Oral mucosal lesions are a common occurrence and very often dentists are called on to see such patients. Among many causes, trauma is one of the leading for oral mucosal diseases. Oral traumatic lesions are diverse in which some present as acute lesions while the majority are chronic lesions. Clinical presentation of traumatic lesions varies significantly and most of the occasions, the cause and the effect can be established with thorough history and clinical examination. Although biopsy of such lesions is not required in most of the occasions, some may warrant histological investigations to exclude conditions which clinically mimic traumatic lesions. This paper provides an overview of common and some rare traumatic conditions of the oral mucosa.

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The color of a lesion is due to its nature and to its histological substratum. To ease diagnosis, oral cavity lesions have been classified according to their color. In the oral cavity, jaundice is classified under yellow lesions as diffuse macular yellow lesions. This interpretation of the lesions by its color is the first step to diagnosis. It should be taken into account that, as happens with any other classification, the yellowish group of lesions includes items with different prognosis as well as possible markers of systemic disorders. In this case report, the author discusses the oral manifestations of a patient with icterus and its dental implications.

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Precocious puberty is the onset of physical and hormonal signs of pubertal development before the age of 9 years in males and 8 years in females. A 2-year 9-month-old Indian male child was brought to the hospital with complaints of excessive growth of pubic hair and increase in penile length for 2 months. On local examination of the genitalia, pubic hair was ++, his penile length was 9 cm, and testicular volume was >4 mL. The Sexual Maturity Rating score was A1P2T4. Serum testosterone levels – 592.76 mmol/L; serum luteinizing hormone – 2.18 IU/L; and serum follicle-stimulating hormone – 4.69 IU/L. His X-ray of the left wrist showed bone age >6 years. Magnetic resonance imaging of the brain showed an ill-defined, T2-hyperintense mass involving the right half of the tuber cinereum. A diagnosis of central precocious puberty due hypothalamic hamartoma was made. During the course of his admission, he was given injection leuprodex 3.75 mg intramuscularly once in 28 days. He was discharged with a plan to follow-up on outpatient basis.

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Rheumatoid arthritis (RA), an auto-immune inflammatory disease is one of the challenging conditions for the physicians to handle due to its chronicity, incurability, complications, morbidity, etc. In spite of potent anti-inflammatory agents and powerful immune-suppressive agents, its prognosis is not good, as these drugs have certain limitations including dependency and other side effects restricting quality of life. Considering these inconveniences, alternatives are being searched from traditional systems. Ayurveda through its armamentarium can provide leads in the management of this condition that is similar to Amavata in its clinical presentation. Amavatari rasa is one of the familiar medicaments used throughout India by Ayurvedic physicians for Amavata. In the current study, a clinical experience with Amavatari rasa is placed. A 32-year-old female with diagnosed history of RA was treated by Amavatari rasa. She received 250 mg of Amavatari rasa thrice a day with lukewarm water for 8 weeks and at the end of the treatment, 35% improvement was observed in the overall effect of therapy.

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Introduction: Proper diet is essential from the very early stages of life for proper growth and development. Increasing the variety of foods and food groups in the diet helps to ensure adequate intake of essential nutrients. The study was conducted with the objective to assess the dietary diversity pattern and to find the association between dietary diversity score and selected sociodemographic variables among adult population, if any. Materials and Methods: A community-based cross-sectional study was conducted between December 2016 and January 2017 among 216 adults with the help of dietary diversity questionnaire from rural and urban field practice area of the Department of Community Medicine, IQ City Medical College, Durgapur, West Bengal, India. Pearson's Chi-square test, Mann–Whitney U-test, and binary multivariable logistic regression analysis were performed using SPSS software. Results: The median dietary diversity score of the participants was 6. Nearly 45.4% of participants had adequate dietary diversity scores. Most common food groups consumed by the participants were starchy staples (100%), followed by oil and oil-based items (99.5%) and milk and milk products (86.1%). Age, residency, type of family, and occupation have a significant association with adequate dietary diversity. Conclusion: Awareness program on dietary diversity should be organized to make people aware about the importance of dietary diversity. Proper diet is essential from the very early stages of life for proper growth and development. Increasing the variety of foods and food groups in the diet helps to ensure adequate intake of essential nutrients.

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Background: Stainless steel and titanium are two different metals with different mechanical and metallurgical properties. Stainless steel is twice more stiffer than titanium. Internal fixation of fractures with stainless steel plates is likely to produce more rigid fixation than titanium plates. Hence, stainless steel plate fixation is likely to produce healing of fracture site with minimum callus/primary healing. This study analyzes whether these properties of the metals influence the healing of the fractures and their outcomes. Materials and Methods: Thirty-five cases of fractures of radius and ulna were treated by internal fixation using stainless steel limited contact-dynamic compression plate (LC-DCP) (Group I) in 17 patients and titanium LC-DCP (Group II) in 18 patients. Follow-up was done at 6 weeks, 12 weeks, 6 months, and 1 year for clinical and radiological healing and complications. Results: All the fractures united in time. 10 (62.5%) patients in Group I and 9 (56.2%) patients in Group II showed primary union and 6 (37.5%) patients in Group I and 7 (43.2%) patients in Group II showed union with callus formation. No complications were observed. Conclusion: Stainless steel and titanium are two different metals with different mechanical and metallurgical properties. However, fixation of fractures with these metals failed to show the difference in the patterns of fracture healing.

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Introduction: Immunization is one of the most effective public health tools available to prevent death and disease. Serious adverse events following immunization (AEFI) are rare. However, coincidental sudden-infant-death-syndrome (SIDS) deaths do occur temporally associated with vaccination. In 2010, the Government of India (GoI) introduced a new standard operating procedure (SOP) to report AEFI. There have been stray newspaper reports of deaths soon after the administration of the pentavalent vaccine (PV) which was introduced by the GoI in December 2011. This study was conducted to examine if there is an epidemiological signal from the data collected passively under the new SOP. Materials and Methods: We used data provided by the GoI on the number children who received three doses of diphtheria-tetanus-pertussis vaccine (DTP), the number receiving PV and the number of deaths in the vaccinated within 72 h. Results: After PV was introduced in the states, 45 million infants received DTP vaccination and 25 million received PV. There were 217 deaths within 72 h after DTP was administered and 237 following PV. There were 4.8 deaths per million vaccinated with DTP (95% confidence interval [CI]: 4.2–5.5) and 9.6 deaths (95% CI: 8.4–10.8) per million vaccinated with PV (odds ratio 1.98 (95% CI 1.65-2.38) There were 4.7 additional deaths (95% CI: 3.5–5.9), per million, vaccinated with PV instead of DTP (P < 0.0001). Discussion: Deaths following DTP vaccination would include the natural rate of deaths within that window period, plus deaths if any, caused by DTP. For purposes of this study, we assumed that all the deaths associated with DTP are coincidental SIDS deaths. Taking that as the base rate of SIDS, we look for any increase in the death rate after PV. This study demonstrated an increase in reports of sudden unexplained deaths within 72 h of administering PV compared to DTP vaccine. Whether improvements in AEFI surveillance system or other factors contributed to this increase cannot be ascertained from this study. Conclusion: These findings do not warrant deviation from current vaccination schedule, but the differential death rates between DTP and PV do call for further rigorous prospective population-based investigations.

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Background: The role of ultrasound in acute viral hepatitis (AVH) is limited to exclude the surgical causes of jaundice. However, there are certain ultrasound features which can help us to suspect AVH in the initial few days before the onset of clinical jaundice. Therefore, the aim of the present study was to detect the changes in the hepatobiliary system on ultrasound in the cases of AVH and to find the significance of these ultrasound findings by comparing them with controls. Materials and Methods: All serologically proven cases of enterically transmitted cases of AVH formed the study group and all healthy patients with clinical diagnosis of lower urinary tract symptoms who had no hepatobiliary disease were taken as controls. Results: Out of 120 cases, 102 cases were male and 18 cases were female. Maximum number of cases 54 (45%) were seen in 21–30 followed by 24 cases (20%) in the age group of 31–40 years. Hepatomegaly was seen in 104 (86.6%) of cases and 38 (25.3%) of controls (P < 0.01). Gall bladder (GB) wall thickening was seen in 91 (75.8%) of cases and 22 (14.6%) controls Contracted GB was seen in 75 (62.5%) cases of AVH and 16 (10.6%) of controls (P < 0.01). Porta nodes were seen in 72 (60%) cases and 15 (10%) controls (P < 0.01). Splenomegaly was seen in 33 (27.5%) of cases and 24 (16%) of controls. Periportal cuffing was seen in 28 (23.3%) of cases and 24 (16%) of controls. Conclusion: The ultrasound findings of hepatomegaly, enlarged porta hepatis nodes, contracted gallbladder and GB wall thickening are significant suggesting a role of ultrasound in the early diagnosis of acute viral hepatitis.

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Antidepressants can be classified into 13 different classes based on their pharmacological mechanisms of action. As of this present moment, 11 out of these 13 classes of antidepressants accomplish their pharmacoactivities by blocking one or more of the reuptake transporter pumps and/or receptors for the three monoaminergic neurotransmitters, namely serotonin, norepinephrine, and dopamine. The 12^th class inhibits the enzyme monoamine oxidase, while the 13^th class works by blocking the N-methyl-D-aspartate (NMDA)-glutamatergic ionoceptor. Previous experimental results suggest that depression is associated with hyperfunction of NMDA-glutamatergic receptors (NMDARs) in the subcortical regions (i.e., hippocampus, locus coeruleus, and amygdala); whereas at the same time, there is hypofunction of NMDARs in the cortical regions (i.e., prefrontal, perirhinal, and temporal cortices). Moreover, this finding has led to a conclusion that postulates the new “Glutamatergic hypothesis of depression” which is now moving our understanding of the pathophysiology of major depression disorder (MDD), a step further from the several decades' old “Monoaminergic theory of depression.” Collectively, clinical data suggest the involvement of the glutamatergic neurotransmission system in the pathophysiology of MDD or bipolar depression or schizoaffective depression, which includes disruptions in glutamatergic substrate concentrations and NMDAR alterations. Although the role of glutamatergic systems is yet to be fully elucidated, a “proof of concept” clinical study reported that the noncompetitive NMDAR antagonist ketamine produced rapid-onset and prolonged antidepressant effects in patients suffering from MDD or bipolar depression or schizoaffective depression. Still, this has generated tremendous interest in developing new drugs that will target the glutamatergic neurotransmission mechanisms for the treatment of MDD or bipolar depression or schizoaffective depression. These potential drug targets are the NMDAR as antagonist or inverse agonist or partial agonist, metabotropic glutamatergic receptors as positive or negative modulator, excitatory amino acid transporter-2 (EAAT-2) as a reuptake enhancer, and as a terminal presynaptic glutamate release inhibitor.

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The umbilical polyp is a rare congenital lesion characterized by bright reddish round mass resulting from the persistence of omphalomesenteric duct enteric mucosa at the umbilicus. Umbilical tissue specimens are uncommonly received in the Histopathology Department of Nnamdi Azikiwe University Teaching Hospital. Approximately, one is seen out of every 300 samples received in this center. The aim of this article is to report a rare case of umbilical polyp which was present at birth in a 3-year-old male child who presented with umbilical ulcer with a bloody discharge on contact. This article is the first of its kind in Nigeria and therefore aims to create awareness of this rare condition among Nigerian histopathologists and to differentiate it from more common umbilical anomalies.

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Vaginal foreign body is a rare condition. We present a 6-year-old girl who had dysuria and itching in the perineum; examination revealed a vaginal foreign body which was a broken safety pin. Radiographs after its removal revealed a pin of the safety pin left in the vagina which was later removed under anesthesia. A high index of suspicion for a vaginal foreign body should be present while evaluating a child with genitourinary complaints. Vaginal foreign body in children may be an indicator of possible sexual abuse; although in the present case, it was a prank by her elder sibling. Importance of postprocedural radiographs has been emphasized after removal as multiple/broken pieces may be present, which may not have been visualized initially. Evaluation for concurrent sexually transmitted diseases is paramount if sexual abuse is suspected.

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A variety of conditions/diseases can involve skin and lungs together. Knowledge about these conditions and the skin and respiratory manifestations in these conditions will lead to early diagnosis and proper management. Some of the dermatological manifestations may be very classical where the diagnosis will be obvious at a glance. Many a times, dermatological manifestations may narrow the differential diagnoses. In some cases, dermatological manifestations may indicate the severity/stage of the disease and prognosis. In some diseases with dermatological manifestations, where no obvious respiratory symptoms or signs are evident, screening for the underlying lung disease may be indicated. Some dermatological manifestations may indicate the underlying lung or other systemic diseases where further evaluation may be warranted even in the absence of other symptoms or signs. Diseases with skin and lung involvement can be classified into congenital/developmental disorders with cutaneous and pulmonary manifestations; primary dermatological diseases with pulmonary manifestations; primary pulmonary diseases with cutaneous manifestations; skin changes due to drugs used to treat respiratory diseases; and miscellaneous conditions involving skin and lungs. In this article, we discuss the various conditions/diseases with skin and lung involvement which a pulmonologist must know.

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One of the promising innovations in the field of surgical dentistry is the use of platelet-rich fibrin (PRF), alone or as an additive with other biomaterials. It accelerates the healing mechanism of the tissue and reduces the inflammation. The following article summarizes the role of PRF in the process of healing, its advantages, disadvantages, and clinical implications including advanced surgical dentistry.

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Chronic insomnia is a fairly common condition affecting one-fourth of the clinical population. It has been variously defined and is related to a large number of conditions. A thorough assessment of the patient presenting with chronic insomnia is of vital importance for the treatment. Treatment consists of modifying sleep habits to reduce autonomic and cognitive factors and education about healthier sleep practice. Drug treatment should be reserved for the short-term alleviation of insomnia. Appropriate treatment of chronic insomnia improves the quality of life. The prevention of insomnia consists of a balance of rest, recreational exercise in combination with stress management and a healthy diet.

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Context: It is needless to state that health and hygiene go hand in hand and of the various categories of hygiene, oral hygiene has a colossal contribution to positive health for any individual. Zealous and correct lifestyle characteristics are related to high standards of oral hygiene, and good habits must be inculcated in the early years of one's life. With this background, a study was conducted among some school-going adolescents. Aims: The aim of this study is to find out the status of their oral hygiene and oral health along with their associated risk factors. Methodology: It was a school-based, observational, cross-sectional study conducted among students of standard 7^th, 8^th, and 9^th of the school who were approached, and the parents of 151 students gave their consent for the oral checkup. Students first filled in a self-administered questionnaire following which their oral health and hygiene were examined. Data were analyzed using statistical package of social science software version 16.0 (IBM, SPSS Inc., Chicago, USA) Descriptive statistics and inferential statistics were performed. Results: Among 151 students, 64.2% had poor oral health, 52.3% and 64.2% student had unsatisfactory awareness toward oral health and oral hygiene practice, respectively. Females had better oral health awareness and better practice scores than males. Factors such as satisfactory practice of oral hygiene (odds ratio [OR] = 6.7 [3.4–12.2]); satisfactory awareness toward oral health (OR = 2.9 [1.9–3.5]); and gender (OR = 2.9 [1.5–5.8]) were associated with good oral health. Awareness toward oral health (OR = 5.8 [2.8–12.2]) are also strongly associated with the good practice of oral hygiene. In the final model of multivariable logistic regression analysis, factors such as the practice of oral hygiene (adjusted OR [AOR] = 6.8 [3.2–14.5]) and awareness toward oral health (AOR = 2.1 [1.3–3.6]) retained significance. Conclusion: Oral health promotion programs and periodic health checkups are needed.

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Introduction: Neck pain is a frequent complaint of the era. The muscles around the neck tend to get shorter, leading to restricted neck mobility. There are not much data about the effectiveness of deep friction massage in comparison with static stretching for reducing nonspecific neck pain. Purpose: The purpose was to find out whether these two interventions gave similar results and if one method is better to the other which could be the substitute of remedy. Study Design: This study was based a randomized control trial. Place of Study: This study was conducted at the Department of Physical Therapy, Mayo Hospital Lahore. Materials and Methods: Fifty-six patients with nonspecific neck pain were randomly located to have static stretching (Group A, n = 28) and deep friction massage (Group B, n = 28). Group A received six sessions of static stretching during 3 weeks (two sessions per week), whereas Group B received six sessions of deep friction massage during 3 weeks (two sessions per week). Results: Paired sample t-test was used. Statistically significant improvement was observed in both the groups in improving pain, Neck Disability Index (NDI), and range of motion (P > 0.05). No difference was found between the deep friction massage and static stretching in improving pain and range of motion. However, deep friction massage shows superior effects in NDI (P > 0.05). Conclusion: Deep friction massage and static stretching are equally effective in reducing the nonspecific neck pain in terms of alleviating pain and improving ranges of neck movement. However, deep friction massage shows superior effects in NDI.

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Background: Thyroid dysfunction may be associated with increased perceived stress. Aims: We aimed to study the correlation of perceived stress and thyroid function among females in a rural population of reproductive age group. Materials and Methods: This pilot study was conducted in Burdwan Medical College on 200 newly diagnosed female hypothyroid patients in a period of 12 months after taking institutional ethical clearance and informed consent of the participants. Parameters studied were body mass index (BMI), Presumptive Stressful Life Event Stress Scale (PSLES) scores, Perceived Stress Scale scores (PSS scores), thyroid-stimulating hormone (TSH), and free thyroxine (fT4) levels. To avoid stress effects of the premenstrual phase, we examined our participants during the postmenstrual phase. All the participants were on nonvegetarian diet and their dietary habits were nearly similar. Participants were divided into two groups: G1 – hypothyroid patients and G2 – patients with subclinical hypothyroidism. The computer software “Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc., Released 2007. SPSS for Windows, version 16.0. SPSS Inc., Chicago, Illinois, USA)” was used to analyze the data. Results: Two hundred newly diagnosed hypothyroid females were included in the present study. Among them, 130 were clinical hypothyroid (G1) and 70 were subclinical hypothyroid patients (G2). A significant difference was found between clinical and subclinical hypothyroid females for mean PSS scores (P = 0.002). There was no significant difference in PSLES scores between the two groups. A significant difference was found between clinical and subclinical hypothyroid females for BMI (P = 0.002), TSH (P < 0.0001), and fT4 (P < 0.0001). There was no significant difference in age between the two groups. There was a significant positive correlation between PSS scores and TSH levels with r value of 0.97 in G1 and r value of 0.26 in G2, respectively. Conclusion: Females of reproductive age group with clinical and subclinical hypothyroidism faced the same amount of stressful life events. However, their perception of stress was significantly different. High TSH was positively correlated with high score on PSS. Clinical hypothyroidism is associated with hypercortisolemia and also depression. However, a cause–effect relation is yet to be established. Moreover, depression and serum cortisol were not assessed, so no further conclusions can be drawn from the present study.

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