: PMC3659867  PMID: 23716974
Biologic width; crown lengthening; extrusion; periotome
20.  Elimination of Lymphatic Filariasis: Mass Drug Administration in Endemic Areas of (Bidar District) Karnataka-2008 
Lymphatic Filariasis is a mosquito transmitted disease, caused by parasitic worm Wuchereria bancrofti. Global Programme for Elimination of Lymphatic Filariasis was established in early 2000. The strategy recommended by the World Health Organization is annual Mass Drug Administration (MDA) of single-dose of Diethylcarbamazine 6 mg/kg (DEC), distributed to inhabitants of Filariasis endemic areas, excluding children below 2 years of age, pregnant women, and seriously ill persons, and Morbidity Management. The health system distributes the drugs by a door-to-door strategy.
To assess the coverage and compliance of MDA in Bidar district during the campaign in November 2008.
Materials and Methods:
Cross-sectional population-based house-to-house visit. Outcome is assessed as actual coverage and compliance, in Percentage and proportions.
Eight clusters, total eligible population of 1 131 individuals were interviewed. The coverage rate was 78% with variation across different areas. The compliance with drug ingestion was 68%.
The effective coverage was below the target (85%). Side effects of DEC were minimum, the overall coverage was better in rural areas compared with urban areas.
PMCID: PMC3531013  PMID: 23293434
Coverage; DEC; lymphatic filariasis; mass drug administration
21.  Estimation of matrix metalloproteinase-3 levels in gingival crevicular fluid in periodontal disease, health and after scaling and root planing 
Initial research has shown a positive correlation between the severity of periodontal disease and matrix metalloproteinase-3 (MMP-3) concentrations in gingival crevicular fluid (GCF). However, there are no enough reports to correlate the MMP-3 concentrations in GCF in periodontal health, disease and after treatment. Hence, the present study is to estimate the levels of MMP-3 in GCF in periodontal health, disease and to evaluate the effect of periodontal therapy on MMP-3 concentrations in GCF.
Materials and Methods:
Periodontal examination and collection of GCF by extracrevicular method was performed in 30 subjects selected randomly and categorized into three groups. Group I (Healthy, n=10), group II (Chronic periodontitis, n=20) and group III (After treatment group, n=20). Scaling and root planing (SRP) was performed and GCF was collected after 8 weeks of treatment. MMP-3 levels were estimated in GCF samples using enzyme linked immunosorbent assay (ELISA).
MMP-3 was detected in all samples. Highest mean MMP-3 concentrations in GCF were obtained for group II (7.490 ng/ml), while the lowest concentrations were seen in group I (0.344 ng/ml) and group III (2.129 ng/ml). This suggests that MMP-3 levels in GCF increases proportionally with the progression of periodontal disease and decreases after treatment.
There is a substantial increase in the concentrations of MMP-3 as periodontal disease progresses. Since MMP-3 levels in GCF are positively correlated with gingival index, probing pocket depth and clinical attachment level, MMP-3 may be considered as a “novel biomarker” in periodontal disease progression. However, controlled, longitudinal studies are needed to confirm this possibility.
PMCID: PMC3590725  PMID: 23493467
Gingival crevicular fluid; matrix metalloproteinase-3; periodontal disease; scaling and root planing
22.  Surgical Management of Aggressive Central Giant Cell Granuloma of Maxilla through Le Fort I Access Osteotomy 
Giant cell granuloma (GCG) is an uncommon bony lesion in the head and neck region, most commonly affecting the maxilla and mandible and has a female predilection. The clinical behavior of central GCG ranges from a slowly growing asymptomatic swelling to an aggressive lesion. The clinical, radiological, histological features and management of an aggressive GCG of maxilla in an 18-year-old female patient are described and discussed. It is emphasized that surgery is the traditional and still the most accepted treatment for GCG. Le Fort I osteotomy has been advocated as one of the access osteotomy for the surgical management of aggressive and extensive GCG involving the maxilla. The postoperative morbidity and recurrence have been discussed.
PMCID: PMC3385503  PMID: 22754742
Giant cell granuloma; Le Fort I access osteotomy; maxillary sinus tumor
23.  Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation 
Indian Journal of Orthopaedics  2012;46(2):242-245.
We report a case of recurrent patellar dislocation with high-grade trochlear dysplasia which persisted despite two previous operations. We did a Dejour's sulcus deepening trochleoplasty, medial patellofemoral ligament reconstruction, and lateral retinacular release. Trochleoplasty and medial patellofemoral ligament reconstruction is required in patients with high grade trochlear dysplasia.
PMCID: PMC3308670  PMID: 22448067
Medial patellofemoral ligament reconstruction; patellar dislocation; trochleoplasty
24.  Assessment and comparison of microleakage of a fluoride-releasing sealant after acid etching and Er: YAG laser treatment – An in vitro study 
The aim of the present study was to estimate and compare the microleakage of a pit and fissure sealant after etching and Er:YAG laser treatment.
Materials and Methods:
Twenty non-carious premolars extracted for orthodontic reasons were equally divided into two groups. Samples in Group- I were treated with 37% phosphoric acid. Samples in Group II were irradiated with Er: YAG laser at 400 mJ at 4 Hz. Sealant was placed and light cured. Then, the samples were subjected to thermocycling. The samples were then immersed in 1% methylene blue. The samples were sectioned and examined under stereomicroscope at ×10 magnification.
Acid etched samples showed significantly less microleakage when compared to laser etching and it was statistically significant (P<0.01).
PMCID: PMC3341762  PMID: 22557900
Er:YAG laser; microleakage; sealants
25.  Role of lifestyle variables on the lipid profile of selected South Indian subjects 
Indian Heart Journal  2012;64(1):28-34.
To study the associations between diet, exercise. and the serum lipid profile.
Materials and methods
Hospital based cross-sectional study. The study participants were selected through purposive sampling. The study participants comprised 316 men and women above 20 years of age from a disease-free cohort and included healthy subjects visiting the lifestyle clinic of CARE Hospitals, Hyderabad, India for health check-up.
Among the participants of the study, 28.5% of the males and 42.2% of the females had hypercholesterolaemia. Body weight was significantly associated with total cholesterol and low-density lipoprotein (LDL) cholesterol. Of the subjects studied, males had a higher mean calorie and fat intake than the females. A positive association was observed between waist circumference and both total cholesterol and LDL cholesterol. Waist circumference was also positively correlated with systolic and diastolic blood pressure and triglycerides. There was a significant difference in the total cholesterol levels of subjects who exercised and those who were not involved in any physical activity. There was a significant difference between the high-density lipoprotein (HDL) cholesterol values of the subjects based on exercise levels. High-density lipoprotein cholesterol levels were significantly higher in males than in females and this is corroborated by the finding of increased exercise levels in males. Duration of exercise had a significant impact on the total cholesterol levels.
Our results confirm that diet and exercise routines significantly affect the serum lipid profile. Obesity and overweight constitute a risk factor for the development of hypercholesterolaemia and hypertriglyceridaemia.
PMCID: PMC3860764  PMID: 22572422
Cholesterol; Diet; Lipid profile; Obesity

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