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Fulltext An Inexpensive Suturing Training Model

Kumaresan R, Karthikeyan P

J Maxillofac Oral Surg, 2014 Dec;13(4):609-11.
PMID: 26225037 DOI: 10.1007/s12663-013-0546-z

Demonstrations and training on live-subjects are not always the optimal means of introducing the students to minor oral surgery. Hence, the use of teaching models permit the students to handle the surgical instruments in a limited field under a semi-realistic circumstance and also helps in developing psychomotor skills in an non stressed situation. One among the competent exercise in oral surgery is suturing. Though there exist a variety of commercially available suturing training models, cost factor restrain their acquirement in few units.
Fulltext Custom-Made Finger Guard to Prevent Wire-Stick Injury to the Operator's Finger while Performing Intermaxillary Fixation

Kumaresan R, Ponnusami K, Karthikeyan P

Craniomaxillofac Trauma Reconstr, 2014 Dec;7(4):327-9.
PMID: 25383158 DOI: 10.1055/s-0034-1378185

The treatment of maxillofacial fractures involves different methods from bandages and splinting to methods of open reduction and internal fixation and usually requires control of the dental occlusion with the help of intermaxillary fixation (IMF). Different wiring techniques have been used to aid in IMF including placement of custom-made arch bars, eyelet etc. However, these wiring techniques are with a constant danger of trauma to the surgeon's fingers by their sharp ends. Though there exist a variety of commercially available barrier products and customized techniques to prevent wire-stick injury, cost factor, touch sensitivity, and comfort aspect restrain their acquirement and exploit. This technical note describes the construction of a simple and economical finger guard made of soft thermoplastic material that provides an added protection to fingers from wire-stick type injuries, and its flexible nature permits a comfortable finger flexion movement and acceptable touch sensitivity. This is a simple, economical, reusable puncture, and cut-resistance figure guard by which we can avoid wire-stick type injury to the operator's fingers during wiring technique.
Reliability and validity of five radiographic dental-age estimation methods in a population of Malaysian children

Kumaresan R, Cugati N, Chandrasekaran B, Karthikeyan P

J Investig Clin Dent, 2016 Feb;7(1):102-9.
PMID: 25048008 DOI: 10.1111/jicd.12116

OBJECTIVE: To evaluate the reliability and validity of Demirjian's, Willems, Nolla's, Haavikko's, and Cameriere's radiographic methods of dental-age estimation in a population of Malaysian children.
METHODS: A total of 426 dental panoramic radiographs of 5-15-year-old Malaysian children were included in the study. The mean age error and absolute age error for all the methods were calculated and their usability analyzed.
RESULTS: The Nolla, Willems. and Demirjian methods overestimated the dental age with a mean of 0.97, 0.54, and 0.54 years, respectively, while the Cameriere and Haavikko methods underestimated by 0.41 and 1.31 years, respectively. The Cameriere method was highly precise and accurate in the population of Malaysian children, whereas the Haavikko and Demirjian methods were the least precise and accurate.
CONCLUSIONS: The Cameriere method of dental-age estimation is highly valid and reliable for Malaysian population, followed by the Willems and Nolla methods.
Fulltext Dental age estimation of growing children by measurement of open apices: A Malaysian formula

Cugati N, Kumaresan R, Srinivasan B, Karthikeyan P

J Forensic Dent Sci, 2015 Sep-Dec;7(3):227-31.
PMID: 26816464 DOI: 10.4103/0975-1475.172445

BACKGROUND: Age estimation is of prime importance in forensic science and clinical dentistry. Age estimation based on teeth development is one reliable approach. Many radiographic methods are proposed on the Western population for estimating dental age, and a similar assessment was found to be inadequate in Malaysian population. Hence, this study aims at formulating a regression model for dental age estimation in Malaysian children population using Cameriere's method.
MATERIALS AND METHODS: Orthopantomographs of 421 Malaysian children aged between 5 and 16 years involving all the three ethnic origins were digitalized and analyzed using Cameriere's method of age estimation. The subjects' age was modeled as a function of the morphological variables, gender (g), ethnicity, sum of normalized open apices (s), number of tooth with completed root formation (N0) and the first-order interaction between s and N0.
RESULTS: The variables that contributed significantly to the fit were included in the regression model, yielding the following formula: Age = 11.368-0.345g + 0.553No -1.096s - 0.380s.No, where g is a variable, 1 for males and 2 for females. The equation explained 87.1% of total deviance.
CONCLUSION: The results obtained insist on reframing the original Cameriere's formula to suit the population of the nation specifically. Further studies are to be conducted to evaluate the applicability of this formula on a larger sample size.
KEYWORDS: Age estimation; Cameriere's method; dental age; forensic odontology
Fulltext Plummer Vinson Syndrome: A Rare Syndrome in Male with Review of the Literature

Karthikeyan P, Aswath N, Kumaresan R

Case Rep Dent, 2017;2017:6205925.
PMID: 28932606 DOI: 10.1155/2017/6205925

INTRODUCTION: Plummer Vinson syndrome also known as Paterson Brown-Kelly syndrome is a syndrome associated with the triad of symptoms comprising microcytic hypochromic anemia, oesophageal strictures, and dysphagia. PVS is commonly found in women of middle age especially in the fourth and fifth decade of life and is rarely reported in males.
CASE REPORT: The authors report a case of 43-year-old male patient who presented with the classic symptoms of Plummer Vinson syndrome.
CONCLUSION: Dentists have to be familiar with symptoms of PVS and a thorough clinical examination of the patient is necessary for early diagnosis and treatment. As PVS is a precancerous condition with high malignant potential, early diagnosis is of utmost importance for better prognosis.
CLINICAL SIGNIFICANCE: Mutual interaction of systemic and oral health has largely been underestimated by many patients in the developing countries and hence this report includes a note on importance of adequate medical history taking and its relevance to the dental health and treatment.
Fulltext A novel technique for the management of blandin-nuhn mucocele: a case report

Kumaresan R, Karthikeyan P, Mohammed F, Thapasum Fairozekhan A

Int J Clin Pediatr Dent, 2013 Sep;6(3):201-4.
PMID: 25206223 DOI: 10.5005/jp-journals-10005-1219

Mucocele, a common benign cystic lesion of minor salivary gland and associated ducts develops following extravasation or retention of mucous material in the subepithelial tissue. Occurrence of mucocele of tongue is considered less frequent when compared to a higher incidence of mucocele in the lower lip of young patients. Different modalities of treatment, such as conventional surgical excision followed by newer techniques like cryosurgery, electrocautery have been proposed to completely remove the lesion and reduce the chances of recurrence. Herewith, we report a novel treatment technique using alginate impression material to aid in complete excision of mucocele of glands of Blandin-Nuhn. How to cite this article: Kumaresan R, Karthikeyan P, Mohammed F, Fairozekhan TA. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report. Int J Clin Pediatr Dent 2013;6(3):201-204.
Fulltext Genome Characterization of Enterococcus faecalis Bacteriophage EFKL

Michelle JiaMin L, Mutusamy P, Karthikeyan P, Kumaresan R, Millard A, Parimannan S, et al.

Microbiol Resour Announc, 2023 Jun 20;12(6):e0016023.
PMID: 37133380 DOI: 10.1128/mra.00160-23

We characterized the complete genome of the lytic Enterococcus faecalis phage EFKL, which was isolated from a sewage treatment plant in Kuala Lumpur, Malaysia. The phage, which was classified in the genus Saphexavirus, has a 58,343-bp double-stranded DNA genome containing 97 protein-encoding genes and shares 80.60% nucleotide similarity with Enterococcus phage EF653P5 and Enterococcus phage EF653P3.
Fulltext Natural history of liver disease in a large international cohort of children with Alagille syndrome: Results from the GALA study

Vandriel SM, Li LT, She H, Wang JS, Gilbert MA, Jankowska I, et al.

Hepatology, 2023 Feb 01;77(2):512-529.
PMID: 36036223 DOI: 10.1002/hep.32761

BACKGROUND AND AIMS: Alagille syndrome (ALGS) is a multisystem disorder, characterized by cholestasis. Existing outcome data are largely derived from tertiary centers, and real-world data are lacking. This study aimed to elucidate the natural history of liver disease in a contemporary, international cohort of children with ALGS.
APPROACH AND RESULTS: This was a multicenter retrospective study of children with a clinically and/or genetically confirmed ALGS diagnosis, born between January 1997 and August 2019. Native liver survival (NLS) and event-free survival rates were assessed. Cox models were constructed to identify early biochemical predictors of clinically evident portal hypertension (CEPH) and NLS. In total, 1433 children (57% male) from 67 centers in 29 countries were included. The 10 and 18-year NLS rates were 54.4% and 40.3%. By 10 and 18 years, 51.5% and 66.0% of children with ALGS experienced ≥1 adverse liver-related event (CEPH, transplant, or death). Children (>6 and ≤12 months) with median total bilirubin (TB) levels between ≥5.0 and <10.0 mg/dl had a 4.1-fold (95% confidence interval [CI], 1.6-10.8), and those ≥10.0 mg/dl had an 8.0-fold (95% CI, 3.4-18.4) increased risk of developing CEPH compared with those <5.0 mg/dl. Median TB levels between ≥5.0 and <10.0 mg/dl and >10.0 mg/dl were associated with a 4.8 (95% CI, 2.4-9.7) and 15.6 (95% CI, 8.7-28.2) increased risk of transplantation relative to <5.0 mg/dl. Median TB <5.0 mg/dl were associated with higher NLS rates relative to ≥5.0 mg/dl, with 79% reaching adulthood with native liver ( p
Event-free survival of maralixibat-treated patients with Alagille syndrome compared to a real-world cohort from GALA

Hansen BE, Vandriel SM, Vig P, Garner W, Mogul DB, Loomes KM, et al.

Hepatology, 2023 Dec 25.
PMID: 38146932 DOI: 10.1097/HEP.0000000000000727

BACKGROUND AND AIMS: Alagille syndrome (ALGS) is characterized by chronic cholestasis with associated pruritus and extrahepatic anomalies. Maralixibat, an ileal bile acid transporter inhibitor, is an approved pharmacologic therapy for cholestatic pruritus in ALGS. Since long-term placebo-controlled studies are not feasible or ethical in children with rare diseases, a novel approach was taken comparing 6-year outcomes from maralixibat trials with an aligned and harmonized natural history cohort from the G lobal AL agille A lliance (GALA) study.
APPROACH AND RESULTS: Maralixibat trials comprise 84 patients with ALGS with up to 6 years of treatment. GALA contains retrospective data from 1438 participants. GALA was filtered to align with key maralixibat eligibility criteria, yielding 469 participants. Serum bile acids could not be included in the GALA filtering criteria as these are not routinely performed in clinical practice. Index time was determined through maximum likelihood estimation in an effort to align the disease severity between the two cohorts with the initiation of maralixibat. Event-free survival, defined as the time to first event of manifestations of portal hypertension (variceal bleeding, ascites requiring therapy), surgical biliary diversion, liver transplant, or death, was analyzed by Cox proportional hazards methods. Sensitivity analyses and adjustments for covariates were applied. Age, total bilirubin, gamma-glutamyl transferase, and alanine aminotransferase were balanced between groups with no statistical differences. Event-free survival in the maralixibat cohort was significantly better than the GALA cohort (HR, 0.305; 95% CI, 0.189-0.491; p <0.0001). Multiple sensitivity and subgroup analyses (including serum bile acid availability) showed similar findings.
CONCLUSIONS: This study demonstrates a novel application of a robust statistical method to evaluate outcomes in long-term intervention studies where placebo comparisons are not feasible, providing wide application for rare diseases. This comparison with real-world natural history data suggests that maralixibat improves event-free survival in patients with ALGS.