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Background: Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment., Method: The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site., Discussion: We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe., Trial Registration: ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC)., (© 2024. The Author(s).)

Objective: Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan., Design: Randomised clinical trial., Setting: Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each)., Interventions: Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2)., Main Outcome Measure(s): Changes in facial and nasolabial morphology., Results: Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle., Conclusions: Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background  The objective of our study was to derive an objective assessment scale for three-dimensional (3D) qualitative and quantitative evaluation of secondary alveolar bone grafting (SABG) using cone-bone computed tomography (CBCT) in patients with unilateral cleft lip and palate (UCLP). Methods  CBCT scans for pre- and 3-month post-SABG were reviewed for bone volume, height, width, and density of the bony bridge formed in the cleft defect in 20 patients with UCLP. Basic descriptive and principal component analysis was used to extract the various sub-components of the scale. Spearman's correlation was used to check the validity of the scale, and intra-class coefficient (ICC) and Cronbach's α were calculated to establish the reliability and retest applicability of the scale. Results  Each CBCT scan was assessed in five areas: cementoenamel junction (CEJ), root apex, root midpoint, 3 and 6 mm below CEJ, and tabulated in percentiles of 20, 25, 40, 50, 60, and 75 for all the parameters (bone volume, density, and width). These scores were validated when correlated to the scale given by Kamperos et al. Cronbach's α for the domains demonstrated acceptable to excellent internal consistency. The ICC showed good test-retest reliability having a range of scores from 0.89 to 0.94. Conclusion  The proposed scale for the 3D assessment of SABG in patients with UCLP provides gradation for the objective assessment of the bony bridge. This gradation enables the qualitative and quantitative assessments of the bony bridge, thus allowing each clinician to judge SABG more conclusively., Competing Interests: Conflict of Interest None declared., (Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To compare cephalometric parameters in parents of children with bilateral cleft lip and palate (BCLP) and parents of children without any craniofacial anomaly., Methods: A sample of 100 sets of parents were segregated into two groups of 50 parents each. The two groups included parents of children with BCLP and the parents of children with no craniofacial anomaly. Lateral cephalograms and postero-anterior (PA) cephalograms were examined for 100 parents of both the BCLP and control group, respectively. Tracings were scrutinized for 34 linear and angular parameters of dentocraniofacial skeleton. Data were analysed using unpaired Student's t-test. Result: Evaluated lateral cephalograms revealed 15 significant parameters in parents of children with BCLP including a significant increase in Ptm-S, maxillary length, SNA, articular angle and gonial angle. A significant decrease was noted in SN length, cranial base flexion, mandibular length, mandibular body length, total facial height, upper facial height, posterior facial height, Y-axis length and soft tissue total anterior facial height. Upon evaluation of PA cephalograms, four significant parameters were found in parents of children with BCLP. Cranial width, bizygomatic width, maxillary width and lateral interorbital width were significantly decreased in the parents of children with BCLP., Conclusion: Distinct dentocraniofacial morphological features have been found in parents of children with BCLP. Evaluation of these features might be the key to predicting the occurrence of clefts in their children and also planning for future linkage analysis studies amongst them., Competing Interests: None

Objective: The Endocrine Society's recently published clinical practice guidelines for the treatment of transsexual persons acknowledged the need for further information on transsexual health. We report here the experience of one provider with the endocrine treatment of transsexual persons over the past 2 decades., Methods: Data on demographics, clinical response to treatment, and psychosocial status were collected on all transsexual persons receiving cross-sex hormone therapy since 1991 at the endocrinology clinic at Albany Medical Center, a tertiary care referral center serving upstate New York., Results: Through 2009, a total 192 male-to-female (MTF) and 50 female-to-male (FTM) transsexual persons were seen. These patients had a high prevalence of mental health and psychiatric problems (over 50%), with low rates of employment and high levels of disability. Mental health and psychiatric problems were inversely correlated with age at presentation. The prevalence of sex reassignment surgery was low (31% for MTF). The number of persons seeking treatment has increased substantially in recent years. Cross-sex hormone therapy achieves very good results in FTM persons and is most successful in MTF persons when initiated at younger ages., Conclusion: Transsexual persons seeking hormonal therapy are being seen with increasing frequency. The dysphoria present in many transsexual persons is associated with significant mood disorders that interfere with successful careers. Starting therapy at an earlier age may lessen the negative impact on mental health and lead to improved social outcomes. However, significant barriers exist, such as insufficient insurance coverage, which limit comprehensive care.

Lactic acid levels were estimated in cerebrospinal fluid and blood of 25 normal individuals and 50 patients with varying grades of head injury. CSF lactic acid levels showed significant elevation proportionate to the degree of brain injury. Elevation of blood lactic acid was less pronounced. CSF lactic acid levels closely correlated with the prognosis of the case, and an increase above 50 mgm% was not compatible with life.

A comparative evaluation of 4 operations designed to treat sacrococcygeal pilonidal disease is presented, to show the duration of treatment time and the recurrence rate. Case records of 112 patients (131 operations) were studied. The results indicate that the healing times with the excision and Z-plasty operation are clearly less than those obtained by incision with drainage and packing, excision with primary closure, or excision and lay open. The overall recurrence rate in this series was 28 percent, all occurring within 3 years of the first operation. With the exception of the Z-plasty operation, other methods required considerable outpatient treatment time and were more susceptible to recurrence. We suggest that by reconstructing the intergluteal cleft, the likely effect of the Z-plasty operation is to eliminate factors that may promote pilonidal disease in this region.

Acid-base parameters and oxygen tension were studied in arterial blood and lumbar CSF of 45 subjects in three groups of controls, head injuries, and postoperative cases. CSF in both groups of head injury and postoperative cases showed changes of metabolic acidosis with the arterial blood changes of respiratory alkalosis. Both groups had significant hypoxaemia. CSF acidosis is an indication of cerebral metabolic disturbance. It is proportional to the severity of brain damage, and permits a prognosis for further clinical progress. It is recommended that patients with severe brain lesions should be put on controlled ventilation to relieve them of respiratory overwork and to combat cerebral oedema.

We present a case of major pulmonary embolization from a hemolymphangiomatous malformation of the loin and lower extremity. Treatment was with a low-dose infusion of urokinase for a short period directly into the pulmonary artery, and dramatic clinical improvement was noted. Prolonged maintenance therapy was with a low dose of heparin.

In vivo sensitivity of salmonella has been studied in 38 children with acute gastroenteritis. They were treated for 7 days with gentamicin, to which the organisms were sensitive in vitro. Stool culture remained positive in 30 of the 38 cases. The children improved on supportive and symptomatic therapy. This study shows that antibiotics have no role to play in the management of acute salmonella gastro-enteritis in children.

Glutamic oxalacetic and glutamic pyruvic transaminase levels in CSF and blood were estimated in 25 normal individuals and 50 patients with varying grades of head injury. CSF GOT, and to a lesser extent GPT, showed significant elevation proportionate to the degree of brain injury. Serum GOT was raised in more severe injuries. CSF GOT and GPT levels showed a significant correlation with the prognosis of the case.