Awareness and Knowledge of General Dental Practitioners in Central India Towards Management of Patients with Temporomandibular Disorder: A Questionnaire-based Survey

Introduction: Temporomandibular Disorders (TMDs) accounts for common Orofacial Pain (OFP) arising from musculoskeletal origins, affecting almost 80% of the overall population. The multifactorial nature of the disease makes it difficult to diagnose and treat and is challenging to a considerable number of General Dental Practitioners (GDPs). They’re increasingly approached by patients for advice on TMD, but little is understood about how this disorder is addressed with in primary health care. Aim: To assess the awareness and knowledge regarding management of TMDs among GDPs in Central India. Materials and Methods: The cross-sectional study was conducted at Central India, Nagpur, Maharashtra, India from 20th June 2020 to 12th December 2020, including 200 general dental practitioners, who were registered under the Dental Council of India. A questionnaire consisting of 17 questions with reference to TMDs was designed and the questionnaire was circulated through a web designed program. The responses were collected, and data were analysed descriptively using Statistical Package for the Social Sciences (SPSS) statistics for windows version 24.0. Results: The mean age of the participants in the study was 24.80±1.63 years. Predominantly, participants were 164 females (82%). Among all the participants, about 181 (90.50%) of GDP’s were practicing Dentistry. The study findings suggest that the overall general practicing dentists encounter TMD cases and 162 (81%) of GDP’s treat patient at their clinic. A 76% of GDPs acknowledged the causative factor for TMD to be multifactorial and physical examination (88.50%) as the diagnostic tool. Most of the general practitioners around 126 (63%) preferred referring the patient to the specialist, maxillofacial surgeon. Among the practitioners who were confident in treating TMD, occlusal splint was the treatment of choice for 198 (96%) of the GDPs. Conclusion: Many GDPs lack standard protocol knowledge, felt insecure in TMD diagnosis, therapy decisions and treatment. There is a requirement for better quality evidence on which TMD diagnosis and treatment, including the event of a valid, reproducible patient-centered outcome measure to enable dental practitioners to feel confident in managing TMD. It is essential to train GDPs to identify individuals with TMDs through professional courses and training. It would be highly beneficial to educate the undergraduates regarding the diagnosis of TMDs in their curriculum.

To Check the Validity of Neoclassical Canon in Western Maharashtra- An Anthropometric Study

Introduction: In ancient days, it was believed that attractive and harmonious faces were having certain fixed proportions known as neoclassical canons. These canons were used extensively by Leonardo Da Vinci, Durer in their art during renaissance. They served as guidelines for artists as well as for aesthetic surgeons for centuries and proved to be helpful till now. From ancient days to modern era, the exact formula of beauty is not yet calculated. The norms of beauty changes from country to country and race to race. A face is beautiful and shows harmonious features if the individual components are proportional, this is what is referred as facial balance. In ancient Greece, they calculated the formula for creation of art and these formulae are called as neoclassical canons. The classical Greek canons of facial balance are still foundation of modern reconstructive and aesthetic surgery. Aim: To check the validity of neoclassical canon in Western Maharashtrian population. Materials and Methods: This was an observational type of study carried out from March 2018 to January 2020. The validity of Naso-oral canon was checked in Western Maharashtrian population. According to this canon ideal mouth width (ch-ch) (mouth width (distance between right and left corners of mouth called chelion)) is 1.5 times of Nose width/alar width (al-al) (alar width (distance between right and left ala of nose)). Mouth width=1.5 times of Nose width. However, the mouth width can be less than 1.5 times of nose width or mouth width can be greater than 1.5 times of nose width. This study was carried out in the five cities Sangli, Kolhapur, Islampur, Karad and Satara of Western Maharashtra, India. Total 1500 male and female students, 300 from each city, between the age group of 18-20 years were selected. Measurements were taken with the help of digital Vernier caliper. The methodology adopted for the measurements was taken from the guidelines given by Farkas LG in his book- “Anthropometric facial proportions in Medicine”. Results: In present study, total 68.33% subjects including males and females were having mouth width (ch-ch) lesser than one and half times of nose width/alar width (al-al) i.e., ch-ch <1.5 (al-al). Remaining 31.67% subjects were having mouth width greater than one and half times of nose width/alar width i.e., ch-ch >1.5 (al-al). Conclusion: Naso-oral neoclassical canon was not found valid in Western Maharashtrian young adults. In 78.32% male and 62.80% female population of Western Maharashtra, mouth width was found lesser than one and half times of nose width.

Diabetic Peripheral Neuropathy and its Association with Diabetes Self-care: A Clinic-based Study in an Urban Health Centre, Kolkata

Introduction: Diabetes mellitus is considered as silent epidemic worldwide including India. Peripheral neuropathy is one of the most common complications of diabetes mellitus. Diabetes Self-Management (DSM) is crucial in mitigating the afflictions of diabetes and it’s after effects. There was dearth of studies in view of Diabetic Peripheral Neuropathy (DPN) and diabetes self-management in Kolkata, West Bengal. Aim: To assess the associations between diabetes self-management and DPN in Type 2 Diabetes Mellitus (T2DM) patients attending an urban health clinic in Kolkata. Materials and Methods: This study was conducted from December 2018 to March 2019 among known case of T2DM patients aged 30 years and above attending the Non-Communicable Disease (NCD) clinic at Chetla, under the purview of field practice areas of Urban Health Unit and Training centre (UHU and TC) of All India Institute of Hygiene and Public Health (AIIH and PH) Kolkata, West Bengal. A pre-designed and pre-tested schedule was used to collect data which were analysed using International Business Machines Statistical Product and Service Solutions (IBM SPSS) version 16.0 and represented using various tables. Results: The mean (SD) age of the participants was 54.89 (8.98) years. About 32.4% of the patients had DPN which was significantly associated with increased duration of T2DM {AOR (95% CI)}={1.52 (1.22-1.91)}, lower glucose management sub-scale score {AOR (95% CI)}={2.84 (1.42-5.67)} and lower healthcare use sub-scale score {AOR (95% CI)}={1.86 (1.05-3.31)}. Conclusion: Early screening and education regarding diabetes self-care would be helpful in glycaemic control and in prevention of DPN.

Role of Squash Cytology in Intraoperative Diagnosis of Meningioma

Introduction: Primary Central Nervous System (CNS) tumours constitute less than 2% of overall cancers in adults and are the second most frequently encountered tumours in children. Meningiomas form 24-30% of primary intracranial tumours. Most intrinsic brain tumours are soft and gelatinous in consistency, smear preparation can readily made which gives excellent cytological details when compared to frozen section as the latter produces ice crystal artifacts. Aim: To assess the diagnostic utility of squash cytological evaluation of meningiomas and its comparison with final histopathological diagnosis. Materials and Methods: The cross-sectional study was done at Thanjavur Medical College, Thanjavur, Tamil Nadu, India for period of three years from January 2015 to December 2017. Total of 54 clinically diagnosed and radiologically suspected case of meningiomas were selected. Smears were prepared from the biopsy samples sent in normal saline and stained by Haematoxylin and Eosin (H&E) method. The cytological features were noted and matched with biopsy findings. Descriptive statistics were used to analyse the results. Results: Total of 54 squash smears with male to female ratio was 1:1.5. Maximum number of cases were seen between 41- 50 years followed by 51-60 years. Complete concordance was obtained in 51 cases (94.44%) and partial concordance was noted in a case due to underestimation of malignancy grade in squash cytology. Out of 54 cases, two cases were found to be discordant with final histopathological diagnosis. Conclusion: Intraoperative squash cytology is easy, rapid, reliable and cost-effective technique for neurosurgical consultation with fairly high accuracy in diagnosing meningiomas.

Concordance of Bronchoalveolar Lavage Cytology with Transbronchial Lung Biopsies in Non-neoplastic Pulmonary Diseases

Introduction: In many pulmonary diseases, despite radiological & clinical investigations, laboratory tests and function studies, the diagnosis becomes difficult. Bronchoalveolar Lavage (BAL) is a minimally invasive method in which cells are collected from bronchial and alveolar spaces for cytology. This is facilitated by using a flexible bronchoscope with which a biopsy is taken following BAL. Bronchoscopy with BAL when used appropriately can offer correct diagnosis which in turn aids in proper management of the patient. Aim: To find the concordance of BAL findings with the histopathological features of Transbronchial Lung Biopsy (TBLB) in non-neoplastic lung diseases. Materials and Methods: It was a retrospective study conducted in Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka. A total of 40 patients presenting with clinico-radiological findings, suggesting a non-neoplastic lung disease in the year 2019, undergoing bronchoscopy with BAL and concurrent TBLB were chosen. The BAL fluid was processed and differential count of cells was done to classify according to the American Thoracic Society Guidelines. Concordance was checked between the diagnoses made on TBLB and BAL analysis. Results: In the present study, a total of 40 cases were included of which 13 (32.5%) cases showed neutrophilic, 16 (40%) cases showed lymphocytic, 5 (12.5%) cases showed eosinophilic and 6 (15%) cases showed normal cellular distribution on BAL cytology. Diagnoses on studying TBLB included nine cases of Nonspecific Interstitial Pneumonia, seven cases of Usual Interstitial Pneumonia, six cases of Bronchiolitis Obliterans Organising Pneumonia, three cases of Bronchiolitis, two cases each of pulmonary tuberculosis and granulomatous inflammation. There was one case each of actinomycosis, sarcoidosis, lung abscess and mucor mycosis. Normal histology was noted in seven cases. The sensitivity of BAL fluid analysis was found to be 84.84% and the concordance was 80%. The Kappa value obtained was 0.71 indicating good agreement/concordance between BAL cytology and TBLB. Conclusion: The data from the current study suggest that differential cell counts in BAL provide diagnostic information of fundamental importance in frequently occurring non-neoplastic lung diseases in the community.

Anatomical Variations of the Extrinsic Musculature of Thumb

Anatomical variations are commonly encountered during human cadaver dissections. Some of these variations are never discovered unless there is an underlying injury that requires attention. For conceivable clinical and rehabilitation treatments, anatomical modifications may have implications on function therefore it is imperative to report them. This case series depicts the anatomical inconsistency in the muscles and tendons of the extrinsic musculature of the thumb in three human specimens. During a cadaver dissection in physical therapy anatomy course, various anatomical variations were found in three human cadaveric specimens. Cadaver 1 exhibited a new muscle with a split tendon near the distal posterolateral radius. The author uncovered the supplementary muscle between the Extensor Pollicis Longus (EPL) and Extensor Pollicis Brevis muscles. Cadaver 2 had two other extrinsic tendons inserted at the thumb. The Extensor Digitorum provided an extra tendon to the pollicis; a similar insertion as the EPL was recognised. In cadaver 3 an extra muscle belly was observed within the tendon of the abductor pollicis longus. The other muscle variation was near the distolateral attachment at the base of the first metacarpal joint, between the abductor pollicis brevis and extensor carpi radialis muscles. Understanding the diverse anatomical arrangements could prove beneficial for surgeons and those involved in rehabilitating upper extremities. A detailed understanding of the forearm structural anatomy and anomalies is essential to comprehend the function and movements when lesions affect the normal biomechanics within teaching and clinical environments.

Serological Characterisation of Auto-antibodies in Patients with Direct Antiglobulin Test Positive Autoimmune Haemolytic Anaemia at a Tertiary Care Teaching Hospital in Tirupati, India

Introduction: Haemolysis in Autoimmune Haemolytic Anaemia (AIHA) is a result of Immunoglobulin G (IgG) or Immunoglobulin M (IgM) auto-antibodies with or without complement components binding to the Red Blood Cell (RBC) surface and initiating its destruction. Serologic evidence is provided by autocontrol or Direct Antiglobulin Test (DAT). Diagnostic work-up is essential as the management depends on the antibody type. Characteristics of the bound antibody and the target antigen determine the degree of haemolysis. Serological characterisation in AIHA helps to differentiate into its various types which help the clinician to decide on the treatment to be given. Aim: To serologically characterise the auto-antibodies in patients with DAT positive AIHA at a tertiary care teaching hospital. Materials and Methods: This cross-sectional study was carried out in the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2019 to February 2020. A 40 consecutive patient samples were included in the study. Characterisation of antibody was done using polyspecific Anti-Human Globulin (AHG) reagent followed by mono-specific AHG reagent by gel method. If antibody was of IgG type, then the subclass was determined by a mono specific anti-IgG1 and anti-IgG3 gel card. Association between antibody types, subtype, and strength of DAT with severity of haemolysis were compared using Chi-square/Fisher’s-exact test. A p-value of less than 0.05 was considered statistically significant. Results: The total study population was 40 patients. The mean age of the study population was 45 years (range 13-78). Out of 40 patients, males were 30 (75%) and females were 10 (25%). The primary and secondary causes for AIHA include 4 (10%) and 36 (90%) respectively. Among 40 patients, 22 (55%) patients had IgG antibody alone, 17 (42.5%) patients had IgG antibody with combination of other antibodies and 1 (2.5%) had only complement (C3d). IgG1 was identified in 7 (18%) of patients, combination of IgG1 and IgG3 in 3 (7.7%). There was a significant association with IgG+combination (p-value=0.03), IgG1+IgG3 (p-value=0.029) and strength of reaction (p-value=0.003) with respect to severity of haemolysis. Conclusion: Presence of multiple antibodies, presence of IgG1 and IgG3 and with complement combination and presence of higher grading of reaction in gel column were associated with severity of haemolysis. We recommend that serological characterisation of auto-antibody in AIHA would help the clinician in assessing the severity of haemolysis so that management can be done appropriately.

Bilateral Sacroiliac Joint Fusion: A Case Report

Sacroiliac (SI) joint is the articulation which forms the part of the bony pelvis. It plays an important role in locomotor activity, and childbirth during labour. It helps in the transmission and distribution of axial body weight from the spine to the pelvis. This synovial joint exhibit limited gliding movements within the joint cavity. About 15-30% of low backache aetiologies are attributed to SI joint dysfunction. People who are overweight, have co-morbid conditions, and pregnant women are at higher risk of developing vertebral joint deformities called spondylarthropathies. They are group of inflammatory disorders which are involving the vertebral spines and peripheral joints, where the symptom of stiffness is prominently seen. The anatomical variations in the SI joint morphology like accessory SI joint, iliosacral complex and sacral defect, dismorphic joint, are of compelling interest concerning SI joint pathologies from the orthopaedic viewpoint. This case report presents a bilateral fusion of SI joint, found in a skeleton in the museum of medical college.

Nodular Subcutaneous Phaeohyphomycosis due to Medicopsis romeroi in an Immunocompetent Patient

Fungal infections like subcutaneous phaeohyphomycosis are uncommon but are increasing lately, especially in tropical regions like India. Identification of correct aetiologic agent is essential as different species can have different organ tropism. Here, a rare case of nodular subcutaneous phaeohyphomycosis in an immunocompetent 62-year-old male patient who developed nodule over right dorsum of foot is reported. After various diagnostic tests a rare dematiaceous fungus Medicopsis romeroi was identified as a causative agent in the nodular material by Internal Transcribed Spacer (ITS) sequencing. Surgical excision and antifungal therapy of itraconazole proved beneficial with no recurrence during a six months of follow-up. Medicopsis romeroi has been debated for its role in human infections however, it should be considered as one of the aetiologic agents of subcutaneous phaeohyphomycosis.

Melanosis of the Uterine Cervix: A Rare Case Report

Cervical melanosis is a rare entity in the spectrum of melanocytic lesions of uterine cervix. Melanosis is defined as presence of melanocytes in the basal layer of squamous epithelium causing hyperpigmentation. Authors here by report a case of 57-year-old female who underwent vaginal hysterectomy for third degree utero-vaginal prolapse, showed an incidental gross pathological finding of brownish macular lesion. Histopathological examination showed hyperpigmentation of basal layer without increase in melanocytes. On immunohistochemical examination, basal melanocytes were highlighted by S-100 and HMB 45 immunostains. Thus final diagnosis of cervical melanosis was made. Clinical differentials of cervical pigmented melanocytic lesions include cervical melanomas, blue nevi, congenital or traumatic lesions and melanosis, hence vigilant clinical, gross pathological examination and biopsy is warranted.