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In orthodontic treatment, brackets need to slide along the archwire to allow for alignment of the teeth. The lesser the friction between the bracket and the archwire, the easier it is to align the teeth and the lighter the forces required to make such movements. In recent years, patients’ esthetic demands have driven the field of orthodontics to find alternatives to conventional stainless steel bracket systems. While ceramic brackets meet the esthetic demands, their inferior frictional characteristics have always been an issue for orthodontists.The present in-vitro research study evaluates and compares the frictional resistance between various types of brackets, archwire materials and ligation methods. The purpose of the study was to equate the frictional resistance among 12 different groups using the universal testing machine, so as to recognize the factors involved in the in-vitro appraisal of resistance to sliding (RS) and inferring their clinical implications. In this study, 120 pre-adjusted edgewise upper central incisor brackets with MBT 0.022″ slot were used, which included 40 standard metal brackets, 40 ceramic brackets, 20 self-ligating metal brackets and 20 self-ligating ceramic brackets. 0.019″ x 0.025″ SS (stainless steel) archwires, esthetic archwires, Teflon-coated ligatures and conventional elastic modules to ligate the archwire to the brackets except in self-ligating brackets, were used. The average frictional resistance of Group A10 was the minimum succeeded by A9, A12, A4, A11, A8, A3, A7, A2, A6, A1 and A5. In the comparison of the mean frictional resistance of 12 different groups, the ANOVA test showed noticeably different frictional resistance amongst the groups (F=745.80, P< 0.001). Self-ligating metal bracket combinations with different archwires showed a significantly smaller magnitude of friction than self-ligating ceramic, metal and ceramic bracket combinations. Teflon-coated ligature combinations possess less friction in comparison with conventional elastomeric module combinations.

A 31-year-old man with no predisposing factors and no history of chronic disease presented with a small painless lump over his anterior chest wall. On evaluation, it was found to be undifferentiated pleomorphic sarcoma. He underwent wide local excision of the tumour with clear margins, followed by adjuvant radiotherapy. At 6-month follow-up, the patient is clinically and radiologically disease free.

Background: Chemotherapeutic drugs are commonly associated with various harmful consequences which can remarkably reduce quality life of patient and lengthen hospital admission. The objective of this study was to evaluate the frequency and its associated factors affecting cancer chemotherapy-related side effects in cancer patients. Methods: Patient case report form was used to gather information on the patient's demographics and adverse drug reactions (ADRSs) to chemotherapy medications. ADRs were analyzed for toxicity grade using National Cancer Institute Common Terminology NCI-CTCAE version 4.0. Causality Assessment and Predictability of ADRs were analyzed using World Health Organization' (WHO) Causality assessment scale and Council for International Organization of Medical Sciences (CIOMS) method respectively. Utilizing the chi square test and descriptive statistics, the relationship between the grade of ADRs and the patient's characteristics was investigated. Results: A total of 120 patients were included in the study. Mean age of participant was 46.87 (SD-10.1). Majority (60%) participants were female. 81.7% of total patient received poly-chemotherapy in their treatment modality. Total 412 numbers of ADRs were noted. The most frequent adverse drug reactions were observed to be nausea and vomiting (17.7%), neutropenia and alopecia. On NCI-CTCAE grading maximum number of ADR was assessed as “Grade 2” ADR (33%).

Introduction: Knowledge and competencies regarding Pharmacology are found difficult to be taught by the traditional teaching methodologies alone. One minute preceptor (OMP) model is an innovative method of teaching and learning activity which is being used to improve reasoning skills in clinical settings but also can be used with modification to improve work place based learning in nonclinical subjects. We conducted OMP for the first time among undergraduate students with the aim of imparting better understanding of basic competencies in Pharmacology and better clinical application of concepts. Materials and Methods: This was a quasi experimental interventional study. Participants included 60 undergraduate second BBS students that were randomized to the OMP group (n = 30) or to the traditional group (n = 30) and 12 faculty members. Six competencies of Pharmacology were selected and validated by the content experts followed by development and validation of six case scenarios from the topics chemotherapy and cardiovascular system (CVS) with regards to the particular competency. One case scenario was developed for one competency. The selected topics had already been covered in didactic lecture. Validated pre/post-test questionnaire and feedback perception questionnaire were developed. Faculty and students were sensitized with the OMP method of teaching with short interactive lecture and role play. Immediate cognitive gain was assessed using pre- and post-tests for each intervention. Formative assessment after 2 months was done to assess long term impact using structured viva. All the questions were based on clinical application with regards to the competencies. Students’ and faculty perceptions were analyzed using feedback questionnaire on a 5-point Likert’s scale. Paired t- test was adopted to assess pre/post scores for immediate effect of learning. Unpaired t-test was conducted to compare viva scores between two groups to assess long term impact. Results: Analysis of results of the both group revealed that OMP group scoring was significantly higher than the traditional group .The average perception on Likert’s scale was between 4(agree) and 5(strongly agree). The OMP model of teaching learning in pharmacology was well perceived by the students and faculty. Teaching skills of the faculty were also improved. Conclusion: Faculties and students rate OMP as more effective model of teaching than traditional model. Students feel confident in applying concepts in clinical settings. OMP promotes self directed learning .and encompasses all three domains- cognitive, psychomotor and affective. Keyword: OMP, Undergraduates, Competencies, Pharmacology

Background: Type II Diabetes mellitus (T2DM) is a multifactorial disease and a leading cause of premature deaths. Inflammatory cytokines are reported that they have potential to enhance insulin resistance and hence T2DM. Assessment of immunological profile in T2DM patients of Kashmir valley is unclear. So, detection of cytokines is relevant to determine the extent and direction of immune responses. The current research was taken to study the role of inflammatory mediators in T2DM along with insulin sensitivity, biochemical and hematological parameters in mountainous valley of Kashmiri population. Methods: A total of 340 subjects were selected in this study among them 160 were T2DM cases and 180 were healthy controls. Serum expression of inflammatory mediators (TNF-α and IL-6 ) were quantified by ELISA technique, WBC count was measured on Sysmax (Germany) hematology analyzer, biochemical and Immunoassay parameters were done on Abbott c4000 (USA) and Abbott C1000 (USA) fully automatic analyzer. Data was analyzed using statistical ‘software SPSS 16.1’ (Chicago, IL). For all assessments, p

Malignant fibrous histiocytoma (MFH) is a malignant mesenchymal tumor uncommonly seen in head and neck region and even rarer in maxillary sinus with less than thirty cases reported in literature. Microscopic diagnosis at this rare site may be challenging because of the spectrum of features, which frequently overlap with other benign and malignant tumors. We herein report a case of malignant fibrous histiocytoma of the maxillary sinus in a 40-year-old man who presented with epistaxis. The initial biopsy appeared benign whereas histopathology of wide surgical excision was consistent with MFH. In view of the deep location, the diagnosis may be missed on a small biopsy, which can appear deceptive leading to diagnostic errors. This case report highlights the histopathological difficulties and pitfalls of this tumor at this rare site.

Differently enabled functional movements of the mandible and different types of maxillomandibular and occlusal relations may share a cause-and-effect relationship with the disorders affecting the temporomandibular joint (TMJ). The purpose of this article is to draw inferences with orthodontic implications for the TMJ from an overview of adverse factors for growth and biomechanics of the TMJ, dentofacial characteristics associated with temporomandibular disorders, and mechanism of action of orthodontic interventions affecting the TMJ. Inferences drawn include the importance of history taking, functional evaluation and the need for radiological evaluation of TMJ condyle and disk, and position and function during procedures that are expected to interfere with TMJ homeostasis, for example, surgical craniofacial corrective procedures, functional therapy, and occlusal reconstructive procedures. Extremes of form (eg, excessive overjet and overbite, open bite and deep bite, skeletal hyperdivergence and hypodivergence) and differently enabled mandibular functions resulting in overloading of TMJs are all potential factors in the etiology of its disorders, thus enhancing the need for its evaluation before, during, and after treatment; a reciprocal relationship exists between growth and biomechanics of the TMJ, dentofacial characteristics and articular afflictions, occlusion and TMJ, and mandibular movements and TMJ. These interrelated, interdependent, and/or coexistent factors have a bearing on the diagnosis and treatment of the disorders of the TMJ. Orthodontic therapy should be directed to achieve a structural balance to facilitate physiologic adaptation and rehabilitation. Because the movements of the mandible are not restricted by the joint structure per se, other operative templates, for example, neuromuscular and psychological, apart from the structural template, contribute significantly to its complex functions and pathology. There is a need to find optimum values of structure and function of the masticatory system and develop mechanisms that can record and reproduce highly accurate geometric models of a subject's TMJ and teeth combined with recordings of chewing trajectories and 3-dimensional TMJ movements to obtain subject-specific models of masticatory system by either improving upon conventional mechanical articulators or by application of virtual-reality techniques for the development of virtual articulators for diagnosis and treatment of the disorders of masticatory system.

Face has always been forerunner in the esthetic persona. Facial form is the key in orthodontic diagnosis. The face is a demarcation of the esthetic and is the first characteristic to be perceived clinically. The knowledge of the facial typing also explicates the problems in the diagnosis and the treatment planning of the case accordingly. To determine the facial type and also the degree of variation within each facial type, a clinically applicable facial measuring device called indigenous biometric facial analyzer was developed.

Different interpretations of the term “Cleft Lip” by clinicians and developmental biologists referred to by Wang et al. (2014) in the introduction of their article on evaluation and integration of disparate classification systems for clefts of the lip, mirrors my observations in an article on nomenclature in craniofacial embryology (Koul, 2006). In that article, I had proposed a change of terminology of pre-palate/primary palate/anterior palate to Antenasal Segment, to remove the ambiguity of interpretations of differing terms for components that are involved in “Cleft Lip” formation. This antenasal segment comprises of (1) antenasal labium, (2) antenasal gnathia, (3) and antenasal palate in the completed face. This new terminology accurately identifies the embryological origin (naso-medial process) and structural precedence of this segment to the nasal frame of reference. The term antenasal segment reconciles the pre-natal and post-natal terminologies, facilitating a correct interpretation of the term “Cleft Lip” for classification and registration of the clefts of this segment in a manner that would reflect its etiologic and phenotypic variability. Evaluation and integration of various classification systems of “Cleft Lip” by Wang et al. is an important contribution to the process of making informed decisions for a cleft lip patient or a group of patients. The ontology of craniofacial development and malformation (OCDM) being developed as a part of NIDCR funded research network, Facebase will facilitate integration of such data for translational craniofacial research (Brinkley et al., 2013; Mejino et al., 2013). A standardized and uniform recording and retrieval of patient data is of fundamental importance for permitting interoperability with multiple resources in an efficient and effective manner. Toward this end, the classification schemes of cleft lip and palate need to be evaluated not only for their accuracy but also for optimization with electronic data registration and retrieval for multiple applications. With the introduction of medical information technology in clinical medicine, a global computerized classification system for cleft lip and palate is a prerequisite for achieving standardization and uniformity. Koul's classification of cleft lip and palate (Koul, 2007) expresses clinical data with a universally accepted natural language that corresponds to the nomenclature of the affected structures of the clefts. The use of this natural language in upper and lower case formats in combination with other keyboard signs and symbols makes this system of classification computer- processable. These are interpretation of facts, further verification and comparison studies are required to arrive at definitive conclusions. A universal, computerized classification system of cleft lip and palate will facilitate efficient and effective recording and retrieval of craniofacial data for translational research.

This prospective study was to evaluate the changes in quality of life (QOL) after 12 months post treatment from their pre-treatment levels, using specific questionnaires of well-known acceptability, responsiveness, and validity, with special emphasis on domains such as chewing, swallowing, speech, psychological aspects (mood and anxiety) and pain.This prospective analytical study included a total of 72 patients affected by oral tongue cancer (T1-2N0M0) who underwent treatment [wide local excision with selective + radiotherapy (RT)] from 2009 to 2012 at the Department of Oncosurgery and Otorhinolaryngology-Head and Neck Surgery, Sir Ganga Ram Hospital, New Delhi.A total of 39 (54.2%) patients were eligible for the study. Death occurred in 12 patients, four patients had disease recurrence and 17 patients lost to follow up. QOL in five domains was improved, there was significant improvement in pain scores [mean difference (-)17.94], overall activity of the patient was significantly improved (-13.46), recreational activities were also significantly improved (-8.33) and mental status of patient which included the mood and anxiety level were also significantly improved (-13.71 and -11.53) respectively. In seven domains which included the appearance of the patient (32.05), swallowing (16.41), chewing (24.35), speech (29.48), shoulder pain and discomfort (6.92), taste (35.12) and saliva production scores (20.51) were significantly worse.By our study we can strongly recommend that oral tongue cancers if diagnosed at early stages and without any neck node (T1-2N0M0) can be easily managed without compromising the QOL of the patients significantly.

Penile Cancer is rare in developed countries but not uncommon in developing countries like India, Brazil and some of the African Countries [1]. In India, it is more commonly seen in costal Tamilnadu, probably related to poor Hygiene. 20–30 % of patients with high risk Penile Cancer harbour microscopic metastasis in the inguinal nodes at presentation [2–5]. Involvement of lymph nodes is one of the important prognostic factors. Radical inguinal lymphadenectomy provides local control of disease and has a survival advantage but is a morbid procedure. Attempts have been made to reduce the morbidity by modifying the template, technique and to preserve the saphenous vein [6–8]. Despite of careful dissection and maintaining vascularity to skin, and refinement of techniques, necrosis of the margins, lymphorrhea and other surgical morbidity is seen in upto 50 % of patients [9–11]. Rare consequence of margin necrosis and infection is catastrophic haemorrhage from femoral vessels. Video endoscopic inguinal lymphadenectomy (VEIL) is the procedure described to reduce the morbidity associated with open counterpart and is a minimally invasive approach, which reduces the pain ensures early recovery and gives cosmetically better outcome [1, 3, 6, 12–18]. Hence we will be describing the technique of VEIL and discussing the advantages and oncological outcome in our series.

The wide spectrum of variations in the types of cleft lip and cleft palate has made standardized and inclusive classification difficult. This article introduces a new method for recording all types of cleft lip and cleft palate for data storage and communication. The proposed Expression System incorporates the actual words for the anatomical structures affected by clefts and can describe in a quickly understood form, without the need to consult reference materials, the location and extent of both typical and atypical clefts. The Expression System overcomes several limitations of previous cleft registration methods, and its simplicity and precision will benefit dental and medical specialists by furthering inter- and intradisciplinary communication.

Supernumerary teeth are rare anomalies of the maxillofacial complex that are more common in the maxilla than in the mandible. This article reports a case of an impacted supplemental type of supernumerary tooth in the mandibular arch, in the left premolar region. The etiology, types and treatment alternatives are discussed.