Retrospective analysis of inpatient and outpatient data from a single academic trauma center.To test the effectiveness of a conservative treatment algorithm for civilian spinal gunshot wounds (CSGSWs) by comprehensively evaluating neurological status and recovery, fracture type, concomitant injuries, indications for surgery, and complications.Few large studies exist to guide treatment of CSGSWs, and none have been published in nearly 20 years.A search of International Classification of Diseases, Ninth Revision (ICD-9) codes was performed for all hospital patients treated from 2003 to 2011 by either neurosurgery or orthopedic surgery to identify 159 consecutive patients who sustained CSGSWs. Mean follow-up was 13.6 months. American Spinal Injury Association grading was used to assess neurological injury.Fifty percent of patients had neurological deficits from CSGSW. Complete spinal injury was the most common injury grade; thoracic injuries had the most risk of complete injury (P < 0.001). Nearly 80% of patients had concomitant injuries to other organs. Operative treatment was more likely in patients with severe neurological injuries (P = 0.008) but was not associated with improved neurological outcomes (P = 1.00). Nonoperative treatment did not lead to any cases of late spinal instability or neurological deterioration. Overall, 31% of patients had an improvement of at least 1 American Spinal Injury Association grade by final follow-up. Nearly half of patients experienced at least 1 GSW-related complication; risk of complications was associated with neurological injury grade (P < 0.001) and operative treatment (P = 0.04).The vast majority of CSGSWs should be managed nonoperatively, regardless of neurological grade or number of spinal columns injured. Indications for surgery include spinal infection and persistent cerebrospinal fluid leaks.3.
Aims and Objectives: To determine the prevalence and etiology of fractured anterior teeth due to trauma among 8–14 years old school going children of Hyderabad city.
Materials and method: A cross-sectional study was carried out in 8-14 year old children studying in various schools of Hyderabad for the assessment of traumatic injuries of anterior teeth. Clinical examination was carried out and type of teeth affected, type of fracture, overjet and lip competence were noted. A closed end questionnaire was given to children with questions regarding etiology of trauma, place of injury, symptoms or outcomes after the injury, whether a dentist was consulted, type of treatment done by dentist and time elapsed between trauma and treatment. All the results were analyzed using “statistical package for social sciences” (SPSS) 20.0 software.
Results: The prevalence of dental trauma was found to be 7.84%. 11-14year old children showed higher prevalence. Males were more affected than females. Maxillary central incisors were most affected. Fracture involving enamel and dentin were recorded the highest. Children having overjet of >3mm and incompetent lips were at a higher risk of dental trauma (p value = 0.001). The most common cause of injury was sports and home was the most common place of occurrence of injury. Most of the traumatic dental injuries (TDI) did not undergo any treatment.
Conclusion: Increasing the awareness of the parents and teachers about the prevention of TDI and the importance of consulting the dentist after trauma should be instituted.
In Brief Study Design. Retrospective case series. Objective. The aim of this study was to determine the revision rates for all revision spinal deformity (SD) surgical procedures performed at a single center and to investigate the changes in measures of HRQL in these patients. Summary of Background Data. Reported revision rates for primary adult spinal fusion surgical procedures have been in the range of 9% to 45%, but to our knowledge, the revision rate after revision SD surgery has not been reported. The reported improvements in health-related quality of life measures after revision SD surgery have also been quite modest. Methods. Four hundred fifty-five consecutive adult revision SD surgical procedures (1995–2008) were identified and the records were reviewed to determine the reason for and timing to any additional operation(s). Scoliosis Research Society (SRS) Outcome scores were recorded at the first visit and at planned follow-up visits. Results. Ninety-four of 455 patients underwent further surgical procedures for a revision rate of 21%. Two-year follow-up was available for 74 (78%) of these patients (mean follow-up, 6.0 yr; range, 2.4–12.6; sex: F = 61, M = 13; mean age, 53 yr; range, 21–78). The most common causes of revision surgery were pseudarthrosis (N = 23, 31%), implant prominence/pain (N = 15, 20%), adjacent segment disease (N = 14, 19%), and infection (N = 10, 14%). Twenty-five (27%) patients underwent more than one revision procedure. SRS outcome scores were available for 50 (68%) patients, at an average follow-up of 4.9 years (range, 2–11.4). The mean improvements in the SRS outcome measures were as follows: pain, 0.74 (P < 0.001); self-image, 0.8 (P < 0.001); function, 0.5 (P < 0.001); satisfaction, 1.2 (P < 0.001); and mental health, 0.3 (P = 0.012). Conclusion. The rate of revision after revision SD surgery was 21%, most commonly due to pseudarthrosis, adjacent segment disease, infection, and implant prominence/pain. However, significant improvements in SRS outcome scores were still observed in those patients requiring additional revision procedures. Level of Evidence: 4 The rate of unplanned, revision for adult spinal deformity surgery at a single institution was 21%. Nearly one-third, 27%, of these patients underwent multiple revision surgical procedures. Despite this, improvement in Scoliosis Research Society-22 scores were observed at a minimum of 2 years of follow-up.
Introduction Childhood granulomatous periorificial dermatitis (CGPD) is a rare, benign, self-limited papular eruption of unknown pathogenesis that occurs commonly in prepubertal dark-skinned children.[1] Clinically, it is characterized by multiple flesh-colored to yellow-brown papules, often accompanied by erythema and desquamation, that are typically grouped around the mouth, nose, and eyes without systemic involvement.[1] The current review was conducted with the objective of determining the various presentations of CGPD and its treatment options. Two of the authors (AC and RA) searched PubMed independently using the terms "childhood granulomatous periorificial dermatitis or CGPD" and used the filters of "case reports" and "the age limit of birth to 18 years". The case reports with a confirmed diagnosis of CGPD were included in the current review. The data extracted were analyzed for gender predominance, age at presentation, duration of rashes, and treatment regimens. Continuous data were described as mean (±SD) or median [range], and categorical data were expressed as a proportion. Cases A total of 22 cases were described in the 20 case reports that were included in this study.[1-20] The details of the cases are described in Table 1.Table 1: Details of the case reports of CGPD reviewed with respect to clinico-epidemiological parameters, histopathological findings, treatment modalities, and resolution timeIn these 22 cases, 12 (55%) were male and 10 (45%) were female. The median age at presentation was 10 [range 2–18] years. The median duration of rashes at diagnosis was 3.5 [range 0.5–24] months. The majority of the cases were asymptomatic (77%), while four (18%) cases presented with pruritus, and only one (5%) case presented with blepharitis. The number of cases presented with monomorphic papules were 20/22 (91%), while only one case presented with papules and pustules, and one case presented with desquamating papules along with erythema. The distribution of the papules was observed in perioral and/or perinasal and/or periorbital regions in all cases. Extra-facial involvement (such as scalp, ears, neck, trunk, upper extremities, and perineum) was observed in six (27%) cases [Figure 1]. Treatment was provided in 20/22 (91%) cases [Figure 2], and the resolution was obtained in 17/20 (85%) cases. The median duration to resolution was 2 [range 0.75–12] months.Figure 1: Distribution of papules at extra-facial sitesFigure 2: Treatment modalities used in CGPDDiscussion The authors conducted a review of case reports of CGPD to determine various presentations and treatment options. A total of 20 case reports were included in this study, which described 22 cases of CGPD. In this study, the authors found that CGPD is equally predominant in males and females with a slightly higher incidence in males. The median age of presentation of CGPD was 10 [range 2–18] years. This finding reinforces the fact that CGPD presents in the first two decades of life (especially in prepubertal children). The authors observed that the median duration of rashes at diagnosis was 3.5 months. The clinical similarity of CGPD with other conditions such as periorificial dermatitis, granulomatous rosacea, sarcoidosis, lupus miliaris disseminatus faciei, and acne may lead to a delay in diagnosis [Table 2].Table 2: Differential diagnosis of childhood granulomatous periorificial dermatitis (CGPD)The distribution of rashes was mainly found to be perioral, perinasal, and periorbital.[1-20] In a few cases, extra-facial regions such as the neck, scalp, ears, trunk, upper extremities, and perineum were involved.[7,14,16,18,19] Most of the cases were asymptomatic at presentation. Occasionally, it was associated with blepharitis or pruritus.[2,9,14,16,18] Histopathological examination is the only confirmatory investigation. In this study, it was observed that most of the cases showed perifollicular noncaseating granulomas with upper dermal and mid-dermal infiltration with lymphocytes and histiocytes.[1-5,7-19] The exact etiology of CGPD remains unknown. It can result from an exaggerated inflammatory response to allergens and irritants. Fakih et al. suggested that the initial allergen causes an inflammatory process, and then a focal disruption of the follicular wall creates a granulomatous reaction.[2] Some reports have implicated reactions to essential oils in bubble gum, formaldehyde, cosmetic preparations, black synthetic mesh, and antiseptic solutions.[2] A possible association between chronic CGPD and hormone growth therapy has been reported recently.[17] In this study, the authors observed that the management of CGPD lacks consensus and guidelines. Multiple studies report the prior use of topical and systemic steroids for the management of this condition.[7,15] This can have dangerous consequences as children are particularly prone to develop both local and systemic side effects of steroids.[21] The authors noted improvement with topical treatment modalities, which included tacrolimus and pimecrolimus, and systemic agents, which included erythromycin/roxithromycin, metronidazole, tetracycline/minocycline, clarithromycin, and isotretinoin.[1-12,14-16,18] Topical agents are preferred over oral therapy for mild disease, characterized by small areas of involvement with no significant emotional distress.[2] This study is limited by the small number of cases reported and the lack of uniformity in the treatment regimens prescribed. Conclusion The current study concludes that CGPD is a self-limited inflammatory dermatosis affecting children which resolves spontaneously without any significant sequelae. Parents need to be reassured regarding the benign nature of the condition as the skin lesions may persist unchanged for months. Consensus guidelines for the management of CGPD need to be developed as inadvertent topical steroid application only exacerbates this disorder and leads to dangerous sequelae, particularly in the pediatric age group. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Oral submucous fibrosis (OSMF) predominantly involves the buccal mucosa, retromolar area, and soft palate in the oral cavity. Curcumin exhibits anti-inflammatory, antioxidant, anticarcinogenic, and anti-fibrotic properties. Aims and Objectives: This study aimed to evaluate and compare the therapeutic response of curcumin–piperine combination with antioxidants in OSMF patients. Materials and Method: Patients with OSMF were divided into groups of four, of which two were allotted to the experimental group and two to the control group. Both groups were given antioxidants with physiotherapy. The experimental group patients were additionally given 6 gm of the study medication (curcumin–piperine tablets) daily in three divided doses. The patients were asked to have two tablets after three meals. Improvement in burning sensation and mouth opening was evaluated every 15 days during both the active and follow-up periods (six months). Results: Burning sensation improved in both groups; however, complete resolution was noted in the curcumin group. The experimental group showed a 10% increase in mouth opening, against 2% in the control group. This increase was highly statistically significant in the experimental group compared with the control group. Conclusion: The curcumin–piperine combination has anti-inflammatory and antioxidant properties, thus used along with physiotherapy in the management of early/moderate cases of OSMF.
Presently, the 5-year survival rate for metastatic osteosarcoma remains low despite advances in chemotherapeutics and neoadjuvant therapy. A majority of the morbidity and nearly all of the mortality in osteosarcoma rely not in the primary disease but in the metastatic disease. The pursuit of novel molecular therapies is attractive due to their targeted ability to combat metastasis. Unlike traditional chemotherapy agents, which work by targeting rapidly dividing cells, targeted therapies may spare normal cells and decrease the adverse effects of chemotherapy by targeting specific pathways. Here, we discuss key molecular pathways in osteosarcoma and their ability to be modulated for the goal of eradication of primary and metastatic disease. We focus specifically on the aldehyde dehydrogenase (ALDH), epidermal growth factor receptor (EGFR), and insulin-like growth factor-1 receptor (IGF-1R) pathways.
Objectives: Natural killer (NK) cells are important effector lymphocytes. NK cells are considered to represent innate immune system. NK cells target and kill aberrant cells such as virally infected and tumorigenic cells. The purpose of this study was to assess the expression of CD57 in oral squamous cell carcinoma (OSCC) and to correlate the expression of CD57 with 3 years survival in patients with OSCC.Materials and Methods: About 100 histopathologically diagnosed cases of OSCC of various grades were divided into two groups, i.e., Group I (dead patients) and Group II (live patients) from the archives of Department of Oral Pathology and Microbiology. CD57 was detected in these tissues by immunohistochemistry.Result: The results were analyzed using Spearman's correlation coefficient and students unpaired t-test. The mean CD57 labeling index in Group II was significantly higher than that found in Group I (P = 0.000). There was a significant correlation (P = 0.00) in the mean CD57 levels between Groups I and II and prognosis of patient.Conclusion: CD57 could be a good prognostic marker for OSCC patients.
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