Plastic Surgery

A transilience? Or a natural progression?! Dinesh Kadam Indian Journal of Plastic Surgery 2018 51(3):263-263

Tony Watson Eulogy Ravin Thatte Indian Journal of Plastic Surgery 2018 51(3):264-265

Intraoperative partial pressure of oxygen measurement to predict flap survival Ankit Gupta, Akhil Kumar, Shyam Gupta, Sameek Bhattacharaya, Manoj Kumar Jha, Vinay Kumar Tiwari, R Pradeep Kulal, Shobhit Gupta, Sahil Niyazi Indian Journal of Plastic Surgery 2018 51(3):266-273 Introduction: Flap monitoring using partial pressure of oxygen (pO2) is a proven modality. Instruments needed are expensive and are not readily available to a clinician. Here, pO2of flap has been determined using readily available and cheap methods, and a cut-off value is calculated which helps in predicting flap outcome. Methods and Results: Total 235 points on 84 skin flaps were studied. Capillary blood was collected from flap and fingertip using 1-ml syringes after at least 30 min of flap inset, and pO2analysed using blood gas analyser. Fall/change of pO2(difference of mean of pO2[diff-pO2]) was also calculated by subtracting the flap pO2from the finger pO2. Flap was monitored clinically in post-operative period and divided into two groups depending on its survival with Group 1 – dead points and Group 2 – alive points. pO2and diff-pO2amongst both the groups were compared and found to be statistically different (P = 0.0001). Cut-off value calculated for pO2was found to be <86.3 mmHg with a sensitivity of 100% and specificity of 89.05%. The difference of >68.503 mmHg of flap pO2compared from finger pO2was calculated as a cut-off with sensitivity of 94.12 and specificity of 79.60%. Conclusions: Flap areas having intra-operative pO2value <86.3 mmHG have higher chances (60.71%) of getting necrosis later. Similarly, if diff-pO2compared to fingertip is >68.5 mmHg, chances of those points getting necrosed in post-operative period are high.

Free fibula flap for lower limb salvage after tumour resection Vinay Kant Shankhdhar, Prabha S Yadav, Ajay Puri, Ashish Kasat, Jaiswal Dushyant, Ram Badari Narayan Raghu, Ashish Gulia Indian Journal of Plastic Surgery 2018 51(3):274-282 Context: Post-tumour resection lower limb salvage. Aim/Introduction: Resection of tumours of the femur and tibia around the knee and ankle joints results in large bony defects. Often arthrodesis is an alternative; in case, adequate functional motors cannot be preserved or due to economic constraints. Thus, in an immunocompromised patient, the vascularised fibula is the best form of reconstruction. The vascularised fibular flap (pedicled/free) can be used in combination with an allograft. We refer to such a combination reconstruction as ‘allocombo’. The vascularised fibular graft hypertrophies in due course of time, and till that period, the allograft provides the required mechanical strength to allow early ambulation. Subjects and Methods: A retrospective study of 24 cases of vascularised fibular graft for lower limb reconstruction was conducted from February 2003 to March 2014. The average defect size was 15.5 cm and the average length of fibula harvested was 24.35 cm. A total of 19 free fibular flaps and 5 pedicled fibula were done. Mean age was 26 years. Fibula was nestled in the allograft obtained from the tissue bank. Results: The mean follow-up time was 52 months. Free flap success rate was 96%. Successful healing was achieved at 45 ends (97.8%). Radiological evidence of union at osteotomy sites occurred at an average of 6.8 months. Eight patients eventually succumbed to disease. At the final follow-up, the mean Musculoskeletal Tumour Society functional score of the evaluable patients was 26 (range 20–30). Conclusions: Pedicled fibula is a good option if the defect is within 14 cm of the knee joint at the femoral end. The vessels have to curve around the fibular head, thus its removal improves the reach of the pedicle. The flap is easy to harvest with predictable vascular anatomy and it can provide a large amount of vascularised bone and skin paddle. It results in early ambulation, rehabilitation and reduced morbidity. We realised that fixation is easier and chances of vascular injury are less in free as compared to pedicled fibula.

Reconstruction with free flaps in robotic head-and-neck onco-surgeries Rajan Arora, Vinay Kumar Verma, Kripa Shanker Mishra, Hemant Bhoye, Rahul Kapoor Indian Journal of Plastic Surgery 2018 51(3):283-289 Aims and Objective: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. Materials and Methods: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. Results: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. Conclusion: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.

Management of cleft lip and palate in Egypt: A National survey Tarek Abdelhameed Abulezz, Ahmed K Elsherbiny, Ahmed S Mazeed Indian Journal of Plastic Surgery 2018 51(3):290-295 Background: Variable protocols for the management of cleft lip and/or palate (CLP) patients are currently used. However, to our knowledge, there are no previously published data about cleft management and practice in Egypt. Materials and Methods: One-hundred questionnaires were distributed to cleft surgeons attending the annual meeting of the Egyptian Society of Plastic and Reconstructive Surgeons in March 2016 to investigate timing, techniques and complications of cleft surgery. Seventy-two colleagues returned the questionnaire, and the data were analysed using Microsoft Excel software. Results: The majority of cleft lip cases are repaired between 3 and 6 months. Millard and Tennison repairs for unilateral cleft lip, while Millard and Manchester techniques for bilateral cleft lip are the most commonly performed. Cleft palate is usually repaired between 9 and 12 months with the two-flap push-back technique being the most commonly used. The average palatal fistula rate is 20%. Pharyngeal flap is the method of choice to correct velopharyngeal incompetence. Polyglactin 910 is the most commonly used suture material in cleft surgery in the country. Multidisciplinary cleft management is reported only by 16.5% of participants. Conclusion: Management of CLP in Egypt is mainly dependent on personal preference, not on constitutional protocols. There is a lack of multidisciplinary approach and patients’ registration systems in the majority of centres. The establishment of cleft teams from the concerned medical specialties is highly recommended for a more efficient care of cleft patients.

Commentary on: Management of cleft lip and palate in Egypt – A national survey Jyotsna Murthy Indian Journal of Plastic Surgery 2018 51(3):296-297

A retrospective analysis of incidence and management of palatal fistula Ravi Kumar Mahajan, Amreen Kaur, Sardar Mahipal Singh, Prakash Kumar Indian Journal of Plastic Surgery 2018 51(3):298-305 Background: Cleft palate repair may be compromised by a number of complications, most commonly the development of a fistula. Fistulas may cause hypernasal speech, articulation problems and food or liquid regurgitation from the nose. Objective: The study determines the incidence and management of cleft palatal fistulas in a series of primary cleft palate repair surgeries. It is a retrospective analysis of total 185 palatal fistula cases operated at our hospital from the year 2004 to 2016. Subjects and Methods: Of 185 palatal fistulas, 132 cases had been operated at our institute for primary palatoplasty, and the rest 53 were the outside-operated cases. The patients with bilateral as well as unilateral cleft lip and palate were included. Isolated cleft palate patients were also included in the study. Palatal fistulas were subdivided into three types depending on their size. Anterior palatal fistulas were mostly treated by using tongue flap (65.57%), followed by local flaps (34.43%). Middle and posterior palatal fistulas were mostly treated by von Langenbeck Palatoplasty. One patient (>5 mm fistula) was treated using free radial forearm flap. Results: Anterior palatal fistulas (65.57%) were most commonly reported, followed by middle (24.86%) and posterior (9.18%). Most commonly, the size of the fistulas ranged from 2 mm to 5 mm. The complication rate was reported to be 3.75% in case of tongue flap and 11.9% complications were reported in case of local flaps. Conclusion: Tongue flap remains the flap of choice for managing very difficult and challenging anterior palatal fistulas compared to local flaps.

Extended adipofascial wrap around radial forearm flap for hard palate reconstruction BC Ashok, Pradeep Kumar Nagaraj, Srikanth Vasudevan, Anantheshwar Y.N. Rao, Sudarshan Reddy Nagireddy, Ritu Singh Batth Indian Journal of Plastic Surgery 2018 51(3):306-308 Background: While using radial forearm free flap in palate reconstruction, the pedicle lies in the nasal floor, constantly exposed to the nasal secretions and turbulent air current. To overcome this problem, we have designed a procedure which utilises the adipofascial extension to wrap the pedicle and nasal side of the flap. Materials and Methods: The study was done during 2017 and 2018, 2 years’ period. Totally 13 consecutive patients with defect in the palate status post-oncological resection and those in whom local flaps were not enough to cover the defect were included into the study. These patients were divided into two groups. First group in whom adipofascial extension was not used to cover the pedicle and second group in whom adipofascial extension was used to cover the pedicle. The incidence of nasal crusting, secondary haemorrage, blow out and flap necrosis were analysed and compared. Results: In Group 1, we had 2 among 6 (33%) patients with secondary haemorrage. One patient had partial flap loss. On exploring, we noticed thrombosis of cephalic vein. We did not had any incidence of blow out of the pedicle. In Group 2, none of the patients had any secondary haemorrage. All flaps healed well. On doing nasal endoscopy at 6 months of follow-up, all flaps showed complete mucosalisation at the nasal side. Conclusion: Use of adipofascial extension while planning a radial forearm free flap to cover the nasal side of the flap and pedicle in the nasal floor helps to reduce the nasal crusting and secondary haemorrhage.

The characteristics of private plastic surgery practice in developing country: An epidemiological study Irena Sakura Rini, Made Ananda Krisna, Adi Basuki, Kasih Rahardjo Djarot Indian Journal of Plastic Surgery 2018 51(3):309-315 Background: With the rise in working-age population, there has been notable economic growth in Indonesia. Along with it, there is an increase in expenditure for non-food items such as health-care service, without exception to plastic surgery practice. Aesthetic plastic surgery practice has gained its popularity in several other developing countries such as Brazil, Russia, India and China. Epidemiology report of private plastic surgery practice in Jakarta, the capital of Indonesia, will provide the evidence of increasing need for aesthetic plastic surgery practices as the basis for further improvement. Methods: This is a single-centre descriptive cross-sectional study with a total sampling method which included all patients registered at a private plastic surgery clinic between January 2008 and December 2016. Results: There were 1457 medical procedures. The majority (93.4%) of patients were female. More than 80% were surgical procedures, the most common ones were breast implant and blepharoplasty with the latter being similarly popular in both gender. The majority of the patients fell into 20–45-year-old group. Patients <20-year-old had undergone a more minor surgical procedure such as skin tumour and nevus excision or scar treatment while patients >45-year-old had more procedures with rejuvenation purpose. Conclusion: The epidemiology of private plastic surgery practice in an urban area of developing country resembles those in either developed or developing countries with a similar socio-demographic profile. This data can be further utilised for a more focused private plastic surgery practice improvement. The limitation however is that, the study is based on a single centre data.

Anesthesia

Peritubal infiltration of fentanyl compared to dexmedetomidine with ropivacaine in percutaneous nephrolithotomy: A randomized comparative analysis Sumit Soni, Kalpesh Parmar, Shyam Meena Charan, Sameer Sethi, Naveen B Naik Anesthesia: Essays and Researches 2019 13(1):1-6 Context: Dexmedetomidine has been found as an effective adjuvant in various nerve blocks. Despite several studies on dexmedetomidine with ropivacaine, there is no study on comparing with fentanyl in peritubal infiltration in percutaneous nephrolithotomy (PCNL). Aims: The aim of this study was to compare the effect of the addition of dexmedetomidine or fentanyl in peritubal local anesthetic infiltration on pain scores and analgesic consumption in patients who underwent PCNL. Settings and Design: This was a prospective, randomized, double-blind, tertiary care center-based study. Subjects and Methods: A total of 60 American Society of Anesthesiologists Class I, II, and III patients were selected and randomly divided into two groups: Group RF ropivacaine and fentanyl (n = 30) and Group RD ropivacaine and dexmedetomidine (n = 30). Balanced general anesthesia was given. After completion of the surgery, peritubal infiltration was given at 6 and 12 O'clock positions under fluoroscopic guidance. Postoperative pain was assessed using the visual analog scale and dynamic visual analog scale rating 0–10 for initial 48 h. Postoperative sedation was assessed using five-point sedation score. Time to first rescue analgesic, number of doses of tramadol, and total consumption of tramadol required in 48 h were noted. Statistical Analysis Used: Descriptive data were expressed in mean and standard deviation for between-group comparisons; the Chi-square and Fisher's exact tests were used for categorical variables, whereas t-test and Mann–Whitney U-test were used to compare continuous variables between two groups. Results: Duration of analgesia in group RD (12.87 ± 3.85) is more prolonged than group RF (8.13 ± 3.28) h. Total dose of rescue analgesia required in 48 h in group RF was higher as compared to group RD. Conclusions: Addition of dexmedetomidine to ropivacaine is more effective than fentanyl in terms of prolongation of analgesic efficacy of local anesthetic in peritubal block along with short-lived mild sedation.

Intra-articular morphine versus dexmedetomedine for knee arthroscopy under local anesthesia Doaa Galal Diab, Alaaeldin Adel Elmaddawy, Abdelrahman Elganainy Anesthesia: Essays and Researches 2019 13(1):7-12 Background: Knee arthroscopy has both diagnostic and therapeutic applications which can be performed under general, regional, or local anesthesia. Morphine is used as an additive to local anesthetics. Dexmedetomedine, the highly selective alpha-2 (α2)-adrenoceptor agonist with the sedative and analgesic effect can be used also to augment local anesthetic effect. Patients and Methods: Sixty patients submitted for elective knee arthroscopy whose age between 25 and 45 years, of either sex, the American society of anethesiologists physical status Classes I and II at a university hospital were enrolled in this study. Patients were classified into two groups. Morphine Group (M) (n = 30): Patients received 20 ml of 0.5% bupivacaine plus 5 ml of 0.2% lidocaine with epinephrine 1:200,000 plus 1 mg morphine. Dexmedetomedine Group (D) (n = 30): Patients received 20 ml of 0.5% bupivacaine plus 5 ml of 0.2% lidocaine with epinephrine 1:200,000 plus 1 μg/kg dexmedetomedine. Results: Demographic data of patients showed no significant difference among the studied groups. Heart rate (HR) was significantly lower in (D) Group compared to that of (M) Group 5 min from the start of procedure to immediately postoperatively. Moreover, (D) Group showed a significant decrease in HR 10 min up to 35 min intraoperatively compared to the basal value. Furthermore, mean arterial blood pressure (MBP) was significantly lower in (D) Group compared to that of (M) Group 15 min from the start of surgery up to 1 h postoperatively. Furthermore, (D) Group showed a significant decrease in MBP 15 min intraoperative up to 2 h postoperatively compared to the basal value. While there was no significant difference in (visual analogue score [VAS], onset and total consumption of ketorolac, surgeon and patients' satisfaction, side effects in (D) Group compared to (M) Group, respectively. Conclusion: Addition of either morphine or dexmedetomidine to bupivacaine intraarticularly improved both intraoperative anesthesia and postoperative analgesia with minimal side effects or complications in knee arthroscopy, with superiority of dexmedetomidine compared to morphine on hemodynamic stability.

A comparison of stress response between insertion of gastro-laryngeal tube and endotracheal intubation in patients undergoing upper gastrointestinal endoscopic procedures for endoscopic retrograde cholangiopancreatography Josemine Davis, Deepak Kumar Sreevastava, Deepak Dwivedi, Siddaramesh Gadgi, Saurabh Sud, Puja Dudeja Anesthesia: Essays and Researches 2019 13(1):13-18 Background: Complex gastrointestinal (GI) endoscopic procedures like endoscopic retrograde cholangiopancreatography (ERCP) require deep sedation or general anesthesia. Comorbidities with the poor physiological condition warrant endotracheal intubation to prevent hypoxia and aspiration. The gastro-laryngeal tube (GLT), a new supraglottic airway device with a separate channel for endoscope looks promising. Aims: The aim of the study is to compare the stress response during insertion of GLT and endotracheal intubation (ETT) in patients undergoing upper GI endoscopic procedures like ERCP. Subjects and Methods: This control versus comparison study comprised two groups with 30 patients each who underwent ETT and GLT insertion. The standard general anesthesia technique was used. In GLT group, the device was inserted without neuromuscular blocker. In ETT group, injection atracurium 0.5 mg/kg intravenous was administered as muscle relaxant for aiding endotracheal intubation. Hemodynamic parameters and time taken for the insertion of GLT/ETT were recorded. Statistical Analysis: Data were analyzed using SPSS version 20. Student's t-test was used to compare quantitative data between the groups. ANOVA test was applied for intragroup comparisons between GLT and ETT groups. Categorical variables were analyzed using the Chi-square test. Results: Heart rate and mean arterial pressure increased from baseline in ETT group, following laryngoscopy and endotracheal intubation as well as with GLT insertion. However, the stress response caused by endotracheal intubation was significantly greater than that caused by GLT insertion. Conclusion: GLT as an airway device is a safe alternative with decreased stress response compared to endotracheal intubation for upper GI endoscopy procedures.

The effect of forced-air warmer, ondansetron or their combination on shivering in pregnant women coming for elective cesarean section under spinal anesthesia: A prospective, randomized controlled comparative study KS Ram Kiran, Kalyani Surya Dhana Lakshmi Sangineni Anesthesia: Essays and Researches 2019 13(1):19-24 Context: Perioperative shivering can occur in up to 85% of patients undergoing cesarean section under spinal anesthesia. It has many detrimental effects and disrupts early mother-child bonding. Therefore, it should ideally be prevented by either pharmacologic or nonpharmacological means. Aims: The primary aim of this study was to evaluate the efficacy of intraoperative forced-air warming, ondansetron or their combination in preventing perioperative shivering in patients undergoing elective cesarean section under spinal anesthesia. Settings and Design: A prospective randomized controlled comparative study done at the tertiary care center. Subjects and Methods: A total of 120 patients undergoing elective cesarean section under spinal anesthesia were randomly assigned to three groups. Group O received ondansetron 4 mg intravenously (i.v.) after giving block with no forced air warming. Group W received forced-air warming intraoperatively. Group C received ondansetron 4 mg i.v. after giving block plus intraoperative forced-air warming. Core temperature (tympanic membrane) and the arm skin temperature were measured and shivering was graded simultaneously. Statistical Analysis Used: Parametric data were analyzed using one-way ANOVA and Student's paired t-test where ever appropriate. Nonparametric data were analyzed using the Kruskal–Wallis and the Chi-square test. Values of P < 0.05 were considered statistically significant. Results: Shivering incidence was higher in Group O and Group W being 17.5% and 20%, respectively, and least in Group C being 5%. The incidence of Grade ≥3 shivering requiring rescue drug was lower in Group C (2.5%) compared to that of the Groups W (5%) and O (10%) but was not statistically significant (P = 0.21). Conclusions: Combined use of ondansetron and forced- air warmer was more effective in reducing the incidence of shivering in pregnant women during elective cesarean section than when used individually.

Efficacy of dexmedetomidine as an adjunct in aiding video laryngoscope-assisted assessment of vocal cord movements at extubation following total thyroidectomy Santhosh Djearadjane, Sunil Rajan, Jerry Paul, Lakshmi Kumar Anesthesia: Essays and Researches 2019 13(1):25-30 Background: Assessment of vocal cord movements following total thyroidectomy diagnoses recurrent laryngeal nerve injury. Use of videoscope along with sedatives may blunt hemodynamic responses seen with the conduct of direct laryngoscopy for assessing vocal cord mobility. Aims: The primary objective of this study was to assess changes in mean arterial pressure (MAP) during vocal cord assessment following total thyroidectomy using video laryngoscope, with and without the use of dexmedetomidine as an adjunct. Secondary objectives included assessment of changes in heart rate (HR), patient reactivity score along with ease of laryngoscopy and vocal cord visibility. Settings and Design: This randomized, prospective, unblinded study was conducted in 54 patients at a tertiary care center. Materials and Methods: Group D received dexmedetomidine 0.5 μg/kg, once the thyroid was removed. Group S did not receive dexmedetomidine. Hemodynamic response at extubation, patient reactivity, ease of laryngoscopy, and ease of vocal cord assessment were noted. Statistical Analysis Used: Chi-square test and Independent t-test. Results: Baseline HR, systolic blood pressure (SBP), and MAP were comparable between the groups. However subsequently, Group D had significantly lower HR and SBP at the time of extubation and at 3 and 6 min later. MAP at extubation and at 3 min later was comparable, but at 6 min, Group D had significantly lower values. In both groups, patient reactivity scores, ease of laryngoscopy, and vocal cord visibility were comparable (P > 0.05). Conclusion: Dexmedetomidine 0.5 μg/kg when used as an adjunct clinically improved conditions for assessing vocal cord mobility with significant attenuation of associated hemodynamic responses.

A prospective study of comparison of analgesic efficacy of dexamethasone as an adjuvant in supraclavicular block with intravenous dexamethasone after supraclavicular block in patients undergoing forearm surgeries Madhavi Rahul Godbole, Seema Shreepad Karhade, Priya P Parihar Anesthesia: Essays and Researches 2019 13(1):31-35 Context: Brachial plexus block is a preferred anesthesia technique for upper limb surgeries below the shoulder joint. Drugs used as adjuvants in block enhance the postoperative analgesia significantly. Aim: We aimed to evaluate the analgesic efficacy, of perineural dexamethasone used as an adjuvant to supraclavicular block as against systemic dexamethasone after supraclavicular block. Time for rescue analgesia was also noted in both groups. Subjects and Methods: In our randomized study, 60 patients belonging to the American Society of Anesthesiologist physical status Classes I and II were randomly allocated in two groups of thirty. Group BD received supraclavicular block with local anesthetic and dexamethasone 0.05 mg/kg as an adjuvant. Group BI received supraclavicular block with local anesthetic and intravenous (IV) dexamethasone 0.05 mg/kg after the block. In both groups, the comparison of postoperative analgesia and time for first rescue analgesic was noted. Statistical Analysis Used: Data analysis was done using SPSS version 20.0. Demographic data and continuous variables were analyzed by independent sample t-test. Categorical data were analyzed by unpaired t-test. Results: Group BD showed significantly prolonged postoperative analgesia as compared to Group BI. Time for rescue analgesic in Group BD was (15.8 ± 2.6) H as compared to Group BI (10.3 ± 1.07) H. Conclusions: Dexamethasone, when used in supraclavicular block significantly, prolongs the duration of analgesia as against IV dexamethasone after supraclavicular block.

A prospective crossover study evaluating the efficacy of king vision video laryngoscope in patients requiring general anesthesia with endotracheal intubation Ramachandra R Avula, Nagendra Nath Vemuri, Rambabu Tallapragada Anesthesia: Essays and Researches 2019 13(1):36-39 Background: Direct laryngoscopy used for tracheal intubation requires aligning the pharyngeal, laryngeal and oral axes to achieve a line of sight. Video laryngoscopy provides a better view of the glottis without the need for aligning the three axes. Aims: To evaluate the effectiveness of King vision laryngoscope over Macintosh laryngoscope in visualizing the glottis and intubating the trachea, when used on a same patient as in a cross over manner. Settings and Design: Department of Anaesthesia, Mediciti Institute of Medical Sciences, prospective crossover study conducted over a period of six months. Subjects and Methods: Sixty adult patients belonging to ASA physical status class I-II, requiring tracheal intubation were randomly assigned to intubation by King vision or Macintosh laryngoscope. Improvement, if any, in the Cormack-Lehane grading using the King vision scope, following initial grading with the Macintosh blade in the same patient was analyzed. Statistical Analysis: Mean and Standard deviation were calculated for different parameters under the study. Where appropriate, results were analyzed using the Mc Nemar χ2 test. A ‘p’ value less than 0.05 was considered statistically significant. Results: In the King Vision group, Cormack and Lehane grade improved in the majority (9/12) of patients in whom the initial Cormack and Lehane grade was >1 using the Macintosh blade. Conclusions: The use of the King vision blade significantly improved the laryngoscopic view over the Macintosh blade but the time for intubation was prolonged.

A comparative study between the efficacy of fentanyl, antihistamines, and dexmedetomidine in suppressing photic sneeze reflex during peribulbar block Karim YK Hakim, Mohammed Awad Alsaeid Anesthesia: Essays and Researches 2019 13(1):40-43 Background: The photic sneeze reflex (autosomal dominant) is a condition that causes sneezing in response to numerous stimuli, such as looking at bright lights or periocular (surrounding the eyeball) injection. Unexpected or sudden sneezing during injection can be a dangerous side effect in periocular injection, in which abrupt head movement may cause globe injury. Aims: We intended to evaluate the efficacy of adding fentanyl, dexmedetomidine, and antihistamines on the incidence of the sneeze reflex associated with propofol sedation during periocular local anesthesia injections. Settings and Design: Our study was a randomized, prospective, double-blinded and controlled clinical study. Patients and Methods: This study was conducted in Ain Shams and Fayoum university hospitals at the ophthalmic surgery department. After obtaining approval from our universities ethical committee and written informed valid consents from the patients, 90 patients were included in this study. The study population included patients of both sex, ASA grade 1 and 2, in the age ranging from 18-65 years. Patients were scheduled for cataract extraction surgeries and received peribulbar block. Then patients were randomly divided into three groups (30 patients each) using a computer- generated table of random numbers. Patients were preoxygenated with supplemental oxygen by nasal cannula, all 90 patients received intravenous propofol 1mg.kg- 1 bolus for sedation and were randomized to receive adjunctive drug 2 to 4 minutes prior to propofol injection: 30 patients received intravenous fentanyl 1 μmg.kg-1 (Group F), 30 patients received dexmedetomidine 1μmg.kg-1 (Group D), and 30 patients received antihistamine (pheniramine 22.75 mg) (Group H). The same local anesthetic admixture, consisting of 5 mL 2% lidocaine with 90 IU hyaluronidase, combined with 5 mL 0.5% plain bupivacaine in a 10-mL syringe at room temperature was administered to all patients using peribulbar block technique. A masked observer (surgeon or anesthesia assistant) recorded whether the patient had a sneezing event. Continuous cardiorespiratory monitoring was performed intraoperatively. Intraoperative and postoperative medication side effects were recorded including bradycardia (HR <55 beats/min), hypotension (MAP <50 mmHg sustained for >10 min), oxygen desaturation (SpO2<90%), nausea, vomiting and prolonged sedation using Ramsay Sedation Score (RSS). Statistical Analysis Used: Student's t-test and Chi-square test were used for analysis. Results: The demographic data of the three study groups revealed non-significant differences between the three study groups as regards age, sex distribution, and the duration of surgery. No patient was excluded after inclusion to the study. All patients were able to complete the entire study and their data were included in the final analysis. Five events of sneezing had occurred in 90 patients. Two in (D) group and three in (H) group with is no statistically significant difference between the three groups as regard sneezing. Bradycardia, hypotension and sedation had occurred significantly in group (D) compared to group (F) and group (D). No patient suffered from nausea, vomiting or oxygen desaturation in all studied groups. No statistically significant difference as regards patient satisfaction between the three studied groups. Conclusion: Fentanyl, dexmedetomidine and antihistamines with propofol sedation suppress photic sneeze reflex during peribulbar block.

Evaluation of neuromuscular blockade with vecuronium during general anesthesia with oxygen, nitrous oxide, isoflurane versus oxygen, air, isoflurane: A randomized controlled study Vishanth Boddu, Srinivasan Swaminathan, Hemavathy Balachander, Ranjith Kumar Sivakumar Anesthesia: Essays and Researches 2019 13(1):44-49 Background: The use of air oxygen mixture with isoflurane has become more common in the place of nitrous oxide, especially in laparoscopic and abdominal surgeries. With a varied mixture of gases and isoflurane used in general anesthesia, the exact dosing requirement and time duration of action have not been precisely studied with vecuronium when given as a bolus, as is given routinely. Purpose: This study was undertaken to evaluate and compare the neuromuscular effect of vecuronium during anesthesia with oxygen, nitrous oxide and isoflurane versus oxygen, air and isoflurane. Methodology: The study was a prospective, randomized controlled trial on 70 patients allocated into two groups as follows: Group N (nitrous oxide group) and Group A (medical air group). The primary objective was to measure and compare the posttetanic count (PTC1) – train of four (TOF1) interval, to evaluate the time taken for recovery from the intense blockade in both groups. The secondary objectives were to compare time duration for twitch height depression to be 30% of baseline after administering vecuronium, time duration from vecuronium administration to appearance of the first PTC1, PTC (n) at the reappearance of the 1st twitch, time interval between TOF1 and TOF3 and time from vecuronium administration to appearance of TOF3 in both the groups. Results: There is no significant difference between both the groups with reference to the block onset time using 30% depression of single twitch and recovery time from neuromuscular blockade using PTC, PTC1-TOF1 and TOF1-TOF3 time intervals. Conclusion: Measuring and comparing neuromuscular transmission monitoring parameters such as the onset time(ST depression to 30%), and recovery using PTC, PTC1-TOF1 and TOF1-TOF3 time intervals, it is concluded that the character of neuromuscular block with vecuronium is unaffected and not prolonged with or without nitrous oxide when used with isoflurane.

Evaluation of ultrasound-guided erector spinae plane block and oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Randomized, controlled, prospective study Serkan Tulgar, Mahmut Sertan Kapakli, Halil Cihan Kose, Ozgur Senturk, Onur Selvi, Talat Ercan Serifsoy, David Terence Thomas, Zeliha Ozer Anesthesia: Essays and Researches 2019 13(1):50-56 Background: Oblique subcostal transversus abdominis plane block (OSTAP) is a recently described regional anesthetic technique used in upper abdominal surgeries such as laparoscopic cholecystectomy (LC). Erector spinae plane block (ESPB) has also been reported for postoperative analgesia in LC. Aim: We aimed to compare the effectiveness of OSTAP and ESPB in providing postoperative analgesia in patients undergoing these surgeries. Setting and Design: This study was designed as a double-blinded, prospective, randomized, efficiency study in a tertiary university hospital, postoperative recovery room, and ward. Materials and Methods: A total of 72 patients were recruited and 60 patients were randomized into three equal groups (ESPB, OSTAP, and control group). Pain intensity between groups was compared using Numeric Rating Scale (NRS) scores. In addition, consumption of paracetamol and tramadol and additional rescue analgesic requirement were measured. Standard multimodal analgesia was performed in all groups, while ESPB block was also performed in Group ESPB and OSTAP block was also performed in group OSTAP. Statistical Analysis Used: Descriptive statistics were expressed as mean ± standard deviation. Independent t-test, Mann–Whitney U-test, Chi-square test, Fisher's exact test, Shapiro–Wilk test, one-way ANOVA, and post hoc Tukey's analysis were used for statistical analysis. Results: NRS was lower in block groups during the first 3 h. There was no difference in NRS scores at other hours. Analgesic consumption and rescue analgesic requirement were lower in groups ESPB and OSTAP when compared to those of control group. Block groups were similar. Conclusion: Bilateral ultrasound-guided ESPB and OSTAP performed at the end of LC lead to akin analgesia requirement and improve the quality of multimodal analgesia.

Crow Moon,τα κοράκια και άλλα πουλιά εμφανίζονται καθώς ο χειμώνας τραβάει το τέλος.March’s full moon is commonly called the Full Worm Moon. This is because of the earthworms that wriggle out of the ground as the earth begins to thaw in March.

One of its other names is the Chaste Moon, symbolizing the purity of early spring. The Pueblo tribe named it the Moon When the Leaves Break Forth, while in Shoshone culture it was known as the Warming Moon. Sometimes it is called the Crow Moon, after the crows and other birds that appear as winter draws to a close. Other times, it's called the Crust Moon, because of the snow that becomes crusty when it thaws in the sun and freezes in the moonlight. 

In India, March's full moon is also seen as a symbol of the arrival of spring, and coincides with the festival of Holi. This is a riotous party where Indian communities all around the world engage in a huge water fight. Everyone goes out into the streets and sprays each other with colored water and powders, singing and dancing with strangers and loved ones alike. Playing and feasting together is a chance for you to repair relationships that have gone bad, reaffirming your existing social bonds as you move forward together into the new year.

Clinical Practice

Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture Q Liu, J Cao, JJ Kong Nigerian Journal of Clinical Practice 2019 22(3):289-292 Objective: This study aims to discuss the clinical effect of balloon kyphoplasty on elderly patients with multiple osteoporotic vertebral fractures. Methods: The observation group was treated with balloon kyphoplasty, and the control group was managed with conservative treatment. Image indices, pain degree, daily life disturbance, and occurrences of complications were compared between the two groups. Results: In total, 116 elderly patients with multiple osteoporotic vertebral fracture admitted in our hospital from January 2016 to June 2017 were chosen and divided randomly into observation (n = 58) and control groups (n = 58). The observation group showed a significantly higher trailing edge, leading edge, and midcourt line and larger upper thoracic kyphosis compared with the control group (P < 0.05). Before the treatment, no statistically significant differences were observed between the two groups in terms of visual analog scale (VAS) score and daily life disturbance score (P > 0.05). However, the VAS score and the daily life disturbance score of the two groups decreased sharply after the treatment (P < 0.05). Moreover, the VAS score and the daily life disturbance score of the observation group were significantly lower than those of the control group (P < 0.05). The observation group showed lower occurrence rate of complications compared with the control group (P < 0.05). Conclusions: Balloon kyphoplasty can significantly improve the image indices of patients with multiple osteoporotic vertebral fractures and relieve their pain degree and daily life disturbance. Balloon kyphoplasty exhibited a low occurrence rate of complications and high safety and is, thus, worthy of clinical applications.

A cross-sectional study of cytomegalovirus retinitis in HIV-1 infected adults in Nigeria MA Adeiza, AG Habib Nigerian Journal of Clinical Practice 2019 22(3):293-297 Background: Cytomegalovirus (CMV) retinitis is one of the most important opportunistic infections in HIV-infected patients in developing countries before the introduction of highly active antiretroviral therapy. In Nigerian and African HIV populations, CMV retinitis is under-reported. Patients and Methods: In a cross-sectional study, 250 HIV-infected adults ≥18 years were recruited by systematic random sampling from March to August 2013. Using a structured questionnaire, information was obtained on socio-demographic characteristics and symptoms of visual impairment. HIV disease was staged according to the WHO clinical staging, and CD4+ T-lymphocyte count was measured. Participants with symptoms of impaired vision and/or CD4+ T-lymphocyte count <50 cells/μL had indirect ophthalmoscopic examination of the retina to detect CMV related eye lesions. Results: Two hundred and fifty adults were HIV-infected, out of which 114 (46%) were males and 136 (54%) were females. The mean age of study participants was 35 years. History of impaired vision was reported by 21 (8.4%) of participants. The right eye was involved in 7 (33%), the left eye in 4 (19%), and both eyes in 10 (48%) of participants. The predominant symptoms were blurred vision 9 (43%), floaters 9 (43%), and blindness 3 (14%). Among participants who had indirect ophthalmoscopy, 3 (1.2%) had characteristic retinal changes suggestive of CMV retinitis. Two (67%) of patients with CMV retinitis were females and 1 (33%) was male. Mean CD4+ count was 25.33 ± 14.19 and all were WHO HIV clinical stage 4 with death occurring within 6 months of diagnosis. Conclusion: CMV retinitis though rare is associated with advanced HIV disease and attendant morbidity and mortality. We recommend integration of CMV diagnostic services and ophthalmological services as routine in HIV care and treatment programs in Nigeria targeted toward high-risk patients.

Factors associated with intraventricular hemorrhage among preterm neonates in Aminu Kano teaching hospital CC Egwu, WN Ogala, ZL Farouk, AM Tabari, AH Dambatta Nigerian Journal of Clinical Practice 2019 22(3):298-304 Background: Intraventricular hemorrhage (IVH) is a severe complication among preterm neonates which can result in hydrocephalus, cerebral palsy, behavioural disorders, learning disabilities, or death. It is important to identify the factors associated with IVH in order to prevent these neurological consequences and reduce the resultant burden of neurological disease. Aim: To determine the factors associated with IVH among preterm neonates. Design: The study was prospective cross-sectional in design. Subjects and Methods: Ninety-nine preterm neonates who were < 37 completed weeks of gestation were recruited consecutively from the Special Care Baby Unit of a Tertiary Hospital. Transfontanelle ultrasonography was used to detect IVH and the factors associated with IVH were classified into: neonatal, maternal (prenatal), and clinical factors. Data were analyzed using SPSS version 16.0 for windows. Chi-squared test and Fisher's exact probability test were used as appropriate. The level of significance was set at P < 0.05. The association between these factors and IVH was evaluated by univariate and multivariate logistic regression analyses. Results: Among the 99 preterm neonates studied, 36 (36.4%) of them were between 28 and 31 weeks of gestation, whereas 63 (63.6%) were between 32 and 36 weeks of gestation. In univariate analysis, the factors found to be associated with IVH were lower gestational age <32 weeks gestation, low Apgar score of <3 in 1 and 5 min, respectively, outborn status of neonates, lower social class, need for respiratory support, and blood transfusion. However, the lower gestational age (odds ratio [OR]: 10.9, 95% confidence interval [CI]:1.95–61.04) and respiratory support (continuous positive airway pressure (CPAP)) [OR: 52.24; CI: 3.40–721.84] were retained as significant predictors of IVH in the multivariate logistic regression model. Conclusion: The lower gestational age and respiratory support (CPAP) are independent predictors for IVH. Prevention of preterm delivery and improvement in interventions of neonatal care (CPAP) are necessary to prevent the risk for IVH especially in the early preterm neonates.

Primary molar pulpotomies with different hemorrhage control agents and base materials: A randomized clinical trial G Atasever, TI Keceli, S Uysal, HC Gungor, S Olmez Nigerian Journal of Clinical Practice 2019 22(3):305-312 Objective: To evaluate the clinical and radiographical success of primary molar pulpotomies which used 15.5% ferric sulfate (FS) or 1.25% sodium hypochlorite (NaOCl) for hemostasis and zinc oxide–eugenol (ZOE) and calcium hydroxide (CH) pastes as base materials. Methods: In 29 healthy children, 80 primary molars were randomly allocated to one of the study groups: Group 1: FS-ZOE, Group 2: FS-CH, Group 3: NaOCl-ZOE, and Group 4: NaOCl-CH. After hemostasis with the respective solutions, pulp stumps and floor of the pulp chambers were covered with either ZOE or CH pastes. All teeth were restored with stainless steel crowns. Follow-up examinations were carried out at 1, 3, 6, and 12 months. Results: One tooth in Group 1 and two teeth in Group 4 were extracted because of pain and periapial pathosis at sixth month. After 12 months, clinical success rates of pulpotomies in Groups 1–4 were 95%, 100%, 100%, and 89.5%, respectively. The differences were not significant (P = 0.548). Radiographic success rates for Groups 1–4 were 80%, 88.9%, 78.9%, and 84.2%, respectively. No statistically significant difference was found (P = 0.968). Pain on percussion was the most observed clinical finding. However, internal root resorption was the most common radiological finding and it was observed significantly more in mandibular primary molars (P < 0.05). Conclusion: Both ZOE and CH can be preferred as base materials after hemostasis achieved by the use of 15.5% FS or 1.25% NaOCl in primary tooth pulpotomy.

In Vitro evaluation of the wear of primary tooth enamel against different ceramic and composite resin materials A Bolaca, Y Erdogan Nigerian Journal of Clinical Practice 2019 22(3):313-319 Background: Although there are several studies on permanent tooth wear caused by dental materials, studies concerning primary teeth are limited. Aim: To evaluate the wear of primary tooth enamel against different ceramic and composite resin materials. Settings and Design: In vitro study. Materials and Methods: We assessed five materials (n = 10 per group): monolithic zirconia (group Z), lithium disilicate glass ceramic (group L), resin nanoceramic (group R), nanohybrid composite resin (group C), and primary tooth enamel (group E). The mesiopalatal cusps of primary maxillary second molars were used as antagonists. Wear tests were performed in a dual-axis chewing simulator, and the volume loss in the antagonist tooth was evaluated using a laser scanner and three-dimensional profiling system. Statistical Analysis Used: Data were statistically analyzed using one-way analysis of variance with Tukey's post hoc tests (P < 0.05). Results: The maximum antagonist tooth wear was observed in group L (3.84 ± 0.7 mm3), followed by groups C (3.68 ± 0.76 mm3), R (3.48 ± 0.71 mm3), Z (2.66 ± 0.65 mm3), and E (1.66 ± 0.42 mm3). Volume loss was significantly lesser in group Z than in groups L and C (P < 0.05), whereas there were no significant differences among groups L, C, and R. Conclusion: Within the limitations of this in vitro study, our findings suggest that zirconia should be used for full coronal coverage in primary tooth restorations because it causes lesser antagonist tooth wear than does lithium disilicate, resin nanoceramic, and nanohybrid composite resin.

The evaluation of preoperative and postoperative fetuin-A levels in patients with primary hyperparathyroidism M Keskin, C Culha, NE Gulcelik, LI Al, M Senes, Y Aral Nigerian Journal of Clinical Practice 2019 22(3):320-327 Objectives: Our objective was to evaluate preoperative and postoperative serum fetuin-A levels in female patients with primary hyperparathyroidism (PHPT) and search for the relationship with parathyroid hormone (PTH) and vitamin D (25OHD). Although a role for fetuin-A is suggested in regulating bone mineralization, its function has not been completely defined. Materials and Methods: In this cross-sectional study, 43 female patients with PHPT and 30 healthy women were recruited as the control group. We evaluated 73 women because we had only women patients with PHPT. Of the 43 patients, 10 symptomatic and 23 asymptomatic patients were surgically treated, whereas 10 patients were not operated. In all 43 patients, 25OHD, PTH, fetuin-A levels, and bone mineral densitometry were evaluated. The biochemical parameters of 33 operated patients were reevaluated at the postoperative sixth week. Results: Fetuin-A levels of the patients with PHPT were significantly higher than that in the controls (56.6 ± 13.8 vs. 42.6 ± 20.7 ng/mL; P = 0.010). Fetuin-A levels of the operated patients were higher than nonoperated group. Furthermore, serum fetuin-A levels of the nonoperated patients were not different from those of controls. After parathyroidectomy, fetuin-A (41.5 ± 25.2 vs. 56.4 ± 13.7 ng/mL; P = 0.003), PTH [80.0 (51.5–137.5) vs. 211.0 (151.5–278.5) pg/mL; P < 0.001], and calcium (9.2 ± 0.7 vs. 10.7 ± 0.8 mg/dL; P < 0.001) values were found to be decreased significantly. Conclusion: In this study, fetuin-A levels of patients with PHPT were higher than those of the controls and significantly decreased after parathyroidectomy compared with the preoperative levels. Fetuin-A levels could be a beneficial marker to determine the changes in bone metabolism of the patients with PHPT and to detect the patients suitable for surgery.

Evaluation of the influence of various restoration techniques on fracture resistance of endodontically treated teeth with different cavity wall thicknesses ET Basaran, Y Gokce Nigerian Journal of Clinical Practice 2019 22(3):328-334 Aims: The aim of this study was to compare the effect of different restoration techniques on fracture resistance of endodontically treated teeth with different wall thicknesses. Materials and Methods: Extracted and endodontically treated 210 premolars were randomly divided into three thickness groups [2 mm (A), 1.5 mm (B), and 1 mm (C)] and, each group was further divided into seven restoration subgroups (n = 10): direct composite (control) (K), composite with fiber on cavity floor (KT), composite with fiber on occlusal level (KO), fiber post and composite (FP), inlay (L), fiber on cavity floor and inlay (LT), and inlay and fiber on occlusal level (LO). Fracture test was performed, and data were compared with Kruskal–Wallis and Mann–Whitney U tests (P < 0.05). Results: There were no differences between the subgroups in A and C statistically (P > 0.05). However, in B, KO subgroup showed statistically higher values (P = 0.039). Conclusion: Wall support of 2 mm was adequate, and support of 1 mm was completely insufficient. When the wall thickness was 1.5 mm, direct restoration with fiber at the occlusal level significantly improved resistance.

Effect of different surface treatments and ceramic primers on shear bond strength of self-adhesive resin cement to zirconia ceramic NE Saleh, MC Guven, G Yildirim, F Erol Nigerian Journal of Clinical Practice 2019 22(3):335-341 Aims: To evaluate the effect of different surface treatments and ceramic primers on the shear bond strength (SBS) of self-adhesive resin cement to zirconia ceramic. Materials and Methods: A total of 40 zirconia discs (10 mm in diameter and 3 mm in height; StarCeram Z-Med, H.C. Starck, Selb, Germany) were prepared from pre-sintered zirconia blocks. Discs were divided into two groups according to surface treatment: (a) airborne particle abrasion (sandblasting) with 50-μm Al2O3 particles and (b) 9.5% hydrofluoric acid etching. Each of these groups was subdivided into two groups according to the type of primer applied: (a) Z-Prime Plus primer and (b) Clearfil Ceramic Primer. A self-adhesive resin cement (Multilink Speed, Ivoclar Vivadent, Schaan, Liechtenstein) was used to bond with polyethylene molds. All specimens were tested at thermocycled (5000 cycles at 5–55°C for 30 s) conditions. The SBS of the luting cement to the ceramic was measured in a universal testing machine (1 mm/min). Results: The sandblasted groups showed significantly higher SBS values than the acid-etched groups for both primers (P = 0.0001). Independent of the surface treatment, the Z-Prime Plus primer groups showed higher SBS values than the Clearfil Ceramic Primer groups (P = 0.0001). Conclusions: Sandblasting is a more effective method to increase bond strength on zirconia ceramics than hydrofluoric acid etching, and the application of Z-Prime Plus primer increases SBS better than Clearfil Ceramic Primer.

Clinical and radiographic characterization of primary seminomas and nonseminomatous germ cell tumors L Gu, L Zhang, N Hou, M Li, W Shen, X Xie, Y Teng Nigerian Journal of Clinical Practice 2019 22(3):342-349 Background: Primary malignant mediastinal germ cell tumors (PMMGCTs) including seminomas and nonseminomatous germ cell tumors (NSGCTs) are rare, and sometimes the diagnosis is very difficult. Purpose: The purpose of this study is to compare the clinical characteristics, biomarkers, and imaging findings of seminomas and NSGCTs and to determine whether these features could help distinguish these two types of PMMGCT. Material and Methods: A retrospective study of 24 male patients with histopathologically proven PMMGCT was performed. We collected the information of computed tomography (CT) (the scan area ranged from the apex of lung to the costophrenic angles) and magnetic resonance imaging blood test and histology characteristics of these patients. Results: Twelve of 24 cases were confirmed to be seminomas, whereas the other 12 cases were NSGCTs. Alfa-fetoprotein (AFP) was found to be elevated in all patients with NSGCT, whereas none of the patients with seminomas had elevated AFP level. Beta-human chorionic gonadotropin (β-HCG) level was elevated in all the patients with seminomas (seven/seven), whereas in NSGCT only two of seven patients had elevated β-HCG. Lactate dehydrogenase level was increased in five of the nine patients with seminomas, as well as in the eight patients with NSGCT. CT imaging revealed that 12 masses from the seminoma group were homogeneous, soft tissue opacity and showed minimal contrast enhancement. On the contrary, all 12 NSGCT cases showed cystic and solid masses; on contrast-enhanced CT, heterogeneous enhancement was found on the capsule of the tumor, septum, and solid masses. Conclusion: Seminomas and NSGCT showed different profiles of tumor biomarkers and radiographic features. Evidence from serum test, histopathological analysis, and imaging should be combined to ensure the accurate diagnosis of these two types of PMMGCT.

An In-vitro study on thermal changes during implant drilling with different irrigation volumes U Mercan, M Sumer, OA Kaya, I Keskiner, DG Meral, O Erdogan Nigerian Journal of Clinical Practice 2019 22(3):350-354 Objective: Irrigation with saline is one of the essential methods for reducing the heat generated during dental implant osteotomy. High irrigation volume impairs visibility of the surgical field, thus complicates the surgery. In this study, we aimed to determine the optimal irrigation volume for heat reduction during dental implant drilling. Materials and Methods: Thirty-two implant osteotomies were prepared on four fresh cow ribs. Heat generated during the final implant drilling was measured both with infrared thermography and thermocouple method. Initial and maximum temperatures were measured at four different irrigation volumes; 32, 44, 56, and 68 ml/min. Results: Both measurement methods showed that the amount of temperature rise is associated with the irrigation volume during implant drilling. There is no further decrease in temperature rise above irrigation volume of 56 ml/min. Conclusion: Saline irrigation with 56 ml/min provides sufficient heat reduction during dental implant drilling and higher irrigation volumes are not necessary.

Pharmacognosy

Quality assessment of pollen typhae by high-performance liquid chromatography fingerprint, hierarchical cluster analysis, and principal component analysis Xin Ma, Haimiao Zou, Yibin Pan, Jing Su, Yujiao Qiu, Mingfeng Qiu Pharmacognosy Magazine 2019 15(61):177-182 Aim: This study aims to establish the quality assessment methods of Pollen Typhae. Materials and Methods: High performance liquid chromatography (HPLC) fingerprint analysis, hierarchical cluster analysis (HCA), and principal component analysis (PCA) were used for quality evaluation of Pollen Typhae from different origins together with microscopic identification. Then, the quantity of 43 crude Pollen Typhae samples in the market was collected and analyzed. Results: In true and false test, four False Pollen Typhae samples, 13 Net Pollen Typhae (NPT) samples, and 26 Grass Pollen Typhae (GPT) samples were identified by microscopic identification. In quality test, the amounts and percentages of Qualified Pollen Typhae, Unqualified Pollen Typhae were 24 (55.81%) and 19 (44.19%), respectively with typhaneoside and isorhamnetin-3-O-neohesperidoside determined by HPLC according to China Pharmacopeia. We analyzed 43 samples from 20 regions and established their fingerprints, then selected 31 peaks as characteristic peaks and calculated their relative peak areas. To express the HPLC fingerprints quantitatively, peak 16, 18, 22, 23, and 26 were verified as typhaneoside, isorhamnetin-3-O-neoheptanoside, rutin, quercetin, and isorhamnetin. The similarity of correlation coefficients in chromatogram was 0.954 ± 0.007 and 0.922 ± 0.004 for NPT and GPT, respectively, while 0.67 ± 0.008 for 43 samples. The analysis of HCA and PCA can distinguish true or false, qualified or unqualified of Pollen Typhae. Conclusion: HPLC fingerprint combined with HCA and PCA provides a very efficient and comprehensive method for quality evaluation of Pollen Typhae. Abbreviations used: HCA: Hierarchical cluster analysis; PCA: Principal component analysis; FPT: False Pollen Typhae; NPT: Net Pollen Typhae; GPT: Grass Pollen Typhae; QPT: Qualified Pollen Typhae; UPT: Unqualified Pollen Typhae; RSDs: The relative standard deviations; CASE: Computer Aided Similarity Evaluation; TCM: Traditional Chinese medicine.

Chamuangone-enriched Garcinia cowa leaf extract with rice bran oil: Extraction and cytotoxic activity against cancer cells Pirunrat Sae-Lim, Supreeya Yuenyongsawad, Pharkphoom Panichayupakaranant Pharmacognosy Magazine 2019 15(61):183-188 Background: Chamuangone has been isolated from Garcinia cowa leaves and exhibited various biological activities, i.e., antibacterial, anti-Leishmania major, and cytotoxic activity against cancer cells. n-Hexane has been reported to be the most suitable solvent for extraction of chamuangone. Objectives: Some vegetable oils were determined as an alternative green solvent for extraction of an anticancer compound, chamuangone from G. cowa leaf. The chamuangone-enriched extract was standardized and evaluated for cytotoxic activity against human cancer cell lines. Materials and Methods: Microwave-assisted extraction and high-performance liquid chromatography were used for extraction and standardization. The cytotoxic activity was determined using a sulforhodamine B assay. Results: The chamuangone-enriched extract was obtained using rice bran oil as the alternative green solvent and standardized to contain 1.97 mg/mL chamuangone. The extract exhibited cytotoxic activity against human lung adenocarcinoma, human breast adenocarcinoma, and human colorectal adenocarcinoma cell lines, with IC50 values of 15.3, 15.9, and 12.8 μg/mL, respectively, but was nontoxic to human gingival fibroblasts, a normal cell line, at a concentration of 50 μg/mL. Moreover, the extract contained several natural antioxidants, including α-tocopherol (76.7 mg/100 g), γ-oryzanol (cycloartenol ferulate: 67.1 μg/mL and 24-methylenecycloartanol ferulate: 85.6 μg/mL), and antioxidant capacity determined as ascorbic acid (258.7-mM ascorbic acid equivalent per gram). Conclusion: Based on these findings, the chamuangone-enriched extract may be considered as a novel functional food in cancer chemopreventive action. Abbreviations used: AAE/g: Ascorbic acid equivalent per gram; CEO: Chamuangone-enriched Garcinia cowa leaf extract with rice bran oil; DMEM: Dulbecco's Modified Eagle Medium; FBS: Fetal bovine serum; HGF: Human gingival fibroblasts; HPLC: High-performance liquid chromatography; IC50:50% Inhibitory concentration; MAE: Microwave-assisted extraction; MHz: Megahertz; MUFAs: Monounsaturated fatty acids; NMR: Nuclear magnetic resonance; ODS: Octadecylsilane; PUFAs Polyunsaturated fatty acids; SD: Standard deviation; SFAs: Saturated fatty acids; SRB: Sulforhodamine B; TCA: Trichloroacetic acid; UFAs: Unsaturated fatty acids; UV: Ultraviolet; W: Watt.

Impact of ginsenoside-Rg3 on catecholamine secretion in the perfused model of the rat adrenal medullae Ki-Hwan Kim, Hyo-Jeong Lim, Young-Jae Ki, Dong-Yoon Lim Pharmacognosy Magazine 2019 15(61):189-198 Background: The present study was the first attempt to explore the characteristics of ginsenoside-Rg3 (Rg3) on release of catecholamines (CA) in the perfused rat adrenal medullae and also to verify the underlying action mechanism. Materials and Methods: The adrenal medulla was separated by some modification of the previous method and perfused with Krebs solution. CA was assayed directly by the fluorometry. Results: Rg3 reduced acetylcholine (ACh)-produced CA release in a dose- and time-dependent manner. Rg3 time-dependently depressed CA release produced by 3-(m-chloro-phenyl-carbamoyl-oxy)-2-butynyltrimethyl ammonium chloride (McN-A-343), 1,1-dimethyl-4-phenyl piperazinium iodide, and angiotensin II. In the presence of Rg3, the CA release produced by high K+, veratridine, cyclopiazonic acid, and methyl-1,4-dihydro-2,6-dimethyl-3-nitro-4- (2-trifluoromethyl-phenyl)-pyridine-5-carboxylate (Bay-K-8644) was also markedly suppressed. However, during the simultaneous perfusion of Rg3 and Nω-nitro-l-arginine methyl ester hydrochloride (l-NAME), the release of CA produced by ACh, angiotensin II, Bay-K-8644, and veratridine was restored closely to the level of each control, in contrast to that of Rg3-treatment alone. The nitric oxide (NO) release was significantly elevated by Rg3-treatment. Furthermore, in the coexistence of Rg3 and fimasartan, ACh-produced CA release was more significantly reduced as compared to that of fimasartan-treatment alone. Conclusions: We present the first evidence that Rg3 markedly depresses the CA secretion produced by activation of neuronal cholinergic and angiotensinergic receptors. Rg3-produced inhibition appears to be evoked not only by blocking the inflow of Na+ and Ca2+ into adrenomedullary cells but also by preventing the Ca2+ release from intracellular storage, partly through enhancement of NO release by NO synthase activation. Coadministration of Rg3 and fimasartan may be clinically beneficial for the treatment of cardiovascular diseases. Abbreviations used: Rg3: Ginsenoside-Rg3; VDCC: L-type voltage-dependent Ca2+ channels; Bay–K-8644: Methyl-1,4-dihydro-2,6-dimethyl-3-nitro-4-(2-trifluoromethyl-phenyl)-pyridine-5-carboxylate; ACh: Acetylcholine; McN-A-343: 3-(m-chloro-phenyl-carbamoyl-oxy)-2-butynyltrimethyl ammonium; DMPP: 1.1-dimethyl-4-phenyl piperazinium; NO: Nitric oxide; L-NAME: Nω-nitro-l-arginine methyl ester; nNOS: Neuronal NO synthase.

New bioactive C15 acetogenins from the red alga Laurencia obtusa Mohamed A Ghandourah, Walied M Alarif, Nahed O Bawakid Pharmacognosy Magazine 2019 15(61):199-203 Background and Objective: With regard to the uniqueness of the red algae of the genus Laurencia as the source of C15-acetogenins, along with the diversity of biological applications; the acetogenin content of the Red Sea Laurencia obtusa was investigated. Materials and Methods: Fractionation and purification of the CH2Cl2/MeOH extract were carried out by applying several chromatographic techniques, including column and preparative thin-layer chromatography; followed by a series of 1H nuclear magnetic resonance measurements to give rise of some interesting notes. Toxicity to Artemia salina was evaluated. The apoptosis induced by these two compounds was demonstrated by DNA fragmentation assay and microscopic observation. Results: A new rare chloroallene-based C15 acetogenin, laurentusenin (1) along with a new furan ring containing C15 acetogenin, laurenfuresenin (2), were isolated from the red alga L. obtusa. Comparing 1D and 2D NMR, MS, ultraviolet and infrared radiation spectral data for the newly isolated compounds with the reported bromoallene containing acetogenins spectral data was played the crucial role for characterization of their chemical structures. 1 and 2 exhibited bare toxicity (LD50 >12 mM) in test organism, A. salina and induced apoptotic death confirmed by DNA fragmentation and microscopic investigations. Conclusion: The isolated metabolite 1 showed unusual substituted allene side chain, while 2 inserted furan ring as a new acetogenin nucleus. Both compounds may play a role in apoptosis induction and initiation and propagation of inflammatory responses. Abbreviations used: NMR: Nuclear magnetic resonance; MS: Mass spectrometry; UV: Ultraviolet spectroscopy; IR: infrared radiation; EIMS: Electron ionization mass spectra; TLC: Thin-layer chromatography; PPP: Platelet poor plasma; PRPDS: platelet-rich plasma derived serum. DEPT: Destortionless Enhancement by Polarization Transfer; NOESY: Nuclear Overhauser Effect Spectroscopy; HSQC: Heteronuclear Single Quantum Coherence; HMBC: Heteronuclear Multiple-quantum Correlation; 1H-1H COSY: Correlation Spectroscopy.

A new antifungal aminobenzamide derivative from the endophytic fungus Fusarium sp. Sabrin R M. Ibrahim, Gamal A Mohamed, Maan T Khayat, Rwaida A Al Haidari, Amal A El-Kholy, Mohamed F Zayed Pharmacognosy Magazine 2019 15(61):204-207 Background: Endophytic fungi attracted attention as a prolific source of bioactive natural products with a potent pharmaceutical activity and unique structure. Objective: The main goal of the study is to separate and identify the bioactive constituents from the endophytic fungus Fusarium sp. as well as to evaluate the antimicrobial of the new metabolites. Materials and Methods: The fungus was cultured on a rice medium, and then, the cultures were extracted with ethyl acetate (EtOAc). The EtOAc extract was chromatographed utilizing different chromatographic methods to give five metabolites. The structural determination of these metabolites was carried out by the analyses of various spectroscopic data, in addition to comparison with the formerly reported data. The antifungal and antibacterial potentials were evaluated toward various microbial strains using disc diffusion assay. Results: A new aminobenzamide derivative, namely fusaribenzamide A (2), and four known metabolites: (22E,24R)-stigmasta-5,7,22-trien-3-β-ol (1), adenosine (3), p-hydroxyacetophenone (4), and tyrosol (5) were isolated. Fusaribenzamide A (2) possessed significant antifungal activity toward Candida albicans with minimum inhibitory concentration (MIC) value 11.9 μg/disc compared to nystatin (MIC 4.9 μg/disc). Conclusion: The endophytic fungus Fusarium sp. could be considered as a wealthy pool for the isolation of aminobenzamide derivatives. Fusaribenzamide A may be a candidate for the discovery of a promising antifungal agent. Abbreviations Used: CC: Column chromatography; CHCl3: Chloroform; COSY: Correlations spectroscopy; DBE: double bond equivalent; EtOAc: Ethyl acetate; DMSO: Dimethyl sulfoxide; H2SO4: Sulfuric acid; HMBC: Heteronuclear multiple bond correlation experiment; HRMS: High-resolution mass spectrometry; HRESIMS: High-resolution electrospray ionization mass spectrometry; HSQC: Heteronuclear single quantum correlation; IR: Infrared; IZD: Inhibition zone diameter; KBr: Potassium bromide; LTQ: Linear trap quadrupole; MeOH; Methanol; MIC: Minimum inhibitory concentration; NMR: Nuclear magnetic resonance; RP: Reversed phase; SiO2: Silica gel; TLC: Thin-layer chromatography; UV: Ultraviolet; VLC: Vacuum liquid chromatography.

Optimization of infrared-assisted extraction of bioactive lactones from Saussurea lappa L. and their effects against gestational diabetes Karim Raafat, Nada El-Darra, Fatima A Saleh, Hiba N Rajha, Nicolas Louka Pharmacognosy Magazine 2019 15(61):208-218 Background: Saussurea lappa (S. lappa, Asteraceae) have immunomodulatory effects and used in the management of many metabolic disorders. Gestational diabetes is one of the metabolic disorders affecting globally one in seven pregnant women. Objectives: The aim of the current study is to optimize an infrared-assisted extraction (IR-AE) method for S. lappa bioactive constituents, phytochemically investigate its content, isolate its most active constituent, and to assess their biological effects against gestational diabetes. Materials and Methods: To optimize IR-AE conditions, four main factors were studied including solvent concentration, extraction time, powder size, and IR power in the yielded extract (SL-IR). Reversed-phase high-performance liquid chromatography coupled with bio-guided fractionation and isolation procedures using 1H and 13C NMR method were utilized. Solid–liquid (SL-SLE) and ultrasound (SL-US) extraction methods were also done. Results: The optimal IR-AE extraction conditions were found to be 20% aqueous phase concentration, 60-min extraction time, 70 mesh powder size, and 70 W IR power. Phytochemically, four major lactones were identified, including costunolide, dehydrocostuslactone, isoalantolactone, and alantolactone (ATL). ATL was the most active lactone. SL-IR, SL-US, SL-SLE, or ATL showed a significant (P < 0.05) and dose-dependent hypoglycemia in pregnant diabetic group, adequate fetus weight percentage elevation and did not show any external anomalies. The best control of gestational diabetes, insulin secretagogue potentials, elevation in serum catalase and reduced glutathione levels, and lipid peroxidation decrease were demonstrated by SL-IR 250 mg/Kg. The antioxidant and the insulin secretagogue activities might be among the main mechanisms, whereby the SL-IR controls gestational diabetes and decreases offspring anomalies. Conclusion: Currently, it is the first time to optimize an IR-AE method for extracting bioactive lactones from S. lappa. The optimized IR-AE technique has shown to be a rapid and efficient extraction method with SL-IR showing superiority in controlling gestational diabetes for pregnant groups coupled with high safety profile on the offspring. Abbreviations used: IR-AE: Infrared-assisted extraction; SL: Saussurea lappa, S. lappa; SL-IR: Saussurea lappa infrared extract; SL-US: Saussurea lappa ultrasound extract; SL-SLE: Saussurea lappa solid–liquid extract; ATL: Alantolactone; NDC: Nondiabetic control; DC: Diabetic control; MTF: Metformin; TBARS: Thiobarbituric acid; GSH: Reduced glutathione; CAT: Catalase; APA: Adequate for pregnancy age; LPA: Large for pregnancy age; SPA: Small for pregnancy age.

Dictamnus dasycarpus Turcz., root bark alleviates oxazolone-induced atopy-like dermatitis in mice Beodeul Yang, Ji Hyo Lyu, Sura Kim, Young Chul Park, Koanhoi Kim, Hyungwoo Kim Pharmacognosy Magazine 2019 15(61):219-225 Background: Dictamnus dasycarpus Turcz., is one of the most frequently used herbal medicine to treat dermatosis associated with psoriasis, pruritus, scabies, and eczema. Objective: We investigated the anti-inflammatory effects of D. dasycarpus extract (DDE) using a mouse model with atopic dermatitis (AD)-like dermatitis. Materials and Methods: The therapeutic effects of DDE on skin lesion, tone of color, and inhibitory effects on histopathological changes and cytokine production in skin tissues were assessed in mice with AD-like dermatitis induced by oxazolone. Results: Topical application of DDE alleviated skin lesions such as erythema, scaling and excoriations, and ameliorated erythema and the melanin index. In addition, DDE effectively prevented skin enlargement induced by oxazolone, while also preventing epidermal hyperplasia, spongiotic change, and hyperkeratosis and reducing the production of tumor necrosis factor-alpha and interleukin (IL)-4 and IL-5 in inflamed tissues. Finally, DDE did not affect changes in body weight and spleen–body weight ratio relative to dexamethasone. Conclusion: These results indicate that D. dasycarpus can be used as a topical agent for inflammatory skin diseases with relative safety. Abbreviation used: HM: Herbal medicine; DNFB: Dinitrofluorobenzene, ICAM-1: Intercellular adhesion molecule-1, AD: Atopic dermatitis, DDE: Dictamnus dasycarpus extract, AOO: Vehicle composed of acetone and olive oil, DEX: Dexamethasone, CBA: Cytometric bead array.

Antidepressant-like effects of methanol extract and fractions of Hypericum juniperinum kunth in the forced swimming test Laura A Mejía-Agudelo, Maritza A Rojas, Mario F Guerrero-Pabón, Freddy A Ramos, Leonardo Castellanos, Juan Camilo Marín-Loaiza Pharmacognosy Magazine 2019 15(61):226-231 Background: Some members of the genus Hypericum have been shown to demonstrate antidepressant-like effects. In Colombia, approximately 54 species of Hypericum have been reported, and only a few have been investigated chemical and pharmacologically. Objective: The aim of this study was to evaluate the antidepressant-like effects of a methanol extract, as well as ethyl acetate and butanol fractions, obtained from aerial parts of Hypericum juniperinum K. Materials and Methods: Behavioral and locomotor activities were evaluated in the open field test (OFT). Antidepressant-like activity was measured in the forced swimming test (FST) in male Swiss albino mice. Preliminary phytochemical screening as well as a high-performance liquid chromatography (HPLC) profile of the active fractions of H. juniperinum was performed. Results: Treatment with the methanol extract at 500 mg/kg and the ethyl acetate and butanol fractions at 150 and 300 mg/kg resulted in a decrease in the immobility times in FST. In the OFT, none of the treatments presented altered behavior or locomotor activity of mice. Preliminary phytochemical screening identified terpenes/steroids, flavonoids, phenol derivatives, tannins, and saponins. In the HPLC analysis of the fractions, rutin, quercitrin, and quercetin were identified with the help of coinjection of standards. Conclusion: This is the first report of the antidepressant-like activity of extracts and fractions obtained from H. juniperinum in the FST model of depression. Flavonoids may be responsible for the antidepressant-like action of H. juniperinum. Abbreviations used: FST: Forced swimming test; HJE: Methanol extract of Hypericum juniperinum; HJEAF: Ethyl acetate fraction obtained from the methanol extract of Hypericum juniperinum; HJEBF: Butanol fraction obtained from the methanol extract of Hypericum juniperinum; HPE: Methanol extract of Hypericum perforatum; HPLC: High-performance liquid chromatography; IMI: Imipramine; MeOH: Methanol; OFT: Open field test; tR: Retention time; UV: Ultra violet; VEH: Vehicle.

Biological evaluation and molecular docking study of metabolites from Salvadora Persica L. Growing in Egypt Mohammed M Ghoneim, Wael M Afifi, Mohamed Ibrahim, Mohamed Elagawany, Maan T Khayat, Mohamed H Aboutaleb, Ahmed M Metwaly Pharmacognosy Magazine 2019 15(61):232-237 Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a resistant staph bacterium to several antibiotics causing several lives-threating diseases such as pneumonia and sepsis. Meswak, Salvadora persica, exhibited promising antimicrobial properties before. Objective: Exploring the anti-MRSA activity of S. persica L. metabolites and its mechanism of action on a molecular level. Materials and Methods: Structure elucidation of the isolated metabolites was carried out by spectroscopic data (one-dimensional and two-dimensional nuclear magnetic resonance). The biological activities of the isolated metabolites against MRSA were evaluated and the molecular mode of action against the dehydrosqualene synthase enzyme have been done. Results: Four compounds have been isolated and identifies to be; apigenin (1), luteolin (2), astragalin (3), and kaempferol-3-O-rhamnoside (4). Compounds 1–4 showed good anti-MRSA activities with IC50 values of 10.3, 11.5, 3.5, and 4.5 μg/mL, respectively. In consistent, astragalin and kaempferol-3 rhamnoside showed close high docking scores. Herein, we are reporting the molecular determinates of activity of these new scaffolds as anti-MRSA, which would be of great importance to developing new anti-MRSA candidates. Abbreviations Used: 1D: One-dimensional; 2D: Two-dimensional; CC: Column chromatography; COSY: Correlations spectroscopy; DMSO: Dimethyl sulfoxide; HMBC: Heteronuclear multiple-bond correlation experiment; HRESIMS: High-resolution electrospray ionization mass spectrometry; HSQC: Heteronuclear single-quantum correlation; IR: Infrared; MRSA: Methicillin-resistant Staphylococcus aureus; NMR: Nuclear magnetic resonance; RP: Reversed phase; TLC: Thin-layer chromatography; UV: Ultraviolet; VLC: Vacuum liquid chromatography.

Ameliorative effects of tannic acid on lipopolysaccharide-induced sepsis and acute lung injury in mice Ruirui Zhang, Minyan Dang, Shoutian Qiu, Hongyan Gu, Pingping He, Gang Guo, Tao Zhang Pharmacognosy Magazine 2019 15(61):238-243 Background: Acute lung injury (ALI) caused by endotoxins is a severe complication causing lethal conditions. Prevention of the inflammatory response is necessary to overcome this condition. Tannic acid is a polyphenol known for its pharmacological properties such as antioxidant, antimicrobial, anti-inflammatory, anticancer, antitumor, and antimutagenic. This study aims to investigate the anti-inflammatory mechanism of tannic acid on lipopolysaccharide (LPS)-induced sepsis and ALI in mice. Materials and Methods: Male BALB/c mice were divided into five groups (n = 12) and induced with LPS (50 mg/kg body weight) and treated with tannic acid (25, 50, and 100 mg/kg) after 1 h. The bronchoalveolar lavage fluids were collected to determine the myeloperoxidase activity and levels of inflammatory cytokines (tumor necrosis factor-α, interleukin [IL]-6, and IL-1 β). Nuclear factor-kappa-β (NF-κβ) activities were examined through Western blot analysis, and hematoxylin and eosin staining was done for histopathological alterations of lung tissues. Results: Results of the study showed that tannic acid was able to prevent the infiltration of inflammatory cells and cytokines into the site of ALI which is also connected to the suppression of NF-κβ activation as shown in the Western blot analysis. The histopathological results further support these results. The safety of tannic acid was also proven on the survival of RAW264.7 cells. Conclusion: The anti-inflammatory mechanism of tannic acid on LPS-induced ALI and sepsis can be credited to the inhibition of inflammatory cytokines production mediated by NF-κβ pathway suppression. Abbreviations used: ALI: Acute lung injury; BALFs: Bronchoalveolar lavage fluids; NO: Nitric oxide; COX-2: Cyclooxygenase-2; iNOS: Inducible nitric oxide synthase; TNF-α: Tumor necrosis factor-α; IL-1β: Interleukin-1 β; IL-6: Interleukin-6.

Oral Research and Review

Oral Health Status of Martyr Memorial Residential School Children of Sunsari, Nepal Santosh Kumari Agrawal, Ashish Shrestha, Tarakant Bhagat Journal of Oral Research and Review 2019 11(1):1-6 Context: Students, who are healthy, active, and well nourished, are likely to attend schools regularly which accelerate their learning process. Poor oral health has a profound effect on general health and quality of life. Aims: The aim of this study was to assess the oral health status of Martyr Memorial Residential School Children of Sunsari, Nepal, during 5-year period and also to assess the effectiveness of school oral health program. Settings and Design: A retrospective longitudinal study was carried out among Martyr Memorial Residential School children. Subjects and Methods: Aretrospective longitudinal study was performed among 411 school children of Martyr Memorial Residential School, Sunsari, Nepal. Five years' data of children were collected from the department record forms from 2009 to 2014. Data on demographic parameters, oral health condition (Decayed, Missing, and Filled Teeth [DMFT], oral hygiene status, type of dentition, malocclusion, and diet history), and treatment done for each child were collected from the surveyed forms. Statistical Analysis Used: Frequency distribution, prevalence, and incidence of dental caries were calculated. Results: This study showed that the prevalence of dental caries in 2009, 2010, 2011, 2012, 2013, and 2014 was 21.0%, 23%, 29.1%, 10.0%, 13.5%, and 30.9%, respectively. The incidence of dental caries in permanent dentition was high (22.0%) in 2011 follow-up. None of the dentition developed new cavity in 2010 follow-up period. More than half of the children had good oral hygiene status in 2012, whereas only 32.9% had so in 2009. Majority (95.5%) of the enrolled children had normal occlusion. Conclusions: This study showed the overall positive impact on the children's prevalence and incidence of dental caries as well as on oral hygiene status. The incidence of developing new caries in both types of dentition decreased. There was an increase in filled component of DMFT/decayed, filled teeth index. Most of them had good oral hygiene status at the end of the study.

Assessment of child's mental health problems using Strengths and Difficulties Questionnaire Miranda George, Shweta Chandak, Milind Wasnik, Sneha Khekade, Niharika Gahlod, Harshita Shukla Journal of Oral Research and Review 2019 11(1):7-11 Background: While a number of studies in the Western countries have provided estimates of prevalence for child psychiatric morbidity and associated risk factors, relatively little is known about child psychiatric problems and risk factors in developing countries like India. Aim: The aim of this study was to assess the patients' emotional status in an age group of 3–14 years to evaluate children's cooperative potential. Methodology: The Goodman's Strengths and Difficulties Questionnaire assessing the mental health status of the child was distributed to the Vidharbhan population attending the dental hospital. A cross-sectional survey including 168 children aged 3–14 years who were instructed how to fill the questions participated in the study. Results: Overall 53% of the children belonged to the normal category, whereas 33% and 14% were under abnormal and borderline categories, respectively. The abnormal category was slightly higher in the age groups of 3.1–5 (35%) and 11.1–14 (28%) years. Similar to certain studies, the mental health problems with males (52.9%) were higher than that of females (47.6%). Conclusion: Identifying the mental health problems of the child seeking dental treatment will help the dentist to formulate an idea of the child's emotional status at the time of treatment and thereby make proper amendments during the treatment procedure. There is a need for developing programs to train, sensitize, and mobilize teachers and parents regarding children's psychological, emotional, and behavioral problems, with special attention to the common population.

The importance of oral health education in patients receiving orthodontic treatment Emad E M. Alzoubi, Valentina Tabone Borg, Gabriella Gatt, Anne Marie Aguis, Nikolai Attard Journal of Oral Research and Review 2019 11(1):12-19 Introduction: Evaluation of the effectiveness of a well-targeted educational campaign specially designed toward the improvement of oral health and maintenance of removable orthodontic appliances should be considered during an orthodontic treatment. Objectives: The objective of this study was to assess the impact of the oral hygiene protocol on oral health through assessing plaque accumulation on the removable orthodontic appliance, to establish the impact of oral hygiene protocol on oral health through assessing the patients' plaque accumulation on the tooth surface and gingival bleeding, and to evaluate the degree of halitosis between the intervention and control groups. Materials and Methods: The study involved 80 patients who were equally assigned to the intervention and control removable orthodontic treatment groups. Data were collected by means of questionnaires, soft-tissue examination, breath checker, and staining the appliance with methylene blue disclosing solution. Results: The plaque score of both groups at Review 2 emphasized a significant difference (P = 0.021), yet neither differences at baseline (P = 0.989) nor Review 1 (P = 0.786) were found. The odor score of both groups at Review 2 showed a significant difference (P = 0.012). All interventional patients and only 10% of the control group patients were aware of appliance removal during sport. There was no significant difference (P = 0.211) between the responses of patients concerning the cleaning method of the appliance. The patients showed a higher user rate of mouthwash, and they were more successful with respect to when it should be used. Conclusion: The effectiveness of an educational session has been demonstrated in some aspects of the research.

Comparative evaluation of two suturing models for preclinical training Triveni Kale, Shruti Shankarrao Lendhey, Varsha Ranmare, Govind Bhartiya, Anuja Hudwekar, Pranav Lendhey Journal of Oral Research and Review 2019 11(1):20-24 Introduction: Demonstration and training on the live subject are not always an optimal means of introducing students to suturing technique. The use of live patient as a test subject is not acceptable with today's ethical standard. It would be advantageous to use a preclinical training model that impersonates real-life conditions, through which manual dexterity and a high degree of psychomotor skill can be achieved. This helps to master the suturing technique under semi-realistic circumstances at an affordable cost. The model most closely resembling the actual condition should be considered. Materials and Methods: A total of 54 postgraduate students participated in the study. The material required for both the models were distributed among participants and asked to prepare the models. Then, suturing was performed on models, and the questionnaires were given for feedback. Model 1: Require orange peel, alginate impression material, and dental stone. Model 2: Require mackintosh, sponge, alginate impression material, and glass slab. Depending on the questionnaire, response results were calculated. Results: All participants experienced that glass slab model was more durable than the orange model. Thirty-six participants experienced that orange model is easy to prepare compared to glass slab model. There was a significant linear trend among the ordered categories seen using Chi-square test. Conclusion: According to the participant's preference orange model was better in all aspects such as ease of preparation, the passage of suture needle, and the time required for suturing compared to glass slab model which was more durable and less gaping experienced with it. Hence, we concluded that orange model was better for preclinical suturing training.

Salivary duct carcinoma of minor salivary gland: A case report with review of literature Arshdeep Kaur, Chetan Dev Singh Boparai, Anusha Rangare Lakshman, Gogineni Subhas Babu Journal of Oral Research and Review 2019 11(1):25-28 Salivary duct carcinoma (SDC) is a rare, highly aggressive neoplasm representing about 1%–3% of all malignant salivary gland tumors. Approximately, 85% of the cases occur in the parotid gland followed by the submandibular gland and minor salivary gland. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as “SDC.” This article highlights a case of rapidly growing swelling in the left mandibular region in a 60-year-old female. As this entity is rare and highly aggressive, an early detection followed by appropriate treatment is very important to improve the survival rate of the patient.

Acquired maxillary double lip Chaithra Kalkur, Krishna Burde, Anusha R L, Nilofer Halim, Atul Sattur Journal of Oral Research and Review 2019 11(1):29-31 Double lip is a rare deformity of the face, which can occur as congenital and acquired anomaly. It most often appears as syndromic variety along with systemic manifestations. It is a rare occurrence with slight male predilection. This article is a report of a 20-year-old female presented with the acquired double upper lip for 1 year developed after orthodontic treatment.

Is drug substitution always a solution? Phenytoin induced gingival enlargement – A case report Chandni Gupta, Ritika Arora, Himani Sharma Journal of Oral Research and Review 2019 11(1):32-36 Gingival enlargement is the most common side effect which is reported with the administration of the anti-epilepsy drug phenytoin (PHT). It is of vital importance as it greatly affects the esthetics and also interferes with the mastication and oral hygiene practices. It is now well known that the presence of gingival inflammation resulting from poor oral hygiene acts as a major risk factor and leads to worsening the condition. Therefore, the patients taking PHT should be made aware of the possible outcomes and the importance of maintaining oral hygiene and periodontal maintenance therapy. This case report describes a case of PHT-induced gingival enlargement in which surgical intervention was done to correct the gingival enlargement, and in spite of patient not discontinuing the drug (PHT), no recurrence of enlargement was seen even after 1 year.

Endodontic management of badly broken down tooth with radix entomolaris using the canal projection technique Huma Iftekhar Journal of Oral Research and Review 2019 11(1):36-40 The management of teeth with minimal coronal structure can be a challenging task when root canal treatment is required as a part of oral rehabilitation. Coronal leakage, isolation complexities, and risk of interappointment coronal-radicular fracture may be major contributors to endodontic failure. It is a great challenge to an endodontist to maintain root canal patency while isolating grossly destructed tooth with open pulp chamber, without blocking the root canals with restorative material. Pre-endodontic build-up of the coronal tooth structure following caries removal and identification of all the canal orifices while maintaining the canal patency can facilitate the endodontic process by providing a strong core and coronal seal. Hence, a restoration before endodontic treatment is mandatory during management of these teeth. This can be achieved successfully by the canal projection technique, wherein a tapered plastic sleeve is used to maintain the canal patency, projecting the canal from pulp chamber to cavosurface margin. Taking into consideration the limited worldwide availability and cost of original projectors, the aim of the present case is to highlight a simple yet effective method of placement of a pre-endodontic restoration using the canal projection technique by custom made plastic sleeves. This case report demonstrates the use of an innovative technique for canal projection, as an efficient method for managing complex cases.

An update on nicotine replacement therapy KA Kamala, S Sankethguddad, SG Sujith Journal of Oral Research and Review 2019 11(1):41-47 Tobacco use is the single greatest preventable cause of death in the world. Most tobacco users want to quit but find it difficult to stop due to the addictiveness of nicotine. Interventions for tobacco cessation are important in enabling tobacco users to stop using, which includes pharmacological and nonpharmacological approaches to aid tobacco cessation. Pharmacological approaches include nicotine replacement therapy (NRT) and nonnicotine medications (bupropion and varenicline). NRT delivers nontoxic forms of nicotine to help tobacco user's deal with nicotine cravings and maintains stimulation of the nicotine receptors. Forms of delivery for NRT include the following: nicotine chewing gum, nicotine lozenge, transdermal patch, nicotine inhaler, nicotine nasal spray, and nicotine sublingual tablets. These NRTs are in general well tolerated and have minimal adverse effects. The present review gives an overview about various modes of NRT methods currently used to treat nicotine dependence.

Periodontal implications of argyrophilic nucleolar organizer region: A mini reviewPeriodontal implications of argyrophilic nucleolar organizer region: A mini review Vandana Kharidi Laxman, GS Madhushankari, Mini Saluja, Shivani Singh Journal of Oral Research and Review 2019 11(1):48-51 The periodontal lesions with cellular proliferation can be assessed by various methods. One of the methods to determine the proliferative activity is silver-staining argyrophilic nucleolar organizer region (AgNOR) staining. AgNOR can be used as diagnostic and prognostic tool for many of periodontal lesions which are proliferative in nature and may be quantitative marker of incipient cellular alterations before the histologic hallmarks appear. Hence, this paper reviewed about the periodontal applications of AgNOR staining.