Correlating Nasal Patency with Obstructive Sleep Apnea in Obese Versus Non-Obese Patients: An Acoustic Rhinometry Study

The aim of this study was to correlate nasal patency with Obstructive Sleep Apnea (OSA) in obese versus non-obese patients using Acoustic Rhinometry (AR). Eccovision® Acoustic Rhinometer equipment was used to compare nasal cross-sectional areas (CSA1,2 & 3 corresponding to nasal valve region, anterior portion of middle & inferior turbinate and posterior portion of middle & inferior turbinate respectively) and volume in age and gender matched sample divided into three groups: Group 1: Non-obese patients without OSA (25 patients, 13 males and 12 females); Group 2: Non-obese patients with OSA (25 patients, 14 males and 11 females); Group 3: Obese patients with OSA (25 patients, 13 males and 12 females). The mean nasal cross-sectional areas and volume were lower in Group 2 compared to Group 1 but statistically non-significant (P value > 0.05 for all). The mean nasal cross-sectional areas and volume were significantly lower in Group 3 as compared to Groups 1 and 2 (P value < 0.05 for all). BMI showed a statistically significant positive (direct) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). The nasal cross-sectional areas and volume showed a statistically significant negative (inverse) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). OSA diagnosed cases with high BMI may not present with an obvious nasal obstruction; the nasal patency may still be compromised due to reduced nasal lumen secondary to obesity. AR, being cost-effective and non-invasive modality; is advocated to evaluate pre-treatment nasal patency, as well as follow up evaluation to ascertain improvement after the intervention.

Plasma cell gingivitis: A perplexing and rare clinical entity

Plasma cell gingivitis (PCG) is a diagnostic dilemma for clinicians. It is also referred to as atypical gingivostomatitis, idiopathic gingivostomatitis, allergic gingivostomatitis, and plasma cell gingivostomatitis which are characterized by bright fiery red gingiva with spontaneous bleeding on slight provocation. It is often confused with inflammatory gingival enlargement, erythematosus lichen planus, and other lesions. One such rare and benign entity is discussed in this article and managed after thorough clinical, radiological, histopathology, immunohistochemistry analysis.

Effect of Mandibular Setback Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions

Introduction

The changes in length and height of tongue following mandibular setback (MS) surgery may affect pharyngeal airway dimensions. There is limited literature correlating tongue dimensional changes with linear and volumetric airway changes following MS with bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class III patients.

Materials and Methods

Treatment records of 18 patients who underwent MS with BSSRO were evaluated for changes in tongue and linear airway dimensions, mean airway volume and area at T1 (1-week pre-surgery), T2 (6-month post-surgery) and T3 (2-year post-surgery). Amount of MS was recorded from case sheets of patients. Mean tongue length reduced, whereas mean tongue height increased at T2 compared to T1 (P value = 0.001 for both). Linear, area and volumetric airway parameters at T2 were significantly reduced (P value = 0.001). All parameters showed statistically nonsignificant increase from T2 to T3 (P value > 0.05). Correlation analysis showed that change in tongue length at T3 did not show statistically significant correlation with amount of MS, changes in linear, area and volumetric airway parameters (P value > 0.05). However, the change in tongue height at T3 showed a significant (P value < 0.05) negative correlation (r value = - 0.742) with change in posterior airway space (PAS).

Conclusions

The appraisal of tongue length and height after MS surgery should be an integral part of diagnosis and treatment planning. The retro-positioning of tongue and increase in its height after MS surgery may compromise pharyngeal airway especially PAS. Additional options such as bi-jaw surgery, debulking of tongue volume and genioplasty should be explored to minimize adverse effects post-surgically.

Utility versus futility of facebow in the fabrication of complete dentures: A systematic review

Aim:

The aim of this review was to investigate utility or futility of facebow for fabrication of complete denture prosthesis to maximise clinical efficiency and acceptability of complete dentures.

Settings and Design:

Systematic review following PRISMA guidelines.

Materials and Methods:

A study question was designed based on PICOT model which was used to evaluate whether facebow transfer is required or not for fabrication of complete denture prosthesis. An extensive search was carried out manually and using electronic databases such as PubMed-Medline, Cochrane, Google Scholar, and Clinicaltrials.gov. Parameters under review included patient satisfaction, masticatory efficiency, occlusal adjustments, clinician time, stability and retention. Boolean operators, MeSH terms and limiters were applied to develop the search and reach to conclusive studies pertaining to study design. Literature dated between 1950 and 2019 were selected. The data extraction and assessment of the studies was done by two independent investigators.

Statistical Analysis Used:

No meta-analysis was conducted due to heterogeneity of data obtained.

Results:

13690 studies were shortlisted, 13672 were excluded based on title and abstract. By the end of search phase, 07 RCTs were considered relevant. 04 studies concluded comparable/ no differences in outcome with and without use of facebow for fabrication of complete denture prostheses, whereas 03 studies concluded better results without the use of facebow.

Conclusion:

The use of facebow results in fabrication of complete denture prostheses with similar results in terms of clinical efficiency and patient acceptability as compared to simplified techniques using anatomical landmarks. Variations in assessment criteria, non uniform distribution of sample size amongst different clinical trials and subjective questionnaire based criteria are the weaker links in the review. Extensive research and long term standardised studies with objective criteria for assessment are required for comprehensive and conclusive results to establish the need for change in clinical practice.

Evaluation of Nasal Patency Among Patients With Unilateral Cleft Lip and Palate: Cleft Versus Non-Cleft Side

OBJECTIVE

To evaluate the nasal patency using acoustic rhinometry (AR) in patients with unilateral cleft lip and palate (UCLP) and to ascertain the rhinological importance of the same.

METHODS

Eccovision Acoustic Rhinometer system was used for assessment of nasal cross-sectional area (CSA) and volume in 15 patients with UCLP. The CSA1, CSA2, and CSA3, which represent the CSA at the nasal valve area and anterior end of the inferior turbinate, the anterior half of the inferior turbinate and the anterior end of the middle turbinate, and the region of middle portion of middle turbinate, respectively, were compared on the cleft and non-cleft side.

RESULTS

The mean ± SD of CSA1, CSA2, and CSA3 as well as the overall nasal CSA were significantly higher on non-cleft side compared to cleft side (P value < .001). The mean ± SD of nasal volume was also significantly higher in non-cleft side compared to cleft side (P value < .001).

CONCLUSIONS

The nasal patency among patients with UCLP demonstrates a range of impairments that can be objectively measured using acoustic rhinometry. The orthodontic, orthopedic, or orthosurgical management of maxillary deficiency in these patients can affect the nasal area and volume and can have an impact on breathing, speech, and sleep. The pretreatment assessment may be useful to identify patients who are at potential risk of deterioration of nasal patency and airway post-intervention. Taking into consideration the multiple diagnostic procedures in the course of long-term multidisciplinary treatment of patients with cleft lip and palate, a noninvasive investigation technique such as AR may be the preferred mode of investigation to ascertain nasal patency.

Forensic odontology: The prosthetic ID

The term “forensic science” involves forensic (or forensis, in Latin), which means a public discussion or debate. In a more modern context, however, forensic applies to courts or the judicial system. Combine that with science, and forensic science means applying scientific methods and processes to solving crimes. People can be identified by their fingerprints, foot creases, and from traces of their DNA from blood, skin, hair, saliva, and semen by DNA analysis. However, in situations where these records are unavailable or unusable due to the nature of the disaster, the dental records and aids prove to be useful for victim identification. This article aims at highlighting the importance of the dental records and the forensic odontology in the accurate and efficient identification of the conflict victims or deceased to serve as an important adjunct to the forensic medicine in a simplified manner.

Evaluation of Airway Dimensions Following Mandibular Setback with Surgery-First Orthognathic Versus Conventional Orthognathic Approach

Background

To evaluate changes in airway dimensions following mandibular setback with conventional orthognathic approach (COA) and surgery-first orthognathic approach (SFOA).

Materials and Methods

Treatment records of 20 patients who underwent mandibular setback with SFOA/COA were divided into two groups (COA and SFOA, ten patients in each group). Acoustic pharyngometry values were obtained at T0 (01 week prior to surgery), T1 (01-month post-surgery) and T2 (01-year post-surgery). Percentage change in mean volume and area was obtained at T1 (T1-T0) to evaluate airway changes and at T2 (T2-T1) to compare relapse of airway changes in both groups. Changes in airway per mm setback at T1 (T1-T0) and T2 (T2-T1) were also obtained in both groups.

Results

For both parameters, SFOA showed greater reduction at T1 and greater relapse at T2 as compared to COA. The reduction in airway volume at T1 was 0.56 mm/mm setback in COA compared to 1.06 mm/mm setback in SFOA (P-value > 0.05). The relapse in airway volume at T2 was 0.15 mm/mm setback in COA compared to 0.25 mm/mm setback in SFOA (P-value > 0.05). The reduction in area at T1 was 0.062 mm/mm setback in COA compared to 0.110 mm/mm setback in SFOA (P-value > 0.05). The relapse in area at T2 was 0.016 mm/mm setback in COA compared to 0.034/mm setback in SFOA (P-value < 0.05).

Conclusion

In setback cases, SFOA has greater airway reduction immediate post-surgically and greater relapse at 01-year follow-up. Predicting these changes at diagnostic and treatment planning stage may prevent potential adverse events on airway.

Root canal obturation of primary teeth: disposable injection technique

The aim of the study was to outline a simple, cost-effective technique for obturation of primary tooth root canals. A total of 75 primary teeth were treated in 52 subjects by the technique discussed, i.e. injecting plastic flowable material into the root canals after desired preparation, using disposable needle and syringe. All the patients were followed up for 3 years and 6 months, with no clinical or radiologic evidence of pathology or need for untimely extraction. In conclusion, the technique described is simple, economical, can be used with almost all filling materials used for the purpose, and is easy to master with minimal chances of failure.

Weaned pig responses to Escherichia coli K88 oral challenge when receiving a lysozyme supplement

Lysozyme is a low-molecular-weight protein with antimicrobial properties. An experiment was conducted to investigate the response of piglets receiving a water-soluble lysozyme supplement [Entegard (EG), Neova Technologies Inc., Abbotsford, British Columbia, Canada; 4,000 lysozyme units/mg] after oral challenge with enterotoxigenic Escherichia coli (ETEC). A total of 36 individually housed weanling pigs were randomly allotted to 1 of the 4 treatments, with 9 replicates per treatment. Treatments were a control (CONT, no additive), antibiotic (AB; 2.5 g/kg of feed of antibiotic with chlortetracycline, sulfamethazine, and penicillin), and EG delivered in the drinking water at concentrations of 0.1% (EG1) and 0.2% (EG2). All pigs received a basal diet similar in composition and nutrients, except for pigs receiving the AB diet, which had an added antibiotic. Pigs were acclimated to treatments for a 7-d period to monitor growth performance. On d 8, blood samples were collected from each pig to obtain serum, and each pig was gavaged with 6 mL (2 × 10(9) cfu/mL) of ETEC solution. Pigs were monitored for another 7 d to assess incidences of diarrhea and growth performance, and then all pigs were killed to obtain intestinal tissue and digesta samples. Treatments did not influence growth performance throughout the study. Greater ETEC counts were observed in the ileal mucosal scrapings (P = 0.001) and colonic digesta (P = 0.025) of pigs in the CONT group compared with pigs in the AB and EG1 groups. Pigs receiving AB and EG1 had greater (P < 0.05) small intestinal weights and ileal villus heights than pigs receiving CONT; however, the ileal villus height-to-crypt depth ratio was greater in pigs fed the AB diet (1.69) compared with those fed the CONT diet (1.34), whereas pigs receiving EG1 were intermediate. Pigs in the EG1 group showed greater (P < 0.001) serum tumor necrosis factor α and IL-6 concentrations before ETEC challenge; however, at 7 d postchallenge, pigs receiving EG2 showed the least (P < 0.05) circulating tumor necrosis factor α and IL-6 concentrations. Overall, better intestinal growth and development, as well as decreased ETEC counts on the intestinal mucosa and serum proinflammatory cytokines, suggest that EG can maintain gut health and function in piglets commensurate with antibiotics. However, it is noteworthy that at the largest dose tested, EG seemed to have a dramatic effect on proinflammatory cytokines but had a minimal or no effect on the other response criteria.

Effects of chop length of alfalfa and corn silage on milk production and rumen fermentation of dairy cows

Effects of chop length (shorter = 10 mm or longer = 19 mm) of alfalfa silage and corn silage were determined in 16 midlactation Holstein cows using a 4 x 4 Latin square design with a 2 x 2 arrangement of treatments. Experimental periods were 21 d long and consisted of 14 d of adaptation and 7 d of sampling. Cows received total mixed ration containing (dry matter basis) 44.0% barley grain-based energy supplement, 12.6% protein supplement, and 21.7% longer chop or shorter chop alfalfa silage and 21.7% longer chop or shorter chop corn silage. Reducing the chop length of alfalfa silage and corn silage reduced the average geometric particle length from 14.4 to 11.0 mm and from 14.2 to 10.4 mm, respectively. Reducing the chop length of both silages reduced the proportion of the diets retained by the 8- and 19-mm screen of the Penn State Particle Separator from 55.0 to 46.0% of dry matter. Reducing the alfalfa chop length increased total rumen volatile fatty acids at 4 to 5 h after feeding but did not affect rumen pH at 4 to 5 h after feeding, feed intake, and milk production. Reducing the corn silage chop length increased dry matter intake from 22.3 to 23.2 kg/d, increased rumen pH at 4 to 5 h after feeding from 6.12 to 6.20, but did not alter rumen volatile fatty acids at 4 to 5 h after feeding or milk production. Daily milk yield, milk fat percentage, and milk protein percentage averaged 38.2 kg/d, 2.62%, and 3.29%, respectively, across all diets. The low milk fat percentages suggest that all diets induced subacute ruminal acidosis (SARA), whereas the rumen pH did not indicate SARA. This discrepancy could be due to a difference in the time of rumen pH measurement and the time of the lowest rumen pH. Hence, the pH data need to be interpreted with caution. Diets could have induced SARA, because for all experimental diets the content of forage neutral detergent fiber was lower than recommended for barley grain-based diets.

Laparoscopic creation of a neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome by modification of Vecchietti's procedure

We performed a modified Fedele technique for laparoscopic creation of a neovagina by Vecchietti's method to treat vaginal aplasia in three patients with Mayer-Rokitansky-Kuster-Hauser syndrome. Three beads forming a triangle, anchored to a disposable syringe mould, were applied to the vaginal dimple and pulled upward by two polypropylene sutures, and passed through the potential neovaginal space created laparoscopically. The women sat on ordinary bicycle seats to provide pressure from below, resulting in formation of neovagina over 10 to 12 days. Good results were obtained in all three women in both anatomy and sexual function.

An outbreak of multidrug resistant Salmonella typhimurium in Delhi (India)

A total of 85 patients with multidrug resistant S. typhimurium were isolated between May and September 1991 at the Sir Ganga Ram Hospital, New Delhi, India. Fifty eight (72.5%) patients out of 80 stool culture positives suffered from enteritis and 23 (39.6%) of them settled with oral rehydration therapy alone. All strains were sensitive to 4 aminoquinolones (oflaxcin) but five were resistant to third generation cephalosporin (Cefotaxime; MIC between 50-75 micrograms/ml) whereas 88-96 per cent isolated were resistant to most of the other antibiotics. The convalescent carrier rate was prolonged with the use of antibiotics. The phage type of S. typhimurium isolated from the index and other cases was 178 and multidrug resistance strains had seven plasmids (1.2 to 16 kb). Barrier nursing and sodium hypochlorite disinfection helped in limiting the outbreak.

Testing of adsorbed diphtheria-pertussis-tetanus (DPT) vaccine for freedom from abnormal toxicity

A total of 112 samples of adsorbed DPT vaccine were tested in mice for freedom from abnormal toxicity by three procedures: (a) single human dose by intraperitoneal route; (2) single human dose by subcutaneous route; and (3) half the single human dose by intraperitoneal route. The percentage of samples passing by the three methods was 25, 90 and 54.5, respectively. Method 3, which is being recommended now by the World Health Organization, is supported by the results of this study to be neither very stringent nor very lenient to pass the adsorbed DPT vaccine for freedom from abnormal toxicity.

Further observations on the stability of cholera vaccine at different temperatures

The stability of cholera vaccine samples held at 4-8 and 20-25 degrees C for 2 1/2 years was studied with regard to the number of organisms, total nitrogen content and relative antigenicity. After this length of time, the percentage loss in the number of organisms averaged 10.7 at 4-8 degrees C and 22.7 at 20-25 degrees C. The maximum loss in number of organisms took place during the first six months and in the next two years there was very little loss in the number of organisms. The total nitrogen content after 2 1/2 years remained almost unaltered at these temperatures. All the ten samples had acceptable relative antigenicity for both the Inaba and Ogawa serotypes after exposure at 4-8 degrees C for 2 1/2 years, while at 20-25 degrees C only two samples for the Inaba serotype and one sample for the Ogawa serotype retained antigenicity within acceptable limits after the same time. The loss of antigenicity after 2 1/2 years at 20-25 degrees C in comparison with antigenicity at 4-8 degrees C ranged from 41.5 to 83.1% (mean 61.9%) for the Inaba serotype and from 47.3 to 80.3% (mean 65.1%) for the Ogawa serotype. From this study on the cholera vaccine manufactured at the Central Research Institute, Kasauli, it is concluded that the shelf life of cholera vaccine may be increased from 18 months to at least 24 months, when the vaccine is stored under refrigeration.

An investigation of a mouse model to estimate the potency of the diphtheria component in vaccines

A mouse model to estimate the potency of the diphtheria toxoid components in vaccines using Vero cells to detect the neutralizing antibodies in the sera from immunized mice is described. The results obtained with this mouse model correlated significantly with those obtained in the lethal challenge test in guinea-pigs. For this reason it is suggested that the potency test in guinea-pigs be replaced by this mouse model because a considerable reduction in the number of animals used and costs can be achieved by the introduction of this mouse test for the routine control of the potency of the diphtheria component of vaccines.

Differentiation between stains of human blood and blood of monkey

The precipitin tube test fails to differentiate between blood stains of closely related animals such as man and monkey because of the close similarity between antigenic determinants of serum proteins of such closely related species. The quantitative precipitin technique cannot be applied to forensic work. This paper cites a case where definite opinion on the species of origin of some blood stains suspected to have come from a monkey was possible. In the method used, extracts of the questioned stain were tested with similar extracts of known human and known monkey blood stains against human globulin antiserum, by comparative double diffusion method in agar gel on microslides.