Arun Kumar Singh

Association of TNF-α promoter gene G-308A polymorphism with metabolic syndrome, insulin resistance, serum TNF-α and leptin levels in Indian adult women.

BACKGROUND Tumour necrosis factor alpha is a multifunctional proinflammatory cytokine involved in the pathogenesis of metabolic syndrome, insulin resistance, and obesity. Aim of this study is to investigate in a North Indian female population the impact of the G-308A TNF-α variant on various components of the metabolic syndrome, Insulin Resistance, serum TNF-α and Leptin levels. METHODS The G-308A TNF-α polymorphism has been studied in 269 females with metabolic syndrome (NCEP ATP III criteria) (age 31.91±6.05) and 272 healthy females without metabolic syndrome (age 30.96±7.01). The G-308A variant was detected by PCR amplification and Nco-1 digestion. RESULTS Homozygous mutant genotype (AA) (p=<0.001: OR=3.24: 95% CI=2.15-4.89) and mutant allele (A) (p=<0.001: OR=3.04: 95% CI=2.08-4.43) of TNF-α was significantly less frequently observed in the control population as compared to study group. Furthermore, on dividing the subjects into two groups according to the absence (TNF-1 allele) or presence of the mutant A (TNF-2) allele, significant results were obtained in most of the metabolic risk factors. CONCLUSIONS Our results suggest that the G-308A polymorphism of the TNF-α gene may be independently associated with hypertension, leptin level and hypercholesterolemia leading to metabolic syndrome independent of Insulin resistance and hyperglycemia.

Micropigmentation: Tattooing for the treatment of lip vitiligo

BACKGROUND Vitiligo of the lips is a common concern of great psychological consequence. Medical therapies are often ineffective mainly due to the absence of hair follicles. Tattooing implants pigment into the skin. For treatment of vitiligo, tattooing works best in the lip area, particularly in a dark skin. AIMS AND OBJECTIVES To assess the effectiveness of medical tattooing for lip vitiligo. MATERIAL AND METHODS Fifteen patients with localised stable lip vitiligo patients (10 women and 5 men; age range: 30-55 years; mean age: 42 years) from the outpatient department were included in the study. The period of follow-up was from 2 to 3 years. The procedure was performed under local anaesthesia on an outpatient basis, unless carried out in conjunction with other procedures. An electric tattooing machine with cluster needles was used. RESULT Cosmetically acceptable results were seen in all patients. In dark-complexioned patients, pigmentation was better as compared to fair subjects. No allergic reactions to the pigment or koebnerisation of the vitiligo were noted. CONCLUSION Tattooing is relatively easy, safe and effective option for lip vitiligo. It is cosmetically more acceptable; sensations are well maintained and are generally devoid of any significant adverse effects.

Association of Resistin with Metabolic Syndrome in Indian Subjects

BACKGROUND The role of resistin in insulin sensitivity and metabolic syndrome has been controversial until now. Increased plasma/serum resistin levels are associated with metabolic syndrome and insulin resistance. The aim of this study was to investigate the relationship between serum resistin levels with markers of metabolic syndrome in males. METHODS A total of 386 male volunteers were enrolled in a case-control study. All of the enrolled volunteers were analyzed to confirm metabolic syndrome following the guidelines of National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) of 2001. Of the 386 volunteers, 192 were categorized as cases of metabolic syndrome, whereas 194 were registered as controls without metabolic syndrome. Volunteers enrolled in the study were analyzed for anthropometrical parameters, lipid profile status, insulin, insulin resistance, and resistin. RESULTS Higher levels of resistin were observed in cases when compared to controls (12.49 ± 4.73 ng/mL vs. 6.99 ± 1.98 ng/mL). Resistin was positively and significantly associated with serum triglyceride, cholesterol, and very-low-density lipoprotein, whereas it was negatively and significantly associated with serum high-density lipoprotein (HDL) levels. Multiple regression analysis of the data observed indicated that the triglyceride level was the major determinant for the development of metabolic syndrome in male samples. CONCLUSION This study demonstrates a positive correlation between resistin and factors of metabolic syndrome, except for HDL cholesterol (HDL-C), which was found to be negatively correlated in Indian male subjects. The study also found resistin to be a suitable peripheral blood marker.

Evolution of instruments for harvest of the skin grafts

Background: The harvest of autologous skin graft is considered to be a fundamental skill of the plastic surgeon. The objective of this article is to provide an interesting account of the development of skin grafting instruments as we use them today in various plastic surgical procedures. Materials and Methods: The authors present the chronological evolution and modifications of the skin grafting knife, including those contributions not often cited in the literature, using articles sourced from MEDLINE, ancient manuscripts, original quotes, techniques and illustrations. Results: This article traces the evolution of instrumentation for harvest of skin grafts from free hand techniques to precise modern automated methods. Conclusions: Although skin grafting is one of the basic techniques used in reconstructive surgery yet harvest of a uniform graft of desired thickness poses a challenge. This article is dedicated to innovators who have devoted their lives and work to the advancement of the field of plastic surgery.

The story of mouth gags

Background: Intra-oral surgeries such as cleft palate repair essentially require holding of the jaws in the open position to facilitate access to the oral cavity, which is mostly achieved with the use of mouth gags. Materials and Methods: The objective of this article is to present an account of various types and modifications of gags as surgeons, anesthetists, and innovators attempt to make that ideal mouth gag. The authors present this compendium of development of mouth gags using articles sourced from Medline, surgical catalogs, museums, ancient manuscripts, original quotes, techniques, and illustrations. Results: This article describes notable types and variants of mouth gags with an attempt to classify them. Conclusions: The huge number of modifications done and reports of newer variants appearing at regular intervals goes to prove that we are still far from developing the ideal mouth gag.

Bilateral cleft lip nasal deformity

Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the literature for correction of this deformity alludes to the fact that no single procedure is entirely effective. The timing for surgical intervention and its extent varies considerably. Early surgery on cartilage may adversely affect growth and development; at the same time, allowing the cartilage to grow in an abnormal position and contributing to aggravation of deformity. Some surgeons advocate correction of deformity at an early age. However, others like the cartilages to grow and mature before going in for surgery. With peer pressure also becoming an important consideration during the teens, the current trend is towards early intervention. There is no unanimity in the extent of nasal dissection to be done at the time of primary lip repair. While many perform limited nasal dissection for the fear of growth retardation, others opt for full cartilage correction at the time of primary surgery itself. The value of naso-alveolar moulding (NAM) too is not universally accepted and has now more opponents than proponents. Also most centres in the developing world have neither the personnel nor the facilities for the same. The secondary cleft nasal deformity is variable and is affected by the extent of the original abnormality, any prior surgeries performed and alteration due to nasal growth. This article reviews the currently popular methods for correction of nasal deformity associated with bilateral cleft lip, its management both at the time of cleft lip repair and also secondarily, at a later date. It also discusses the practices followed at our centre.

Prosthetic Rehabilitation Following Socket Reconstruction with Blair‐Brown Graft and Conformer Therapy for Management of Severe Post‐Enucleation Socket Syndrome – A Clinical Report

One of the most common tumors of the eye diagnosed in childhood is retinoblastoma, which mandates enucleation with adjunctive chemotherapy and radiotherapy to save the patients life. The most common late enucleation complication is post-enucleation socket syndrome (PESS), which poses a management dilemma for the prosthodontist and surgeon, along with being a major esthetic concern for the patient. The reconstruction of such sockets is complex. The purpose of this clinical report is to describe the rehabilitation of such a pediatric patient with severe PESS. The patient was successfully rehabilitated by presurgical conformer therapy, socket reconstruction surgery with non-meshed intermediate split thickness skin graft (STSG)/Blair-Brown graft, and postsurgical conformer stent. This was followed by fabrication of a custom ocular prosthesis, to achieve favorable functional, physical, and psychological effects.

Modified trapezius transfer technique for restoration of shoulder abduction in brachial plexus injury

Aims and Objectives: Shoulder stability and restoration are very important in providing greater range of motion to the arm and forearm. When brachial plexus repair does not have the desired outcome and in patients with long standing denervation, the trapezius muscle is frequently used for transfer to restore the shoulder abduction and external rotation. We propose a modified simple technique for trapezius muscle transfer. Materials and Methods: From February 2004 to February 2006, eight patients with posttraumatic brachial plexus injury with insufficient shoulder abduction were treated by trapezius muscle transfer. All patients with brachial plexus palsy were posttraumatic, often resulted from motor cycle accidents. Before operation a full evaluation of muscle function in the affected arm was carried out. All patients were treated with trapezius muscle transfer performed by the modified technique. S-shaped incision from the anterior border of the trapezius just above the clavicle to the Deltoid up to its insertion was made. The accessory nerve and its branches to the trapezius were secured. The trapezius was dissected and detached from its insertion along with the periosteum and sutured to the insertion of the Deltoid muscle. Results: All patients had improved functions and were satisfied with the outcome. The average increase in active abduction of shoulder was from 13.7 degrees (0 to 35 degrees) preoperatively to 116 degrees (45 to 180 degrees) postoperatively and of shoulder flexion from 24.3 degrees (15 to 30 degrees) to 107 degrees (90 to 180 degrees). Conclusion: The modified technique proposed here for trapezius transfer is safe, convenient, simple and reliable for restoration of shoulder abduction and stability with clear subjective benefits.

Penile tourniquet injury due to a coil of hair

Penile strangulation caused by a coil of hair is frequently an unrecognized clinical entity with several potential complications, such as necrosis of glans penis, urethrocutaneous fistulae and partial or complete amputation of the glans. We report on a 7 year old boy with a tourniquet injury to the penis secondary to strands of hair being tied around the glans at the level of the corona.

Comparison of oral and dental health status in patients with or without cleft lip and palate deformities undergoing orthodontic treatment

Objective: To compare the oral and dental health in patients with or without cleft lip and palate (CLP) deformities, undergoing orthodontic treatment. Materials and Methods: The study group comprised fifty patients with CLP. These patients were compared with fifty matched patients (control group) who had no CLP and had undergone orthodontic treatment for other indications at the same institute. Oral hygiene was evaluated clinically according to the simplified oral hygiene index (OHI). Dental caries examination was done according to decayed, missing, and filled teeth (DMFT) index. The scores were compared between the two groups. Results: The mean OHI score in cleft patients was 4.5 and in noncleft patients was 3.9 (P < 0.001).The mean DMFT score was 0.980 in cleft patients and 0.380 in noncleft patients (P < 0.001). Conclusion: This study clearly found that oral and dental health is compromised in CLP patients undergoing orthodontic treatment compared to patients undergoing routine orthodontic treatment. This article also proves that CLP is more predominant in males than in females.