Anil Chandra

Retrograde Wallerian degeneration of cranial corticospinal tracts in cervical spinal cord injury patients using diffusion tensor imaging

Diffusion tensor imaging (DTI) has the potential to reveal disruption of white matter microstructure in chronically injured spinal cords. We quantified fractional anisotropy (FA) and mean diffusivity (MD) to demonstrate retrograde Wallerian degeneration (WD) of cranial corticospinal tract (CST) in cervical spinal cord injury (SCI). Twenty‐two patients with complete cervical SCI in the chronic stage were studied with DTI along with 13 healthy controls. Mean FA and MD values were computed for midbrain, pons, medulla, posterior limb of internal capsule, and corona radiata. Significant reduction in the mean FA and increase in MD was observed in the cranial CST in patients with SCI compared with controls, suggesting retrograde WD. Statistically significant inverse FA and MD changes were noted in corona radiata, indicating some restoration of spared white matter tracts. Temporal changes in the DTI metrics suggest progressing degeneration in different regions of CST. These spatiotemporal changes in DTI metrics suggest continued WD in injured fibers along with simultaneous reorganization of spared white matter fibers, which may contribute to changing neurological status in chronic SCI patients.

Dental amalgam: An update

Dental amalgam has served as an excellent and versatile restorative material for many years, despite periods of controversy. The authors review its history, summarize the evidence with regard to its performance and offer predictions for the future of this material. The PubMed database was used initially; the reference list for dental amalgam featured 8641 articles and 13 publications dealing with recent advances in dental amalgam. A forward search was undertaken on selected articles and using some author names. For the present, amalgam should remain the material of choice for economic direct restoration of posterior teeth. When esthetic concerns are paramount, tooth-colored materials, placed meticulously, can provide an acceptable alternative. All alternative restorative materials and procedures, however, have certain limitations.

Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy

OBJECT Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment for post-tuberculous meningitis (TBM) hydrocephalus. The aim of this study was to affirm the role of ETV in patients with TBM hydrocephalus and also to study the usefulness of cine phase-contrast MR imaging (cine MR imaging) for functional assessment of the ETV stoma. An additional goal was to identify factors that influence the outcome of ETV, so as to define patients with TBM hydrocephalus in whom ETV is warranted. METHODS Twenty-six patients with TBM hydrocephalus treated with ETV were evaluated clinically and with cine MR imaging postoperatively. The duration of follow-up ranged from 1 to 15 months. The authors evaluated flow void changes in the floor of the third ventricle and analyzed parameters from the preoperative data, which they then used as a basis for comparison between endoscopically successful and endoscopically unsuccessful cases. RESULTS The overall success rate of ETV in TBM hydrocephalus was 73.1% in this case series. Cine MR imaging showed a sensitivity of 94.73% and specificity of 71.42% for the functional assessment of third ventriculostomy in these patients, with the efficacy being maintained during follow-up. The outcome of ETV showed a statistically significant correlation with the stage of illness and presence of intraoperative cisternal exudates. Although duration of symptoms and duration of preoperative antituberculous therapy (ATT) appeared to influence the outcome, their correlation with outcome was not statistically significant. CONCLUSIONS Endoscopic third ventriculostomy should be considered as the first surgical option for CSF diversion (that is, before shunt surgery) in patients with TBM hydrocephalus. Cine MR imaging is a highly effective noninvasive tool for the postoperative functional assessment of stomata. Patients who presented with a history of longer duration and those who were administered preoperative ATT for a longer period had a better outcome of endoscopic treatment. Outcome was poorer in patients who presented with higher stages of illness and in those in whom cisternal exudates were observed intraoperatively.

Advances in dental local anesthesia techniques and devices: An update

Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available.

Antibiotic prescription pattern among Indian oral healthcare providers: a cross-sectional survey

OBJECTIVES Inappropriate prescribing of antibiotics by healthcare professionals is a worldwide concern. The purpose of this study was to determine the pattern of antibiotic prescription among oral healthcare providers in India. METHODS A one-page questionnaire was sent to 1600 oral healthcare practitioners registered under the Indian Dental Association by using multistage sampling; 552 (34.5%) responded to the survey. The data were analysed using the χ(2) test and multiple logistic regression analysis. RESULTS Of 552 questionnaire respondents, 405 (73.4%) chose amoxicillin in non-allergic patients, alone [279 (50.5%)] or associated with clavulanic acid [126 (22.8%)]. The average duration of antibiotic therapy was 4.26 ± 1.26 days. The drug of first choice for patients with an allergy to penicillin was erythromycin [242 (43.8%) of respondents]. A majority prescribed antibiotics for irreversible pulpitis and acute apical periodontitis [395 (71.6%)] and necrotic pulp, acute apical periodontitis and no swelling [326 (59.1%)]. Five hundred and ten (92.4%) of the oral healthcare providers overprescribed antibiotics. CONCLUSIONS Oral healthcare providers in India are overprescribing, which could be a major contributor to the world problem of antimicrobial resistance. As there is overprescription of antibiotics by Indian oral healthcare providers, there is an urgent need to raise public and professional awareness regarding the risks of antibiotic use.

A comparative evaluation of smear layer removal using two rotary instrument systems with ethylenediaminetetraacetic acid in different states: a SEM study.

AIM The aim of the study was to evaluate the ability of 17% ethylenediaminetetraacetic acid (EDTA) solution and 19% EDTA gel to remove debris, and smear layer produced during root canal preparation with two NiTi files systems, Mtwo and Protaper. MATERIALS AND METHODS Twenty freshly extracted human anterior teeth with single root canal were collected. The crowns were sectioned at the cemento-enamel junction, and working length was measured. These samples were randomly divided into four groups of five samples each. In each group, 2 ml of 3 % sodium hypochlorite solution was used with first instrument. The groupings were as follows. Group 1: 2 ml of 17% EDTA solution and 2 ml of 3% NaOCl were used alternatively each time a new file was employed. This group was prepared with Mtwo rotary files. Group 2: The samples in this group was prepared with Mtwo rotary files. EDTA gel (19%) was used and the samples were irrigated with 2 ml of 3% NaOCl. NaOCl and EDTA gel were used alternatively. Group 3: Five samples were prepared with Protaper file. Irrigation regime was the same as in Group 1. Group 4: Five samples were prepared with Protaper files and irrigation regime was the same as in Group 2. SEM study was done and the collected data were submitted for statistical analysis. RESULTS There was no statistically significant difference with the varied instruments used (Mtwo and Protaper files), and 17% EDTA solution and 19% EDTA gel. CONCLUSION Both the NITI instruments produced a similar dentin surface on root canal wall when used with EDTA gel and EDTA solution.

Are full cast crowns mandatory after endodontic treatment in posterior teeth

The success of endodontic treatment is not only measured by the alleviation of pain and formation of healthy bone, replacing the diseased periapical tissue. Concepts for restoring pulpless teeth have been formed more from clinical observation than valid scientific investigation. Endodontically treated posterior teeth present numerous problems because of coronal destruction from dental caries, fractures, and previous restorations or endodontic techniques. The result is loss of tooth structure and a reduction in the capacity of the tooth to resist a myriad of intraoral forces. A summary of this review article suggests that coronal coverage significantly improves the clinical success rate of endodontically treated posterior teeth.

A randomized study of twist drill versus burr hole craniostomy for treatment of chronic subdural hematomas in 100 patients

Abstract Chronic subdural hematoma (CSDH) has been treated by a variety of surgical approaches like twist drill craniostomy (TDC), burr hole craniostomy (BHC), craniotomy, etc. There are large variations in cure rates and recurrence rates among the surgical options in literature and like all surgical techniques, there is a paucity of well-designed trials to sort out the issue. It is an accepted fact of surgery that the least invasive approach will often be the best approach. We set out with the hypothesis that TDC is as safe and as effective as BHC for CSDH treatment. A prospective randomized controlled trial for 100 patients was done to compare the results of TDC and BHC (both with drain) in patients of unilateral CSDH. Recurrence rate was the primary outcome variable evaluated. A strict clinic-radiological criteria was used to avoid ambiguity in the study. Forty-eight patients underwent TDC and 52 patients underwent BHC. Mortality was 2% (patients in low GCS), and 2% unexpected mortality occurred (unrelated causes). Complication rate was 14% overall and was similar in both groups. Overall outcome (primary and secondary) was comparable across both groups with no significant difference. Cost, invasiveness and duration of surgery was significantly less in the TDC group. The cure rate, recurrence rate, mortality and morbidity of TDC with drain is significantly similar to that of BHC with drain for treatment of defined patients of unilateral sub-acute and chronic subdural hematoma. The cost, duration and invasiveness of TDC surgery is significantly less than that for BHC surgery.

Influence of caries detection dye on bond strength of sound and carious affected dentin: An in-vitro study

Objectives: The objective of this study was to evaluate the influence of caries detection dye on the in-vitro tensile bond strength of adhesive materials to sound and carious affected dentin. Materials and Methods: Forty healthy and carious human molars were ground to expose superficial sound dentin and carious affected dentin. Caries Detector dye was applied to sound and carious affected dentin and rinsed. Subsequently the dentin was etched with 37% phosphoric acid and rinsed leaving a moist dentin surface. The adhesive (Single bond) was applied in single layers and light cured. A posterior composite (Filtek Z 250) were used to prepare the bond strength specimens with a 3 mm in diameter bonding area. Control and experimental groups were made with and without application of dye respectively. Each group includes both sound and carious affected dentin. After 24 hour immersion in distilled water, tensile bond strength (MPa) was measured using an Instron testing machine. Results: Analysis of variance (ANOVA) was used to evaluate the data. The tensile bond strength were significantly less in experimental subgroup than control subgroups. Conclusion: The tensile bond strengths were higher in sound and carious affected dentin without application of caries detection dyes.

Dumbbell-Shaped Paraganglioma of the Cervical Spine in a Child

Paragangliomas are tumors arising from extra-adrenal paraganglia and account for 0.3% of all neoplasms. The carotid body and temporal bone are the most frequent sites of paraganglioma, though it has been reported to occur in almost every part of the body. Spinal paragangliomas are uncommon and mainly take the form of intradural compression of the cauda equina or thoracic cord. Extradural paragangliomas are still rare; only few cases involving the dorsolumbar spine have been reported. We are reporting an interesting case of a dumbbell-shaped primary extradural paraganglioma of the cervical spine in an 8-year-old boy that presented with progressively increasing spastic quadriparesis.