Plastic & Reconstructive

 British Association of Plastic Surgeons

The historical relationship between art and plastic surgery: is this relationship still relevant to the modern plastic surgeon?

Publication date: Available online 9 April 2019Source: Journal of Plastic, Reconstructive & Aesthetic SurgeryAuthor(s): Alexander J Baldwin

British Association of Plastic Surgeons

Tue Apr 09, 2019 14:18

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 Journal of Plastic, Reconstructive & Aesthetic Surgery

The current gold standard breast volumetry technique seems to overestimate fat graft volume retention in the breast: A validation study

MRI is generally considered the gold standard for measuring breast volume due to its high accuracy of the modality. Many techniques used to measure total breast volume have been validated, but none of these techniques have been validated for their ability to measure the volume retention of fat grafts in the breast. In this study, the authors investigated the accuracy of the most common MRI technique used to measure fat graft retention in the breast by measuring the volume changes after breast augmentations.

Journal of Plastic, Reconstructive & Aesthetic Surgery

Tue Apr 09, 2019 03:00

Intra-pedicular Injection of Indocyanine Green in Flap Surgery - a preliminary report.

"How long it can be?" is a question that continues to nag many, if not all, reconstructive surgeons performing flaps surgery. Taylor,1 Saint-Cyr2 and Rozen3 among others, gave an invaluable contribution in understanding the anatomical and the clinical territories of individual cutaneous perforating arteries. The purpose of their researches was more or less the same, i.e., to provide the foundations to a method to guide surgeons in designing safe flaps. Unfortunately, even though they developed some...

Journal of Plastic, Reconstructive & Aesthetic Surgery

Tue Apr 09, 2019 03:00

The sooner the better? Patients' satisfaction following ortho-plastic treatment of lower limb open fractures within and after one week from injury

Lower limb open fractures (LLOF) treatment still represents a major challenge. The timing for flap reconstruction remains controversial, especially the ideal timing for wound coverage, despite being considered essential for limb salvage.1

Journal of Plastic, Reconstructive & Aesthetic Surgery

Tue Apr 09, 2019 03:00

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 Latest Results for Aesthetic Plastic Surgery

Quality of Randomized Controlled Trials Published By Plastic Surgeons: Long-Term Follow-Up

Abstract Introduction In two previous studies, the quality of randomized controlled trials (RCTs) with the participation of at least one plastic surgeon was evaluated in two periods: 1966–2003 and 2004–2008. Objective To evaluate the evolution of the quality of RCT publications by plastic surgeons in the subsequent 5-year period, from 2009 to 2013. ...

Latest Results for Aesthetic Plastic Surgery

Tue Apr 09, 2019 03:00

The Soft Tissue Angular Analysis of Facial Profile in Unoperated Adult Patients with Unilateral Cleft Palate

Abstract Objective The purpose of this study was to investigate the differences in facial profile development between unoperated adult cleft palate (UACP) patients and normal controls and to analyse the reasons for the differences. Materials and Methods A total of 50 individuals with a unilateral cleft palate and 20 normal controls were selected to undergo...

Latest Results for Aesthetic Plastic Surgery

Mon Apr 08, 2019 03:00

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 Latest Results for European Journal of Plastic Surgery

Squamous cell carcinoma following multiple revision breast surgeries with massive chest wall reconstruction via flow-through double ALT free flaps

Abstract Implant-associated breast cancer is a well-described pathologic process that occurs in patients with breast implants. Anaplastic large cell lymphoma (ALCL), the most prominent malignancy associated with breast implants, has been extensively described, while literature regarding non-ALCL implant-associated cancers is limited. Here, we present a rare case of a 55-year-old female with squamous cell carcinoma (SCC) of the breast and chest following multiple breast revision...

Latest Results for European Journal of Plastic Surgery

Mon Apr 08, 2019 03:00

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 Ophthalmic Plastic & Reconstructive Surgery - Published Ahead-of-Print

Bilateral Punctal Foreign Body Granulomas Secondary to Multiple Retained Punctal Plugs

No abstract available

Ophthalmic Plastic & Reconstructive Surgery - Published Ahead-of-Print

Mon Apr 08, 2019 03:00

Lower Eyelid Distraction Test: New Insights on the Reference Value

Purpose: The evaluation of palpebral laxity can be performed by the distraction test (DT). Although widely used in ophthalmologic practice, there is no consensus about the results considered normal by the test. The objectives of this study are to obtain the value of DT in a group of individuals with healthy eyelids and to compare with the measurements in subjects with senile ectropion. Methods: Lower eyelid DT was performed in 200 individuals without any eyelid pathology and in 30 individuals...

Ophthalmic Plastic & Reconstructive Surgery - Published Ahead-of-Print

Mon Apr 08, 2019 03:00

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 Ophthalmic Plastic & Reconstructive Surgery - Published Ahead-of-Print

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Otolaryngology

Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension Publication date: Available online 8 April 2019 Source: American Journal of Otolaryngology Author(s): Adele Chin Wei Ng, Heng Wai Yuen, Xin Yong Huang Abstract Thyroglossal duct cysts (TDC) are the most common congenital neck masses. Although they are anatomically closely related to the larynx, intra-laryngeal extension is very rare. We present a case, review the literature and discuss the challenges of intra-laryngeal TDC. A 55-year-old man presented with a neck mass associated with dysphagia. Computer Tomography neck scan showed a midline cyst extending to the pre-epiglottic space with partial obliteration of the right pyriform sinus and narrowing of the larynx. The cyst was excised en-bloc via Sistrunk procedure. Intra-laryngeal TDC are surgically challenging due to risk of perforation into the aerodigestive tract.

The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review Publication date: Available online 5 April 2019 Source: American Journal of Otolaryngology Author(s): Parsa P. Salehi, David Kasle, Sina J. Torabi, Elias Michaelides, Douglas M. Hildrew Abstract We present two unique cases of myoclonus-induced objective tinnitus (OT), along with a comprehensive literature review on the topic. Primary goals include: explore the relationship between palatal myoclonus (PM) and middle ear myoclonus (MEM), highlight the embryologic, neurologic, and anatomical relationship between the involved peri-tubular muscles, exemplify the first case of OT which documents video evidence demonstrating the link between objective tinnitus and eustachian tube movement. Also, we discuss available treatment interventions and why they often do not fully resolve patients' symptoms. Finally we introduce a novel way to objectively quantify the severity of OT. Ultimately, our series hopes to inform future diagnostic and treatment guidelines.

Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients Publication date: Available online 3 April 2019 Source: American Journal of Otolaryngology Author(s): Sotirios Karamagkiolas, Ioannis Giotakis, Efthimios Kyrodimos, Evangelos I. Giotakis, Agapi Kataki, Fani Karagianni, Andreas M. Lazaris Abstract Purpose Laryngeal squamous cell carcinoma (LSCC), a common type of head and neck cancer, is associated with high rates of metastasis and recurrence. In this study, we investigated the potential combinatorial prognostic value of NOTCH1, Vimentin (VIM), and Metastasis-associated 1 (MTA1) protein in LSCC, using immunohistochemistry. Materials and methods Tissue specimens from 69 patients with LSCC were immunohistochemically evaluated for the protein expression of NOTCH1, VIM, and MTA1. Then, biostatistical analysis was performed, in order to assess the prognostic value of the expression of each one of these proteins. Results NOTCH1 expression status was not a significant prognosticator in LSCC, as shown in Kaplan-Meier survival analysis. On the contrary, both VIM and MTA1 seem to have an important prognostic potential, independently of TNM staging and histological grade of the tumor. In fact, positive VIM expression was shown to predict patients' relapse and poor outcome regarding patients' overall survival, in contrast with MTA1, the positive expression of which predicts higher disease-free survival (DFS) and overall survival (OS) rates in LSCC. Conclusions VIM and MTA1 constitute potential tumor biomarkers in LSCC and could be integrated into a multiparametric prognostic model. Undoubtedly, their prognostic value needs further validation in larger cohorts of LSCC patients.

Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo? Publication date: Available online 2 April 2019 Source: American Journal of Otolaryngology Author(s): Salvatore Martellucci, Giuseppe Attanasio, Massimo Ralli, Vincenzo Marcelli, Marco de Vincentiis, Antonio Greco, Andrea Gallo Abstract Purpose Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy. Materials and methods The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days. Results The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831–0.973, p = .008). Conclusions Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.

Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center Publication date: Available online 2 April 2019 Source: American Journal of Otolaryngology Author(s): Kwan Pok Tsui, Wai Yin Kwan, Tam Lin Chow Abstract Background There is much debate in the literature over the extent of surgery for patients with intermediate risk papillary thyroid cancer. We herein report our results in a local tertiary hospital. Method We identify from our database patients with papillary thyroid cancer who underwent surgery in our hospital and were stratified to be of intermediate risk from the GAMES stratification system. Patients' demographic data, surgical and pathological details were recorded. Primary end points were disease specific survival (DSS) and recurrence free survival (RFS). Results From January 1993 to December 2016, 231 patients with papillary thyroid cancer underwent surgery of which 137 (59%) were of intermediate risk. 45 (33%) patients had hemithyroidectomy and 92 (67%) patients had total thyroidectomy. In the total thyroidectomy group, patients had a higher tumor (T) (p value = 0.009) and nodal (N) staging (p value = 0.001). They were also predicted to have a higher risk of recurrence according to the American Thyroid Association (ATA) classification (p value = 0.005). The 5 year DSS in both groups were 100%. The 5 year RFS in the total thyroidectomy and hemithyroidectomy groups were 92% and 100% respectively and were significantly different by the log rank test (p value = 0.02). The median follow up time was 54 months (range 4–276 months). Conclusion The 5 year survival in intermediate risk papillary thyroid cancer is favorable. Hemithyroidectomy is an acceptable choice of operation in intermediate risk patients with a better risk profile.

Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish Publication date: Available online 2 April 2019 Source: American Journal of Otolaryngology Author(s): Carlos Miguel Chiesa-Estomba, Elizabeth Ninchritz, Teresa Rivera Schmitz, Jose Angel González-García, Ekhiñe Larruscain-Sarasola, Jon Alexander Sistiaga-Suarez, Christian Calvo-Henríquez, Xabier Altuna-Mariezcurrena Abstract Introduction There are >400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the quality of our patients after parotidectomy is necessary. Material and methods Validation and cross-cultural adaptation of the POI-8 questionnaire to the Spanish language. Internal consistency of Sp-POI 8 measured with Cronbach α. Results 35 patients met the inclusion criteria during the mentioned period. Mean age was 59 ± 15,37 (Min: 18/Max: 87). 20 patients (57,1%) were male and 15 (42,9%) were female. Internal consistency with Cronbach α was 0.868. The intraclass correlation coefficient was 0.830 [CI] (95%: 0,791–925). Hypoesthesia was the most severely weighted problem (0,91) and xerostomia was the second (0,89). However, the high score was for fear of revision surgery (1,26). Conclusion The Spanish Language is the second most spoken language with regard to the number of native speakers and the Sp-POI 8 translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.

Spontaneous cervical chyle fistula: A case report Publication date: Available online 2 April 2019 Source: American Journal of Otolaryngology Author(s): Swathi Appachi, Joseph B. Meleca, Paul C. Bryson Abstract Background Cervical chylous fistulae are rare complications usually occurring from iatrogenic injury to the thoracic duct. There have been no reported cases of spontaneous chyle leaks in surgical naïve necks. Methods Case report. Results A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence. Conclusion A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.

Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting Publication date: Available online 29 March 2019 Source: American Journal of Otolaryngology Author(s): Nael M. Shoman Abstract Objective Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting. Study design Retrospective case series. Setting Tertiary care facility. Patients Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection. Intervention In-office modified myringoplasty technique under local anesthesia without sedation. Main outcome measures Complete perforation closure rate and audiometric outcomes. Results 250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04). Conclusion The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.

Sex-specific enlarged vestibular aqueduct morphology and audiometry Publication date: Available online 29 March 2019 Source: American Journal of Otolaryngology Author(s): Jeremy Ruthberg, Mustafa S. Ascha, Armine Kocharyan, Amit Gupta, Gail S. Murray, Cliff A. Megerian, Todd D. Otteson Abstract Objective Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest. Materials and methods A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds. Results Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB). Conclusions Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.

Cricoarytenoid joint abscess associated with rheumatoid arthritis Publication date: Available online 28 March 2019 Source: American Journal of Otolaryngology Author(s): Megan J. Foggia, Henry T. Hoffman Abstract Cricoarytenoid joint arthritis is an uncommon manifestation of rheumatoid arthritis. We encountered a 68-year-old woman with rheumatoid arthritis who presented with odynophagia, dysphagia, and progressive shortness of breath. Examination findings showed diminished mobility of the left vocal cord and right arytenoid swelling associated with an immobile right vocal cord. Computed tomography (CT) imaging identified a ring-enhancing lesion of the right lateral cricoarytenoid joint. Microdirect laryngoscopy with drainage of the cricoarytenoid abscess and tracheotomy were performed. Development of a laterally based cricoarytenoid joint abscess is identified as a complication of chronic rheumatoid arthritis with successful management described.

Trichology

Applicability of trichoscopy in scalp seborrheic dermatitis Sandra Widaty, Erdina HD Pusponegoro, Githa Rahmayunita, Rinadewi Astriningrum, Meidisa Akhmad Adinda, Caroline Oktarina, Eliza Miranda, Triana Agustin International Journal of Trichology 2019 11(2):43-48 Introduction: Seborrheic dermatitis (SD) is a chronic-recidive inflammatory skin disorder with predilection in areas rich of sebaceous gland. The most common clinical manifestations are pruritus and scales. Although SD can be diagnosed without special tools, other examinations may be needed to determine additional specific therapy. Trichoscopy is one of the noninvasive tools which can help to diagnose SD as it can provide the microstructure view of the scalp. Materials and Methods: This descriptive study was conducted to explore the trichoscopic features of SD and its characteristics. There were 96 SD patients enrolled in this study. The scalp was divided into four areas, and each area was scored based on Seborrheic Area Severity Index, comprising erythema, desquamation, number of papules, and percentage of lesion area. The most severe area was examined with a trichoscopy to observe the characteristics of hair and scalp. The association between trichoscopic findings and SD severity was analyzed with Fisher's exact test. Results: Overall, the participants were 36% males and 64% females with the mean age of 30 (13–70) years old. Based on the trichoscopic examination, the most common findings were thick hair shafts (72%), white scales (69%), arborizing thin vessels (38%), yellowish area (36%), and structureless red area (19%). These findings were not significantly different between mild and moderate SD (P > 0.05). Conclusion: Considering the merits and demerits of trichoscopic examination, it can be helpful to aid the diagnosis of SD. Further studies in Asian population with greater sample size are needed to demonstrate more significant result.

Serum Vitamin D levels and Alopecia areata- A hospital based case-control study from North-India Fozia Rehman, Naina Dogra, Mashkoor A Wani International Journal of Trichology 2019 11(2):49-57 Background: Alopecia areata (AA) is an autoimmune disease which is characterized by hair loss and affects any hair-bearing area. Low levels of Vitamin D have been implicated in a variety of autoimmune diseases. This study was conducted to assess the levels of Vitamin D in patients with AA and its correlation with severity, pattern, and extent of the disease. Materials and Methods: This hospital-based study included 135 cases with AA and 135 age- and sex-matched controls. AA cases were grouped according to the severity, pattern, and extent of the disease. The levels of Vitamin D were assessed and compared between cases and controls and among different groups of cases. The data were analyzed, and the correlation was derived. Results: The more number of patients from the case group had deficient and insufficient levels of Vitamin D as compared to controls, the difference being statistically significant (P = 0.01). A highly significant difference was found in mean Vitamin D levels between cases and controls (P = 0.0004). A negative correlation was found between Vitamin D levels and severity of AA as accessed by SALT score. A negative correlation was also found between Vitamin D levels with pattern and extent of the disease. Conclusion: Vitamin D deficiency may be one of the factors having a role either in etiopathogenesis or exacerbation of AA. Supplementation of Vitamin D as a treatment modality may improve the clinical outcome of AA.

Comparative study between mesotherapy and topical 5% minoxidil by dermoscopic evaluation for androgenic alopecia in male: A randomized controlled trial Prachi Chetankumar Gajjar, Hita Hemant Mehta, Manish Barvaliya, Bhavesh Sonagra International Journal of Trichology 2019 11(2):58-67 Aim: This study aims to compare efficacy and safety between mesotherapy (intralesional injection) and 5% topical minoxidil solution in male androgenic alopecia (AGA) by dermoscopic evaluation. Methodology: In a randomized active controlled trial, we enrolled 49 clinically diagnosed males of AGA and randomly allotted them into two groups – mesotherapy (A) (25) and minoxidil (B) (24). Males in Group A were given total 8 sessions of intralesional mesosolution with microneedling procedure while Group B males were prescribed topical solution of minoxidil 5% twice daily for 4 months. Results were evaluated at baseline and then monthly for 4 months with clinical photographs, dermoscopy, trichoscan, 7-point standard assessment tool, and patient-self assessment scores. Results: Grade II was the most common presentation in our study. All dermoscopic parameters such as variation of hair shaft diameter, follicular units with single and multiple hairs, yellow dots, and perifollicular halo did not show any significant difference between the groups at all time points except at 1st month where the difference in variation of hair shaft diameter between the two group was 0.04. We observed a significant increase (P = 0.01) in the variation of hair shaft diameter between pre- and post-treatment in mesotherapy group compared to minoxidil group. The rest of parameters failed to show any significant difference within the group in mesotherapy and minoxidil. Conclusion: In our study, we observed a significant increase in the variation of hair shaft diameter between pre- and post-treatment in Group A compared to B. Other dermoscopic, trichoscan, and subjective measurement tool failed to show significant difference between two groups. Our observation suggests that there is no significant improvement of mesotherapy in male AGA over minoxidil.

A study to compare the efficacy of platelet-rich plasma and minoxidil therapy for the treatment of androgenetic alopecia Kuldeep Verma, Gita Ram Tegta, Ghanshyam Verma, Mudita Gupta, Ajeet Negi, Reena Sharma International Journal of Trichology 2019 11(2):68-79 Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in men with limited treatment options. Platelet-rich plasma (PRP) therapy is one of the newer treatment options in the management of AGA which has shown promising results. Aims and Objectives: This study was aimed at comparing the clinical efficacy of PRP therapy with minoxidil therapy. Materials and Methods: In the study, patients were randomized into two groups – Group A (given PRP therapy) and Group B (given minoxidil therapy). Both groups were followed up over a period of 6 months, and final analysis was done with the help of global photography, hair pull test, standardized hair growth questionnaire, patient satisfaction score; in addition, a comparison of platelet counts in PRP was done, to know that if a clinical correlation exists between platelet concentration and clinical improvement. A total of 40 patients clinically diagnosed with AGA were enrolled in the study with 20 patients in each group. Four patients from Group A (PRP) and six patients from Group B (minoxidil) could not complete the treatment for 6 months and were eventually excluded. Results: At the end of 6 months, 30 patients were evaluated to compare the efficacy of intradermal PRP and topical minoxidil therapy. On global photography, Group A (PRP) was found to have a comparatively better outcome than Group B (minoxidil). In hair pull test, hair growth questionnaire, and patient satisfaction score, Group A was found to be better than Group B. Mean platelet count at baseline was 3.07 ± 0.5 lac/mm, 3 while platelet count in final PRP prepared was 12.4 ± 1.7 lac/mm, and patients with a higher platelet count in PRP had a much better clinical improvement compared to patients with a low platelet count in PRP. Side effects with PRP therapy were minimal with better results which may improve the compliance of the patient. Conclusion: PRP therapy can be a valuable alternative to topical minoxidil therapy in the treatment of AGA.

Drug-associated plica polonica: An unusual presentation Sumir Kumar, Balvinder Kaur Brar, Priya Kapoor International Journal of Trichology 2019 11(2):80-81 Plica polonica is an uncommon condition characterized by irreversible matting of hair on the scalp. It is usually associated with psychiatric disturbance, neglect of hair, scalp infestation, and use of ionic surfactants for shampooing. Rarely, plica polonica has been associated with drugs. We report this condition in a patient of metastatic carcinoma breast on docetaxel chemotherapy.

A rare case of white piedra caused by Candida parapsilosis in the Sub-Himalayan Region of North India Reena Kumari Sharma, Ghanshyam K Verma, Santwana Verma, Saru Thakur, Anumeha Gupta International Journal of Trichology 2019 11(2):82-85 White piedra is a superficial fungal infection of the hair shaft, caused by Trichosporon, a noncandidal yeast characterized by the presence of numerous, discrete, asymptomatic nodules attached to the infected hair shafts. White piedra is considered a disease of tropical regions and occasionally reported from temperate countries. Although Candida parapsilosis such as Candida albicans is well known to cause cutaneous infections, it has been reported as a co-isolate for white piedra along with Trichosporon. We report a case of white piedra from a temperate region caused by C. parapsilosis.

Trichoscopy of scalp metastases Giulia Maria Ravaioli, Michela Starace, Aurora Maria Alessandrini, Federica Guicciardi, Farah Moustafa, Nicolò Brandi, Bianca Maria Piraccini International Journal of Trichology 2019 11(2):86-87 A 69-year-old woman with invasive ductal breast cancer (BC) presented multiple asymptomatic alopecic areas of the scalp. Trichoscopy revealed peripheral black dots (BDs) and an atypical vascular pattern. Histopathology confirmed the diagnosis of BC metastases. Cutaneous and scalp metastases are a possible sign of advanced and widespread BC, and the diagnosis may be challenging. The trichoscopy of scalp metastases has never been described. BDs and an atypical vascular pattern in our case were a diagnostic clue.

Pili migrans T Pari International Journal of Trichology 2019 11(2):88-89

Loose anagen syndrome: A little response to minoxidil Ilyass Anouar, Naoufal Hjira, Mohammed Boui International Journal of Trichology 2019 11(2):89-91

Does straight-hair nevus exist? Juan Ferrando, Roxana Castañeda, Antonio Guilabert International Journal of Trichology 2019 11(2):92-93

Craniovertebral Junction and Spine

Is central atlantoaxial instability the nodal point of pathogenesis of "idiopathic" dorsal spinal kyphoscoliosis? Atul Goel Journal of Craniovertebral Junction and Spine 2019 10(1):1-2

Treatment algorithm for spontaneous spinal infections: A review of the literature Fabrizio Gregori, Giovanni Grasso, Giancarlo Iaiani, Nicola Marotta, Fabio Torregrossa, Alessandro Landi Journal of Craniovertebral Junction and Spine 2019 10(1):3-9 Background: Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. The aim of this review article was to identify the importance of a methodological attitude toward accurate and prompt diagnosis using an algorithm to aid on spinal infection management. Methods: A search was done on spinal infection in some databases including PubMed, ISI Web of Knowledge, Google Scholar, Ebsco, Embasco, and Scopus. Results: Literature reveals that on the basis of a clinical suspicion, the diagnosis can be formulated with a rational use of physical, radiological, and microbiological examinations. Microbiological culture samples can be obtained by a percutaneous computed tomography-guided procedure or by an open surgical biopsy. When possible, the samples should be harvested before antibiotic treatment is started. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and failure of conservative treatment. Conclusion: A multidisciplinary approach involving both a spinal surgeon and an infectious disease specialist is necessary to better define the treatment strategy. Based on literature findings, a treatment algorithm for the diagnosis and management of primary spinal infections is proposed.

Diffusion tensor imaging as an additional postoperative prognostic predictor factor in cervical myelopathy patients: An observational study Sunil Bhosale, Pramod Ingale, Sudhir Srivastava, Nandan Marathe, Prajakta Bhide Journal of Craniovertebral Junction and Spine 2019 10(1):10-13 Introduction: Multiple investigation modalities have been invented for diagnosis and for planning management of degenerative cervical myelopathy, which include magnetic resonance imaging (MRI), computed tomography scan, and plain X-rays. Diffusion tensor imaging (DTI) of the spinal cord is a special variety of MRI where diffusion of water molecules across and along the tracts is mapped. The changes in anisotropy at the stenotic level can be a postoperative prognostic factor. The aim of this study was to establish postoperative prognostic predictive value of DTI in cases of degenerative cervical myelopathy. Materials and Methods: The study included 30 indoor patients in a tertiary care hospital diagnosed with degenerative compressive cervical myelopathy based on both clinical and radiological parameters with complete clinical data including follow-up. All patients with medical neurological diseases, cases who underwent repeat surgery, cases who developed surgical site infection, and those patients who were lost to follow-up were excluded from the study. The patients underwent operative decompression through either anterior or posterior approach with or without fixation with titanium implants as per indication. All patients underwent pre- and postoperative DTI. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were noted in both pre- and postoperative imaging. Epidemiological data such as age and sex were noted. Pre- and postoperative modified Japanese Orthopedic Association (mJOA) scores were calculated. Results: There was a significant improvement in FA values postoperatively. Preoperatively, both FA and ADC values showed a significant correlation with preoperative Neurological status of the patient while postoperatively only FA values were found to be significantly correlated. The regression equations for determining postoperative mJOA score based on preoperative FA and ADC values revealed mJOA = 9.77 + 12.1 (FA), mJOA = 14.2 + 2408.4 (ADC), and mJOA = 9.54 + 11.2 (FA) +1575.5 (ADC). This means that postoperative mJOA score, i.e., postoperative clinical status improvement can be determined using DTI variables which are an objective preoperative data. However, relative strength of prediction for FA value is 66.7% and for ADC value is 28.7%. Conclusion: DTI tractography of the spinal cord will be a helpful objective prognostic factor for patients in whom surgery is planned. However, a study with larger subject size is required to increase the accuracy of determination of regression coefficient.

Effectiveness of titanium plate usage in laminoplasty Arya Nick Shamie, Hamed Yazdanshenas Journal of Craniovertebral Junction and Spine 2019 10(1):14-18 Background: Laminoplasty is an established technique for the treatment of cervical stenosis. However, the usage of plates to maintain patency of the laminoplasty door has not been well reported. This study plans to compare the clinical outcomes of laminoplasty with the usage of Sofamor-Danek laminoplasty plates versus techniques without plate usage. Materials and Methods: This study conducted a 2-year medical record review of all patients with multilevel cervical myelopathy who were treated with laminoplasty at UCLA or Cedars-Sinai medical center. Of 46 patients 18 had sufficient documentation to assess clinical outcome, 11 of which had placement of laminoplasty plates. Clinical outcomes were assessed using Odom's scoring criteria. Results: Blood loss and hospital stay are decreased with plate usage during laminoplasty. Average Estimated Blood Loss (EBL) was 160 cc with plate and 380 cc without. Hospital stay was 4.8 days with plate and 5.6 days without. There were no complications during any of the laminoplasty procedures regardless of instrumentation. All patients demonstrated improvement in symptoms after laminoplasty, with 73% of patients in the plate cohort having Odom Scores of “Excellent” versus 44% in the nonplate group. All patients, regardless of technique, showed improvement in symptoms. Conclusions: Laminoplasty with plate utilization is an effective treatment for cervical myelopathy. The similarity in outcomes and complications between these two similar cohorts suggests plate usage in laminoplasty is an attractive alternative to other methods. We hope that future efforts will continue to demonstrate the effectiveness and perhaps superiority of plate utilization in laminoplasty.

Is cervical instability the cause of lumbar canal stenosis? Atul Goel, Ravikiran Vutha, Abhidha Shah, Survendra Rai, Abhinandan Patil Journal of Craniovertebral Junction and Spine 2019 10(1):19-23 Aim: On the basis of an experience with 12 cases, the validity and rationale of cervical spinal stabilization for cases having both cervical and lumbar spinal canal stenosis is analyzed. Materials and Methods: From March 2017 to May 2018, 12 patients presented with a major symptom of neurogenic claudication pain generally related to lumbar canal stenosis in addition to other symptoms related to cervical myelopathy. The average age was 57 years. All patients were clinically and radiologically diagnosed to have both cervical and lumbar spinal canal stenosis. Based on the concept that degenerative spinal spondylotic myelopathy is an outcome of spinal instability, all patients underwent cervical spinal stabilization. No decompression by bone resection was done. The lumbar spine was not surgically treated. Visual analog scale, the Japanese Orthopaedic Association, and Oswestry Disability Index were used to monitor patients before and after surgery. Results: There was dramatic relief from symptoms related both to cervical and to lumbar canal stenosis in the postoperative period. During the average period of follow-up of 12 months, none of the patients have experienced recurrence of lumbar pain or needed any surgery. Conclusion: The report highlights the possibility of recovery in lumbar canal stenosis related symptoms following cervical spinal stabilization surgery for associated cervical spinal stenosis. We conclude that in select cases, cervical spinal instability may be the cause of clinical and radiological observations in cases having lumbar canal stenosis.

Effect of posterior fusion surgery on idiopathic scoliosis in Iran Masih Falahatian, Mohammad Farid Masaeli Journal of Craniovertebral Junction and Spine 2019 10(1):24-27 Background: Scoliosis is a sideways curve in the spine. Considering that postoperative complications are common among these patients, the aim of this study is to examine the postoperative complications of posterior fusion surgery with instrumentation among adult patients with idiopathic scoliosis. Methods: In this cross-sectional descriptive study, the postoperative complications were examined among 93 patients with idiopathic scoliosis who underwent posterior fusion surgery with instrumentation. The convenience sampling was used by referring to the files of these patients. The patients were classified into four groups according to the type of scoliosis deformity (long C-shaped, thoracic, thoracolumbar/lumbar, and double-curve) and the complications were compared together. Results: Postoperative respiratory problems were significantly different between the four groups of scoliosis deformity (P = 0.009); 35 cases of postoperative complications occurred and 20 of them were related to postoperative pulmonary complications. Conclusion: Postoperative complications are common among patients with idiopathic scoliosis who underwent posterior fusion surgery with instrumentation; in addition, pulmonary complications are the most common postoperative complication among these patients.

Clinical presentation and outcome after anterior cervical discectomy and fusion for degenerative cervical disc disease Ninad N Srikhande, V A. Kiran Kumar, NA Sai Kiran, Amrita Ghosh, Ranabir Pal, Luis Rafael Moscote-Salazar, V Anil Kumar, Vishnu Vardhan Reddy, Amit Agrawal Journal of Craniovertebral Junction and Spine 2019 10(1):28-32 Background: Anterior cervical discectomy and fusion (ACDF) is a well-described surgical approach for symptomatic degenerative cervical disc disease which does not respond to conservative management. In the present study, we assessed clinical presentation and outcomes of ACDF. Materials and Methods: The present study was conducted from October 1, 2015, to October 31, 2017, in the Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, among 100 consecutive adult patients who underwent single- or two-level ACDF for degenerative cervical disc disease. Results: The mean age was 47.2 ± 12.8 years (range: 20–74 years). Majority of the patients were male (86/100). Presenting symptoms were neck pain (77%), limb weakness (73%), paresthesias (53%), radicular pain (49%), stiffness in limbs (16%), and bladder involvement (13%). Fusion was done with stand-alone titanium cage/bone graft or titanium cage/bone graft with anterior cervical plate. At the time of discharge, significant improvement in preoperative symptoms (neck pain [47/77-61%], radicular pain [31/49-63%], limb weakness [53/73-72.6%], paresthesias [44/53-83%], stiffness in limbs [13/16-81%], and bladder symptoms [8/13-61%]) was reported by majority of these patients. Majority of these patients also reported improvement in preoperative sensory deficits at the time of discharge. Postoperative complications were hoarseness of voice (22%), dysphagia (16%), deterioration of motor power (8%), and postoperative hematoma (7%). Conclusions: A significant proportion of patients with degenerative cervical disc disease show remarkable recovery after ACDF.

Lumbar rocking test: A new clinical test for predicting lumbar instability Ashok Keshav Rathod, Bipul Kumar Garg, Varun Mukesh Sahetia Journal of Craniovertebral Junction and Spine 2019 10(1):33-38 Purpose: Significant number of low back pain is caused by spinal instability. Clinical and radiological tests are used to diagnose lumbar instability, but the practical utility of clinical tests has not been studied extensively. Hence, it was decided to study lumbar rocking test and passive lumbar extension (PLE) clinical tests to identify their accuracy for lumbar instability, in comparison to the radiological assessment. Materials and Methods: This cross-sectional prospective study was conducted in 2017 at an Indian tertiary care center, after Ethics Committee approval. No financial transection involved anywhere at any stage of the study. Patients of 30–65 years having low back pain were included following informed consent. Clinical tests conducted were rocking test and PLE tests. All patients were subjected to a neutral anteroposterior, lateral and flexion-extension X-rays of lumbosacral spine. The association between clinical tests and lumbar instability was represented by Chi-square analysis. The rest of the findings were represented as descriptive statistics. Results: Fifty patients enrolled in the study, of which 28 (56%) were females. On X-rays, the maximum angular rotation and sagittal translation were seen at L5–S1 level. 35 (70%) and 46 (92%) patients showed positive PLE and rocking test, respectively. Significant association (P < 0.05) was seen between rocking test and lumbar instability. The sensitivity of rocking test was 95.56% and positive predictive value as 93.47%. Conclusion: Clinical tests can be used effectively for the diagnosis of lumbar spine instability. Rocking test was found to be accurate and sensitive for detecting subtle lumbar instability.

Proposal of a new anatomical landmark to identify the disc space in endoscopic lumbar discectomy Keyvan Mostofi, Morad Peyravi, Babak Gharaei Moghaddam, Reza Karimi Khouzani Journal of Craniovertebral Junction and Spine 2019 10(1):39-41 Introduction: In endoscopic lumbar discectomy for posterolateral disc herniation, we determined some anatomical landmarks for improved disc space access. These landmarks are based on the beginning of the insertion of the ligamentum flavum (LF) to vertebral lamina. Materials and Methods: In 978 patients operated by posterolateral disc herniation, we measured prospectively the distance between the beginning of the insertion of the LF and space disc rostrally. Results: The distance between the beginning of the insertion of the LF and space disc was broader at the level of L3–L4, with an average of 14 mm. At L4–L5, the average distance was 13.5. At L5–S1, the average distance was 12 mm. Conclusion: Knowing the accurate distance between the insertion of LF and disc space contributes to reducing the average duration of the surgical procedure to avoid empirical search of disc space by a surgeon and avoiding unnecessary and excessive LF and bone removal.

Superficial anterior atlanto-occipital ligament: Anatomy of a forgotten structure with relevance to craniocervical stability Shogo Kikuta, Joe Iwanaga, Koichi Watanabe, R Shane Tubbs Journal of Craniovertebral Junction and Spine 2019 10(1):42-45 Introduction: The superficial anterior atlanto-occipital ligament (SAAOL) is a narrowband located anterior to the anterior atlanto-occipital membrane. Nearly forgotten, it has not been well described in older anatomical textbooks and is missing in the current anatomical literature. As all of the binding structures of the craniocervical junction (CCJ) are important in maintaining stability, this study aims to clarify the anatomy and potential function of the SAAOL. Materials and Methods: The CCJ from ten fresh-frozen cadavers was studied. These specimens were derived from three males and seven females, and the age at death ranged from 57 to 91 years (mean, 79.8 years). The length, width, and thickness of the SAAOL were measured. In five specimens, the force to failure was recorded. Results: The SAAOL was found between the anterior tubercle of the atlas and the occiput and located as central thick fibers in front of the anterior atlanto-occipital membrane in 9 (90%) specimens. In one specimen, the vertical band to the occipital bone did not attach to the anterior tubercle of the atlas, but extended to the anterior aspect of the axis. The mean length, width, and thickness of the SAAOL were 19.8, 6.2, and 0.6 mm, respectively. The force to failure for the ligament was 38.8 N. Conclusion: The SAAOL was a constant structure of the anterior atlanto-occipital joint. This ligament seems to be a secondary stabilizer of the CCJ by limiting the extension of CCJ. Knowledge of this ligament may help in further understanding of craniocervical stability.

Neurology

Cross-cultural differences in dementia: Indian etiquette of honorifics Apoorva Pauranik Annals of Indian Academy of Neurology 2019 22(2):129-130

Can we treat secondary progressive multiple sclerosis now? Rohit Bhatia, Nishita Singh Annals of Indian Academy of Neurology 2019 22(2):131-136 Secondary progressive multiple sclerosis (SPMS) is characterized by progressive accumulation of disability without intermittent recovery. Treatment of these patients is challenging due to limited understanding of pathogenesis and fewer therapeutic options. This article summarizes difficulties in defining and conducting trials in SPMS, review major clinical trials on therapies approved and unapproved in SPMS and lastly, therapies in pipeline for use in SPMS.

Expert group meeting on aphasia: A report Apoorva Pauranik, Annamma George, Aparna Sahu, Ashima Nehra, Avanthi Paplikar, Chitralekha Bhat, Gopee Krishnan, Harsimar Kaur, Jitendra Saini, PA Suresh, Pawan Ojha, Pinky Singh, Pratap Sancheti, Prathibha Karanth, PS Mathuranath, Satyapal Goswami, Sonal Chitnis, N Sundar, Suvarna Alladi, Yasmeen Faroqi-Shah Annals of Indian Academy of Neurology 2019 22(2):137-146 A multidisciplinary team of experts took stock of the current state of affairs about many aspects of aphasia in India, including community burden, diagnostic assessment, therapy, rehabilitation, research, education, and advocacy. The broad spectrum of aphasiology was matched by the types of participants ranging from neurologists, speech-language pathologists, clinical psychologists, linguists, to experts in neuroimaging and computer sciences. Threadbare discussion in 16 sessions over 3 days leads to the identification of pressing problems and possible solutions. Many action plans have been envisaged and recommendations made. A few examples with high priority are community-based and hospital-based study incidence and prevalence of aphasia, development of test batteries for the assessment of many components of speech and communication in Indian languages which are validated on rigorous psychometric, and linguistic criteria, national registry for aphasia, educational modules about aphasia for different target groups, resources for advocacy and its training, a bank of research questions and outlines of research protocols for young professionals to pursue. The expert group will continue to oversee execution of some of the actionable plans in short and long term.

Aspirin and clopidogrel resistance in Indian patients with ischemic stroke and its associations with gene polymorphisms: A pilot study Samir Patel, Vandana Arya, Amrita Saraf, Manorama Bhargava, CS Agrawal Annals of Indian Academy of Neurology 2019 22(2):147-152 Introduction: Antiplatelet resistance is one of the urgent issues in current stroke care. One-third to one-half of the patients who experience a recurrent stroke is already on antiplatelet medications. We studied resistance to aspirin and clopidogrel in Indian stroke patients and its association with gene polymorphisms. Methods: Platelet function testing by light transmission aggregometry was performed on 65 patients with ischemic stroke who were stable on dual antiplatelet therapy (clopidogrel 75 mg OD and aspirin 75 mg OD) along with 65 age-matched controls. Aspirin resistance was considered as mean platelet aggregation ≥70% with 10 μM adenosine diphosphate (ADP) and ≥20% with 0.75 mM arachidonic acid. Clopidogrel resistance was defined as <10% decrease from the baseline in platelet aggregation in response to ADP 10 μM and semi-response as <30% decrease from the baseline. Polymorphisms CYP2C19 * 2 and GPIIb/IIIa (PLA1/A2) were genotyped by polymerase chain reaction-restriction fragment length polymorphism. Results: We found 64.6% (42/65) patients with inadequate response to clopidogrel (15.4% [10/65] resistant and 49.2% [32/65] semi-responders) and 4.6% (3/65) patients with inadequate response to aspirin (3.1% [2/65] resistant and 1.5% [1/65] semi-responder). The frequency of CYP2C19*2 mutant genotype was significantly higher in clopidogrel nonresponders compared to responders (P = 0.014). Clopidogrel nonresponsiveness was much higher in small vessel stroke. Conclusion: Unlike aspirin, a high proportion of nonresponders to clopidogrel was identified. In an interim analysis on 65 Indian patients, a significant association was found between CYP2C19*2 and clopidogrel nonresponsiveness.

Scrub typhus-associated opsoclonus: Clinical course and longitudinal outcomes in an Indian cohort Ravikar Ralph, AT Prabhakar, Sowmya Sathyendra, Ronald Carey, John Jude, George M Varghese Annals of Indian Academy of Neurology 2019 22(2):153-158 Context: Opsoclonus, a rare neurological manifestation in scrub typhus, causes significant distress and disability. There is a paucity of clinical data and outcomes in these patients. Aim: This study aims to describe the clinical and laboratory profile and longitudinal outcomes in a scrub typhus patient cohort with opsoclonus. Settings and Design: This retrospective study was conducted in a 2700-bed teaching hospital in South India, in scrub typhus patients with opsoclonus over a 5-year period. Patients and Methods: Clinical, laboratory, and radiological data and outcomes at discharge and 6- and 12-weeks postdischarge were documented. Results: Of 1650 scrub typhus patients, 18 had opsoclonus. 17 had opsoclonus at presentation, while one patient developed opsoclonus on the 5th admission day, 1-day postdefervescence. Opsoclonus was first noted after a median interval of 11 (7–18) days from fever onset. It was associated with myoclonus in 94% (17/18), cerebellar dysfunction in 67% (12/18), extrapyramidal syndrome (EPS) in 33% (6/18), and aseptic meningitis in 17% (3/18) patients. Mean cerebrospinal fluid (CSF) white blood cell (WBC) count was 9 ± 2.7 cells/cumm, with mean CSF protein 118.5 ± 53.9 mg% and mean CSF glucose 97 ± 13 mg% in 1l/15 patients. Brain magnetic resonance imaging was unremarkable in 75% (9/12). Case-fatality rate was 5.5% (1/18). Complete resolution of the index neurological syndrome occurred at 12-week postdischarge. Conclusions: Opsoclonus is a rare neurological manifestation in scrub typhus, usually occurring in association with myoclonus, cerebellar dysfunction, or EPS. It appears to occur during the resolving febrile phase, with neurological deficits completely resolving at 12 weeks.

Study of wrist ratio and wrist-to-palm index radio in individuals suffering from carpal tunnel syndrome Suchitra Sachin Palve, Sachin Bhaskar Palve Annals of Indian Academy of Neurology 2019 22(2):159-163 Background: Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy, with preponderance in females. Aims and Objective: The aim of the present study was to find out wrist ratio (WR) and wrist/palm ratio (WPR) in clinically diagnosed patients of CTS. Methodology: One hundred individuals (fifty patients of CTS and fifty as control group) aged between 30 and 50 years were recruited for the study. Early confirmation of clinically suspected patients of CTS was done by performing electrodiagnostic tests of median and ulnar nerves. Motor and sensory conduction velocities, distal motor and sensory latencies, and F-wave latencies were performed in the recruited volunteers. Results: The values for mean wrist ratio in control groups were 0.694, 0.703 respectively, and in patients with carpal tunnel syndrome, it was 0.704 and 0.719 respectively in moderate and severe type. The mean wrist to palm ratio (WPR) in control group was 0.371, while in patients with CTS, it was 0.374, 0.382, 0.387, and 0.401 based on progression of severity. Both were statistically significant for the last two groups (wrist to index finger [WIF] >4.4 m/s, moderate, and WIF nonrecordable, severe). Statistically significant (P < 0.001) decrease of motor conduction velocities for median nerve was seen in the CTS group as compared to control group. Statistically significant (P < 0.001) increase in distal motor and sensory latencies was observed for both median and ulnar nerves in CTS group with more increase in distal motor latency than sensory latency. Increase in F-wave latencies of both nerves was seen in CTS group. Conclusion: The study results confirm selective slowing of sensory and motor conduction within wrist-to-palm segment in patients of CTS. Both WR and WPR have a progressive correlation with the severity of CTS, but statistically significant changes were seen in the groups with moderate and severe CTS. Thus, WR/WPR can act as one of the essential parameters in the diagnosis of CTS with moderate-to-severe CTS.

A study of assessment of knowledge of childhood autism among medical students in Mumbai Samia D Ellias, Henal R Shah Annals of Indian Academy of Neurology 2019 22(2):164-169 Aims: This study is to study the knowledge and awareness on autism among medical students and the factors which impact their knowledge on autism. Settings and Design: For the study, a multicenter cross-sectional research has been carried out among medical students in seven medical colleges in Mumbai. Subjects and Methods: A total of 201 final-year medical students from seven medical colleges in Mumbai completed the knowledge on childhood autism among healthcare workers (KCAHW) survey and a semi-structured pro forma. Of the 201 students, 152 are from the public medical colleges and 37 from the private medical colleges. Statistical Analysis Used: Data collected have been represented in the form of frequency and percentage. SPSS 20.0 is used to analyze the mean distribution of KCAHW scores. A value of P < 0.05 is regarded as statistically significant. Results: The total mean score in the KCAHW questionnaire is 11.85 ± 3.15 out of 19. This is considered as poor knowledge. Our study reveals that students' knowledge on autism is limited. Knowledge gaps identified in certain autism spectrum disorder (ASD) symptoms are associated with the obsessive and compulsive repetitive pattern of behavior and that autism is associated with epilepsies. Conclusions: It is thus important that these children displaying ASD symptoms are diagnosed correctly and at the earliest. To enable this, doctors in all fields must be able to accurately identify the diagnostic features of autism both within and outside the four walls of the hospital.

Storage, degradation, and new connectivity of face-related semantic memory in Alzheimer's disease Sandip Pal, Prasenjit Sengupta, Malay Ghosal, Asutosh Pal, Rudraprasad Acharya, Debsadhan Biswas Annals of Indian Academy of Neurology 2019 22(2):170-174 Background: Excepting amnesia, impairment of other domains also hampers the activity of daily living in Alzheimer's disease (AD). Although prosopagnosia poses problem in interacting with other persons, it rarely causes problem during interaction with close relatives as known voice acts as cue for recognition. Objective: In a cohort of AD, we planned to study errors in recognition, naming, and assigning relationship of close relatives, to assess the type and frequency of errors and to explain with current knowledge and hypothesis. Materials and Methods: This cross-sectional study was conducted in Memory Clinic of Medical College Hospital, Kolkata, India, between July 2013 and June 2015. Patients were evaluated by history, general neurological examination, and neuropsychological tests. A structured questionnaire was used to assess recognition (use of honorifics) and naming defect of close relatives. Results: AD was diagnosed in 42 patients. Prosopagnosia was found in 14 and anomia in 6 patients. Four patients exhibited problem during conversation with close relatives. They assigned name and relation of one generation earlier to close relatives with proper recognitions. Discussion: We got predictive error of name and relation assignment of close relatives by one generation back with normal recognition. It can be explained by two memory traces in connection of face-visual and name (with/without relation) representation, earlier being hierarchically older and more resistant to wearing. Conclusions: We hypothesize that the name/relation store is orderly conserved. In AD, after degradation of part of name/relation store, a new wiring might be built up between these two traces.

Terminal latency index, residual latency, and median-ulnar F-wave latency difference in carpal tunnel syndrome Aslihan Uzunkulaoglu, Sevgi Ikbali Afsar, Betul Tepeli Annals of Indian Academy of Neurology 2019 22(2):175-179 Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but no electrodiagnostic test alone shows sufficient sensitivity for CTS. We aimed to investigate the value of median motor terminal latency index (mTLI), median motor residual latency (mRL), and median-ulnar F-wave latency difference (FdifMU) as additional tests to nerve conduction studies which are performed traditionally in electromyography laboratories. Methods: This is a retrospective study. The results of electrodiagnostic studies performed on patients with CTS were examined. We divided the enrolled hands of the patients diagnosed with CTS into two groups: affected hands with abnormal electroneuromyographic parameters indicating CTS diagnosis (CTS group) and hands with normal electroneuromyographic parameters (control group). Then, we analyzed the results of these completed electrodiagnostic studies. Results: A total of 320 hands of 160 patients were studied. FdifMU and mRL were found to be significantly higher in CTS group compared with the control group (P < 0.001). mTLIs were found to be significantly higher in control group compared with the CTS group (P < 0.001). Given that, the area under the curve is more than 70% for mTLI and mRL, but not for FdifMU. Conclusion: When combined with mMDL, both mTLI and mRL have excellent specificity for the diagnosis of mild and moderate CTS. However, the sensitivities for both parameters were lower. In suspected patients, FdifMU can be an additional tool for the diagnosis of CTS also, but alone it is not valuable.

Vasculitic neuropathy: A retrospective analysis of nerve biopsies and clinical features from a single tertiary care center Monalisa Hui, AK Meena, Liza Rajasekhar, Yareeda Sireesha, Jabeen Afshan, Rukmini Mridula, Rupam Borgohain, Megha S Uppin Annals of Indian Academy of Neurology 2019 22(2):180-186 Objective: Vasculitic neuropathy can be either restricted to the peripheral nerves or associated with systemic involvement of other organs. The objective of this study was to analyze the nerve biopsies reported as “vasculitic neuropathy” with clinical features. Materials and Methods: All cases diagnosed with vasculitic neuropathy were retrospectively analyzed and categorized as systemic vasculitis and nonsystemic vasculitic neuropathy based on the clinical features. The histological features were further evaluated and classified according to the Peripheral Nerve Society Guidelines. Results: Of the 126 cases, there were 65 nonsystemic vasculitis, 45 secondary systemic vasculitis, and 16 primary systemic vasculitis. Definite vasculitis was more common in the systemic vasculitis group. The epineurial vessels were predominantly involved with chronic axonal changes. Conclusion: The sensitivity of definite vasculitis on nerve biopsy was 54.76%. The sensitivity increases when the diagnostic criteria of definite and probable vasculitis were applied taking into account perivascular inflammation accompanied by vascular changes and axonopathy.

Dental Research

Role of dentist in genetic counseling: A critical appraisal of the current practices and future requirements in Indian scenario Ruchika Gupta, BR Chandra Shekar, Pankaj Goel, Sudheer Hongal, Rahul Ganavadiya Dental Research Journal 2019 16(3):131-138 Genetic disorders are showing an upward trend. The social and economic impact of genetic disorders on individual, family and society is enormous. There is an urgent need to explore alternate strategies to mitigate the burden of genetic disorders. This is especially true with regard to developing countries such as India where there is a shortage of health personnel adequately trained in genetic counseling at present. Dental professionals have a unique opportunity to observe the development of preadolescent and adolescent patients during periods when important growth and development changes occur. The objective of this study was to review the existing literature on the role of dentist in genetic counseling with a critical appraisal on the current practices among dentists on genetic services in India, the need, scope, and future requirements. The literature on genetic services and genetic counseling was identified by searching the biomedical databases for primary research material by one investigator over a period of 8 weeks. The articles related to dentist's role in genetic counseling were assessed and discussed in the present review. A total of 239 resource materials were retrieved in the initial search. The literature from these sources was thoroughly scrutinized by the authors, and the literature (review articles, descriptive studies, or any form of study) focusing on role of dentist in genetic counseling was finally considered for critical appraisal in the present review. The role of genetics in health and oral health care has not received due attention of the dental practitioners who otherwise are in a crucial position in identifying the patients with genetic disorders and offer requisite counseling and referral to designated genetic centers. The short training courses for practicing dentists, faculty members, and a small change in dental curriculum to make provision for teaching genetics to undergraduate students may go a long way in filling the void created by these obstacles.

Anxiety, depression, and oral health: A population-based study in Southeast of Iran Tayebeh Malek Mohammadi, Amin Sabouri, Salehe Sabouri, Hamid Najafipour Dental Research Journal 2019 16(3):139-144 Background: Depression and anxiety are two psychosocial illnesses that mostly are comorbid. The prevalence of these diseases is increasing worldwide. Both can affect general health also oral and dental health. The effects can be physiological and behavioral. Patients with these disorders are not willing to keep oral hygiene. The purpose of this study was to investigate the association between depression/anxiety and oral health indices in the 15–75-year-old population of Kerman. Materials and Methods: This cross-sectional study recruited 5900 people aged 15–75 years through one-stage cluster sampling (Kerman coronary artery disease risk factors study, KERCADRS). Data were collected through beck questionnaires for anxiety and depression and clinical examinations. Oral health indices including decayed, missing, filled teeth, gingival index (GI), and community periodontal index (CPI) were also measured. Data were analyzed by SPSS 21 software. Chi-square, t-test and regression analysis were used to determine the relationship between the variables. P ≤0.05 was considered as the level of statistical significance. Results: In the study, 1975 (33.6%) of patients showed moderate-to-severe anxiety and 3502 (59.5%) got the scores as depressed. There was a significant difference between GI and CPI indices of the normal and depressed group (P < 0.01), but the difference in the anxious and normal group was not statistically significant (P > 0.05). Conclusion: The results of the study showed a significant relationship between depression and oral health indices but not with anxiety. Therefore, the present study suggests that more attention should be paid to the oral health of people with a history of depression.

A three-dimensional finite element analysis of the influence of varying implant crest module designs on the stress distribution to the bone Shweta Maruti Patil, Abhijit Suresh Deshpande, Rahul Ramesh Bhalerao, Suryakant Bhanudas Metkari, Prithviraj Maruti Patil Dental Research Journal 2019 16(3):145-152 Background: The aim of this study is the effect of stress distribution within the bone with varying implant crest module designs. Materials and Methods: Finite element models of a straight two-piece 4 mm × 13 mm screw-shaped threaded implant with divergent, straight, and convergent implant crest module with their surrounding suprastructure embedded in mandibular second premolar area were created with ANSYS software. Different implant crest module designs incorporated in D2 types of bone under 100N axial and 100N at 20° oblique load were created to evaluate stress distribution in the crestal bone around implant crest module. Results: Maximum von Mises stress was observed at the crestal region of the bone and at crest module region of the implants in all the models. Divergent crest module design shows minimum von Mises stress at crestal bone during vertical loading within bone and at implant crest module. Straight crest module designs result in minimum stresses during oblique loading than vertical loading. Convergent crest module design shows maximum von Mises stress. Conclusion: Within limitations of the study, it was concluded that stress distribution in adjacent compact bone is greatly influenced by implant crest module design. Divergent crest module designs result in minimum stresses at crestal bone and in the implant crest module region, followed by straight and convergent crest module in ascending order of stress distribution.

The antibacterial activity of "Satureja hortensis" extract and essential oil against oral bacteria Leila Golpasand Hagh, Atefe Arefian, Ahmad Farajzade, Sana Dibazar, Neda Samiea Dental Research Journal 2019 16(3):153-159 Background: Recently, there has been an increasing growth in research on medical plant's effect on dental plaque bacteria. The aim of this study was to determine the antibacterial effects of Satureja hortensis extract and its essential oil (EO) on Streptococcus salivarius, Streptococcus sanguis, and Streptococcus mutans as important bacteria in early supragingival dental plaque formation. Materials and Methods: In this in vitro study, different concentrations of S. hortensis extract and its EO were prepared using double dilution method. The disc diffusion method was used to determine antibacterial activity. Based on these measurements, the minimal inhibitory concentration value was reported for each bacterium. Antibiotics used as positive controls in this study were erythromycin (15 μg) and tetracycline (30 μg). t-test and ANOVA were used for statistical analysis (P < 0.05). Results: Aqueous and methanolic extract did not show significant antibacterial activity, but the EO significantly inhibited the growth of the test bacteria compared to positive control (P < 0.05). High concentrations of EO processed greater antimicrobial effects against three oral bacteria than other low concentrations (P < 0.0001). For S. mutans, the inhibition effect of tetracycline 30 μg was similar with 50% (P = 0.789) and 25% (P = 0.158) dosages of the EO. For S. salivarius, the effect of tetracycline 30 μg was similar to 50% dosages of the EO (P = 0.122). For S. sanguis, the effect of erythromycin 15 μg was lower than 50% (P = 0.0006) and 25% (P = 0.003) dosages of the EO. The inhibition effects of all concentrations of EO were higher for S. sanguis. S. salivarius and S. sanguis are more sensitive than S. mutans to S. hortensis EO. Conclusion: Due to the strong antibacterial effect of S. hortensis EO on the oral bacteria growth, it can be served as herbal mouth rinse, while to confirm this antibacterial effect, further clinical studies are necessary.

The coronal pulp cavity index: A forensic tool for age determination in adults Swati Shrikant Gotmare, Tanmik Shah, Treville Periera, Mandavi S Waghmare, Subraj Shetty, Sushama Sonawane, Maina Gite Dental Research Journal 2019 16(3):160-165 Background: Various biochemical and histological methods are available for human age determination which are invasive and may require extraction of teeth. The present study aims to assess the accuracy of age estimation from tooth-coronal index (TCI) of known age and sex individuals and to present a noninvasive method for age estimation. Materials and Methods: This retrospective study comprised 88 patients, which included 54 males and 34 females. An orthopantomogram of these individuals were taken, and premolars and molars in the same were evaluated. The height of the crown (coronal height [CH]) and the height of the coronal pulp cavity (coronal pulp cavity height [CPCH]) was digitally measured on the computer screen. The TCI given by Ikeda et al. in 1985 (TCI = [CPCH × 100]/CH.) was computed on each tooth and regressed on real age of the sample. The mean, median, range, and standard deviation of the computed index were calculated. The correlation between the actual age and the estimated age was calculated using t-test. P < 0.05 was considered significant. Results: Results revealed that there is a significant correlation between the TCI with age. Increase in TCI observed with age; however, it showed no significant sex difference. Conclusion: TCI is a precise, noninvasive and easily used reliable biomarker for age estimation and is applicable to both living and dead individuals.

In vitro evaluation of dentin tubule occlusion by three bioactive materials: A scanning electron microscopic study Maryam Ghafournia, Maryam Hajnorouzali Tehrani, Afsaneh Nekouei, Reyhaneh Faghihian, Mehrnaz Mohammadpour, Atiyeh Feiz Dental Research Journal 2019 16(3):166-171 Background: Dentin hypersensitivity (DH) is a common problem characterized by a short, sharp pain. Reduction of dentin permeability by occluding dentin tubules is considered as a method for treating DH. Many substances are available to decrease hypersensitivity. The aim of this study is to evaluate the ability of three different remineralizing agents for occluding dentinal tubules in comparison with positive and negative controls. Materials and Methods: In this in vitro scanning electron microscopic (SEM) study, 75 extracted premolars were cut into crown and root fragments with a bur and divided into five groups: group 1: Sodium fluoride 5% varnish was applied (positive control), Group 2: No treatment (negative control), Group 3: Treated with Remin Pro (contains hydroxyapatite and fluoride), Group 4: Treated with MI paste (contains casein phosphopeptide-amorphous calcium phosphate [CPP-ACP]) and Group 5: Treated with GC tooth mousse (contains CPP-ACP). SEM images were obtained and mean tubular diameter was measured in each group. One-way ANOVA and Duncan's tests were used for statistical analysis. A significant level of α = 0.05 was set for comparison between the groups. Results: Statistically significant difference was observed between Group 2 (negative control) and other four groups (P < 0.05). There was no significant difference between Groups 1, 3, 4, and 5 (P > 0.05). Conclusion: Under the limitations of the present in vitro study, it can be concluded that the application of a CPP-ACP paste as well as a paste which contains fluoride is effective on reduction of dentin permeability.

Effectiveness of placement of second miniplates as tension band unit in mandibular parasymphysis fractures Javad Yazdani, MohamadAli Ghavimi, Mahsa Taghizadeh, Yousef Kananizadeh, Milad Ghanizadeh Dental Research Journal 2019 16(3):172-178 Background: The ideal position of the plates and the need for additional plates are discussed continuously. In mandible, the tensile forces at the fracture line should be neutralized with a tension band. This study evaluated the role of the mandibular arch bar as a tension band eliminating the need for an upper miniplate (tension band plate) in cases of parasymphysis fractures. Materials and Methods: In this randomized control trial, a total of 90 patients with mandibular parasymphysis fractures underwent treatment in two groups. Group A was treated with one titanium miniplate along with Erich's arch bar. In Group B, two titanium miniplates were placed across the fracture site along with Erich's arch bar. Then, the complications and duration of the operation time were compared between two groups. The results were considered statistically significant when the P < 0.05. Results: No significant difference was observed between the groups regarding postoperative complication rate. 1 month after surgery in Group A, number of patients with sensory impairment (17%) was significantly lower than Group B (37%) (P = 0.029). Furthermore, the operation time of Group A was significantly shorter than Group B (P < 0.001). Conclusion: In the presence of arch bar, placing one miniplate instead of the routine technique of placing two, do not increase complication rates. Furthermore, it reduces the operation time and costs and results in a better neurosensory recovery outcome in short time.

In vitro effect of XP-Endo finisher on the amount of residual debris and smear layer on the root canal walls Shahrzad Azimian, Hengameh Bakhtiar, Shahram Azimi, Ehsan Esnaashari Dental Research Journal 2019 16(3):179-184 Background: A successful endodontic treatment depends on efficient cleaning and shaping and effective irrigation of root canals. The irrigating solution may not be effective in some areas in the canal. The manufacturer of XP-Endo finisher claims that it can effectively clean the root canals with complex morphology. This study aimed to assess the effect of XP-Endo finisher on the amount of residual debris and smear layer on the root canal walls of mandibular second premolars. Materials and Methods: In this In vitro study Fifty extracted mandibular second premolars with a root curvature <20° were collected. Root canals were prepared using BioRaCe rotary system. The root canals were in contact with the file and different irrigating solutions for 1 min. The teeth were then randomly divided into four experimental (n = 10) and one positive control group as follows: (1) XPF + saline, (2) XPF + ethylenediaminetetraacetic acid (EDTA), (3) XPF + sodium hypochlorite (NaOCl), (4) XPF + EDTA + NaOCl and (control) EDTA + NaOCl. The teeth were longitudinally sectioned into two halves and the amount of debris and smear layer remaining in the coronal, middle, and apical thirds of the roots was quantified and scored under an electron microscope. The Kruskal–Wallis test was used to compare the groups, and P < 0.05 was considered statistically significant. Results: The highest mean amount of residual debris (2.9 ± 1.13) was noted in XPF + saline group (P < 0.05). XPF + saline and XPF + NaOCl (3.8 ± 0.60) had the lowest efficacy for smear layer removal (P < 0.05) with no significant within-group difference. No significant difference was noted between Groups 2, 3, and 4 with the positive control group regarding debris removal. Groups 2 and 4 had no significant difference with the positive control group regarding smear layer removal. Conclusion: Use of XP-Endo finisher has no superiority to the standard protocol for the use of irrigating solutions (EDTA + NaOCl) for debris and smear layer removal, but in some cases, such as second appointment of regeneration treatment we cannot use NaOCl because of its destructive effects on stem cells; thus, we can benefit from the synergistic effects of XPF and EDTA for better smear layer removal.

Comparison of color stability and fracture resistance of two temporary fiber-reinforced fixed partial denture materials Ramin Mosharraf, Pirouz Givehchian, Farzin Ansaripour Dental Research Journal 2019 16(3):185-192 Background: Temporary crown and bridge materials have to fulfill a couple of important functions within the timeframe between tooth preparations until luting of the definitive restoration. The aim of the current study was to evaluate the color stability and fracture resistance of two fiber-reinforced provisional fixed partial denture (FPD) materials. Materials and Methods: In this in vitro study Using a plexiglass mold, 96 bar-shaped specimens (4 mm × 2 mm × 20 mm) were fabricated and divided into four groups (n = 24): nonreinforced composite (NRC) resin, glass fiber-reinforced composite resin (RC), nonreinforced polymethylmethacrylate (PMMA), and glass fiber-reinforced PMMA. Values of CIEL*a*b* were recorded for all the samples. Then, the samples were immersed in coffee, chlorhexidine mouthrinse, and distilled water. After 1 day and 1 and 4 weeks, CIEL*a*b* values were recorded again and color differences (ΔE) were calculated. All the specimens immersed in distilled water were then subjected to force to measure their fracture resistance. Data were analyzed with one-way ANOVA, honestly significant difference Tukey tests, and paired t-test (α = 0.05). Results: The NRC group, immersed in coffee for 1 month, exhibited the highest ΔE (17.1 ± 0.69) and the lowest ΔE belonged to the RC group immersed in water for 1 day. The RC group, immersed in water, exhibited the highest fracture resistance. Conclusion: Coffee is considered as one of the most important factors affecting color changes in provisional FPDs, either in composite resins or in PMMAs. Fracture resistance of both composite resin and PMMA FPDs revealed no significant differences between the groups; however, there were significant differences between the nonreinforced and fiber-reinforced FPDs in both groups.

Effect of ceramic translucency and luting cement shade on the color masking ability of laminate veneers Bassem S. M. Kandil, Amena M Hamdy, Ahmed K Aboelfadl, Mohamed I El-Anwar Dental Research Journal 2019 16(3):193-199 Background: The aim of this study was to evaluate the effect of ceramic material types, degree of veneer translucency, and luting cement shades on masking the underlying dark dental substrate to achieve best esthetics. Materials and Methods: In this in vitro study, 56 specimens each of 0.5-mm thickness were fabricated from two esthetic veneer materials Vita Enamic and Vita Suprinity, with two different translucencies, i.e., HT and T. To simulate the color of a dark underlying dental structure, background discs with C3 shade were fabricated using resin composite. The ceramic specimens with varying translucencies were cemented on the dark background of the resin composite with A1 and opaque white shades of resin luting cement. Color difference (ΔE) values from a reference color (A1 shade) were calculated using a spectrophotometer. The results were then statistically analyzed using three-way ANOVA test (α = 0.05). Results: The ΔE values of both ceramic systems were affected by both the degree of veneer translucency (P = 0.00) and the luting agent shade (P = 0.016). The use of an opaque luting agent and T translucency resulted in a decrease in the ΔE* values for all ceramics tested, regardless to the material type. Suprinity and Enamic showed similarity in the masking ability of dark substrate after cementation. Conclusion: None of the 0.5-mm veneers of the two ceramic systems could reach A1 shade without a detectable color difference after cementation. The change in degree of veneer translucency was more effective than the change in luting agent shade in masking the underlying dark substrate.