Inappropriate and inadequate handling of biomedical waste may have serious public health consequences and a significant impact on the environment. It is necessary to manage infectious materials to prevent or reduce exposure of persons and the environment to potentially harmful bio-waste. Dental clinics generate a number of biomedical wastes, including the materials such as scrap amalgam, photochemical waste (developer and fixer), lead foil from traditional X-ray packets, blood-soaked materials, human tissue, and disinfectants, which are challenging to the environment. Wise handling and disposing them is critical. Sound management of biomedical waste is thus a crucial component of environmental health protection. The purpose of this article is to discuss about various types of biomedical waste produced in the dentistry, different waste management practices, the hazards of indiscriminate disposal of biomedical waste and to create awareness among the dental profession, regarding minimizing the production of biomedical waste and dentists are encouraged to follow the best management practices, while disposing hazardous wastes.

Background: In the modern era because of the poor coping mechanisms of stress, every individual has ample chance of developing one or other psychiatric manifestations in their lifetime. Prevalence rates of psychiatric morbidity and suicides were increasing, particularly among medical students. Aims: This study was aimed to improve the knowledge of psychiatric manifestations and to estimate the prevalence of psychiatric manifestations in medical students. Materials and Methods: A cross-section study was conducted in medical students (n = 100) to assess their psychiatric status. Medical students aged between 18 and 24 years were selected randomly and explained about the study. Mini International Neuropsychiatric Interview (M.I.N.I.) was used to assess psychiatric status of the medical students. Results: In our study, 34% of the subjects were having major psychiatric manifestations observed were social phobia (13%) and agoraphobia (10%). Both generalized anxiety disorders and hypomanic episodes were observed in 7% of the subjects. Panic disorder with social phobia and social phobia with agoraphobia were observed in 2% of the subjects. Conclusion: Implicating knowledge about the common psychiatric manifestations among medical students will lead to the early presentation of the suffering people to clinician, to get proper treatment of their illness and improve the quality-of-life.

Background: The directly observed therapy short course (DOTS therapy) has achieved a case detection rate of 70% and cure rate of 85% in new sputum positive cases of tuberculosis. Despite this, a few patients still default from treatment. This study is an attempt to find the sputum conversion and defaulter rates among new sputum positive cases treated by tuberculosis center attached to a tertiary care hospital, Tirupati, Andhra Pradesh. Materials and Methods: This longitudinal observational study was conducted during the period from January to December, 2011 among 200 new sputum positive patients attending Revised National Tuberculosis Control Program unit. The patients were followed-up at their houses individually and necessary information collected. Sputum results after 2, 3 and 6 months were obtained from Tuberculosis Clinic Laboratory Register. Results: The sputum conversion rate was found to be 54.0% after 2 months and 85% at the end of treatment. The defaulter rate was found to be 15% with higher prevalence in relation to male sex (18.8%), 15-44 years (25.9%) and unskilled labor (23.9%). The main reasons for default were found to be travel (33.3%) and lack of motivation (26.7%). Conclusion: Even under DOTS therapy, the defaulter rate can be significantly high indicating the need for constant supervision.

Background: The autoimmune bullous diseases are characterized by pathogenic autoantibodies directed at target antigens whose function is either cell-cell adhesion within the epidermis or adhesion of stratified squamous epithelium to dermis or mesenchyme. Aim: To assess the correlation between clinical, histopathological and direct immunofluorescence patterns in autoimmune vesiculobullous diseases and to assess the diagnostic value of direct immunofluorescence in various autoimmune vesiculobullous diseases. Materials and Methods: The study was conducted for a period of 24 months from August 2006 to August 2008. Total of 59 patients aged 3-80 years with vesiculobullous lesions of both sexes attending the department of dermatology were selected for the study. These samples were tested and analyzed under light microscope and direct immunofluorescence (DIF) testing. Results: Among the patients of vesiculobullous disorders studied most common disorder was found to be pemphigus vulgaris, constituting 40.6% cases. About 43.5% of patients presented with flaccid vesicles and bullae. Around 26.4% of the patients presented with tense bullae. Mucosal involvement was found in 57.6% of cases. Tzanck smear was positive for acantholytic cells in 54.2% of cases. Bullae were located sub epidermally in 30.5% of the patients, for 54.2% of patients they were located intra epidermally and no bullae were seen in 15.25% of cases. DIF was positive in 93.2% cases of autoimmune vesiculobullous disorders. Out of 59 cases of autoimmune vesiculobullous disorders, only 41 (69.4%) cases correlated clinically and histopathologically with direct immunofluorescence patterns. Conclusion: Our study proves DIF is not only diagnostic but also confirmatory for all autoimmune bullous disorders.

Aim: The aim of the present study is to evaluate the implant stability determined by Osstell Mentor® resonance frequency analysis unit during initial healing period with different bone density and whether resonance frequency analysis (RFA) can be integrated into the routine clinical evaluation to determine the implant stability. Materials and Methods: To measure the implant stability, 24 patients with an age group of 20 yrs to 40 yrs were included in the study. In all patients implants were placed by one stage technique using life care dental implants. RFA was measured at the time of implant placement, 2, 4, 8, and 12 weeks by using Osstell Mentor® device. Bone density was classified according to Lekholm and Zarb index. Results: The overall mean minimum RFA value at the time of implant placement was 66.25 + 9.6 which gradually decreased to 63.25 + 11.4 at 4 weeks and gradually increased to 68.50 + 10.2 after 3 months. Mandibular implants showed higher values ranging from 68 to 72 compared to maxillary implants which ranged from 62 to 65. Type II bone showed higher values than type III bone. Statistical analysis was done by SPSS software version 20. Conclusion: RFA by using Osstell ^TM mentor device is a non-invasive intraoral method designed to reflect the bone/implant interface and hence may be useful in documenting clinical implant stability and outcome of implant treatments. This test has been proven reliable for detecting alterations in implant stability during early healing and is sensitive enough to identify differences in implant stability based on bone density at the implant recipient site.

Introduction: The purpose of this study was a prospective investigation into the occurrence of impairment of labial sensation after surgical removal of impacted third molars. Aims and Objectives: The aim of this study was to determine the incidence of postoperative sensory impairment of inferior alveolar nerve (IAN) after extraction of impacted mandibular third molars. Materials and Methods: The study sample consisted of 200 patients who were indicated for removal of impacted mandibular third molars. Extraction of the impacted tooth was done by using surgical bur technique. Postoperatively, patients were evaluated for impairment of labial sensation. Objective evaluation of IAN was carried out using light touch sensation, tactile discrimination, pain awareness, and two point discrimination. Results: Of 200 subjects, only two patients showed neurosensory deficit in relation to IAN. Conclusion: The main cause of neurosensory impairment was due to variables associated with tooth position, degree of impaction, operator skill and also depth of impaction and age of the patient.

Lutembacher syndrome is a rare combination of congenital ostium secundum atrial septal defect (ASD) and acquired rheumatic mitral stenosis. The gold standard treatment for this condition is the surgical closure of ASD and mitral valve replacement. Here, we report a case of Lutembacher syndrome treated percutaneously with a combined ASD closure with Cocoon septal occluder and balloon mitral valvotomy.

Endocrine tumors are known for their varied presentations. Parathyroid adenomas (PAs) are tumors of endocrine origin and are rarely detected clinically. We report a case of a young male with PA with unusual features.

Ocular surface squamous neoplasia (OSSN) represents a rare spectrum of disease ranging from mild dysplasia to carcinoma in situ to invasive squamous cell carcinoma of the ocular surface. OSSN is more common in elderly males, in countries closer to equator and countries where exposure to excessive sunlight is more common. Diagnosis of OSSN is mainly based on clinical suspicion. Definitive diagnosis needs histopathological evaluation. In this article, we report a case of OSSN in a 28 year old male presented with limbal nodule of right eye. Excisional biopsy was done. Histopathological examination revealed a well differentiated squamous cell carcinoma.

Lymphangioleiomyomatosis (LAM) is a rare disease of unknown etiology that traditionally affects young women of child bearing or premenopausal age. It is characterized by proliferation of atypical smooth muscle cells, preferentially along bronchovascular structures that causes progressive respiratory failure. Due to its unusual and nonspecific presenting symptoms, patients often receive missed or delayed diagnosis. This disease occurs sporadically or in association with the genetic disease tuberous sclerosis complex (TSC). We present 34-year-old young premenopausal woman with LAM.

Gastro pleural fistula resulting from strangulation and perforation of the fundus in a diaphragmatic hernia in an adult is a rare entity. A 56-year-old male presented with severe dyspnea. Emergency chest X-ray showed left hydropneumothorax with mediastinal shift for which chest tube was placed. Patient improved symptomatically, but liquid food particles started coming through the intercostal chest tube. Gastroscope, contrast fluoroscope and computed tomography chest carried out to detect exact anatomical and pathological diagnosis. Investigations revealed intrathoracic location of the stomach and spleen. Laparoscopy and then midline laparotomy carried out. Fundus of the stomach and spleen were in left pleural cavity through the hernia Bochdalek. There was perforation of prolapsed stomach leading to pyopneumothorax; hence pus drained out through the chest tube and then food particles appeared in the water seal bag. The stomach and the diaphragm were successfully repaired after doing the splenectomy.

Pathological basal ganglia calcification can be due to various causes such as metabolic disorders, infections and genetic diseases. Hypoparathyroidism is one of the most common causes of pathological basal ganglia calcification. However, the presence of extensive intracranial calcifications involving other areas of the brain is uncommon. Patients with hypoparathyroidism can present with neurological symptoms related to hypocalcemia, extrapyramidal signs and seizures. We report the case of a young adult who presented with seizures, signs of cerebellar involvement and extensive intracranial calcifications. Investigations revealed that the patient had hypocalcemia, hyperphosphatemia and low parathyroid hormone levels. Since adequate treatment of hypoparathyroidism may lead to marked clinical improvement, this entity should be considered as a differential diagnosis in patients presenting with seizures and extensive intracranial calcifications.

A 55-year-old female developed a gradually increasing soft-tissue mass with peripheral calcifications in the lower thigh. The mass was surgically removed. The lesion was histologically identical to an aneurysmal bone cyst (ABC), therefore, it was diagnosed as an extraosseous ABC. The differential diagnoses and a review of the literature are presented.

Osteochondromas of the skeleton are common tumors, in the facial skeleton they appear on the skull base, maxilla and sometimes in mandibular condyle. Osteochondroma of the coronoid is rare and joint formation with the zygoma is called Jacob's disease.

When esthetic demands of the patient require accentuated precision in surgical technique, incorporation of advanced surgical aids in general clinical practice becomes a necessity. Periodontal plastic surgical procedures have been reviewed in the dental literature and assessed for their validity so as to provide the practitioner with the knowledge required in making patient-centered, evidence-based decisions with respect to the treatment of gingival recession. Connective tissue grafts is considered the gold standard for root coverage procedures due to statistically significantly superior results compared to other procedures. However, the coverage of multiple tooth recessions and patient morbidity due to the need of larger second surgical wound at the donor site in the gingival recession reduction are the major shortcomings. A case report of multiple roots recession treated using a modified connective tissue grafting procedure, the free rotated papilla autograft using periodontal microsurgery has been presented here. The advantages are the use of a single surgical site, avoiding any palatal patient discomfort, good color compatibility with adjacent tissue and healing by primary intension.

This report presents an extremely rare occurrence of two inverted impacted mesiodentes in a 16-year-old child patient. Extraction of both mesiodentes was indicated, owing to the abnormal diastema, rotation and impaction of teeth. Anterior cross bite as well as slightly concave profile was associated features in the child who presented with skeletal Class I relationship of the jaws. Development of these abnormalities would have been prevented if the impacted mesiodentes had been diagnosed and extracted early.