dsDentinal translucency and width of cementum: predicting the age over 55 years in South Indian adults using extracted sectioned teeth

The main intention of this article was to evaluate the reliability of root dentine translucency (RDT) and the width of cementum (CW) in indicating the age over 55 years in forensic and criminal investigations. 600 non-restored, single rooted teeth (300 males and 300 females) which were extracted for periodontal or orthodontic reasons were collected. Each tooth was sectioned longitudinally until the desired thickness (250 µm) was obtained. Both the length of the RDT and CW were measured from these unstained ground sections of teeth using ImageJ computer software. Pearson’s correlation coefficient indicated a very strong and positive correlation for RDW and CW with age in both sexes. Cut-off values of RDT= 7.07 and CW= 52.06 were obtained using the maximum Youden’s index. The value for the area under the curve (AUC) was 0.987 for RDT and 0.910 for CW was seen as indicating a very high discrimination. The performance of these cut-off values was tested in a separate sample of sectioned teeth (n= 300) and was analyzed using contingency tables in both sexes. The sensitivity was 88.2% and 92.3%, while specificity was 98.9% for RDT in males and females. For CW, the sensitivity was 96.1% and 90.3%, and specificity was 76.7% and 74.4% in males and females, respectively. Bayes post-test probability was 98.9% for RDT in both sexes, while 80.5% in males and 78% in females, for CW. Based on our study findings, it can be concluded that both variables have performed well in predicting the age over 55 years. Further research concerning the radiographic study of secondary dentine deposition to predict legal age thresholds would be a great benefit for living adults who require age estimation in civil proceedings.     

Medical Therapy for Eisenmenger Syndrome: A Case Report and Review of Literature

Eisenmenger syndrome (ES) is defined as the process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect is eventually reversed into a cyanotic right-to-left shunt. It is crucial to recognize this grave pathology at the earliest because once it develops, treatment by medical or surgical means becomes even more challenging. In past decades, various therapeutic options have been developed that address the specific pathophysiological aspects of the disease and have shown to improve functional capacity and quality of life. There are three major therapeutic pathways in pulmonary hypertension treatment - endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, and prostacyclin derivatives. These therapies not only improve hemodynamic parameters and exercise capacity but they also improve prognosis with various form of Pulmonary hypertension including ES. We report a case of a 35-year-old female of ostium secundum atrial septal defect with ES, started on upfront combination therapy of ambrisentan and tadalafil who demonstrated marked improvement after 3 months of medical therapy.     

Is there a role for a specialized follow-up clinic for survivors of pediatric cancer?

Due to advances in chemotherapy and supportive care, greater than 70% of patients with childhood cancer will survive 5 years. However, there are long-term physiological and psychological sequelae of these treatments that may not manifest until pediatric survivors are into adulthood. Various studies done in the long-term pediatric survivors have noted that they are at increased risk for poor health and for chronic health problems. One complicating factor in treating these patients for their health problems is that many childhood cancer survivors are unaware of their past medical history and what their past cancer treatment entailed. There are also a number of barriers to medical care in survivors of childhood cancer which include inadequate insurance coverage for many and lack of knowledge of long-term effects physicians. As pediatric cancer survivors age they usually transition to community physicians. This paper proposes different models for follow-up clinics for survivors of pediatric cancers so childhood cancer survivors are not be subjected to cost ineffective or excessive evaluations but rather medical screening tests that are risk and guidelines that are set forth by experts.