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The clinical management of a maxillary first molar with six root canals is described in this case report having two canals in the mesiobuccal root (MB), two canals in the distobuccal root (DB), and two canals in the palatal root (P). The prevalence of such a complex internal anatomy of teeth is a rare variation. The endodontic management of such deviant canal morphology can be challenging to diagnose and treat. For proper management of such unusual cases, it is essential to have sound knowledge of the intricacies of the anatomy and additional canals. Hence, it is imperative to record such cases in dental literature.

Sodium hypochlorite is the most widely used irrigant in endodontics because of its tissue dissolving ability and effective antimicrobial action. However, extrusion of sodium hypochlorite from the root canal system may lead to severe cytotoxic effects, regardless of the concentration used. This case report entails the management of inadvertent extrusion of sodium hypochlorite.

Background Irreversible pulpitis is a painful and debilitating condition. Root canal treatment (RCT) provides prompt relief and salvages the affected tooth/teeth. It has classically been performed as a multivisit procedure. A relatively newer approach constitutes performing all the steps in one single visit. This study was designed to explore if single-visit RCT could be confidently used as an effective and preferred treatment modality for irreversible pulpitis in the Indian Armed forces. Methods The study compared the incidence of postoperative pain, tenderness on percussion (TOP), flare-ups, and the analgesic drug use in 60 cases of acute irreversible pulpitis who were treated by either single or multiple visit root canal therapy. Each treatment group included 30 patients who were evaluated preoperatively and postoperatively at 24 h, one week and one month. Results The study found statistically higher incidence of postoperative pain (mild variant) and TOP in single visit therapy, 24 h after the obturation while the difference was insignificant at one week and one month after therapy. Analgesic use was significantly higher after the single visit therapy in the first 24 h. No flare-ups were recorded in either group. Significant pain and tenderness was observed after chemo-mechanical preparation (appointment 2) in multivisit regimen. Conclusion Single visit therapy is a safe, practical, and effective approach. The treatment results are similar to the multivisit regimen. It should therefore be considered for wider adoption and application.

Background: Breast pain or mastalgia is one of the most common symptoms presenting to general surgeons. Approximately 60-70% of the women experience some type of breast pain at some point of their lives. Mastalgia may be classified as cyclical and non-cyclical. In cyclical mastalgia the pain intensity is changing during the menstrual cycle. In non-cyclical mastalgia there is no other obvious cause present, the pain is considered to be originating from the breast and the pain remains unchanged during the menstrual cycle. If the pain persists there are a variety of pharmacological agents for treatment of mastalgia. These include 3-6 months course of low dose tamoxifen (10 mg) or evening primrose oil. Other agents include bromocriptine and danazol but are obsolete now days. Newer treatments include centchroman and topical non-steroidal anti-inflammatory preparations. In pursuit of finding an effective safe and economical agent to treat it, plan to compare centchroman to evening primrose oil as treatment of mastalgia.Methods: In this study, two groups with 40 patients each will be taken and treatment will be given for 12 weeks and follow up to 24 weeks will be done without medication to assess sustained response or recurrence of mastalgia.Results: Centchroman is a non-steroidal drug found to be effective in the treatment of mastalgia with early and better relief in a time period of 3 months with minimal side effects as compared to evening primrose oil.Conclusions: This study has demonstrated that Centchroman therapy offers safe, effective and economical alternative to Evening Primrose oil for treatment of mastalgia.

Aims: The study was aimed to acquire better understanding of C-shaped canal systems in mandibular second molar teeth through a clinical approach using sophisticated techniques such as surgical operating microscope and cone beam computed tomography (CBCT). Materials and Methods: A total of 42 extracted mandibular second molar teeth with fused roots and longitudinal grooves were collected randomly from native Indian population. Pulp chamber floors of all specimens were examined under surgical operating microscope and classified into four types (Min's method). Subsequently, samples were subjected to CBCT scan after insertion of K-files size #10 or 15 into each canal orifice and evaluated using the cross-sectional and 3-dimensional images in consultation with dental radiologist so as to obtain more accurate results. Minimum distance between the external root surface on the groove and initial file placed in the canal was also measured at different levels and statistically analyzed. Results: Out of 42 teeth, maximum number of samples (15) belonged to Type-II category. A total of 100 files were inserted in 86 orifices of various types of specimens. Evaluation of the CBCT scan images of the teeth revealed that a total of 21 canals were missing completely or partially at different levels. The mean values for the minimum thickness were highest at coronal followed by middle and apical third levels in all the categories. Lowest values were obtained for teeth with Type-III category at all three levels. Conclusions: The present study revealed anatomical variations of C-shaped canal system in mandibular second molars. The prognosis of such complex canal anatomies can be improved by simultaneous employment of modern techniques such as surgical operating microscope and CBCT.

Methylmalonic acidemia (MMA) is most common inherited type of organic acidemia. It has diverse presentation in older infants without any initial apparent symptoms. MMA sometimes present with sudden metabolic decompensation, which may mimics common emergencies like septic shock and diabetic ketoacidosis (DKA) without early recognition can be fatal. In born error of metabolism especially organic acidemia should be suspected in any infant presented with severe high anion gap metabolic acidosis. We report two cases of MMA in infants presented acutely mimicking DKA and septic shock.

Introduction: Varicella gangrenosa is an uncommon but serious complication of chicken pox in young children. It should be suspected in any child with a history of varicella infection and increasing complaints of pain and swelling in an extremity or other body area, along with increasing fever, erythema, lethargy, and irritability. Early surgical intervention with intensive antibiotic therapy is essential to prevent fatal consequences. Case Presentation: We describe a case of a previously healthy child who presented with sepsis due to varicella gangrenosa. While she initially responded well to a conservative antibiotic and acyclovir treatment, her subsequent rapid deterioration required urgent and repeated debridement. Conclusions: This report highlights the significance of prompt diagnosis and early surgical intervention for management of varicella gangrenosa.

Sir, Compartment Syndrome is a life-threatening condition in which rapidly increasing interstitial pressures in a limb compartment compromise the vascular supply to the limb tissues, causing ischaemic tissue injury. If uncorrected, tissue necrosis may ensue, requiring limb amputation.[1,2] For the prevention of intraoperative compartment syndrome, the importance of an excellent intravenous access and constant visual monitoring of the catheter site is often stressed.[3] We report a unique case in which a patient undergoing coronary artery bypass surgery (CABG) developed forearm compartment syndrome intraoperatively after infusion of about 2000 ml of intravenous fluids via a peripheral 16 gauge intravenous cannula without showing any signs of resistance to flow. A 62-year-old male, known hypertensive and diabetic on medication, was taken up for CABG after a thorough pre-anaesthetic check-up. In the operation theatre, a peripheral vein (cephalic) on the flexor aspect of the right forearm was cannulated with a 16 gauge cannula in a single attempt without any difficulty and a normal saline infusion started. Flow was good without any signs of extravasation. The patient was then induced with intravenous fentanyl 150 μg, thiopentone 250 mg and vecuronium 8 mg through the same cannula. Radial arterial (left arm) and right jugular central line were inserted and positioning done for CABG with the arms tucked in by the side of the patient. After positioning, the flow to the peripheral vein was checked again and found to be satisfactory. Surgery was then started and proceeded as routine. During the surgery, the patient was infused about 1500 ml of crystalloids and 500 ml of colloid (tetrastarch). There was no resistance to flow in the peripheral vein at any point of time. When drapes were removed after the surgery, the patient's right arm was extremely tense and swollen with cyanosed fingers and absent pulses. A diagnosis of acute forearm compartment syndrome was made and a decision to do emergency fasciotomy of the forearm and upper arm was taken to salvage the limb. The limb was draped, and fasciotomy done along the entire length of the forearm and upper arm. The colour of the limb rapidly changed to red as the compartmental pressures reduced. The right arm was kept elevated to reduce the oedema by gravity. The limb circulation was monitored with a combination of limb colour, plethysmography tracing and capillary refill. The fasciotomy was closed on the 3rd day after a considerable amount of oedema had dissipated and capillary refill and plethysmography trace were normal for about 48 h. The patient was then shifted to the ward and recovered uneventfully. Acute forearm compartment syndrome due to intravenous fluid extravasation is uncommon, but many case reports of forearm compartment syndrome due to mannitol extravasation[3,4] and autologous blood transfusion[5] have been published. This case report highlights the fact that although obtaining a secure intravascular access, securing it properly and constant visual inspection of the cannula site[3,6] are of paramount importance; this is not always possible particularly in surgeries where the upper limbs are tucked by the patient's side as a part of surgical positioning. Due to the absence of resistance to flow, the compartment syndrome could be recognised only at the end of surgery when the drapes were removed. This case illustrates the fact that prompt recognition and treatment are vital for limb salvage in compartment syndrome. Time is the key when circulation to any tissue is compromised, and the forearm compartment syndrome is no exception.

Objective: To determine the cause and disease pattern of neonatal morbidity and mortality in the secondary care neonatal unit of a district hospital. Study Design: Descriptive prospective study. Setting: Department of Pediatrics, General Hospital, Sec 16, Chandigarh. This hospital is providing optimal neonatal Level 2 care. Participants: All neonates who born in General Hospital Sec 16, Chandigarh, over 1 year were enrolled in the study. Outside born neonates and those who were re-admitted in the neonatal nursery after their discharge from hospital were excluded from the study. Methods: All consecutive live-born babies in the period of 1-year were included in the study. Babies received in labor room or operation theater were assigned Apgar score, and vital parameters were recorded. Sick babies were shifted to neonatal nursery as per admission policy, and rest of the babies were shifted with mother. All the babies were examined within 24 h of birth and daily thereafter till their discharge from the hospital. Main Outcome Measure: Antenatal and postnatal services, maternal education. Results: There were 6509 live births, of which 50 were twin pairs and 6409 were singleton birth. About 4.33% babies were born prematurely (