End Of 6th Month Research Articles

Cyclosporine or methotrexate, which one is more promising in the treatment of lichen planopilaris?; A comparative clinical trial

Background: Lichen Planopilaris (LPP) is a primary scarring alopecia with unknown etiology and its management is a challenge for dermatologists. We aimed to compare the safety and efficacy of methotrexate and cyclosporine in LPP patients. Methods: In a randomized clinical trials, 33 patients were randomly allocated to receive either 15-mg oral methotrexate per week or 3–5-mg/kg/day cyclosporine for six months. During the treatment course, side effects, signs/symptoms and laboratory test were assessed periodically. Lichen planopilaris activity index (LPPAI) was measured at baseline and 2, 4, and 6 months after the intervention. Score of both photography and patient’s opinion were also obtained. The collected data were analyzed in SPSS software (Ver.25.0. Armonk, NY: IBM Corp). Results: Both medications had positive effects on the signs and symptoms of LPP with a significant difference between the variables (p < 0.05), and the results showed similar efficacy at the end of 6th months of the therapy with both cyclosporine and methotrexate (p > 0.05). Conclusions: Regarding the results of the present study, both cyclosporine and methotrexate are effective in treating refractory lichen planopilaris and we propose methotrexate as a possible earlier choice over cyclosporine.This study was registered in Iranian Registry of Clinical Trials (IRCT20190717044256N1).

Evaluation of Long-Term Results of Two Different Calcium Silicate Based Materials in Primary Molar Teeth Vital Pulpotomies: An Invivo Study

Aim: Pulpotomy is one of the pulp therapy for cariously exposed pulps in primary molar teeth. There are several materials that allows regeneration of the residual pulp. The purpose of this study was to evaluate the efficacy of two different calcium silicate based materials (ProRoot MTA, BIOfactor MTA) in primary molar teeth vital pulpotomies. Materials and Methods: A total of 12 children (24 human mandibulary primary second molar teeth) aged between 6 and 9 years were selected in this randomized clinical study. The patients were randomly assigned to receive the pulpotomy medicaments. All pulpotomized teeth were restored with stainless steel crowns and evaluated clinically and radiologically at 1, 3, 6 and 12 months. Statistical analysis using chi-square test was performed to determine the significant differences between two materials. Results: Neither clinical nor radiographical differences were seen in 1st, 3rd and 6th months but in 12th month ProRoot MTA showed statistically better results in clinical evaluation (p=0,047). Conclusion: Both two calcium silicate based materials showed similar clinical and radiographical results by the end of 6th month but ProRoot MTA showed better results at the end of 12th month.

Study of the incidence of acute kidney injury in HCV infected patients receiving DAAs

Abstract Background Egypt had the highest burden of hepatitis C virus infection worldwide with genotype 4. The new direct-acting antivirals DAAs can target almost all steps of the HCV life cycle. The objective of our study was to detect AKI events during and on follow up after the end of treatment with combination DAAs. Aim of the work to study the incidence of acute kidney injury in HCV infected patients receiving IFN-free combination new DAAs. Patients and Methods A longitudinal prospective study that was conducted in the virology clinic in Kobry El-Koba Military Armed Forces Hospital on 63 male patients (&amp;gt;18years) who are HCV antibody and PCR positive, treatment-naïve, who received treatment with sofosbuvir, daclatasvir and ribavirin. They were divided into Group A: 33 patients with normal kidney functions stage I and Group B: 30 patients with chronic kidney disease (CKD) with estimated GFR (eGFR) &amp;gt;30 mL/min and &amp;lt; 90 mL/min stage II, III. The fluctuations in serum creatinine and eGFR were measured while on-therapy and for 3 months follow up after end of treatment. Results Sixty three male patients, treatment-naive were included. Thirty of them had eGFR of less than 90 mL/min/1.73 m2 (25 with eGFR = 60-89 mL/min) &amp; (5 with eGFR = 45-59 mL/min) of mean age 62.4 ± 7.4. These were compared to thirty-three patients with eGFR of more than 90 mL/min/1.73 m2 of mean age 53.8 ± 11 (P = 0.001). Our included treatment regimen was daclatasvir/sofosbuvir/RBV. A total of 54% had liver cirrhosis, 62/63 (98.5%) of the patients achieved SVR at 12th week; One CKD stage II patient continued treatment for 6 months because he had a detectable HCV RNA after 1st month of starting treatment. All other patients completed the treatment for 3 months. There is a statistical difference between different readings of serum creatinine in both groups on therapy and on follow up during the next 3 months after the end of therapy with a P value of 0.001 in group A and a P value of 0.005 in group B. There is a rise in serum creatinine in group A during the three months of therapy with slight improvement during follow up after the end of therapy without reaching the baseline. In group B it was noticed that there is slight increase in serum creatinine after 1st month of start of therapy then there is significant improvement after 3rd and 4th months of start of therapy to come to a plateau by the end of 6th month. The incidence of AKI was more observed in patients with eGFR &amp;gt; 90 ml/min per 1.73 m2 by being 13.65% by the end of treatment but decreases to 6.1% by the end of the three months follow up after the end of treatment. This was compared to 3.3% in those with eGFR &amp;lt; 90 ml/min per 1.73 m2 and &amp;gt;45 ml/min per 1.73 m2 that was the same all through the follow up, but of no statistical significant difference. Conclusion daclatasvir/sofosbuvir/ribavirin antiviral therapy is effective in patients with stage 1-3 CKD with SVR of 98.5%. Although adverse effects are common, serious adverse effects and treatment discontinuations are rare. There were AKI events during and after the end of therapy especially in patients with normal baseline serum creatinine by 12.76% in comparison to 3.3% in already CKD patients stage 2 and 3. Patients with CKD stage 2 and 3 experienced improvement in their kidney functions during and after end of therapy . Future studies are needed to determine predictors of kidney recovery with HCV eradication and confirm the long-term effects of HCV eradication on kidney function.

A study on haloperidol and risperidone induced metabolic derangements in patients with newly diagnosed schizophrenia

Background: The occurrence of metabolic abnormalities in schizophrenic patients has been increased with the rampant use of second-generation antipsychotics. The aim and objective of this study is to compare the metabolic derangements induced by a typical antipsychotic: haloperidol and an atypical antipsychotic, risperidone in patients with newly diagnosed schizophrenia in a tertiary care hospital.Methods: Out of 60 newly diagnosed schizophrenic patients, 30 patients received tablet haloperidol and the remaining 30 patients received tablet risperidone orally. The anthropometric measurements like height, weight, waist circumference was measured and blood investigations like fasting blood glucose level and fasting lipid profile were taken at baseline and at the end of 3 and 6 months of drug therapy. The metabolic derangements induced by the two antipsychotics were compared and analyzed at end of 3rd and 6th month using SPSS software version 16.Results: At the end of 6th month statistically significant differences (p&lt;0.05) were observed in weight, waist circumference, fasting blood sugar, fasting triglyceride and high-density lipoprotein level between the haloperidol and risperidone group on following the International Diabetic Federation (IDF) criteria of metabolic syndrome. Risperidone caused metabolic abnormalities in 13.3%, 4 patients whereas none of the patients in haloperidol group developed metabolic syndrome.Conclusions: Hence it is concluded that the atypical antipsychotic risperidone has been associated with an increased risk of causing metabolic abnormalities than the typical antipsychotic haloperidol. Regular and periodic monitoring of the anthropometric and metabolic parameters in schizophrenic patients on antipsychotics especially the atypical antipsychotics is mandatory to prevent further complications.

Dawn of a New Age Fissure Sealant? A Study Evaluating the Clinical Performance of Embrace WetBond and ART Sealants: Results from a Randomized Controlled Clinical Trial.

Objectives The main purpose of this article is to evaluate the clinical performance of atraumatic restorative treatment (ART) sealant versus Embrace WetBond sealant in terms of retention and fissure caries prevention among a section of school children in the southern Indian state of Karnataka (ClinicalTrials.gov NCT02716558). Materials and Methods After obtaining consent from the parents and screening the children against the inclusion cum exclusion criteria, 90 school children whose mandibular first molars were caries free and with a well-defined pit and fissure system were recruited for this spilt mouth trial. The respective molars were allocated either to the ART sealant or the embrace group after the randomization process. The sealants were applied according to the manufacturer’s instructions and followed up at the end of 3rd, 6th, and 12th month, respectively. The outcome measures assessed were the retention and the caries preventive effects of the materials. Results At the end of the 6th month, about one-fourth of the sealants in either group remained totally intact, without evidence of caries. No significant differences were seen between the sealants either in terms of retention or caries preventive benefits at the end of 12 months. Statistical Analysis The chi-squared test was used to check differences in proportions. The significance value was set at <0.05. Kappa test was performed to assess the intraexaminer reproducibility with respect to retention and caries status. Conclusion The moisture-tolerant resin sealant could not replicate the physical properties usually associated with conventional resin sealants. The usage of ART sealants was deemed to be less cumbersome in an outreach setting as observed in this trial.

Role of corticosteroid as an adjunct to antitubercular drugs in the treatment of pleural effusion: A one year study

Background: To compare the effect of corticosteroid as an adjuvant to antitubercular treatment (ATT) in view of improving the symptoms, resolution of pleural fluid and prevention of pleural thickening. A prospective case control study was conducted in the Department of Respiratory Medicine, King George’s Medical University, Lucknow, India. Methodology: The present study has been conducted on 76 diagnosed cases of tubercular pleural effusion, 38 in case group and 38 in the control group. ATT was given to both the groups and steroid (prednisolone) was given to the case group as an adjuvant to ATT. Clinico-radiological follow-up has been done at the end of 1st, 2nd, 4th, and 6th month. Results: The mean duration of resolution of fever, cough and breathlessness in case group was significantly less as compare to control group and their differences were statistically significant with p value nd month of treatment, after that the difference was not significant. At the end of 6th month, 35 patients developed pleural thickening, out of which 21 were of the control group while the remaining 14 were of the case group. Conclusions: Use of corticosteroids as adjuvant to ATT resolve the clinical symptoms more quickly and hasten the absorption of pleural fluid and to some extent pleural thickening in patients with tubercular pleural effusion. Keywords: Tubercular Pleural Effusion; Extrapulmonary tuberculosis (EPTB); Anti-tubercular treatment; Corticosteroid.

COMPARISION OF CEMENTED VERSUS UNCEMENTED HEMIARTHOROPLASTY OF THE HIP.

The objective of this study was to compare the mean residual pain after cemented versus uncemented hemiarthroplasty of hip. Study Design: Randomized Controlled Trial. Setting: Orthopaedic Department, Allied Hospital, Faisalabad. Period: September 2016 to October 2017. Materials and Methods: Total 150 patients were admitted in orthopedic Department of Allied Hospital Faisalabad according to inclusion &amp; exclusion criteria. After taking informed written consent, all patients were divided into two groups randomly. Cementedhemiarthroplasty was done in Group A patients and uncemented hemiarthroplasty was done in group B patient. All procedures were done by surgeon who has minimum 5yrs post fellowship experience. Monthly Follow up was done and residual pain was noticed at the end of 6th month. All the data was analyzed by using SPSS version 20.0. Results: In this study, in Group-A the patients between 65-75 years of age were 57.33% (n=43) and between 76-85 of age were 42.67% (n=32). In Group B the patients between 65-75 years of age were 56%(n=42) and between 76-85 years were 44% (n=33). The mean+sd was calculated and it is 73.49+4.99 years in Group-A patients and 73.73+4.74 years in Group-B patients. In Group A, males were 61.33% (n=46) and female were 38.67% (n=29). In Group B, males were 57.33% (n=43) and female were 42.67% (n=32). When we compared the residual pain after cemented versus uncemented hemiarthroplasty of the hip, it shows 1.69+0.35 in Group-A patients and 2.62+0.30 in Group-B patients. When we calculated p-value it was 0.0001 showing a significantdifference. Conclusion: It is concluded that residual pain in cemented hemiarthroplasty is lower than uncemented hemiarthroplasty.

The Influence of the First-Stage DO Treatment of Palate Defect on Growth of Maxilla.

To study the influence of distraction osteogenesis (DO) on the maxillary growth as first-stage treatment of palatal defect. The uniform palate defect experimental animal models (21 miniature pigs) were established surgically. Then animals were randomly divided into negative control group (A, n = 6), conventional surgery group (B, n = 6), and distraction osteogenesis group (C, n = 9) respectively. The group A underwent none treatment as control group, the group B were undergoing a conventional defect repair surgery, and the group C were undergoing a distraction osteogenesis treatment. Cone beam computed tomography examination was performed monthly to analyze the growth of maxilla for 6 months. One pig of group C was randomly sacrificed at 2, 4, and 8 weeks after the completion of DO and the tissue of distraction gap was stained with hematoxylin-eosin and Masson staining. At the end of 6th months, all pigs were sacrificed and tissues of the surgical area were stained as previous described. The palate defect was repaired by the distraction osteogenesis with the successful bone formation on the distraction gap. Group A and group C kept a similar growth rate, but that of group B was relatively slow. Distraction osteogenesis is efficient and successful for closing the defect of palate and there is no significant disturbance on the subsequent growth of the maxilla.

A novel triple combination in treatment of melasma: Significant outcome with far less actives.

Melasma is an acquired hyperpigmentation, often involving the face, and a source of distress for the affected individuals. Although treatment is challenging and frequently a multimodality approach, topical applications are the mainstay of therapy. Due to the frequent relapses, a therapy both acting rapidly and suitable for long-term use, with fewer adverse effects should be administered. In our outpatient clinic, we treated the melasma patients with a previously unreported triple combination which was empirically formulated with lesser amount of active components, regarding the balance between long-term use and safety. Sixty-eight female patients with melasma who referred to our hospital dermatology clinic in the years 2016-2017 were retrospectively recruited. They all had completed 6-month treatment with a prescribed cream mixture comprised of azelaic acid (4%), hydroquinone (1.6%), methylprednisolone aceponate (0.04%), and salicylic acid (2%). The outcomes were evaluated both instrumentally (Melanin Index/MI) and by patients (Patient Self-Assessment Scale/PSAS). Adverse effects declared by the patients were transient irritation in three and mild hypertrichosis in two. Both the MI and PSAS values were found extremely significant at the end of 6th month, compared with initial values. Approximately 62% of total decrease in MI was realized in the first 3months. The triple combination containing active ingredients with lesser concentrations than proposed, and with the addition of 2% salicylic acid, may be promising as a quite effective and safe protocol in treatment of melasma for longer durations.

Efficacy of metronidazole and lactobacillus in the treatment of bacterial vaginosis- A comparative study

Efficacy of metronidazole and lactobacillus in the treatment of bacterial vaginosis- A comparative study - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/2581-4729.2019.0004, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Assessment of quality of life among stroke survivors: a longitudinal study

Background: Quality of life (QoL) among stroke survivors is a concern which has not received sufficient attention in India. The objective of the study was to assess the quality of life of stroke survivors in rural population of Chikkaballapur district, Karnataka.Methods: A community based longitudinal study was done amongst the 150 incident stroke cases registered during the period from March 2013 to November 2014 and who survived beyond 28 days. The cases were enrolled and interviewed using a semi-structured questionnaire and were followed up for 6th month period. QoL was assessed at baseline (at 28 days), at 3rd month and 6th Month using Stroke Specific QoL scale (SSQoL) and Barthel index (BI).Results: The mean age of the persons with stroke was 61.3±15 years with a majority being males (69.3%). Baseline median score (IQR) of SSQoL at 28th day was poor i.e. 131 (77-183). Among the 150 cases, 136 (91%) survived until the end of 6th month. The overall QOL gradually improved to 182 (133-213) and 185 (147-213) at 3rd and 6th month respectively and similar improvement was seen individually in physical, psychological and social domains as well and on multivariate logistic regression age &lt;60 years and few disturbed consciousness among the stroke survivors during the 6th month follow up were found to be predictors for improved quality of life.Conclusions: QoL showed significant improvements in all physical, psychological and social domains by the end of the 6th month of follow up.

Vitrectomy with Inverted Internal Limiting Membrane Flap Technique for Treatment of a Traumatic Macular Hole

Background: Macular hole is a round full-thickness opening in foveal center which is an important cause of central vision loss. In most cases it is idiopathic, i.e., due to abnormal vitreo-foveal traction without any apparent predisposing conditions. Other causes include 1) High myopia. 2) Blunt ocular trauma. Aim: to evaluate the anatomical closure rates and visual outcomes in patients with traumatic macular holes treated by vitrectomy with inverted internal limiting membrane (ILM) flap technique. Patients and Methods: a prospective interventional study was conducted on 10 eyes of 10 patients with traumatic macular holes not spontaneously closed for more than 3 months after trauma and treated by vitrectomy with inverted internal limiting membrane flap technique at I-vision private center, Cairo and Alforsan eye private center, Assiut between September 2015 and December 2018. After surgery, both closure rate and visual outcome were re-evaluated monthly during the follow up period up to 6 months. Results: the main best-corrected visual acuity improved after PPV with inverted ILM flap technique from 0.87 ± 0.09 logMAR at baseline to 0.73 ± 0.11 logMAR at 1st month, to 0.49 ± 0.13 logMAR at 3rd month and reached to the maximum improvement 0.29 ± 0.10 logMAR by the end of 6th month (P < 0.001). The macular holes were successfully closed in all cases (100%). Conclusion: vitrectomy with inverted internal limiting membrane flap technique is associated with complete closure of the macular hole with restoration of the normal architecture and also a significant improvement of vision.

PO-188 Effects of Tai-Chi exercise on blood lipids, inflammatory factors and baPWV of middle-aged and elderly people

Objective To investigate the interventional effects of 12 months Tai-Chi exercise on blood lipids, inflammatory factors and the interventional mechanism of exercise in arteriosclerosis of middle-aged and elderly people&#x0D; Methods 30 in middle-aged and elderly people with average age of 63.50±2.91 joined 12 months taijiquan exercise that conducted 60 minutes ecth time, six times per week. Left brachial-ankle pulse wave velocity (L-baPWV), right brachial-ankle pulse wave velocity(R-baPWV) , left ankle brachial index (L-ABI), right ankle brachial index(R-ABI), serum triglyceride(TG), total cholesterol(TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), interleukin 6 (IL-6) and hypersensitive c-reactive protein (hs-CRP) were detected at 3 time points including before exercise programme, by the end of exercise for 6th and 12th month.&#x0D; Results ①Compared with pre-exercise, the R-baPWV and R-ABI of the elderly people were decreased at the end of the 6th month, and the L-baPWV, R-baPWV, R-ABI and L-ABI were decreased significantly at the end of the 12th month. ②Compared with pre-exercise, TC and LDL-c were declined markedly (P&lt;0.01) at the end of the 6th and the 12th month, and there was no difference of the level of TG and LDL-c between pre-exercise and post-exercise.③Compared with before exercise, the subjects had significantly decreased IL-6 at the end of 6th months of exercise (P &lt; 0.01), and the decrease of hs-CRP was not obvious. At the end of 12 th months, IL-6 and hs-CRP decreased significantly (P &lt; 0.01). ④According to the correlation analysis, baPWV were positively correlated with TC, IL-6 and hs-CRP.&#x0D; Conclusions 12 months of exercise intervention can effectively reduce the elderly baPWV and ABI level, improve the blood pressure, blood lipid and body inflammation levels, thus to prevent the happening of the atherosclerosis development plays an important role.

Conservative Follow-up of Severely Displaced Distal Radial Metaphyseal Fractures in Children.

IntroductionDistal radius fractures are the most frequent fractures seen in pediatric population and usually treated with closed reduction and casting. However, there is a risk of reduction loss and/or angulations in distal radial metaphyseal fractures. The purpose of this study is to evaluate the radiological and functional results of pediatric patients with distal radius metaphyseal fractures in which excessive displacement and/or angulations were accepted and to question upper acceptable limits in light of current literature.MethodsPatients between five and 15 years of age with displaced distal radius fractures who were treated conservatively with significant angulation or translation were included in this study. Patients’ demographic data were gathered from hospital’s digital database. Clinical and radiological evaluations of all patients were done prospectively based on the last outpatient clinic control. Range of motion of wrist and elbow joint was measured with a goniometry, neurovascular status was documented, muscle strength was assessed and finally existing deformity measurements were performed clinically. Radiological evaluation was performed on pre-reduction, post-reduction, cast removal, 6th and 12th months and final examination radiographs. All measured values were compared with uninjured side. Radiologically, the percentage of translation, the amount of angulations, the distance from the fracture to the epiphyseal line, and the radius lengths were measured. Radial inclination and palmar tilt angles as well as ulnar variance and residual angulation were measured in both antero-posterior (AP) and lateral forearm radiographs. The Mann–Whitney U test was used to compare the variables in SPSS version 21. p < 0.05 was considered statistically significant.ResultsTwenty-nine patients with a mean age of 8.8 ± 3.1 years were included in this study. The mean follow-up duration was 17.4 ± 6.7 months. Compared to the uninjured side, in 24 (83%) patients, there were no limitations on wrist movements except five patients in forearm pronation clinically. In patients with re-displacement, the mean displacement occurrence time was 13.3 ± 4.9 (7–21) days. The translational and/or angulations in AP and lateral radiographs fully remodeled at the end of 6th month.ConclusionThis study demonstrates that radial and dorsal angular deformities up to 39° and 22° volar angulation and complete displacement correct fully in children up to 10 years old. In children between 10 and 15 years, the dorsal angulation up to 38°, radial angulation up to 23°, and volar angulation up to 16° are acceptable for remodeling capacity of the child.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P5. Effect of glucocorticoid withdrawal on glucocorticoid-inducing bone impairment

BACKGROUND CONTEXT Glucocorticoid (GC) withdrawal after a short-term use was common in clinical practice like immediate post-transplant period. However, previous studies without setting age-control group failed to determine whether the BMD recovery was sufficient and whether it is necessary to accept anti-osteoporosis therapy after GC withdrawal. PURPOSE The aim of this study was to investigate the effect of GC withdrawal on bone impairment in glucocorticoid-induced osteoporosis (GIOP) rats. STUDY DESIGN/SETTING Twenty-four female Sprague-Dawley rats (3 months’ old) were randomly divided into two treatment groups: an untreated age-control group (con, n=12); another group receiving a dexamethasone injection (DEXA, n=12). Animals in the con group were euthanized at 3rd month (M3) and 6th month (M6), respectively. Six rats in the DEXA group were euthanized at 3rd month (M3), whereas GC intervention was withdrew in the remaining animals of DEXA group, which were euthanized at the end of 6th month (M6). OUTCOME MEASURES Bone mass, bone microarchitecture, biomechanical properties of vertebrae, morphology, serum levels of PINP and β-CTX were evaluated. METHODS Twenty-four female Sprague-Dawley rats (3 months’ old) were randomly divided into two treatment groups: an untreated age-control group (con, n=12); another group receiving a dexamethasone injection (DEXA, n=12). Animals in the con group were euthanized at 3rd month (M3) and 6th month (M6), respectively. Six rats in the DEXA group were euthanized at 3rd month (M3), whereas GC intervention was withdrew in the remaining animals of DEXA group, which were euthanized at the end of 6th month (M6). Bone mass, bone microarchitecture, biomechanical properties of vertebrae, morphology, serum levels of PINP and β-CTX were evaluated. RESULTS Compared with the con (M3) group, the con (M6) group showed significantly better bone quantity, morphology and quality. Compared with the con (M3) group, the DEXA (M3) group showed significantly lower BMC, BMD, BS/TV, BV/TV, Tb.N, Tb.Th, vBMD, bone strength, compressive displacement, energy absorption capacity, PINP levels, β-CTX levels, and damaged trabecular morphology. And the same change trend was observed in the comparison between the con (M6) group and DEXA (M6) group. Compared with the DEXA (M3) group, the DEXA (M6) group showed significantly higher BMC, BMD and AREA, but no significant difference in BS/TV, BV/TV, SMI, Tb.N, Tb.Th, Tb.Sp, vBMD, bone strength, bone stiffness, compressive displacement, energy absorption capacity, PINP levels, β-CTX levels, and improvement in trabecular morphology was observed. CONCLUSIONS These results indicate that the reverse effect of GC withdrawal for 3 months on bone impairment in GIOP rats was insufficient, which implied that related anti-osteoporosis treatment might be still necessitated after GC withdrawal in clinical setting.

Outcome of ear surgeries in dry and wet ear

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media (CSOM) can present with dry and wet ear (discharging ear). It’s an accepted fact that an actively draining central perforation is not a contraindication for ear surgery. The discharging ear presents the otologists with the dilemma of operating on it or not, this is due to widespread belief that the success rate while doing ear surgeries on wet ears is decidedly inferior. Hence the present dissertation is intended to find the outcome of ear surgeries in dry and wet ear.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study comprises of 60 patients who have undergone type 1 tympanoplasty with cortical mastoidectomy, at Fr Muller’s Medical College, Mangalore. These patients were divided into two groups- Wet and Dry, based on the presence or absence of ear discharge at the time of surgery respectively. Inclusion Criteria: Patients of age group 16-60 years and both sexes, with mucosal type of chronic otitis media who underwent type 1 tympanoplasty with cortical mastoidectomy. Exclusion criteria: Patients with squamosal type of chronic otitis media or with ossicular chain erosion. A comparative analysis was done on the hearing improvement and incidence of the graft uptake postoperatively between the two groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In dry group, complete graft uptake was seen in 90% cases, whereas in wet group, a graft uptake rate of 86.7% was achieved. The graft take up rate is better in high x socio-economic status. Higher take up rates were seen in small and medium perforation compared to subtotal perforations. Hearing improvement, assessed by mean gain of PTA at the end of 6th month postoperatively, was achieved in 86% cases in Wet group and 90% cases in Dry group. There was an average hearing improvement of 13.08 db in speech frequencies in 88.3% cases. The difference between the two groups was statistically insignificant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In our study, we found no statistically significant differences between the success rates of Wet and Dry group, either in terms of graft uptake or the hearing improvement. Thus, from our study, we conclude that the presence of ear discharge at the time of surgery does not affect the success rate of type 1 tympanoplasty. &lt;/p&gt;

Functional outcome with modified tension band wiring for patella fractures

Background: Patella is the largest sesamoid bone in the body to an integral part of the extensor mechanism of the knee joint. The functional outcome of patella fractures depends on age, severity of injury, treatment modality, anatomical reduction and restoration of articular congruity, post-operative rehabilitation [1]. Aim of the study to assess the functional outcome of modified tension band wiring in patella fractures.Materials and methods: This is prospective study of 32 patients conducted at Basaveshwara Medical College and Hospital over a period of 2 years. All patients with 32 patellar fractures treated by modified tension band wiring. Functional outcome assessed as per the knee pain score, good fellow grading for range of motion. Patients were evaluated at 2nd week, 4th week, 3rd month and 6th months. Results: Age of patients ranged from 23-65 years with mean age of 40.6 years. Out of 32 patients, 22 (68.75%) patients were male and 10(31.25%) patients were female. Right knee was involved in 20 (62.5%) cases. About 18 (56.25%) cases attained fracture due to indirect trauma. Mean operation time was 90 minutes. Complications like superficial infection were seen in 2 patients. Average duration of hospital stay was 16 days. At the end of 6th month 2(6.25%) patients had ROM 120 degrees motion. At 6th month follow up 3(9.4%) patients had mild (30-45) knee pain score. Majority of patients show excellent results according to good fellow grading for range of motion.

Comparative Evaluation of Fresh Aloe barbadensis Plant Extract and Mineral Trioxide Aggregate as Pulpotomy Agents in Primary Molars: A 12-month Follow-up Study.

Background:The purpose of this study was to compare the clinical and radiographic outcomes of fresh Aloe vera barbadensis plant extract and mineral trioxide aggregate (MTA) as pulpotomy agents in primary molar teeth.Materials and Methods:Pulpotomy procedure was performed in sixty primary molar teeth which were randomly allocated to two groups, i.e., Aloe vera pulpotomy (Group A) and MTA pulpotomy (Group B). All the pulpotomized teeth were evaluated clinically and radiographically at 1, 3, 6, 9, and 12 months of time interval using predetermined criteria.Results:The success rates between Groups A and B at the end of the 1st month were 24.1% and 96.4%, at the end of 3rd month were 57.1% and 100%, at the end of 6th month were 75% and 100%, at the end of 9th month were 66.6% and 100%, and at the end of 12 months were 100% and 100% respectively. The overall success rates at the end of 12-month follow-up period were 6.9% and 71.4%, respectively, after taking dropout patients into consideration, and the difference was statistically significant (P < 0.001).Conclusions:MTA pulpotomy was found to be superior when compared to fresh A. barbadensis plant extract pulpotomy in primary molars.

Effect of bisphosphonate as an adjunct treatment for chronic periodontitis on gingival crevicuar fluid levels of nuclear factor-κB ligand (RANKL) and osteoprotegerin in postmenopausal osteoporosis.

Osteoporosis and periodontal disease are linked by an altered receptor activator of nuclear factor κB ligand and osteoprotegerin ratio (RANKL/OPG), and medical treatment with bisphosphonate (BP) may help control these molecules. The effect of BP on clinical findings and gingival crevicular fluid (GCF) values of RANKL and OPG using enzyme-linked immunosorbent assays was evaluated in postmenopausal women; 13 patients with both chronic periodontitis and osteoporosis (group A), 12 systemically healthy patients with chronic periodontitis (group B), 12 periodontally healthy patients with osteoporosis (group C), and 10 systemically and periodontally healthy individuals (group D). Recordings were repeated at the end of months 1, 6, and 12 in groups A, B, and C. At the baseline, groups A and B exhibited the lowest OPG values (P < 0.05). After periodontal treatment, OPG values were markedly increased at the end of 6th month in group A and 12th month in group B (P < 0.008). There was no significant difference in GCF RANKL values among groups (P > 0.05) or during the observation period (P > 0.008). The use of BP may be effective in preventing periodontal breakdown by controlling the levels of these markers in osteoporosis as an adjunct to periodontal treatment.

Effect of glucocorticoid withdrawal on glucocorticoid inducing bone impairment

Glucocorticoid (GC) withdrawal after a short-term use was common in clinical practice like immediate post-transplant period. However, previous studies without setting age-control group failed to determine whether the BMD recovery was sufficient and whether it is necessary to accept anti-osteoporosis therapy after GC withdrawal. The aim of this study was to investigate the effect of GC withdrawal on bone impairment in glucocorticoid-induced osteoporosis (GIOP) rats. Twenty-four female Sprague-Dawley rats (3 months’ old) were randomly divided into two treatment groups: an untreated age-control group (Con, n = 12); another group receiving a dexamethasone injection (DEXA, n = 12). Animals in the Con group were euthanized at 3rd month (M3) and 6th month (M6), respectively. Six rats in the DEXA group were euthanized at 3rd month (M3), whereas GC intervention was withdrew in the remaining animals of DEXA group, which were euthanized at the end of 6th month (M6). Bone mass, bone microarchitecture, biomechanical properties of vertebrae, morphology, serum levels of PINP and β-CTX were evaluated. Compared with the Con(M3) group, the Con(M6) group showed significantly better bone quantity, morphology and quality. Compared with the Con(M3) group, the DEXA (M3) group showed significantly lower BMC, BMD, BS/TV, BV/TV, Tb.N, Tb.Th, vBMD, bone strength, compressive displacement, energy absorption capacity, PINP levels, β-CTX levels, and damaged trabecular morphology. And the same change trend was observed in the comparison between the Con(M6) group and DEXA (M6) group. Compared with the DEXA (M3) group, the DEXA (M6) group showed significantly higher BMC, BMD and AREA, but no significant difference in BS/TV, BV/TV, SMI, Tb.N, Tb.Th, Tb.Sp, vBMD, bone strength, bone stiffness, compressive displacement, energy absorption capacity, PINP levels, β-CTX levels, and improvement in trabecular morphology was observed. These results indicate that the reverse effect of GC withdrawal for 3 months on bone impairment in GIOP rats was insufficient, which implied that related anti-osteoporosis treatment might be still necessitated after GC withdrawal in clinical setting.