BackgroundIndia has one of the world's largest burdens of cleft lip and palate (CLP), yet lacks a national outcomes registry or standardized system for cleft care evaluation. The Cleft Care India Study is a multicentric national initiative to assess current treatment outcomes for patients with non-syndromic unilateral CLP for 5-, 12-, and 20-year-old age groups.MethodsFourteen cleft care centers across India participated in this cross-sectional study. Standardized protocols for collecting data were formulated with input from the Study Steering Committee, validated through pilot testing, and employed for data collection. Data collected included intra-oral and extraoral photographs, study models, radiographs, surgical information, oral health assessments, speech recordings, hearing evaluations, psychosocial measures, and the intelligibility in context scale questionnaire. In this paper, we present the dentofacial outcomes. Skeletal relationships were analyzed using ANB, SNA, and SNB angles derived from cephalometric radiographs; dental arch relationships were evaluated using the 5-year or modified GOSLON indices; and nasolabial esthetics were assessed with the Asher-McDade index.ResultsData from 294 non-syndromic unilateral cleft lip and palate (UCLP) patients aged 5 (n = 72), 12 (n = 155), and 20 years (n = 67) were analyzed. Reliability testing showed strong intra and inter-rater agreement for all indices and cephalometric data (class correlation coefficient > 0.9). Nearly half of 12 year olds (46.5%) and more than half of 20 year olds (58.7%) demonstrated a Class III skeletal relationship (ANB < 0). Poor to very poor dental arch relationships (score > 3) were observed in 45%, 48%, and 43% of the 5-, 12-, and 20-year groups, respectively. Nasolabial esthetic outcomes were rated poor to very poor in 24.3% of 5 year olds, 25% of 12 year olds, and 55.4% of 20 year olds.ConclusionThis multicentric cleft outcomes audit in India demonstrated suboptimal skeletal, dental, and nasolabial outcomes when benchmarked against international standards. These findings highlight an urgent need for the centralization of cleft services, implementation of systematic national outcome monitoring, and adoption of standardized multidisciplinary care pathways to improve the quality and consistency of cleft management across India.
Purpose To evaluate the efficacy and steroid‑sparing potential of tofacitinib in patients with non‑infectious refractory anterior uveitis who failed conventional immunosuppressive therapy. Methods Retrospective observational study of thirty one eyes of 29 patients with refractory anterior uveitis of various systemic associations. All had failed ≥ 1 immunosuppressant plus topical and systemic corticosteroids (failure to maintain remission on 7.5 mg or below after 3 months of initiation). Tofacitinib 5 mg twice daily was initiated, and patients were followed for 12 months. Primary outcome was clinical remission (SUN grade 0 cells) and steroid discontinuation. Secondary outcomes were BCVA improvement,time to remission, adverse events, and comparative analysis of responders vs non‑responders. Results Twenty‑six (89.6%) patients achieved remission. Mean age 34.6 ± 8.2 yrs. 73.1% patients achieved steroid‑free state by 4 weeks and by 6 weeks was achieved by 26.9% patients. Faster steroid taper was associated with ankylosing spondylitis (p = 0.04). No major adverse events were observed. Conclusions Tofacitinib demonstrated significant steroid‑sparing efficacy in refractory anterior uveitis with favorable safety and high remission rates, suggesting its potential as an accessible oral alternative to biologics.
Vaginal calculi are exceptionally rare and usually develop secondary to foreign bodies, chronic infection, urinary contamination, or eroded synthetic materials. Presentation as post-menopausal bleeding is uncommon and may mimic genital tract malignancy. The coexistence of mesh erosion, actinomycosis, and vaginal calculus formation is exceedingly rare. A 68-year-old postmenopausal multiparous woman presented with bleeding per vaginum. She had undergone abdominal hysterectomy approximately 20 years earlier. Pelvic examination revealed a hard posterior vaginal wall mass suspicious for malignancy. Examination under anesthesia and vaginoscopy demonstrated a vaginal calculus surrounding eroded mesh protruding through the posterior vaginal wall. Complete removal of the calculus and exposed mesh was performed. Histopathological examination revealed actinomycosis without evidence of malignancy. The postoperative course was uneventful. Vaginal calculus formation secondary to mesh erosion with associated actinomycosis should be considered in elderly women presenting with post-menopausal bleeding. Histopathological examination is essential for excluding malignancy and confirming the diagnosis.
