AIDS

TRIGGERED: could refocused cell signaling be key to natural killer cell-based HIV immunotherapeutics? Natural killer (NK) cells are one of the critical innate immune effector cells that directly kill tumors and virus-infected cells, and modulate other immune cells including dendritic cells, CD4+ and CD8+ T cells. Signals from activating and inhibitory surface receptors orchestrate the regulatory and cytotoxic functions of NK cells. Although a number of surface receptors are involved, multiple signaling molecules are shared so that NK cell responses are synergistically regulated. Many pathogens and tumors evade NK cell responses by targeting NK cell signaling. Particularly in HIV/simian immunodeficiency virus (SIV) infection, the NK cell repertoire is diminished by changes in subsets of NK cells, expression of activating and inhibitory receptors, and intracellular signaling molecules. However, in-depth studies on intracellular signaling in NK cells in HIV/SIV infections remain limited. Checkpoint blockade and chimeric antigen receptor (CAR)-NK cells have demonstrated enhanced NK cell activities against tumors and viral infections. In addition, targeting intracellular signaling molecules by small molecules could also improve NK cell responses towards HIV/SIV infection in vivo. Therefore, further understanding of NK cell signaling including identification of key signaling molecules is crucial to maximize the efficacy of NK cell-based treatments. Herein, we review the current state of the literature and outline potential future avenues where optimized NK cells could be utilized in HIV-1 cure strategies and other immunotherapeutics in PLWH.

A systematic review of early adoption of implementation science for HIV prevention or treatment in the United States Objective: To provide the first systematic review of the early adoption of implementation science for HIV prevention or treatment in the United States. We identified primary research studies that addressed implementation of HIV prevention or treatment in the United States and qualitatively assessed the reporting of implementation outcomes and intervention descriptions. Methods: We searched PubMed, PsycInfo, and CINAHL databases for evaluations of HIV prevention or treatment interventions that at least reported one implementation outcome and were published between 2014 and 2018. We used the 12-item Template for Intervention Description and Replication to assess study interventions. Results: A total of 2275 articles were identified. Thirty-nine studies met inclusion criteria. Of these, 84.6% used quantitative methods with 5% being hybrid effectiveness-implementation studies and 15% used qualitative methods. No studies cited a formal theoretical framework for implementation science. Acceptability and feasibility were the most frequently reported implementation outcomes. Eligible studies were diverse with regard to demographic categories. Most interventions focused on HIV prevention, particularly risk-reduction strategies. HIV treatment interventions targeted linkage to care and adherence to medications. Key implementation outcome findings indicated that these interventions are feasible and acceptable in the real world. Conclusion: HIV implementation science could support dissemination of HIV prevention or treatment in the United States, although HIV treatment interventions are limited. Theoretical frameworks and key implementation outcomes like fidelity, penetration, and appropriateness could promote the rigor of future HIV treatment implementation research, helping the field deliver the promise of HIV prevention or treatment efforts in the United States.

Genome-wide association study of high-sensitivity C-reactive protein, D-dimer, and interleukin-6 levels in multiethnic HIV+ cohorts Objectives: Elevated levels of interleukin-6 (IL-6), D-dimer, and C-reactive protein (hsCRP) are associated with increased incidence of comorbid disease and mortality among people living with HIV (PLWH). Prior studies suggest a genetic basis for these biomarker elevations in the general population. The study objectives are to identify the genetic basis for these biomarkers among PLWH. Methods: Baseline levels of hsCRP, D-dimer, and IL-6, and single nucleotide polymorphisms (SNPs) were determined for 7768 participants in three HIV treatment trials. Single variant analysis was performed for each biomarker on samples from each of three ethnic groups [African (AFR), Admixed American (AMR), European (EUR)] within each trial including covariates relevant to biomarker levels. For each ethnic group, the results were pooled across trials, then further pooled across ethnicities. Results: The transethnic analysis identified three, two, and one known loci associated with hsCRP, D-dimer, and IL-6 levels, respectively, and two novel loci, FGB and GCNT1, associated with D-dimer levels. Lead SNPs exhibited similar effects across ethnicities. Additionally, three novel, ethnic-specific loci were identified: CATSPERG associated with D-dimer in AFR and PROX1-AS1 and TRAPPC9 associated with IL-6 in AFR and AMR, respectively. Conclusion: Eleven loci associated with three biomarker levels were identified in PLWH from the three studies including six loci known in the general population and five novel loci associated with D-dimer and IL-6 levels. These findings support the hypothesis that host genetics may partially contribute to chronic inflammation in PLWH and help to identify potential targets for intervention of serious non-AIDS complications.

Unexpected interactions between dolutegravir and folate: randomized trial evidence from South Africa Objective: Dolutegravir exposure at conception was associated with a preliminary signal of increased infant neural tube defect risk. As low maternal folate levels are linked with neural tube defects, we aimed to assess serum folate concentrations in women starting dolutegravir. Design: We analysed serum folate concentrations from stored plasma among women enrolled in the South African ADVANCE trial. Methods: We compared changes in mean serum folate and occurrence of low serum folate (<14.0 nmol/l) at weeks 0, 12 and 24 across study arms. In ADVANCE, 1053 treatment-naïve participants were randomized to initiate tenofovir–alafenamide/emtricitabine + dolutegravir (TAF/FTC + DTG), tenofovir–disoproxil–fumarate (TDF)/FTC + DTG or TDF/FTC/efavirenz (EFV). Results: Analysis includes 406 females, mean age 31.5 years and baseline CD4+ cell count 356 cells/μl. At baseline, folate concentrations were similar across treatment arms. However, serum folate increased over 12 weeks in the TAF/FTC + DTG arm (+4.0 ± 8.1 nmol/l), while folate concentrations decreased slightly in the TDF/FTC + DTG arm (−1.8 ± 8.9 nmol/l) and decreased in the TDF/FTC/EFV arm (−5.9 ± 8.1 nmol/l). Women taking TDF/FTC/EFV had low folate concentrations at both 12 and 24 weeks compared with the other arms (P < 0.001). Of 26 women who became pregnant on study before week 24, folate concentrations increased between baseline and 12 weeks by a mean 2.4 ± 7.1 nmol/l in the TAF/FTC + DTG arm and 2.3 ± 8.4 nmol/l in the TDF/FTC + DTG arm, but decreased by −3.3 ± 8.1 with TDF/FTC/EFV arm. Conclusion: Unexpectedly, no declines were noted in the dolutegravir-containing arms, and concentrations were considerably higher than in the EFV arm. The possibility that dolutegravir may block cellular uptake of folate warrants investigation.

Unveiling the basis of antiretroviral therapy-induced osteopenia: the effects of Dolutegravir, Darunavir and Atazanavir on osteogenesis Objectives: Osteopenia is frequent in HIV-infected patients treated with antiretroviral therapy (ART) and has been linked to increased osteoclastogenesis. Little is known about the effects of ART on osteogenesis. Design: We investigated the effect on human mesenchymal stem cells (hMSC) and osteoblasts of Darunavir and Dolutegravir, the most highly used as anchor drugs within a three-drug regimen, and Atazanavir, which was widely utilized in the past. Results: We found that Atazanavir and Dolutegravir delay the osteogenic differentiation of hMSC, impair the activity of osteoblasts and inhibit their conversion into osteocytes, whereas Darunavir exerts no effect. Conclusion: Atazanavir and Dolutegravir impair osteogenesis. It is essential to diagnose impaired osteogenesis early and to devise effective therapeutic interventions to preserve bone health in ART-treated HIV patients, putting it in the context of a correct antiretroviral combination.

Risk of birth defects and perinatal outcomes in HIV-infected women exposed to integrase strand inhibitors during pregnancy Objectives: Following an alert on neural tube defects and dolutegravir, we sought to evaluate if the exposure integrase strand transfer inhibitors (INSTIs) at conception was associated with birth defects or other adverse pregnancy outcomes. Methods: In the prospective national French Perinatal Cohort (EPF), we studied birth defects and other perinatal outcomes by matching each pregnant woman exposed to INSTIs with a pregnant woman exposed to darunavir/ritonavir receiving the same backbone of nucleoside reverse transcriptase inhibitors and matched for other characteristics such as age, geographic origin, centre and year of delivery. Results: Among 808 women exposed to INSTIs during pregnancy (raltegravir = 703, dolutegravir = 57 and elvitegravir = 48), we reported a slightly higher rate of birth defects in infants exposed at conception to raltegravir (6.7%) vs. infants exposed to raltegravir later in pregnancy: 2.9% if initiated during pregnancy as first-line, and 2.5% as second-line treatment,  P =0.04. When compared with matched controls, raltegravir exposure at conception was not significantly associated with birth defects: 6.4 vs. 2.3%, P = 0.08. There was no cluster of birth defect type and no neural tube defects were observed. Other perinatal outcomes, such as preterm birth and stillbirths, did not differ significantly between raltegravir-exposed women and matched counterparts. No difference in any outcome was observed for elvitegravir/cobicistat or dolutegravir. Conclusion: We found a nonsignificant trend for an association between exposure to raltegravir at conception and birth defects, which needs to be evaluated by larger prospective surveillance data, as these drugs are increasingly prescribed in women living with HIV.

High-throughput sequencing reveals a high prevalence of pretreatment HIV-1 drug resistance in Sweden Objectives: HIV-1 pretreatment drug resistance (PDR) is a global concern. Our aim was to evaluate high-throughput sequencing (HTS) for HIV-1 resistance testing and describe PDR in Sweden, where 75% of diagnosed individuals are foreign-born. Design: Cross-sectional study. Methods: Individuals entering HIV-1 care in Sweden 2017 to March 2019 (n = 400) were included if a viremic sample was available (n = 220). HTS was performed using an in-house assay. Drug resistance mutations (DRMs) (based on Stanford HIV DB vs. 8.7) at levels 1–5%, 5–19% and at least 20% of the viral population were described. Results from HTS and routine Sanger sequencing were compared. Results: HTS was successful in 88% of patients, 92% when viral load was at least 1000 copies/ml. DRMs at any level in protease and/or reverse transcriptase were detected in 95 individuals (49%), whereas DRMs at least 20% in 35 (18%) individuals. DRMs at least 20% correlated well to findings in routine Sanger sequencing. Protease/reverse transcriptase (PR/RT) DRMs at least 20% were predicted by treatment exposure; adjusted OR 9.28 (95% CI 2.24–38.43; P = 0.002) and origin in Asia; adjusted OR 20.65 (95% CI 1.66–256.24; P = 0.02). Nonnucleoside reverse transcriptase inhibitor (NNRTI) DRMs at least 20% were common (16%) and over-represented in individuals originating from sub-Saharan Africa or Asia. Low-level integrase strand transfer inhibitor (INSTI) DRMs less than 20% were detected in 15 individuals (8%) with no association with INSTI exposure. Conclusion: Our HTS can efficiently detect PDR and findings of DRMs at least 20% compare well to routine Sanger sequencing. The high prevalence of PDR was because of NNRTI DRMs and associated with migration from areas with emerging PDR.

Central nervous system disease with JC virus infection in adults with congenital HIV Objective: The aim of this study was to describe the natural history of individuals with congenital HIV who develop JC virus (JCV) infection of the central nervous system (CNS). Methods: We retrospectively evaluated individuals with congenital HIV who met criteria for progressive multifocal leukoencephalopathy (PML) or JCV granule cell neuronopathy (JCV GCN) at three major healthcare centres in the northeast USA. Data on adherence to combined antiretroviral therapy (cART), neurologic symptoms, serum markers of immunity and HIV infection, cerebrospinal fluid (CSF) analyses, radiographic features, modified Rankin Scale (mRS) scores and survival were collected from the electronic medical record up to a censoring date of 1 August 2020. Results: Among 10 adults with congenitally acquired HIV, nine were diagnosed with definitive PML and one was diagnosed with probable JCV GCN. Individuals presented at the time of their PML or JCV GCN diagnosis with a mean mRS of 2.0 (standard deviation 1.0). A premorbid mRS was documented for six patients and was zero in all cases. The most common risk factor was confirmed cART nonadherence in nine individuals. Five individuals with PML and one with JCV GCN died, with a latency from symptom onset to death of approximately 3 months for three individuals, and approximately 2 years for the remaining two. Conclusion: Youth-adulthood transition is a high-risk point for dropping off from medical care. The study of this timepoint in people living with HIV could help inform effective care in these individuals.

All-cause hospitalization according to demographic group in people living with HIV in the current antiretroviral therapy era Objective: We investigated differences in all-cause hospitalization between key demographic groups among people with HIV in the UK in the current antiretroviral therapy (ART) era. Design/Methods: We used data from the Royal Free HIV Cohort study between 2007 and 2018. Individuals were classified into five groups: MSM, Black African men who have sex with women (MSW), MSW of other ethnicity, Black African women and women of other ethnicity. We studied hospitalizations during the first year after HIV diagnosis (Analysis-A) separately from those more than one year after diagnosis (Analysis-B). In Analysis-A, time to first hospitalization was assessed using Cox regression adjusted for age and diagnosis date. In Analysis-B, subsequent hospitalization rate was assessed using Poisson regression, accounting for repeated hospitalization within individuals, adjusted for age, calendar year, time since diagnosis. Results: The hospitalization rate was 30.7/100 person-years in the first year after diagnosis and 2.7/100 person-years subsequently; 52% and 13% hospitalizations, respectively, were AIDS-related. Compared with MSM, MSW and women were at much higher risk of hospitalization during the first year [aHR (95% confidence interval, 95% CI): 2.7 (1.7–4.3), 3.0 (2.0–4.4), 2.0 (1.3–2.9), 3.0 (2.0–4.5) for Black African MSW; other ethnicity MSW; Black African women; other ethnicity women respectively, Analysis-A] and remained at increased risk subsequently [corresponding aIRR (95% CI): 1.7 (1.2–2.4), 2.1 (1.5–2.8), 1.5 (1.1–1.9), 1.7 (1.2–2.3), Analysis-B]. Conclusion: In this setting with universal healthcare, substantial variation exists in hospitalization risk across demographic groups, both in early and subsequent periods after HIV diagnosis, highlighting the need for targeted interventions.

Factors associated with worse cerebrovascular function in aging women with and at risk for HIV Objective: Women may be disproportionately impacted by the negative effect of HIV on cerebrovascular risk. We examined the association of HIV, sex, menopause, and immune activation with cerebrovascular function among women with HIV (WWH) and at risk for HIV from the Women's Interagency HIV Study and men with HIV. Design: Cross-sectional. Methods: Participants were aged at least 40 years with coronary heart disease or at least one cardiometabolic risk factor. All persons with HIV were on antiretroviral therapy with undetectable viral load. Cerebral vasoreactivity was assessed by the transcranial Doppler breath-holding test, with lower vasoreactivity corresponding to worse cerebrovascular function. Menopausal status was determined by anti-Müllerian hormone level. We used mixed effects linear regression to identify factors associated with cerebral vasoreactivity. Results: Mean cerebral vasoreactivity was similar in WWH (n = 33) and women at risk for HIV (n = 16). A trend toward higher cerebral vasoreactivity in WWH compared with men with HIV (n = 37) was no longer present after excluding women on estrogen replacement therapy (n = 3). In women, menopausal status was not significantly associated with cerebral vasoreactivity. WWH with higher cardiovascular risk (−0.14 for each additional cardiometabolic risk factor, P = 0.038), sCD163 (−0.20 per doubling, P = 0.033), and proportion of CD4+CX3CR1+ T cells (−0.14 per doubling, P = 0.028) had lower cerebral vasoreactivity. Conclusion: Among older women at high cardiovascular risk, women with virologically suppressed HIV and women at risk for HIV had similar cerebrovascular function. Our findings, which must be interpreted in the context of the small sample, highlight the contribution of traditional cardiometabolic risk factors and immune activation to cerebrovascular risk in WWH.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,

Optometry and Vision

Be a Mentor No abstract available

Uncorrected Refractive Error and Distance Visual Acuity in Children Aged 6 to 14 Years SIGNIFICANCE This study presents the relationship between distance visual acuity and a range of uncorrected refractive errors, a complex association that is fundamental to clinical eye care and the identification of children needing refractive correction. PURPOSE This study aimed to analyze data from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study to describe the relationship between distance uncorrected refractive error and visual acuity in children. METHODS Subjects were 2212 children (51.2% female) 6 to 14 years of age (mean ± standard deviation, 10.2 ± 2.1 years) participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study between 2000 and 2010. Uncorrected distance visual acuity was measured using a high-contrast projected logMAR chart. Cycloplegic refractive error was measured using the Grand Seiko WR-5100K autorefractor. The ability of logMAR acuity to detect various categories of refractive error was examined using receiver operating characteristic curves. RESULTS Isoacuity curves show that increasing myopic spherical refractive errors, increasing astigmatic refractive errors, or a combination of both reduces distance visual acuity. Visual acuity was reduced by approximately 0.5 minutes of MAR per 0.30 to 0.40 D of spherical refractive error and by approximately 0.5 minutes of MAR per 0.60 to 0.90 D of astigmatism. Higher uncorrected hyperopic refractive error had little effect on distance visual acuity. Receiver operating characteristic curve analysis suggests that a logMAR distance acuity of 0.20 to 0.32 provides the best balance between sensitivity and specificity for detecting refractive errors other than hyperopia. Distance acuity alone was ineffective for detecting hyperopic refractive errors. CONCLUSIONS Higher myopic and/or astigmatic refractive errors were associated with predictable reductions in uncorrected distance visual acuity. The reduction in acuity per diopter of cylindrical error was about half that for spherical myopic error. Although distance acuity may be a useful adjunct to the detection of myopic spherocylindrical refractive errors, accommodation presumably prevents acuity from assisting in the detection of hyperopia. Alternate procedures need to be used to detect hyperopia.

Case Report: Successful Corneal Crosslinking in a Patient with Corneal Ectasia Associated with Stevens-Johnson Syndrome SIGNIFICANCE Corneal ectasia can be a complication of Stevens-Johnson syndrome. When detected in a timely manner, corneal crosslinking can be a safe treatment. This is an important association to highlight that early diagnosis and treatment can prevent the need for invasive surgical procedures such as keratoplasty. PURPOSE This study aimed to report a successful accelerated epithelium-off corneal crosslinking in a rare case of corneal ectasia secondary to Stevens-Johnson syndrome. CASE REPORT A 25-year-old Indian man presented with a progressive visual acuity decline 5 years after an acute episode of Stevens-Johnson syndrome secondary to penicillin ingestion. Serial tomography scans confirmed the diagnosis of corneal ectasia. After the preparation of the ocular surface, which was deemed to have a mild degree of limbal stem cell deficiency, with frequent preservative-free lubrication and steroid use, accelerated epithelium-off crosslinking was performed with 4 minutes of continuous ultraviolet-A exposure at 30 mW/cm2 and a total energy dose of 7.2 J/cm2. Complete re-epithelialization was observed at 72 hours after crosslinking with no complications. Corneal tomography 15 months after treatment showed stabilization of ectasia, with improvement in visual acuity. CONCLUSIONS Corneal ectasia is a rare but important complication of Stevens-Johnson syndrome. Accelerated epithelium-off crosslinking treatment can be considered in patients with a compromised ocular surface after Stevens-Johnson syndrome. Pre-operative optimization of the ocular surface and vigilant monitoring in the early post-operative period are recommended for the prevention of complications.

Technical Report: A New Device Attached to a Smartphone for Objective Vision Screening SIGNIFICANCE A new device attached to a smartphone was created for objective vision screening of young children including infants and newborns. The device is compact, lightweight, portable, cost-effective, and easy to operate. Therefore, it is suitable for screening large numbers of children in clinical settings, schools, and communities. PURPOSE This article introduces a new device attached to a smartphone for objective vision screening. It can detect and categorize significant refractive errors, anisometropia, strabismus, cloudy ocular media, and ptosis that may cause amblyopia. METHODS The new device applies the same principles as conventional streak retinoscopy but examines both eyes simultaneously and records the results electronically. The device comprises optical elements that produce a precise streak light beam and move it across a child's both eyes. The smartphone's video camera catches and records the motion of retinal reflex inside the child's pupils. By observing the direction of motion of the retinal reflex relative to the light beam motion, as well as its speed, width, and brightness, the examiner is able to assess the individual and comparative refractive status, ocular alignment, and other conditions. RESULTS Vision screening with this device does not require any subjective response from children. The examination can be performed and analyzed by nonprofessionals after a short learning period of time. Because the examination results are electronically recorded by the smartphone, they can be stored in the child's files and sent out for professional consultations. CONCLUSIONS The new device will provide the same functions as conventional streak retinoscopy but examines a child's both eyes simultaneously, so that, in addition to categorizing refractive errors and assessing clarity of refractive media of the eyes, it can also detect anisometropia, strabismus, and anisocoria. In addition to showing the examination results on the smartphone's screen, the device can also store the results electronically.

Indicators for Assessing the Quality of Refractive Error Care SIGNIFICANCE Quality refractive error care is essential for reducing vision impairment. Quality indicators and standardized approaches for assessing the quality of refractive error care need to be established. PURPOSE This study aimed to develop a set of indicators for assessing the quality of refractive error care and test their applicability in a real-world setting using unannounced standardized patients (USPs). METHODS Patient outcomes and three quality of refractive error care (Q.REC) indicators (1, optimally prescribed spectacles; 2, adequately prescribed spectacles; 3, vector dioptric distance) were developed using existing literature, refraction training standards, and consulting educators. Twenty-one USPs with various refractive errors were trained to visit optical stores across Vietnam to have a refraction, observe techniques, and order spectacles. Spectacles were assessed against each Q.REC indicator and tested for associations with vision and comfort. RESULTS Overall, 44.1% (184/417) of spectacles provided good vision and comfort. Of the spectacles that met Q.REC indicators 1 and 2, 62.5 and 54.9%, respectively, provided both good vision and comfort. Optimally prescribed spectacles (indicator 1) were significantly more likely to provide good vision and comfort independently compared with spectacles that did not meet any indicator (good vision: 94.6 vs. 85.0%, P = .01; comfortable: 66.1 vs. 36.3%, P < .01). Adequately prescribed spectacles (indicator 2) were more likely to provide good comfort compared with spectacles not meeting any indicator (57.7 vs. 36.3%, P < .01); however, vision outcomes were not significantly different (85.9 vs. 85.0%, P = .90). Good vision was associated with a lower mean vector dioptric distance (P < .01) but not with comfort (P = .52). CONCLUSIONS The optimally prescribed spectacles indicator is a promising approach for assessing the quality of refractive error care without additional assessments of vision and comfort. Using USPs is a practical approach and could be used as a standardized method for evaluating the quality of refractive error care.

Negative Fusional Vergence Is Abnormal in Children with Symptomatic Convergence Insufficiency SIGNIFICANCE Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic convergence insufficiency. PURPOSE This study aimed to determine whether NFV is normal in untreated children with symptomatic convergence insufficiency and whether NFV improves after vergence/accommodative therapy. METHODS This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic convergence insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies. RESULTS At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P < .001) than normative values. The post-therapy mean improvements for blur, break, and recovery of 5.2, 7.2, and 1.3Δ, respectively, were statistically significant (P < .0001). Mean pre-therapy responses to 4° disparity divergence step stimuli were worse in the convergence insufficiency group compared with the NBV group for peak velocity (P < .001), time to peak velocity (P = .01), and response amplitude (P < .001). After therapy, the convergence insufficiency group showed statistically significant improvements in mean peak velocity (11.63°/s; 95% confidence interval [CI], 6.6 to 16.62°/s), time to peak velocity (−0.12 seconds; 95% CI, −0.19 to −0.05 seconds), and response amplitude (1.47°; 95% CI, 0.83 to 2.11°), with measures no longer statistically different from the NBV cohort (P > .05). CONCLUSIONS Despite clinical NFV measurements that seem greater than normal, children with symptomatic convergence insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.

A Comparison of Foveal and Peripheral Contour Interaction and Crowding SIGNIFICANCE Performance on clinical tests of visual acuity can be influenced by the presence of nearby targets. This study compared the influence of neighboring flanking bars and letters on foveal and peripheral letter identification. PURPOSE Contour interaction and crowding refer to an impairment of visual resolution or discrimination produced by different types of flanking stimuli. This study compared the impairment of percent correct letter identification that is produced in normal observers when a target letter is surrounded by an array of four flanking bars (contour interaction) or four flanking letters (crowding). METHODS Performance was measured at the fovea and at eccentricities of 1.25, 2.5, and 5° for photopic (200 cd/m2) and mesopic stimuli (0.5 cd/m2) and a range of target-to-flanker separations. RESULTS Consistent with previous reports, foveal contour interaction and crowding were more pronounced for photopic than mesopic targets. However, no statistically significant difference existed between foveal contour-interaction and crowding functions at either luminance level. On the other hand, flanking bars produced much less impairment of letter identification than letter flankers at all three peripheral locations, indicating that crowding is more severe than contour interaction in peripheral vision. In contrast to the fovea, peripheral crowding and contour-interaction functions did not differ systematically for targets of photopic and mesopic luminance. CONCLUSION The similarity between foveal contour interaction and crowding and the dissimilarity between peripheral contour interaction and crowding suggest the involvement of different mechanisms at different retinal locations.

High Rates of Uncorrected Vision Conditions among Schoolchildren in Rural Queensland, Australia SIGNIFICANCE This study is the first to report high rates of uncorrected vision conditions among Australian secondary schoolchildren living in a rural area and to comment on the rate of eye examinations undertaken on Australian Indigenous children. Uncorrected vision problems that continue throughout the school years have significant implications for children's quality of life and education. PURPOSE This study aimed to investigate the prevalence of uncorrected vision conditions among Australian schoolchildren. METHODS Participants included 280 students from rural primary and secondary schools (aged 4 to 18 years), of whom 40% identified as being of Aboriginal and/or Torres Strait Islander descent (Indigenous). All participants underwent an eye examination including measurements of monocular distance and near visual acuity, assessment of accommodative and vergence function, stereoacuity, color vision, and cycloplegic autorefraction. A parental questionnaire was used to determine whether the child had previously had his/her eyes examined. RESULTS The overall prevalence of uncorrected vision conditions in this population was 35%. The odds of previously having had an eye examination were 2.3× higher for non-Indigenous compared with Indigenous children despite both groups exhibiting high rates of uncorrected vision conditions (Indigenous, 31 [29%]; non-Indigenous, 66 [40%]; χ21 = 3.24, P = .07). Of the children who had significant refractive error (Indigenous, 23 [21%]; non-Indigenous, 49 [30%]; χ21 = 2.70, P = .10), 82% were uncorrected, and only 39% of Indigenous children and 54% of non-Indigenous children had previously had an eye examination. CONCLUSIONS These findings suggest that high rates of uncorrected vision conditions are present among Australian primary and secondary schoolchildren from a rural area and highlight that Indigenous children are much less likely to have had an eye examination. Understanding factors that affect the rate of eye examinations and compliance with spectacle correction must be addressed given the potential impact of these vision conditions.

In Vivo Human Corneal Shear-wave Optical Coherence Elastography SIGNIFICANCE A novel imaging technology, dynamic optical coherence elastography (OCE), was adapted for clinical noninvasive measurements of corneal biomechanics. PURPOSE Determining corneal biomechanical properties is a long-standing challenge. Elasticity imaging methods have recently been developed and applied for clinical evaluation of soft tissues in cancer detection, atherosclerotic plaque evaluation, surgical guidance, and more. Here, we describe the use of dynamic OCE to characterize mechanical wave propagation in the human cornea in vivo, thus providing a method for clinical determination of corneal biomechanical properties. METHODS High-resolution phase-sensitive optical coherence tomography imaging was combined with microliter air-pulse tissue stimulation to perform dynamic elasticity measurements in 18 eyes of nine participants. Low-pressure (0.1 mmHg), spatiotemporally discreet (150 μm, 800 μs) tissue stimulation produced submicron-scale tissue deformations that were measured at multiple positions over a 1-mm2 area. Surface wave velocity was measured and used to determine tissue stiffness. Elastic wave propagation velocity was measured and evaluated as a function of IOP and central corneal thickness. RESULTS Submicron corneal surface displacement amplitude (range, 0.005 to 0.5 μm) responses were measured with high sensitivity (0.24 nm). Corneal elastic wave velocity ranged from 2.4 to 4.2 m/s (mean, 3.5; 95% confidence interval, 3.2 to 3.8 m/s) and was correlated with central corneal thickness (r = 0.64, P < .001) and IOP (r = 0.52, P = .02). CONCLUSIONS Phase-sensitive optical coherence tomography imaging combined with microliter air-pulse mechanical tissue stimulation has sufficient detection sensitivity to observe submicron elastic wave propagation in corneal tissue. These measurements enable in vivo corneal stiffness determinations that will be further studied for use with disease detection and for monitoring clinical interventions.

Visual Function in Eyes with Intermediate AMD with and without Retinal Pigment Abnormalities SIGNIFICANCE In intermediate AMD, a simple, clinically feasible vision test of sensitivity to radial deformation is significantly more impaired in eyes with hyperpigmentation than in eyes with large drusen but normal retinal pigmentation, consistent with the former's increased risk of progression to advanced AMD. This ongoing longitudinal study will determine whether this vision measure is predictive of progression to advanced AMD. PURPOSE This study aimed to determine whether simple, clinically feasible psychophysical measures distinguish between two levels of intermediate AMD that differ in their risk of progression to advanced AMD: eyes with large macular drusen and retinal pigment abnormalities versus eyes with large macular drusen without pigment abnormalities. Abnormal pigmentation in the presence of large drusen is associated with a higher risk of development of advanced AMD. METHODS Each eye of 39 individuals with the same form of intermediate AMD in both eyes was tested monocularly on a battery of vision tests. The measures (photopic optotype contrast sensitivity, discrimination of desaturated colors, and sensitivity to radial deformation [shape discrimination hyperacuity]) were compared for both dominant and nondominant eyes. ANOVA with eye (dominant or nondominant) as a within-subject factor and retinal status (pigmentary abnormalities present or absent from the macula) as a between-subject factor was used to determine statistical significance. RESULTS Sensitivity to radial deformation was significantly reduced in eyes with large drusen and pigment changes compared with eyes with large drusen and normal retinal pigmentation (−0.40 ± 0.04 vs. −0.61 ± 0.02, respectively; F = 13.31, P = .001). CONCLUSIONS In the presence of large macular drusen, performance on a shape discrimination task is related to the presence versus absence of abnormal retinal pigmentation, being poorer in the higher-risk group, supportive of the measure's potential to predict progression to advanced AMD.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,

Ophthalmology

The story is the thing - The Birth of Indian Journal of Ophthalmology Case Reports Santosh G Honavar Indian Journal of Ophthalmology - Case Reports 2021 1(1):1-1

Diamonds are forever… and so are case reports Carol L Shields, Jerry A Shields Indian Journal of Ophthalmology - Case Reports 2021 1(1):2-3

Verrucous carcinoma: A rare variant of eyelid squamous cell carcinoma Tarjani V Dave, Sasi Pyda Indian Journal of Ophthalmology - Case Reports 2021 1(1):4-4

Periocular cutaneous leishmaniasis Md Shahid Alam, Sanhita Chatterjee Indian Journal of Ophthalmology - Case Reports 2021 1(1):5-5

Beware of the bruise: Eyelid and periocular cutaneous angiosarcoma Tarjani V Dave, Richa D Wagh, Dilip K Mishra Indian Journal of Ophthalmology - Case Reports 2021 1(1):6-6

Congenital keratopellis R Balamurugan, Parul Chawla Gupta, Sameer Sethi, Savleen Kaur, Jagat Ram Indian Journal of Ophthalmology - Case Reports 2021 1(1):7-7

Pre-Descemet's corneal dystrophy Alka Sonkeshri, Deepshikha Agrawal, Samrat Chatterjee, Sharad N Gomase Indian Journal of Ophthalmology - Case Reports 2021 1(1):8-8

An interesting case of corneal burn following electrocution Shweta Patro, Anushri Agrawal, KS Siddharthan Indian Journal of Ophthalmology - Case Reports 2021 1(1):9-9

Intracameral fungal bridge Mohamed Ibrahime Asif, Suman Lata, Shristi, Rahul Kumar Bafna, Rajesh Sinha Indian Journal of Ophthalmology - Case Reports 2021 1(1):10-10

Complete Schwalbe's ring in Axenfeld-Rieger anomaly Sagarika Snehi, Gaurav Gupta, Deepika Dhingra, Sushmita Kaushik Indian Journal of Ophthalmology - Case Reports 2021 1(1):11-11

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Social Psychiatry

Substance abuse in the elderly: A hidden behemoth Subhash Das, Siddharth Sarkar Indian Journal of Social Psychiatry 2020 36(4):267-269

Of mice and men.....The unforgettable narrative of how social factors shape substance use, addiction, and recovery Debasish Basu Indian Journal of Social Psychiatry 2020 36(4):270-276 The currently predominant model to explain addiction is the brain disease model of addiction, which emphasizes drug-induced brain changes at the individual level, producing an uncontrollable, chronic relapsing disease. It tacitly de-emphasizes the complex sociocultural, contextual, and other environmental determinants of substance use and addiction. In this oration, I challenge these assumptions with a hop-and-stop tour of five countries: Canada, the USA, India, Vietnam, and Iceland. The journey covers five narratives: isolation, pain, frustration, and then the positive narrative of recovery, and finally the narrative of hope. The socially enriched rats in the “Rat Park” in a laboratory in Canada consumed much less morphine than the isolated, caged rats. People dying of opioid overdose in the worst-ever opioid epidemic in the USA might be using opioids as an escape from broadly defined “pain,” where pain is an emblem of deeper societal isolation and suffering. In Punjab, India, frustrated youths due to complex socio-political-economic reasons are falling easy prey to the profiteering drug mafia. On the positive side of the narratives, most of the Vietnam war veterans who had been using heroin heavily while in Vietnam quit after returning to the comfort of their home, family, and friends, thus providing the narrative of recovery. Finally, the Icelandic Model, a series of pro-social policy measures at the government level targeting the children, the parents, the school, and the environment in Iceland, where teenage substance abuse had been peaking alarmingly in the mid-1990s, demonstrated the preventive prowess of these measures. All in all, this journey teaches us vital lessons not to forget the social psychiatry of addiction. It also teaches us that it would be a wise investment to improve the social determinants of health, including mental health and addiction.

The role of "Attributions" in social psychology and their relevance in psychosocial health: A narrative review Debanjan Banerjee, Chehak Gidwani, TS Sathyanarayana Rao Indian Journal of Social Psychiatry 2020 36(4):277-283 Assigning motives or reasons to situations and actions have been the basic premise of human existence. Attributing cause to an action makes it logical and easier to comprehend. In social psychology, attribution is the process through which individuals explain the causes of behavior and events. Various theories and models have been proposed to explain this concept, starting from the early works of Fritz Heider in the early 20th century and further advances by Harold Kelley and Bernard Weiner. Attributional concepts can be used in a wide arena of behavioral science ranging from mental health stigma-related interventions to consumerism, corporate and jury psychology, and finally, attributional bias in psychosis and learned helplessness in depression. Attribution theories are viewed as the relevant concepts in the exploration and explanation of a wide repertoire of psychopathologies, especially for culture bound syndromes. Research into the translational use of attributional theories has declined in the recent years, the models being criticized for being mechanistic and reductionistic in approach. Nevertheless, the role of “attributions” in social psychology remains equally important today to explore the various facets of human behavior and reactions. The article explores the relevance of attributions in the fields of psychosocial health. It discusses various theoretical perspectives and frameworks premised on attributional models and narrates the understanding as well as the applications of the relevant theories in the realms of stigma research and consumerism. The criticism and implications in mental health are highlighted thereafter.

Care of transgender individuals in India: A clinical perspective Shiva Prakash Srinivasan, Sruti Chandrasekaran Indian Journal of Social Psychiatry 2020 36(4):284-288 India is making rapid strides in recent times in recognizing and providing legal supports to the transgender community. An increasing number of individuals are seeking medical assistance for gender-affirming medical interventions. Many medical and surgical practitioners working with transgender clients in the Indian subcontinent face clinical and social challenges. In this article, we highlight some of the common challenges experienced by healthcare professionals and the solutions adopted in providing care for transgender clients.

Social media disorder among Indian undergraduate medical students and its association with depression: An institution-based mixed-method study Rajib Saha, Manisha Sarkar Indian Journal of Social Psychiatry 2020 36(4):289-295 Background: Social media disorder (SMD) is the current entity in this decade that leads to different screen-related health problems. Despite of tremendous academic pressure, how social media affects the future doctors, is yet unknown. Aims: The aim is to determine the prevalence of SMD among the undergraduate medical students of a tertiary care hospital in West Bengal and to determine its predictors. Settings and Design: A cross sectional analytical mixed-method study was conducted at a tertiary care center of Bankura. Methodology: During April–June 2019, 216 undergraduate medical students were selected through two-stage sampling method. Data were collected using semi-structured questionnaire, 9-item SMD scale, and Beck's Depression Inventory Scale. Statistical Analysis Used: Data were analyzed using SPSS (version 16) initially through bivariate analysis using Chi-square test and later logistic regression was used to determine the actual predictor(s). Results: The prevalence of SMD was found to be 11.6%. All of the students were found to be social media users and among them the prevalence of screen-related sleep disturbance, headache, eye problem, musculoskeletal problems, and overweight or obesity was 35.6%, 36.1%, 28.7%, 31.5%, and 50.9%, respectively. However, no significant relationship was obtained between SMD and above health problems. Through logistic regression model, it was found that the students with depression were 6.7 times more prone to develop SMD. Conclusions: Depression being a risk-factor for SMD needs to be addressed as priority by providing appropriate counseling and/or professional consultation.

Taking therapy beyond clinics – An evaluation of family therapy training program with lay counselors Janardhana Navaneetham, Tania Roy Indian Journal of Social Psychiatry 2020 36(4):296-302 Background: Families have been accommodating the changes to suit the present situation. Indian families even though structurally moving toward nuclear families, still carry on the values of the joint families of connectedness, interfamily influences, extended family influences on decision-making, etc., Subjects and Methods: The study aims at understanding the effectiveness of family training with lay counselors. An interview schedule was prepared to collect sociodemographic profile, knowledge about family therapy (FT), and confidence of practicing FT. The participants were enrolled for training based on ‘first come first serve’; those who completed postgraduation and PG diploma were included for the training program, and most of them were involved in the helping profession either as part of the training or service. This study was of a quasi-experimental design with assessments at two timelines – pre-post training sessions. Results: Most of them expressed that they had previously worked with families with child abuse, academic difficulties in children, marital issues, domestic violence, etc. A test of Wilcoxon's signed-rank test showed the change in the knowledge and confidence level of the trainees. Nearly 48.1% and 46.3% of the participants felt they have high and moderate skills in identifying cases that require family interventions, respectively, 70.4% said that the sessions were high in clarity, while 25.9% reported moderate clarity. Almost 68.5% expressed no difficulty in understanding sessions. This article attempts to share their experience of conducting the dissemination of systemic family intervention for the people in the service sector. It was found that the participants appreciated the training programs and were able to see the benefit of including systemic approach in their family intervention. Conclusion: This article attempts to share the experience of conducting the dissemination of systemic family intervention for the people in the service sector. It was found that the participants appreciated the training programs and were able to see the benefit of including systemic approach in their family intervention.

Impact of social-emotional learning intervention on emotional intelligence of adolescents Shruthi Kothari, Mareena Susan Wesley Indian Journal of Social Psychiatry 2020 36(4):303-309 Adolescents face a variety of challenges, some of which include social, emotional, cognitive, and interpersonal. In order to help them with their emotions, adolescents should be taught a variety of skills to regulate and handle emotions better. With this intent in mind, a social-emotional learning (SEL) intervention module was developed by the researchers. This module covered aspects related to self-awareness, social awareness, responsibility, empathy and decision-making. These components also form the basis for emotional intelligence (EI) which is defined as the ability to perceive, understand, and regulate emotions of oneself and others. The present study aimed to understand if there arises any difference in scores of EI post the SEL intervention. Second, the gender differences with respect to EI were also be analyzed. The EI Scale (2014) was administered to 80 students between the age group of 13–14 years, from a CBSE school in Chennai. These adolescents were selected through the convenience sampling, and the four subscales were also analyzed. The findings from the study revealed a significant difference in scores from pretest to posttest (t = −4.66, P < 0.05). With respect to gender, no significant difference was found. On the subscales, two of four subscales showed significant difference in understanding emotions (Z = −4.63, P < 0.05) and handling emotions (Z = −4.023, P < 0.05).

The influence of social environment on children of a commercial sex worker V Deepa, MY Manjula Indian Journal of Social Psychiatry 2020 36(4):310-316 The case study aims to understand the influence of social environment on the course of life of children of a commercial sex worker. The participants of the study were two sons of a commercial sex worker who grew up in different environments. The older sibling who is 19 years of age (case 1) lives with his mother, whereas the younger sibling who is 17 years of age (case 2) lives in a hostel distant from everyday influence of a brothel. The study adopts multiple case study design and in-depth interviews were conducted to gather data. The obtained data were subjected to thematic analysis. Each case was analyzed individually, and then cross comparison of the themes derived was carried out. The themes derived on analyzing case 1 were social categorization, mercenary activity, substance aficionado, complacency in life, and compliance with life while the themes derived on analyzing case 2 were disgust toward commercial sex work, feeling of precariousness, antipathy toward home environment, irrational thoughts and anticipation of a better future. The only overlapping issue that emerged in both cases was being protective about their mother. It was concluded that environmental variance contributes to the difference in experience and perception of the situation and society.

Medical students and marijuana, attitudes and beliefs: A comparative study Gurappa Puttanna Gururaj, Ruth Sneha Chandrakumar Indian Journal of Social Psychiatry 2020 36(4):317-320 Background and Objectives: Various studies indicating that cannabis is associated with various psychiatric disorders despite which is a controversy existing regarding the legalisation of cannabis by all the promoters and consumers of the substance. Our objective was to find out the knowledge and awareness among the 1st year and final year medical students toward the effects and experiences with the consumption of cannabis. Methodology: It was a cross-sectional study done on first and final year medical students between July 2019 and August 2019 in Sri Devaraj Urs higher education and research center, who are assessed using a structured and validated instrument, Marijuana Effect Expectancy Questionnaire-Brief (MEEQ-B) questionnaire. Results: Both the first-year and final-year medical students in our study had poor awareness and inadequate knowledge about the various adverse effects of cannabis, especially on all the six parameters of the MEEQ questionnaire. Conclusion: Extensive and elaborative teaching regarding substance use, especially of cannabis and its implication must be updated in the curriculum of both UG teaching and PG teaching in other specialities as well.

Psychological aspects of infertility: A comparative study Nigesh Kalorath, Tilottama Mukherjee Indian Journal of Social Psychiatry 2020 36(4):321-326 Introduction: Psychosocial aspects of infertility in couples are of much relevance. This paper attempts to compare psychological factors that may play a role in couples with and without infertility. The main objectives are to examine the differences concerning marital quality, attachment styles, and defense styles of infertile and fertile couples. Methods: A total of 60 individuals (30 infertile couples and 30 matched fertile couples) were assessed through administering the personal information schedule, Marital Quality Scale, Attachment Style Questionnaire, and Defense Style Questionnaire-40. General Health Questionnaire-28 was administered in the fertile couples to rule out psychiatric morbidity. Results: Statistical analyses revealed that infertile couples differed from fertile couples on marital quality dimensions of understanding, satisfaction, trust, role functioning, despair, and rejection. On the attachment style, component of preoccupation with relationships and the use of immature defenses such as acting out and displacement. Conclusions: This research identified several psychological dimensions related to fertility. Understanding these factors may be helpful for the couples, their family members, and practitioners, with regard to the psychological and social needs related to infertility.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Dental Sciences

Knowledge, attitude, and practices of parents on the importance of their Children's oral health in Greater Noida, India Sukhdeep Singh, Neha Awasthi, Dhirja Goel, Deepak Khandelwal, Priyanka Sachdeva, Rakshana Bakhtawar Indian Journal of Dental Sciences 2021 13(1):1-5 Background: Parents and family members are considered the primary source for knowledge about child rearing and health habits for children. Young children's oral health maintenance and outcomes are influenced by their parent's knowledge and beliefs, which affect oral hygiene and healthy eating habits. Parental perception has a long-term influence in determining a child's oral health status. Aim: The aim of this study is to assess the oral health-related knowledge, attitude, and practices (KAP) of parents with children aged 3–5 years. Materials and Methods: A total of 500 parents of children aged 3 to 5 years were included in the study. A self-administered questionnaire, written both in English and local language (Hindi), validated through pre-tested survey, was given to the parents to assess the oral health related KAP. The results were calculated on the basis of frequency and percentages using the SPSS software. Results: Males comprised 49.8% and females comprised 50.2% of the respondents of questionnaire. Majority of fathers and mothers of the study population agreed for the importance of primary teeth. Almost all the participants in this study agreed that a child's teeth should be brushed/cleaned. A little less than half of study population considered 1 year as the suitable age for the child's first dental visit. A higher proportion of females as compared to males felt that night time bottle/breastfeeding leads to caries. Conclusion: Parental attitude, knowledge, and practices are responsible for their child's oral health. No statistical significance was seen between mothers and fathers on perception of their child's oral health care.

The role of decalcified freeze-dried bone allografts in the healing of postoperative osseous defects resulting from cyst enucleation: A pilot study Tejashvini Joshi, Neha Vyas, Nitu Shah, Saket Thaker, Nesha Sanghvi Indian Journal of Dental Sciences 2021 13(1):6-11 Background: We performed this pilot study to evaluate the osteoinductive potential of decalcified freeze-dried bone allografts (DFDBA) in the healing of postsurgical osseous defects after cyst enucleation through radiographic bone density monitoring over a 6-month period. Materials and Methods: Patients aged between 18 and 70 years of either gender with noninfected odontogenic or nonodontogenic cystic jaw lesions measuring 1–5 cm in size were enrolled and randomly assigned to study group or control group. The study group patients were filled with DFDBA graft in bony defects resulting from the enucleation of the cysts, whereas no filling material was used in the control group. Sutures were removed on the 7th postoperative day and healing was assessed. Further follow-up visits were done at 1, 3, and 6 months. Bone densities were recorded with grayscale histogram using Adobe Photoshop (version CS 5.1) and compared across all follow-ups. Results: A total of 20 patients were enrolled in the study. Both the groups were balanced in terms of the baseline (preoperative) characteristics. There was a significant increase in bone density in the study group as compared to the control group at months 1, 3, and 6 after the surgery. There was an overall percentage increase in bone density (postoperative density as reference) at months 1, 3, and 6 in the study and control groups. However, the increase was significantly greater in the study group as compared to the control group at month 3 and month 6, whereas there was no difference between both the groups at month 1. Conclusion: Our findings suggest the osteoinductive potential of DFDBA in the healing of osseous defects resulting from the enucleation of cysts.

Epidemiological and clinicopathological analysis of oral leukoplakia in Patna Madhuresh Kumar, Manisha Singh, S Suwasini Indian Journal of Dental Sciences 2021 13(1):12-17 Background: The early detection of oral potentially malignant disorder can reduce the transformation risk to oral squamous cell carcinoma, thereby reducing cancer morbidity and mortality. Aim: To obtain epidemiological information of oral leukoplakia (OL) and distribution of this disease in Patna. Subjects and Methods: Data were collected and analyzed for prevalence of OL among gender, age group, various oral sites, habits, and clinical and histopathological basis. Results: The overall prevalence shows high incidence of homogenous leukoplakia along with mild dysplasia in middle age male persons. Conclusion: Appropriate steps should be taken for early intervention, as it is the key to effective prevention.

Evaluation and comparison of smear layer removal potency of three different irrigation regimes – A stereomicroscopic and scanning electron microscopic study Megha C Patel, Roshni A Bhatt, Kaushal R Joshi, Lilavanti L Vaghela Indian Journal of Dental Sciences 2021 13(1):18-23 Background: Irrigation plays a pivotal role in pulp therapy owing to its flushing action and removal of the smear layer which if present prevents penetration of medicaments and sealers into the dentinal tubules. Aim: This study aims to evaluate and compare the smear layer removal potency of three commercial Irrigating agents. Materials and Methods: Single rooted 30 teeth were selected, decoronated, and randomly divided into three groups according to the irrigation regime to be used (Group I − 5% sodium hypochlorite [NaOCl] + ethylenediaminetetraacetic acid [EDTA], Group II – Chloraxid Gel + EDTA, Group III – Tween Kleen + 3% NaOCl). After recommended biomechanical preparation and irrigation, teeth were stained with 1% methylene blue dye for 24 h and sectioned in 2 halves. Stereomicroscopy was used to assess dye penetration and scanning electron microscope (SEM) analysis was done to detect dentinal surface changes. Data were analyzed using one-way ANOVA test and Tukey honestly significant difference test by statistical software SPSS version 20.0. Results: The highest dye penetration exhibiting smear layer removal for the apical third was seen in Group II (44.78) and for the middle third in Group I (64.73) which was statistically significant. SEM analysis showed maximum dentinal tubules visibility and patency in Group I and minimum in Group III. Conclusion: Newer irrigating materials (1-hydroxyethylidene-1, 1-bisphosphonate) exhibited weak potency for smear layer removal. The sequential use of gold standard NaOCl + EDTA gave satisfactory results, however, in apical third NaOCl Gel + EDTA was found to be more effective. Therefore, it can be prudent to use NaOCl Gels as a safer alternative to conventional means.

Comparing original and universal screwdrivers in terms of torque loss in the abutment screw Vasilios Alevizakos, Nadine Achilles, Björn Rahlf, Philipp Jehn, Marcus Schiller Indian Journal of Dental Sciences 2021 13(1):24-29 Objective: The aim of this study was to examine whether tightening or loosening the abutment screw results in torque loss and whether there is a difference in this respect between original screwdrivers and universal screwdrivers. Materials and Methods: For the purpose of the study, two groups were formed, with the original screwdriver used in group 1 and the universal screwdriver used in group 2. One Straumann implant and one BEGO implant were each inserted into a stationary torque transducer. The next step was to screw 13 abutments into each implant with 13 original abutment screws, using the screwdriver assigned to the group with the torque specified by the manufacturer. To establish whether the torque transmitted to the abutment screw via the screwdriver is also transmitted to the implant rather than causing deformation of the screw head or being transmitted to the surrounding area, the actual torque transmitted from the screw to the implant was measured and recorded electronically during the experiment. Results: There was no loss of torque in the transmission of the tightening torque to the Straumann implant with either screwdriver (P > 0.05). There was a loss of torque in the transmission of the tightening torque to the BEGO implant when using the universal screwdriver but not with the original screwdriver (P < 0.01). Relative to the previously applied tightening torque, a loss of torque when loosening the screw was found with both screwdrivers, both Straumann (P > 0.05) and BEGO (P < 0.05). Conclusion: Using universal screwdrivers can result in loss of torque. The loosening torque is thus decreased, which in turn increases the likelihood of complications such as screw loosening.

Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewer in Bihar population: A community-based research Rashi Chauhan, Amit Kumar Singh, Kriti Singh, Khushboo Rani, Kumar Anand, Aparajita Tiwari Indian Journal of Dental Sciences 2021 13(1):30-33 Background: The aim of the study was to determine the prevalence and severity of oral submucous fibrosis (OSMF) among habitual gutkha, areca nut, and pan chewers of Bihar population. Materials and Methods: The study was conducted of 3000 adult patients aged over 15 years who visited the Department of Oral Medicine and Radiology, Buddha Institute of Dental Sciences and Hospital. They were subjected to a thorough oral examination, and the bindings were recorded in the prescribed WHO Pro forma. Results: Our study revealed that the prevalence of OSMF was 1.6%. The prevalence among males was 2.60% and among females was 0.16%. All the 243 cases (100%) were associated with areca nut habits. Conclusion: Educating the population about the deleterious effects of the practice of tobacco and related habits on the body in general and the oral cavity. It is hoped that this study would serve as a reference for further epidemiological studies on the abovementioned lesion in this region.

The bridge connecting sella turcica and palatally impacted canine Isha Aggarwal, Ashwin Pradhan, Sanjay Mittal, Mandeep Kaur Bhullar, Aman Sachdeva, Merry Setia Indian Journal of Dental Sciences 2021 13(1):34-39 Introduction: The calcification of sella trucica bridge might be positively associated with canine impaction, the reason being that sella turcica, dental epithelial progenitor cells along with maxilla, palatal, and frontonasal development share a common embryological origin (neural crest cells). Therefore their assessment might provide useful clinical information in predicting palatal canine impaction. Aim: To evaluate the calcification of sella turcica bridging in patients with palatally impacted canine. Materials and method: A total of 21 pretreatment lateral cephalograms of patients with palatally impacted canine and 29 patients with normally erupted canine were selected for the study. Lateral cephalograms of the patients were acquired and landmark were identified and marked. Various Sella values (sella length/interclinoid distance, sella depth, sella diameter) were measured. The values obtained were then subjected to statistical analysis. Result: Suggested that patients with a palatally impacted canine showed smaller interclinoid distance. The frequency of sella bridging was significantly higher in subjects with canine impaction than in controls (P <0.001). Conclusion: Sella bridging is frequently found in palatally impacted canines. The smaller intercliniod distance could be an indicative factor for diagnosis of palatal canine impaction.

Accidental displacement of third molar root into the lingual pouch: A case report and review of treatment approaches Mudit Agarwal, R Muthunagai, Amit Agarwal, Himanshu Aeran Indian Journal of Dental Sciences 2021 13(1):40-42 Third molar surgery is the most common procedure performed by oral and maxillofacial surgeons. A thorough understanding of the complications associated with this procedure will enable the practitioner to identify and counsel high-risk patients, appropriately manage more common complications, and be cognizant of less common sequelae and the most effective methods of management. We present a case of displaced third molar root into the lingual pouch (submandibular space) and ways to prevent and manage this rare complication. In this article, we have compared different surgical approaches for the removal of displaced root from the submandibular space.

Ectopic nasal tooth associated with cleft lip and palate Subhransu Basu, Sudipto Sahu, Abhinaba Bose, Sucharu Ghosh Indian Journal of Dental Sciences 2021 13(1):43-45 Ectopic nasal tooth is a rare phenomenon with only 0.1%–1% incidence rate. They are more frequently found coupled with cleft lip and palate. Here, we present a case of intranasal tooth in a 12-year-old male child with operated cleft lip and palate. The condition was diagnosed only on the basis of intraoral periapical radiograph and was extracted using gauge-holding forceps at a rural health-care center. We discuss the possible etiology, clinical findings, diagnosis, and treatment modalities of this condition. The purpose of this paper is to highlight that this rare condition can be managed with minimum available equipment in a rural setup.

Misdiagnosis or missed diagnosis? Cone-beam computed tomography-aided multidisciplinary management of maxillary central incisor with palatogingival groove R Kurinji Amalavathy, KM Vidya, Sonali Nabil Sarooshi, Hrudi Sundar Sahoo Indian Journal of Dental Sciences 2021 13(1):46-49 Palatogingival groove is a developmental anomaly that is most often seen on maxillary incisors, with a predilection for lateral incisors. It begins in the central groove and can extend to varying lengths and depths into the root. This groove can communicate with the pulp internally and periodontium externally, thereby establishing a milieu for the development of complex endodontic-periodontic lesion. In this article, we report multidisciplinary management of a maxillary central incisor, which was mistaken to be a vertical root fracture instead of a palatogingival groove. We also discuss the significance of early recognition of this lesion, differential diagnosis, and it's interdisciplinary management with the aid of cone-beam computed tomography.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Tropical Pathology

Histopathologic analysis of endometrial biopsies in a Northern Nigerian Teaching Hospital Murtala Abubakar, Balarabe Kabir, Almustapha Aliyu Liman, Sani Muhammed Shehu, Bilkisu Lawal Kankia, Anisa Yahya, Zainab Adamu Ali Annals of Tropical Pathology 2020 11(2):101-106 Background: Endometrial biopsy is a reliable means of evaluating the physiologic and pathologic states of the endometrium. The aim of this study was to examine the histopathological pattern of endometrial biopsies as seen in Zaria, Nigeria and to compare the results with similar studies elsewhere. Method: A retrospective analysis was carried out based on the records of the Department of Pathology, Ahmadu Bello University Teaching Hospital, Shika, Zaria between January 2014 and December 2018. The neoplastic lesions were classified according to 2014 World Health Organization classification for endometrial neoplasms. Results: A total of 1518 endometrial tissue samples were analysed. Pregnancy related conditions (41.76%) and functional endometrial changes (27.24%) were the most common morphologic diagnostic category seen. Endometrial hyperplasia (7.13%) was the most common pathologic lesion diagnosed. Of the malignant endometrial tumours, endometrial carcinoma is the most common with 29 cases (58% of all malignant endometrial lesions). One Hundred and Nine cases (7.2%) of the total cases reviewed were found to be inadequate for histopathologic evaluation. Conclusion: Retained product of conception was the most common morphologic entity seen in endometrial biopsy in Zaria. The proportion of endometrial samples that are inadequate for histopathologic evaluation is high. There is a need, therefore, for retraining of staff and standardization of biopsy procedures.

Seroprevalence and factors associated with risk of human brucellosis among febrile patients attending health-care facilities in Bauchi, North-Eastern Nigeria Hafiz Halilu, Fatima J Giwa, Saad A Ahmed, Mu'awiyyah B Sufiyan, Amina I Mohammed Annals of Tropical Pathology 2020 11(2):107-112 Background: Brucellosis is a neglected underdiagnosed zoonotic disease of worldwide distribution with varying symptoms similar to those occurring in other febrile illnesses. A recent screening survey conducted among butchers in Bauchi state reported a high prevalence of human brucellosis; however, its burden among patients with other febrile illnesses is unknown. We determine the seroprevalence and factors associated with risk of brucellosis among febrile patients attending health-care facilities (HCFs) in Bauchi metropolis, North-Eastern Nigeria. Methodology: We conducted a hospital-based descriptive cross-sectional study of 382 participants using a multistage sampling technique. Brucella antibodies were detected using Rose Bengal plate test, and a questionnaire was used to identify risk factors associated with human brucellosis. Data analyses were conducted using Epi Info version 7.0. Bivariate and multivariate analyses were conducted at P = 0.05. Results: Fifty-seven (14.9%) of the 382 febrile patients tested had Brucella antibodies. Males: female ratio was 1.1:1, and the mean age was 29.9 (standard deviation ± 12.03). Age, sex, occupational status, keeping animals, having ever milked an animal, handling animals during birth, and consuming unpasteurized milk or meat were found to be significantly associated with brucellosis on bivariate analysis. Conclusions: Up to 14.9% of the febrile patients attending HCFs in Bauchi metropolis had Brucella antibodies. Age, occupational status, consuming unpasteurized milk or meat, handling animals during birth, and lack of awareness on zoonosis remained independent predictors for brucellosis. Therefore, conducting routine serological screening tests for Brucella antibodies in all febrile patients presenting to HCFs will assist in its diagnosis and proper management.

Breast lesions in a district hospital: Demographic and histopathologic characteristics Kevin Nwabueze Ezike, Solomon Raphael, Ijeoma Ahunna Okwudire-Ejeh, Damian Ikechukwu Okonkwo Annals of Tropical Pathology 2020 11(2):113-118 Background and Aim: Breast cancer is increasingly the most common malignancy among Nigerian women. This study documents the demographic and histopathologic characteristics of breast lesions in a district hospital over a 5-year period. Patients and Methods: Data were collated from patients' request forms and duplicate copies of histology reports of all cases seen under the study period. Results: Breast lesions represented 13% of all histologically diagnosed lesions during the period of the study. Almost 98.6% of these breast specimens were received from females, with a female-to-male ratio of 58.9:1.0. The overall age range of the patients seen was from 10 to 96 years, with a mean of 33.3 ± 13.1 years at the time of presentation. There were 37 (4.4%) nonneoplastic breast lesions, 547 (65.3%) benign breast neoplasms (BBNs), and 254 (30.3%) malignant breast neoplasms (MBNs). The peak age incidence of MBNs was seen in the fifth decade (33.1%). The most common BBN was fibroadenoma (54.5%), followed by fibrocystic change (29.3%). The most common MBN was invasive ductal carcinoma (84.3%), followed by lobular and mucinous carcinoma, each accounting for 4.3%. About 77.1% of the breast carcinomas were Grade II. Conclusion: Breast lesions are common in our setting, strikingly more common in females, predominantly benign in nature with fibroadenoma which peaks in the 20–29 years age group being the most common variety. Invasive ductal carcinoma is the most common malignancy, affecting more women in their 40s with one of every three cases seen in women before their 40th birthday.

Indications and diagnostic utility of bone marrow aspiration cytology: A 12-year experience at a tertiary health center in Gombe, Northeastern Nigeria Saleh Yuguda, Ahmed Iya Girei, Kasim Mohammed Pindiga, Rufai Abdu Dachi, Aliyu Ibrahim Lawan, Yusuf Mohammed Abdullahi Annals of Tropical Pathology 2020 11(2):119-122 Background: Bone marrow aspiration (BMA) cytology is very important in the diagnosis and management of a wide range of both hematological and nonhematological disorders. It has several indications ranging from the evaluation of cytopenias to staging and assessment of remission in the course of management. Aim: The aim of the study was to determine the indications and diagnostic utility of BMA cytology at the Federal Teaching Hospital, Gombe, Gombe State, Nigeria. Methodology: A retrospective review of BMA cytology records performed at the department of Haematology and Blood Transfusion of the Federal Teaching Hospital, Gombe, over a 12-year period from January 1, 2006, to December 31, 2017. Results: A total of 596 BMAs were performed over the study period. The age ranges were from 2 months to 88 years, with a median age of 36 years. Majority of the patients were males (61%). The most common indication for the bone marrow examination was for the evaluation of recurrent anemia 32.2%, followed by presumptive diagnosis of leukemia 27.7%. Normal marrow finding constituted 4.7%, while the diagnosis was inconclusive in 4.2% of the cases. The most frequently diagnosed diseases are the nutritional deficiency anemia together accounting for about one-third of the cases (megaloblastic anemia 20.3%, combined deficiency anemia 9.9%, and iron deficiency anemia 2.5%) and leukemia. Conclusion: Anemia and leukemia are the most common indication for BMA, and nutritional deficiency anemia is the major BMA diagnosis in Gombe, Northeastern Nigeria.

Adherence to glivec (imatinib mesylate) therapy amongst patients with chronic myeloid leukaemia in Nigeria Charles Erhinyodavwe Origbo, Rahman A Bolarinwa, Anthony A Oyekunle, Temitope O Afolabi, Benedict Nwogoh, Muheez A Durosinmi Annals of Tropical Pathology 2020 11(2):123-127 Background: Adherence to Imatinib (Glivec®) is of critical importance in achieving optimal treatment outcomes in patients with chronic myeloid leukemia (CML). Objective: This study aims to investigate adherence to therapy and factors that could influence patient adherence to Glivec®. Methods: This is a prospective cohort study conducted at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. Seventy consenting newly diagnosed CML patients in the chronic phase were counseled on adherence to therapy and administered 400 mg/day dose of Glivec. Six months after commencement, they were evaluated for adherence using two structured self-administered questionnaires. The first one to evaluate adherence (Morisky Medication Adherence Scale) and the other was administered to identify factors known to influence adherence to therapy. Data were analyzed using SPSS version 21.0 Statistical package (2012, IBM Corp, Armonk, NY, USA.). Results: The study participants had a mean age of 38.4 ± 12.7 years. The male-to-female (male:female) ratio was 1.7:1. Thirty-three (47.1%) of the patients were classified as adherent. Family support was significantly associated with adherence (P = 0.012). The distance of >200 km away from the point of drug collection, OAUTHC, Ile-Ife was significantly associated with nonadherence to Glivec therapy (P = 0.008). Conclusion: This study found that adherence in patients on Glivec® therapy was <50%. Distance of >200 km and family support were significant determinants of adherence in this study.

Overexpression of human epidermal growth factor receptor 2 protein in urothelial carcinoma of the urinary bladder in Ibadan: A single-institutional experience Ebenezer O Fatunla, Mustapha A Ajani, Francis A Onakpoma, Augustine O Takure, Clement A Okolo Annals of Tropical Pathology 2020 11(2):128-132 Background: Overexpression of human epidermal growth factor receptor 2 (HER-2) protein has been shown to have both prognostic and therapeutic values in several malignancies including urothelial carcinoma of urinary bladder (UCB). Aims: This study aimed to determine HER-2 protein overexpression and evaluate its correlation with clinico-pathological parameters in UCB. Materials and Methods: This was a descriptive-analytical study involving the immunohistochemical review of all histologically diagnosed urinary bladder malignancy in the Department of Pathology, University College Hospital, Ibadan, between January 2002 and December 2016. Urinary bladder malignancies whose tissue blocks could not be found and/or demographic data were not available were excluded. Immunohistochemistry analysis was done using rabbit anti-HER-2 antibody (Biocare) and American Society of Clinical Oncology/College of American Pathologists guidelines established for breast cancer were used for HER-2 status scoring. The statistical analysis was carried out usingthe Statistical Package for the Social Sciences, version 22 (SPSS Inc, Chicago, Illinois, USA). Results: HER-2 overexpression was found in four (6.3%) cases. All the HER-2-positive cases were males. One (2.9%) of the 35 high-grade UCB showed positive HER-2 overexpression, whereas three (10.7%) of the 28 low-grade tumor were positive for HER-2 protein overexpression.There was no statistically significant association between HER-2 protein overexpression and histological grades of UCB and muscle invasion by the tumor. Conclusion: Our study demonstrated the low percentage of HER-2 overexpression in UCB with no significant association with tumor grades and muscle invasion. Larger samples involving multiple centers can provide more robust information and further evaluate HER-2 overexpression in urothelial carcinoma in our environment.

Antimicrobial activity of garlic (Allium sativum ) on selected uropathogens from cases of urinary tract infection Okunye Olufemi Lionel, Idowu Philip Adegboyega, Adeleke O Ezekiel, Babalola Caroline Olufunke Annals of Tropical Pathology 2020 11(2):133-138 Introduction: The etiologic agents of urinary tract infection (UTI) occur among both the Gram-positive and Gram-negative bacteria including those that exhibit resistance to commonly used standard antibiotics. Both the male and female individuals can be prone to developing UTI. Garlic (Allium sativum) has been associated with antibacterial activity, though with scanty reports on uropathogens. This study was, therefore, carried out to determine the antibacterial efficacy of aqueous and methanol extracts of garlic (A. sativum)in vitro against six uropathogens (Escherichia coli , Staphylococcus saprophyticus, Pseudomonas aeruginosa, Proteus spp., Klebsiella spp., and Serratia marcescens ) and a reference strain, E. coli ATCC-25922 . Materials and Methods: The bacterial isolates were collected from the Routine Microbiology Laboratory, University College Hospital, Ibadan, and were authenticated by Gram staining and some conventional biochemical tests. The isolates were then subjected to antimicrobial susceptibility testing against both the aqueous and methanol extracts of garlic. Phytochemical screening was also carried out on the plant. Results: Both aqueous and methanol extracts had maximum zones of growth inhibitions of 22 mm at 200 mg/mL and 25 mm at 200 mg/mL against E. coli, followed by P. aeruginosa with zones of growth inhibitions of 21 mm and 25 mm at the same concentration. Proteus spp., exhibited the lowest zones of growth inhibition of 16mm at 200mg/mL.and 10mm at 25mg/mL to methanol and aqueous extracts respectively. The minimum inhibitory concentrations MICs and MBCs of the aqueous and ethanol extracts of garlic varied for each organism. Escherichia coli had the MICs' of 100mg/mL and MBC of 220mg/mL while the MIC and MBC of the aqueous extract on the Proteus spp. are 100mg/mL and 320mg/mL respectively. The MBCs recorded were relatively higher in comparison to the MIC values. Conclusion: These findings showed that garlic could be of therapeutic use in the management of bacterial mediated UTI.

Analysis of argyrophilic nucleolar organizer region score and epithelial dysplasia in common odontogenic cysts seen in a university teaching hospital Oluseyi Folake Ajayi, Oladunni M Ogundana, Moses T Kolade, Onatolu Odukoya Annals of Tropical Pathology 2020 11(2):139-145 Aim: Carcinomatous transformation in odontogenic cysts (OC) lining may be more common than is generally appreciated. Thus, the aim of this study is to predict the potential for neoplastic transformation in the epithelial lining of OC using argyrophilic nucleolar organizer region (AgNOR) scores and degree of epithelial dysplasia. Subjects and Methods: A retrospective clinicopathological study was undertaken on OC histologically diagnosed over a 40-year period in a university teaching hospital in Southwestern Nigeria. Paraffin blocks of selected cases were retrieved and sectioned for hematoxylin and eosin and AgNOR stain. Evaluation of epithelial dysplasia was done using the WHO 2005 protocol. Estimation of atypical features and AgNOR scoring were done using modified and established protocols. Epi info and GraphPad InStat software packages were employed to manage the ensuing data. Results: The commonly observed OC was odontogenic keratocyst (OKC), which accounted for 44.5%, radicular cyst (RC) (24.2%), calcifying odontogenic cyst (COC) (12.7%), and dentigerous cyst (DC) (11.5%). Nuclear pleomorphism was the most common atypical feature and was present in 50% each of DC and COC, 42% of OKC, and 36% of RC. Drop-shaped rete pegs were rarely observed. A significant association was observed between the presence of moderate dysplasia and histologic type of OC (P = 0.022). Mean AgNOR scores per 100 cells was OKC (137.38 ± 35.82), RC (132.04 ± 34.22), COC and DC (119.00 ± 10.93) and (96.91 ± 38.88) respectively. This was not statistically significant (P = 0.218). Conclusions: As moderate epithelial dysplasia was more significantly associated with OKC than other cysts, it is concluded that the potential for malignant transformation is higher in OKC than other histologically categorized types of cysts.

Evaluation of lipid profile pattern among apparently healthy students of Niger Delta University Benedicta Erere Kasia, Victoria Y Nyondia, Promise O Oseajeh, Prohp The Prophet Annals of Tropical Pathology 2020 11(2):146-150 Background: Dyslipidemia constitutes a high risk of cardiovascular disease. Aim: This study was designed to evaluate the lipid profile pattern of apparently healthy students of Niger Delta University to detect any possible abnormality. Setting and Design: This was a cross-sectional descriptive study. Materials and Methods: A total of 102 apparently healthy students were studied. A convenient sampling technique was employed for willing participants. The studied group constituted 55 males and 47 females aged within 20–40 years. Relevant demographic data were obtained by a one-on-one interview with the participants. A blood specimen was collected for measurements of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) by standard assay methods. The data obtained were analyzed using SPSS 22.0, and the student t -test was performed at P < 0.05 for comparison of means. Results: The mean plasma TC and LDL-c values for males were significantly lower than females values of 3.865 ± 0.675 mmol/L versus 4.251 ± 0.851 mmol/L and 2.38 ± 0.49 versus 2.64 ± 0.64 with P = 0.012 and 0.023, respectively. Similarly, the mean plasma HDL-c and TGs for males were lower than female values of 1.126 ± 0.190 mmol/L versus 1.194 ± 0.224 mmol/L and 0.77 ± 0.20 versus 0.82 ± 0.27 with P = 0.099 and 0.27, respectively which were not statistically significant. The age group of 24–27 years constituted the highest mean values and the age group of 28–40 years constituted the least mean values for all the studied parameters. These values, however, did not differ statistically. Most of the participants had significantly within low-normal reference range values. Conclusion: These findings revealed within normal lipid profiles for most subjects.

Peritrabecular clefting in differentiating ossifying fibroma from fibrous dysplasia of the jaws Adetokunbo B Olawuyi, Olajumoke A Effiom, Sunday Omilabu, Onatolu Odukoya Annals of Tropical Pathology 2020 11(2):151-156 Context: Fibrous dysplasia (FD) and ossifying fibroma (OF) are the most prevalent fibro-osseous lesions in Nigerians and present with overlapping clinical, radiological, and microscopic features, resulting in diagnostic challenges for the pathologist and surgeon. Aims: The objectives of this study were to differentiate between FD and OF using clinical features, radiographic features, growth rate, and microscopic method to evaluate the prevalence of peritrabecular clefting. Settings and Design: Random sampling was used to select the sample size of 30 for each lesion from cases diagnosed from 1994 to 2014 in the oral biopsy service of Lagos University Teaching Hospital. Subjects and Methods: Hematoxylin and Eosin sections were prepared from retrieved blocks of FD and OF which had been blinded. Each section was divided into four quadrants, largest vertical and horizontal dimensions of cleft surrounding five trabeculae in each quadrant were measured with ocular grid and multiplied to project an estimation of area of each cleft. Data retrieved on clinical and radiographic information were statistically compared to differentiate between the lesions. Statistical Analysis Used: Statistical Package for the Social Sciences for Windows (version 16.0, Chicago, IL, USA) was used. Results: In the study, 77% of FD had clefts, none was seen in OF. This difference was statistically significant P = 0.001. Ill-defined radiographic borders occurred in 60% of FD, well-defined borders occurred in 81% of OF. In lesions with mixed radiolucency and radiopacity, an association was established between border definition and type of lesion. P = 0.02122. Conclusions: Peritrabecular clefting was observed in 77% of FD, while this feature was not observed in OF and could therefore serve as a reliable parameter to differentiate the lesions.

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