Periodontitis is multifactorial in nature. The effects of fluorosis as an environmental factor are not evaluated and researched to designate it as a risk factor similar to smoking. The primary objectives of this study were to investigate whether there is any association between fluorosis and periodontal disease and to assess salivary oxidative stress in fluorosed and nonfluorosed patients with periodontitis contributing to periodontal disease.

This is a case—control study with an aim to investigate whether fluorosis acts as a risk factor for periodontal disease and to assess salivary oxidative stress in fluorosed and nonfluorosed patients with periodontitis contributing to periodontal disease.

About 295 systemically healthy patients were divided into test group (n = 154 fluorosed subjects) and control group (n = 141 nonfluorosed subjects) and assessed for their periodontal status. Clinical parameters recorded were plaque index, gingival bleeding index (GBI), and Jackson's fluorosis index to assess the degree of fluorosis, and community periodontal index was to assess the periodontal status. Biochemical analysis of saliva was done for assessment of malondialdehyde (MDA) levels, superoxide dismutase (SOD) levels, and total antioxidant (TAOC) levels.

The plaque and GBI scores were found similar in fluorosed and nonfluorosed groups. Gingivitis was significantly higher in nonfluorosed than in fluorosed group; in contrast, periodontitis was significantly higher in fluorosed group than in nonfluorosed group. Gingivitis appeared to decline as the fluoride status worsened, while periodontitis showed an increasing gradient from lower fluoride score to higher fluoride score. As the degree of fluorosis increased, periodontitis also increased. The salivary antioxidant levels were found similar in both the groups.

Dalvi PJ, Vandana KL, Ghosh S, Joshi VM, Bhat K, Prakash VH. Fluorosis: Environmental Risk Factor for Periodontal Disease? J Postgrad Med Edu Res 2017; 51(4):157-161.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by periods of remission and flares of symmetrical joint inflammation slowly progressing to joint and cartilage destruction leading to deformities. Evidence is accumulating suggesting vitamin D deficiency and its correlation in autoimmune diseases including RA.

(1) Estimation of vitamin D levels in RA patients. (2) Correlation of vitamin D levels with severity of the disease.

A study population of 50 included 25 cases and 25 controls. Both males and females of 30 to 40 years of age were taken for this study. Patients of RA having any other autoimmune disease were excluded. Twenty-five healthy adults, whose ages were between 30 and 40 years, both male and female, free from any systemic illness were taken as controls. Routine systematic examination and detailed joint examination were done. Disease activity was measured in patients of RA according to Disease Activity Score (DAS-28). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and anticyclic citrullinated peptide (CCP) among other routine blood investigations were done.

In cases, the mean vitamin D level was 18.41 ng/mL with standard deviation (SD) of 7.10, while controls had mean level as 22.32 ng/mL with SD as 4.80. The difference between the two was recorded as statistically significant, i.e., p-value <0.05. While 4 (16.0%) patients had low severity, 15 (60.0%) had moderate severity, and 6 (24.0%) patients had high severity of disease as per DAS-28. Patients whose RA disease activity was high had lower vitamin D levels.

It is thus concluded that in RA patients the serum vitamin D levels are significantly lower than in healthy control, and vitamin D deficiency may be one of the causes contributing to worsening of RA.

Latief M, Abbas F, Minhas A, Dar W, Parry M, Gupta PD. Vitamin D Deficiency in Rheumatoid Arthritis and Vitamin D Levels that vary with Rheumatoid Arthritis Severity: An Indian Study. J Postgrad Med Edu Res 2017;51(4):162-165.

Bhagat P, Bharti S, Gupta P, Minz RW, Joshi K, Chhabra S. Immune Complex-positive Glomerulonephritis in Antineutrophil Cytoplasmic Antibody-positive Patients. J Postgrad Med Edu Res 2017;51(4):166-169.

Postural stability assessment is an important task that has found widespread medical and therapeutic applications. Typically, balance measurement systems are used for this purpose. The quantitative score of postural balance is very important in determining improvement of the patients suffering from balance disorder. Postural stability of humans is highly dependent on the position of centre of pressure of the body. The analysis of sway of a human body can be successfully done by studying oscillations of its centre of pressure. The distribution of foot pressure over different regions namely medial—lateral and anterior— posterior, governs the balance of the posture in both directions.

The aim of this study is to assess quantitative changes in the postural stability of patients suffering from balance disorders after providing them biofeedback based balance training.

We used Force Sensing Resistors (FSRs) to sense the magnitude of forces acting at various points of both the feet. The centre of pressure is determined using the positions of various force points and magnitude of the force acting on them. The higher capability of the body to remain at that position implies higher postural stability and a lower power of sway. The force sensors produce signal proportional to the magnitude of the foot pressure. This signal after being collected by the Data Acquisition Board is fed to the system for calculating the centre of pressure and drawing a real time graph. Different algorithms are used to determine its mean position and compare the stability. The repeated analysis shows the amount of change in patient's postural behaviour, before and after the training.

Until the publication of this research work, analysis of the data of 4 patients was performed. Post intervention trials resulted in higher scores of their postural performance. Hence, favourable results were obtained showing improvement in postural stability of the patients.

Wider variety of ataxia patients can be chosen to perform this assessment. The system is capable of determining a quantitative score of improvement of the postural stability and thus can be used to assess the postural performance of patients suffering from different postural disorders.

Bari S, Saxena S, Sherwani K, Kumar N, Dhillon MS. Effect of Balance Training on Postural Analysis of Patients suffering from Balance Disorders: A Preliminary Report. J Postgrad Med Edu Res 2017;51(4):170-174.

Dhillon HS, Dhillon S, Bachhal V, Dhillon MS. Tendinopathy and Sports: Understanding the Problem and Options of Management-perspectives from Physiotherapy, Sports Medicine, and Orthopedics. J Postgrad Med Edu Res 2017;51(4):175-181.

Complications, Outcomes, Pain, Reverse total shoulder, Shoulder hemiarthroplasty, Surgery, Systematic review.

Borade AU, Familiari F, Choi K, Joseph J, McFarland EG. Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review. J Postgrad Med Edu Res 2017;51(4):182-187.

To highlight the need of high suspicion of hemophagocytic lymphohistiocytosis (HLH) in pyrexia of unknown origin (PUO) and also the need of specific guidelines for the management of the disease.

The HLH is a rare disease of overactive histiocytes and lymphocytes. Although seen in all age groups, it is less common in adults as compared with infants. It usually presents with fever, hepatosplenomegaly, pancytopenia, lymphadenopathy, and rash. Cutaneous involvement is seen in as many as 65% of patients.

A 25-year-old male presented with high-grade fever and cough since 4 weeks. Examination at presentation revealed only hepatosplenomegaly. During the course of the disease, he developed pancytopenia, but there was no lymphadenopathy or neurological or cutaneous manifestations. The patient was thoroughly investigated, but it remained inconclusive. He did not respond to any antibiotics, antimalarials, or antituberculars. There was an initial response to steroids, but it did not sustain. Bone marrow remained normal throughout the course of illness. Based on other features, we made a diagnosis of HLH, but the patient's condition worsened rapidly and proved to be fatal despite all treatment.

The HLH must be suspected in a case of PUO especially in presence of pancytopenia and hepatosplenomegaly. It is important to look for other features like hyperferritinemia and hypertriglyceridemia to reach an early diagnosis as bone marrow features may present very late during the course of illness. Early diagnosis is all the more important in view of rapidly progressive fatal course of the disease.

Bhuta P, Patel A, Yadav L, Patel U, Kosamia V, Muley A. A Fatal Case of Pyrexia of Unknown Origin: Hemophagocytic Lymphohistiocytosis? J Postgrad Med Edu Res 2017;51(4):188-191.

Gupta R, Singh H, Verma GR. Laparoscopic Cholecystectomy in Kartagener Syndrome. J Postgrad Med Edu Res 2017;51(4):192-194.