Introduction:The design of an appliance for retraction of six anterior teeth using orthodontic mini-implant (OMI) anchorage and sliding mechanics must take into account the position and height of the mini-implant and the height of the anterior retraction hook, we used finite element analysis to examine effective en masse retraction with orthodontic mini-implant anchorage and sought to identify a better combination of the above factors.Materials and methods: Base models were constructed from a measurements given in the Wheeler's dental anatomy book. The center of resistance for the 6 anterior teeth in the base model was calculated. The working archwires were assumed to be 0.019" × 0.025" in stainless steel. The amount of tooth displacement after finite element analysis was measured. Results and conclusions:In low OMI (6 mm) anteriors showed tipping movement. Mid implant condition (8 mm) showed more of bodily movement during retraction as the force passes near or through the CRs of all the six anterior teeth. In high OMI (10 mm) and 0 mm ARH condition, all the six anterior teeth showed intrusion with retraction.

Background:When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations.Materials and Methods:Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery.Results:All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture.Conclusions:Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

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Editor-We would like to highlight an infrequent but serious adverse effect of tramadol. We report a case of generalized tonic-clonic seizure associated with sympathetic nervous system hyperactivity, which included profuse diaphoresis, tachycardia (HR: 136 beats min 21), hypertension (BP: 160/110 mm Hg), and widespread erythema after the administration of tramadol. A healthy 49-yr-old male was admitted to hospital for management of a fractured humerus. The only medication the patient received was morphine 30 mg followed by oral tramadol 100 mg approximately 40 min before the grand mal seizure. Tramadol can precipitate seizures in epileptic patients 1-3 by lowering the seizure threshold. There have been several case reports of tramadol precipitating a seizure in non-epileptic patients. However, our patient had a more complicated seizure presentation, which included generalized erythema, and profuse sustained diaphoresis. Tramadol increases cerebral serotonin activity by partial inhibition of its uptake, particularly when it is given in combination with other drugs including morphine. This increased serotonin activity can produce serotonin syndrome which is characterized by disorders in cognitive-behavioural, neuromuscular, and autonomic function. 4 5 To qualify for the diagnosis, it has been suggested that a patient should have at least one or two manifestations from each of these functional categories. There is no formal test for the diagnosis of serotonin syndrome. The onset of clinical effects is relatively rapid (minutes to a few hours). Management is discontinuation of the causative agents with supportive treatment and the clinical symptoms and signs usually resolve within 24 h. Hyperthermia should be treated with active cooling. Rigidity, seizures, and agitation should be treated with benzodiazepines. Severe symptoms have been treated successfully with cyproheptadine-a 5-HT2 antagonist.

Objective: The objective of this study was to evaluate the effect of intravenous fluid supplementation in healthy term neonates with non-hemolytic hyperbilirubinemia receiving phototherapy. Study Design: Randomized controlled trial conducted in a tertiary level neonatal care unit of a teaching institute in North Karnataka. Methods: A total of 60 healthy term neonates with non-hemolytic hyperbilirubinemia (total serum bilirubin [TSB] >15 mg/dL [256 ?mol/L]–<25 mg/dL [428 ?mol/L]) were randomized to two groups. Group I (case group, n=30) received 1/3rd the maintenance intravenous fluid in addition to breastfeeding and phototherapy. Group II (control group, n=30) received only breastfeeding and phototherapy. The duration of phototherapy and rate of fall of bilirubin was compared. Results: Both the groups were comparable with respect to mean birth weight, gestational age, gender, mode of delivery, age at admission, admission weight, percentage of weight loss at admission, and TSB at inclusion. There was a significant difference in the duration of phototherapy between the two groups (mean [standard deviation (SD)] Group I, 39.6 [7.8] h and Group II, 45.2 [10.22] h, p<0.05). Percentage of fall in bilirubin was not significant at 4, 12, 48, and 60 h but was significant at 24 and 36 h. Conclusion: Intravenous fluid supplementation in healthy breastfed term neonates with non-hemolytichyperbilirubinemia significantly reduces the duration of phototherapy.

Introduction: Coronavirus Disease-2019 (COVID-19) infection in pregnant women can have important effects on the perinatal and neonatal outcomes. Multiple modes of transmission of infection from mother to the newborn have been suggested as also the increased risk of complications in COVID-19 infected neonates. Aim: To study the clinico-epidemiological characteristics and short-term outcomes of neonates born to mothers infected with COVID-19 in relation to maternal COVID-19 severity and co-morbidities and to compare the same between COVID-19 infected and non infected neonates. Materials and Methods: This was a retrospective study of 174 neonates born to COVID-19 positive mothers admitted and delivered from 1st August 2020 to 31st October 2020, at Belagavi Institute of Medical Sciences (BIMS), North Karnataka, India. Data was collected from medical records about the clinical and epidemiological characteristics of the mothers and their neonates, symptoms and severity of COVID-19 and their management and short-term outcomes. Pearson’s Chi-square or Fisher’s-exact test was used for statistical analysis. The p-value of less than 0.05 was considered statistically significant. Results: Out of 174, 18 (10.35%) neonates tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The rates of pre-maturity and low birth weight amongst all 174 neonates were 17.24% and 24.14%, respectively. There were no significant differences in demographic features, in the need for resuscitation and incidence of complications like prematurity, low birth weight, birth asphyxia, meconium aspiration syndrome, sepsis between COVID-19 infected and non infected neonates. However, an increased risk of Early Onset Sepsis (EOS) (OR– 2.21) in COVID-19 infected neonates. None of the COVID- 19 infected neonates required Continuous Positive Airway Pressure (CPAP) or mechanical ventilation and all were discharged subsequently. In this study there were 3(1.72%) deaths, all among COVID-19 non infected, neonates. Conclusion: The incidence of COVID-19 infection in neonates born to COVID-19 infected mothers in this study was 10.35%. Most of the infections in neonates were of less severity without a significantly increased need for respiratory support and without significant mortality.

Exomphalos minor is one among uncommon disorders of the umbilical region. Here, we report a fatal case of exomphalos minor with enterococcal septicemia. A male baby, born with exomphalos minor, developed clinical features of septicemia on the fourth postnatal day. Blood samples were collected by venepuncture from two sites for culture. Enterococcus faecium was isolated from both the blood samples. The swabs collected from the site of exomphalos also yielded growth of Enterococcus faecium, confirming the source of infection. The antibiogram with Minimum Inhibitory Concentrations (MIC) for various antibiotics was done for isolates from all three sites, which was similar. The isolate was resistant to multiple antibiotics with high level aminoglycoside resistance. The baby was treated with antibiotics and other supportive measures. However, the baby succumbed to the septicemia. As per our knowledge, this is the first reported case of fatal septicemia by multidrug-resistant Enterococcus faecium in a case of exomphalos minor.

Introduction: Late-onset Sepsis (LOS) causes significant morbidity and mortality in preterm infants. Probiotics have been suggested to improve the integrity of mucosal barrier by modifying the enteric microflora and suppress the overgrowth and translocation of pathogens in the gut, thus preventing life- threatening infections. Although probiotics have a definite role in prevention of Necrotising Enterocolitis (NEC) in preterm neonates, their effect on prevention of LOS in preterm neonates is still uncertain. Aim: To evaluate the role of probiotics in reducing incidence of LOS in preterm neonates (<34 weeks). Materials and Methods: A double blinded randomised control trial was conducted in a tertiary care Neonatal Intensive Care Unit (NICU) in Karnataka, India between 1st January 2019 to 31st December 2019. Seventy haemodynamically stable preterm neonates, <34 weeks of Gestational Age (GA), were randomised into ‘Probiotic’ and ‘Placebo’ groups. The probiotic group (n=36) was prophylactically administered Bacillus clausii suspension at a dose of 2.5 mL per-oral (0.4×109 spores in 1 mL) BD with breast milk, from initiation of enteral feeds till seven days, discharge/ death/LOS, whichever was earlier. The placebo group (n=34) received breast milk with sterile water 2.5 mL per- oral BD. All the neonates were investigated and managed as per standard hospital protocol. Primary outcome of the study was to find the incidence of LOS. Student’s t-test, Mann-Whitney U test, Chi-square test and Fisher’s exact test were used for statistical analysis. Results: There was no significant difference between the probiotic vs placebo group, with respect to incidence of LOS (11.11% vs 17.64%; (p>0.05)) and duration of hospital stay (10.86±3.19 vs 11.23±2.98 days; (p>0.05)). However, incidence of feed intolerance in the probiotic group (11.11%) was significantly less than that the other (26%) (p<0.05). Conclusion: Probiotics, prophylactically fed enterally, did not reduce the incidence of LOS but provide a promising strategy to prevent feed intolerance in premature neonates.