Background: Coronary slow flow phenomenon (CSFP) is not a benign phenomenon and has been associated with recurrent angina and sudden cardiac death but its etiopathogenesis remains unclear. Aims and Objectives: To evaluate the role of endothelial function in patients with coronary slow flow (CSF) and to compare them with patients with normal coronary flow. Methods: Fifty (n = 50) patients >18 years of age who presented with history of angina and whose coronary angiogram revealed normal epicardial coronaries with slow flow were included in the study. Fifty patients who presented with chest pain with normal epicardial coronaries and normal flow were taken as controls. Results: There were no major differences in terms of mean age, sex distribution, prevalence of hypertension, diabetes, smoking status, lipid profile, haemoglobin, blood glucose, serum creatinine levels in between the two study groups ([Table 1]). A significant difference was found in the hs-CRP levels between the two groups (5.52 + 3.03 vs. 2.98 + 1.48 mg/L, P < 0.0001). CIMT was found to be significantly more in patients with CSF group than that in patients with normal coronary arteries and normal coronary flow (NCF group) (0.058 + 0.007 cm vs. 0.0045 + 0.005 cm, P < 0.0001). Percentage of endothelial dependent dilatation in patients with CSF group was significantly lesser than in NCF group (2.78 ± 0.10% compared with 6.11 ± 0.10%, P < 0.01). The percentage of nitroglycerine (NTG)-induced dilatation was not significantly different between patients with SCF and patients with NCF (7.4 + 1.1% compared with 8.1 ± 1.0%, P = 0.87). Conclusion: Coronary slow flow phenomenon is a marker of atherosclerosis (as documented by carotid intima media thickness) and our study has also shown that endothelial function is significantly impaired in patients with coronary slow flow (as documented by impaired endothelial dependent vasodilatation) than that of patients with normal epicardial coronaries with normal flow.

Context: Missed splenic injury is the most common cause of preventable death after abdominal trauma. As clinical presentation varies widely awareness of spectrum of presentations and their relative importance is vital for diagnosing and managing splenic injuries successfully. Aim: To study various clinical presentations, modes of management and analyse outcomes of splenic trauma. Setting and design: Retrospective observational study conducted at a tertiary care teaching hospital. Methods and Material: 154 cases of adult splenic trauma presented to our teaching hospital between 2006 and 2014 diagnosed by FAST or CT scan or per operatively were enrolled retrospectively. Hemodynamically stable patients with grade 1 and 2 injuries with no other injuries necessitating laparotomy were chosen for NOM. Rest underwent splenectomy. Statistical Analysis Used: Descriptive statistics were used for analysis of data and results were expressed as percentages. Results: Highest number (44.15%) of victims were aged between 31-40 years. RTAs constituted 69.48%. 13.63% patients were asymptomatic initially. 58.94% were Grade-III injuries. Fracture ribs (90.25%) and hemo or pneumothorax (72.72%) were the most common associations. Number of cases selected for NOM were only 13.64%. Conclusions: Grade I and II isolated splenic injuries can be safely managed by NOM however under close monitoring. Absence of abdominal signs and symptoms do not exclude splenic trauma.

Background: Psoriasis is a chronic inflammatory disease of skin and joints affecting 1-3% of the population. Psoriasis may act as an external indicator of underlying immunological and metabolic dysregulation. Previous studies found higher prevalence of metabolic syndrome in patients with psoriasis, the former being a significant predictor of cardiovascular disease. Aims: We aimed to study the prevalence of metabolic syndrome and its individual components in patients with psoriasis and to determine the relationship of disease duration and severity with metabolic syndrome. Materials and Methods: A hospital-based comparative study was conducted involving 100 patients with psoriasis and 100 age- and sex-matched controls. Metabolic syndrome was diagnosed by the presence of three or more criteria of the National Cholesterol Education Program Adult Panel III (ATP III). Statistical analysis of the data was done using statistical processing software (SPSS 17). Results: Metabolic syndrome was significantly more common among patients with psoriasis than among controls [42% vs 22%, odds ratio (OR) = 2.5674, P < 0.0028]. Psoriatic patients also had higher prevalence of triglyceridemia (59% vs 35%, P = 0.0008), hypertension (37% vs 12%, P = 0.0001), and impaired blood glucose levels (56% vs 24%, P = 0.0001) compared to controls. Significant correlation has been found between disease duration and severity, and metabolic syndrome. Conclusion: Metabolic syndrome is more common in patients with psoriasis than in the general population. As most of the studies from India as well as the rest of the world are proving this association, psoriasis can be considered as one of the markers of metabolic syndrome.

Objectives: To examine the association between oral manifestations and type, frequency and duration of inhaler usage, also type and dosage of medication used in asthmatic and chronic obstructive pulmonary disease (COPD) patients. Materials and Methods: A cross-sectional study was conducted on 250 patients of both sexes suffering from asthma and COPD who were using inhalers. Frequency of oral manifestation seen on the tongue, buccal mucosa, teeth, periodontium, palate, floor of the mouth, lips, and xerostomia in inhaler users depending on the type of inhaler, type and dosage of medication, frequency and duration of use of inhaler were examined. Chi-square test was used for statistical analysis and P < 0.05 was considered statistically significant. Results: Ulceration (36.6%) and candidiasis (27.1%) on the tongue were most commonly found among those who were 25-50 years old and the elderly group, respectively. The differences were not statistically significant (P = 0.081). A significant association was observed (P < 0.05) for a higher percentage of females (59.7%) with gingivitis/gingival enlargement and periodontitis in males (25.6%). The teeth were affected in all types of users but it was not statistically significant (P > 0.05). Gingivitis/gingival enlargement (53.6% and 51.5%) was almost similar but periodontitis was higher in those using >500 μg. Significant association (P < 0.05) was observed with duration <1 year; oral manifestations seen were taste alterations (53.2%) in tongue, ulcerations (63.6%) in the buccal mucosa, teeth affected (87%), gingivitis/gingival enlargement (66.2%), and xerostomia (89.6%). Conclusions: As asthmatics and COPD patients are at a higher risk of developing oral diseases during inhalation therapy, it is necessary to educate patients on proper oral health care and maintenance.

Aim: The objective of this study was to assess the effectiveness of smear layer removal with a newer endodontic irrigation device, i.e., endoactivator system and with hard tissue laser, i.e., erbium, chromium:yttrium, scandium, gallium garnet laser (Er,Cr:YSGG). Materials and Methods: Forty-four mandibular premolars, single-rooted, noncarious teeth were selected. All the canals were prepared by using ProTaper Universal rotary files (Dentsply Maillefer, Ballaigues, Switzerland) and 3% NaOCl. Teeth were then divided into two control groups and two experimental groups. Group A: Negative control group (N = 11)- without any final irrigation, Group B: Positive control group (N = 11)- final rinse with 1 mL smear clear for 1 min using no. 30 gauge needle, Group C: Endoactivator group (N = 11)-1 mL smear clear + endoactivator, Group D: Er,Cr:YSGG laser group (N = 11). Teeth were sectioned and observed for smear layer removal at apical, middle, and coronal thirds under scanning electron microscope (SEM). Results: Results were interpreted analytically by Kruskal-Wallis test and Wilcoxon signed-ranks test. Conclusion: The two experimental groups were significantly more efficient in smear layer removal than the control groups. There was no significant difference between the endoactivator and laser groups. All groups showed more efficient smear layer and debris removal coronally than in the middle and apical regions.

Aim: The aim of the study is to assess the effect of dentin conditioners and luting cements on the retention of full metal crowns. Materials and Methods: Sixty recently extracted caries free molar teeth were prepared using airotor hand piece mounted to a surveyor with a custom made jig, to obtain a standardized 26° total convergence and 4 mm of axial height. Individual crowns were fabricated using base metal alloy. Thus prepared specimens were divided into six groups: 1) Two groups with no dentin conditioning (Control groups A and B), 2) Two groups, dentin conditioned with 10% polyacrylic acid conditioner (First test groups C and D), and 3) Two groups, dentin conditioned with 17% Ethylenediaminetetraacetic acid (EDTA) (Second test groups E and F). Groups A, C, and E were cemented with conventional glass ionomer whereas Groups B, D, and F were cemented with resin-modified glass ionomer. De-cementation was done using universal testing machine at a cross head speed of 1 mm/min after 48 hours of cementation. The obtained results were analysed using One-way analysis of variance (ANOVA) and Post hoc test. Results: The mean retentive (tensile) strength of Group A specimens was 2.26 ± 0.15 MPa, Group B specimens was 2.71 ± 0.15 MPa, Group C specimens was 12.26 ± 0.67 MPa, Group D specimens was 14.28 ± 1.47 MPa. Similarly, Group E specimens was 5.23 ± 0.62 MPa, and Group F specimens was 7.36 ± 0.51 MPa. Conclusion: Within the limitations of the study, retentive (tensile) strength required to dislodge the metal crowns was higher with the combination of resin-modified glass ionomer luting cement and 10% polyacrylic acid dentin conditioner.

Introduction: Orthodontics a unique branch in dentistry is inter-related with biology, mathematics and engineering sciences. Biomechanics is fundamental to the practice of orthodontics. Stresses generated at any point during orthodontic treatment are critical in remodeling of bone and type of tooth movement. Aims and Objectives: The aim of the following study is to determine the initial stresses produced in the tooth, periodontal ligament (PDL) and bone when force is applied on the tooth for intrusion and tipping on labial and lingual sides in the presence of varying alveolar bone heights. Materials and Methods: A geometric model generated using AutoCAD (Autodesk, Inc.). Six three-dimensional finite element models of a maxillary central incisor were designed with PDL and varying alveolar bone heights after applying the boundary conditions of the model, force was applied on the tooth. Results: Results were obtained with color coded three-dimensional fringe patterns. Conclusion: Alveolar bone loss causes an increase in the maximum initial stresses relative to the bone heights.

Background of the study: Human identification is a challenging aspect in forensic odontology. There are different methods for identification of an individual, such as finger prints, dental records and lip prints. The palatal rugae may also be considered an alternative method for identification as once formed in the embryo, their shape and consistency will be maintained throughout the life of an individual. Aims and Objectives: The present study is conducted to analyze the difference in shape and number of palatal rugae and compare the gender dissimilarities in the major rugae pattern prevalent in Costal Andhra and Telangana populations. Materials and Methods: A total of 100 persons in the age range of 17-25 years (Costal Andhra 50 and Telangana 50) were selected for the study and casts were prepared. Rugae were recorded based on the shape as wavy, curved, straight, circular, divergent and convergent. The results were analyzed using Statistical Package for Social Sciences (SPSS) version 16.01 statistical package. Results: Average number of rugae pattern in males was slightly more when compared with females. Curved rugae pattern were more in Costal Andhra and statistically significant (P ≤ 0.001). There was no significant association between the rugae shape and population group studied. Divergent and wavy rugae patterns were more in males compared to females in both groups. Conclusion: Rugae were more in number in Costal Andhra when compared to Telangana population. Wavy pattern were more in Telangana population when compared with Costal Andhra population. This is only preliminary study using geographically similar population and requires further studies on a larger sample.

The successful treatment of periapical inflammatory lesion depends on the reduction and elimination of the offending organism. Periapical surgery, one of the treatment alternatives, includes the curettage of all periapical soft tissues and sometimes application of different biomaterials to enhance the new bone formation in the defect site. The cases reported here present the management of the periapical inflammatory lesion using platelet-rich fibrin (PRF) which acts as a source of growth factors at the healing site. PRF features all the necessary parameters permitting optimal healing, but numerous perspectives of PRF have still to be clinically tested.

Alkaptonuria (AKU) is a rare autosomal recessive disorder caused by deficiency of homogentisate 1,2-dioxygenase, an enzyme that converts homogentisic acid (HGA) to maleylacetoacetic acid in the tyrosine degradation pathway. The three major features of AKU are the presence of HGA in the urine, ochronosis (bluish-black pigmentation in connective tissue), and arthritis of the spine and larger joints. We present a case of 48-year-old woman with a history of low back pain and left sided sciatica. Preoperative radiograph and computed tomography scan showed multiple calcified discs. Magnetic resonance imaging demonstrated an extruded disc at L4-L5, which was the culprit for her symptoms. She underwent complete discectomy. During discectomy, the disc found to be brittle and dark pigmented. Histopathology reported the disc had ochronoid pigment, and her urine turns dark after alkalization, and she admitted that she passed dark urine since childhood. Prolapsed lumbar disc is a rare entity in calcified discs of ochronotic spine. It requires discectomy in symptomatic patients. It requires long-term follow-up.

Primary splenic lymphoma (PSL) is a rare entity accounting for less than 1% of lymphoid malignancies. Follicular lymphoma primarily involving the spleen is still rare and constitutes only 10% of the PSLs. PSLs constitute a heterogeneous group of diseases with wide variations in clinical presentation as well as lymphoid populations from which they originate. Here we are reporting a case of a 43-year-old female presenting with massive splenomegaly and hypersplenism with anemia, leucopenia, and thrombocytopenia. Other investigations revealed no abnormality. When the patient underwent splenectomy for hypersplenism and the specimen was subjected to histopathological examination and immunohistochemistry the diagnosis of follicular lymphoma was made. As splenomegaly and hypersplenism are common in clinical practice, other common causes of splenomegaly and hypersplenism should be excluded. High level of suspicion and thorough investigation are required to establish the diagnosis. In the present case, the diagnosis was made retrospectively after splenectomy.

Neurocutaneous melanosis is a rare congenital disorder characterized by the presence of large or multiple congenital melanocytic cutaneous nevi associated with intracranial leptomeningeal melanocytosis. An association with Dandy-Walker malformation has been reported in 8-10% of children with neurocutaneous melanosis. ^[1] The main objective of this case report is to present the rare association as only few cases have been reported in literature, besides, as well, to discuss this as a case that appeared to be as meningitis with posterior fossa cystic malformation but turned out as neurocutaneous melanosis with Dandy-Walker malformation. In addition, we wanted to highlight the importance of correlating clinical examination findings with imaging findings and not limiting to imaging findings alone.

Development of vitiligo or halo naevus within or around congenital melanocytic naevus (CMN) is a rare phenomenon. Very few cases on regression of CMN after the onset of halo naevus or vitiligo were reported in the literature. We hereby report a case of 25 yr old female who presented with giant CMN since birth and development of vitiligo lesions within the CMN for the past 5yrs which is gradually progressing and showing regression of CMN.

The practice of using bone grafts in repairing periodontal defects has been the classical approach to periodontal regeneration in the last 30 years. To optimize the regeneration and preserve soft tissues, many techniques of papilla preservation have been described in the literature. The "whale's tail" technique is a surgical technique designed to preserve interdental tissue in guided tissue regeneration. This clinical case report describes and demonstrates the successful use of "whale's tail" flap in conjunction with bovine bone-derived mineral to reconstruct wide intrabony defect in the esthetic zone. A 28-year-old woman presented with an 8-mm probing depth on the mesial aspect of her maxillary right central incisor with midline diastema along with highly placed labial frenum with deep intrabony defect. A combined periodontal and orthodontic approach improved the anterior esthetic zone.

The median palatal cyst is a developmental cyst at the midline of the palate, usually presenting as an asymptomatic swelling, located just behind the maxillary central incisors. It is the most common non-odontogenic cyst of the jaws, but is rarely seen in children. The median palatal cyst has recently been identified as a possible posterior version of the nasopalatine duct cyst. The purpose of this paper is to report an unusual case of a median palatal cyst in a 7-year-old boy who presented with a slow-growing swelling in the anterior palatal region and management of the cyst.

Ectodermal dysplasias are rare hereditary disorders characterized by abnormal development of certain tissues and structures of ectodermal origin. The condition is of importance to dentists as it affects the teeth resulting in hypodontia or anodontia, and a dentist plays an important role in the rehabilitation of the patient. Apart from having difficulties in eating and speaking, young affected individuals can also feel that they look different from their contemporaries resulting in low self-esteem. Well-fitting and functioning prosthesis could be a great help during their schooling years, as it will improve appearance and thus boost their self-confidence. We report a case of hypohidrotic ectodermal dysplasia in a 12-year-old girl who exhibited partial anodontia, and a multidisciplinary approach comprising restorative, orthodontic, surgical, and prosthetic treatment was planned to rehabilitate the girl.The aim of the treatment was to improve psychological development apart from promoting better functioning of the stomatognathic system.