Search

Introduction: The use of morphological features of the mandible is a common approach used by anthropologists and forensic dentists in the determination of sex. Among many anatomical landmarks of the skull, the mental foramen (MF) is a stable landmark on the mandible. Aim of the Study: The aim of the study was to analyze the sex‑based variations of MF using cone‑beam computed tomography (CBCT). Materials and Methods: This retrospective study evaluated 60 CBCT scans, retrieved from the radiological archives of our institution. MF was identified in the sagittal section of both the right and left sides. Parameters such as width of MF (W), the height of MF (H), the distance from superior border of MF to the lower border of the mandible (SMF‑LM), the distance from inferior border of MF to the lower border of the mandible (IMF‑LM), and the interforaminal distance (IFD) were evaluated and compared between the two groups. Statistical Analysis: The data obtained were analyzed using the SPSS 27 version software. Paired t‑test was done for intragroup analysis; unpaired t‑test was done for intergroup analysis. Results: The SMF‑LM distance, IMF‑LM distance, and the IFD were significantly greater in males compared to females. Conclusion: Based on the results of this study, the distance from MF to the lower border of the mandible and the IFD showed clear sexual dimorphism and can be used as an effective tool for sex discrimination. [ABSTRACT FROM AUTHOR]

Outlier detection in multivariate data is one of the critical challenges in preprocessing phase. Many outlier detection methods have been emerged for the past few years to perform outlier detection efficiently in multivariate datasets. The prediction accuracy cannot be improved without proper outlier analysis and the prediction model might not confirm the expected behavior. The generation of huge data in real time applications makes the outlier detection process more crucial and challenging. Most of the currently available detection methods are based on mean and covariance that are not suitable for handling large volume of datasets, they are suitable for handlind static data and simple data to detect outliers. They cannot cope up with large scale data. So, there is a need for an efficient outlier detection model to detect the outliers in multivariate datasets. The primary objective of this research work is to develop a robust model for outlier detection in multivariate data. To achieve this, the work proposed an enhanced Hidden Semi-Markov Model (HSMM) which allows arbitrary time distribution in its states to detect outliers. The proposed work utilized six benchmark datasets and the performance is compared with several outlier detection algorithms such as HMM, iForest, FastABOD, and Expose. The work achieves 98.2 % of accuracy which is significantly better for detecting outliers in multivariate dataset. The proposed work improvised the percentage of acheivements between 2% to 25% than the currently available models.. The experimental analysis shows that the proposed model performs well than the currently available models in terms of accuracy, and receiver operation curve (ROC). [ABSTRACT FROM AUTHOR]

According to studies, maintaining a stable relationship between a parent and a child requires frequent eye contact, one-onone time, and undivided attention. The study's purpose was to discover if there was a link between how much time parents spend on social media (screen usage) and their children's health, as well as a number of parental traits. Parents were asked to answer surveys regarding their social media usage, time spent on their devices, and parenting approaches in a variety of parenting forums and online discussion boards. They also discussed whether their child has ever been harmed as a result of their social media usage, as well as whether they have a strong overall bond with their child. On the other hand, parents who identified with a balanced parenting style were more likely to do so. Other demographic parameters' implications are investigated further. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether stemless shoulder implants in rheumatoid arthritis (RA) patients provide comparable functional outcomes to patients with osteoarthritis or post-traumatic arthritis. In addition, the study assessed for differences in incidence of radiolucent lines or proximal humeral bone loss during radiographic follow-up.Methods: Consecutive stemless shoulder arthroplasties performed in RA patients and a matched control group were retrospectively identified between February 2012 and 2018. Thirty-five patients were included in each group: 24 total shoulder arthroplasty (TSA) and 11 hemiarthroplasty (HA). Patients were evaluated annually using the Oxford Shoulder Score (OSS) and radiographically.Results: The mean OSS significantly improved in all groups until 24 months. The mean improvement for RA TSA and HA patients at 24 months was 19.86 (95% CI 10.66-29.05, p = 0.0004) and 19.71 (95% CI 7.33-32.31, p = 0.0084), respectively. The mean improvement in the control TSA and HA patients at 24 months was 20.86 (95% CI 17-24.71, p = 0.0001) and 17.86 (95% CI 1.36-34.35, p = 0.0381), respectively. During the study period, two patients in the RA TSA group (8%), one patient in the control TSA group (4%) and one patient in the control HA group (9%) required revision. The proportion of progressive proximal humeral bone loss after TSA was 33% in the RA group and 13% in the control group.Conclusion: Stemless shoulder implants can provide significant improvement in functional scores in RA patients in the short term. However, early bone loss around the humeral implant is a concern and the authors recommend long-term clinical and radiological follow-up. [ABSTRACT FROM AUTHOR]

Breast cancer in men is a rare entity. It represents about 0.2% of all cancers, and about 1% of all breast cancers. Presentation is usually a lump or nipple inversion, but is often late, with more than 40% of individuals having stage III or IV disease. Risk factors for MBC are poorly understood and include working in high-ambient temperatures and exhaust fume exposure. MBC is associated with hyperoestrogenic states found in liver disease, Klinefelter's syndrome, gonadal dysfunction or obesity. We describe a case of breast cancer in a 62 year old man who presented with advanced disease. [ABSTRACT FROM AUTHOR]

Background: Guidelines on the management of displaced intracapsular fractures recommend using an Orthopaedic Data Evaluation Panel-rated cemented implant. Prior to the National Institute for Health and Care Excellence guidelines, uncemented implants were commonly used in the UK. Methods: We retrospectively examined the outcomes of patients with uncemented Thompson’s hemiarthroplasties at our unit, between April 2005 and December 2010. Patients who underwent revision surgery before December 2011 were identified. Implant survival calculation utilised the primary outcome of revision to total hip arthroplasty, revision hemiarthroplasty or excision arthroplasty. Patients who died post-operatively were identified and censored.Results: A total of 1445 patients received uncemented Thompson’s implant. Patient mean age was 82 years with 76% female. Forty-six (3.2%) patients required revision with 15% performed within 30 days of surgery and 62% within 1 year. Reasons for revision were infection (0.83%), acetabular erosion (0.83%) and loosening (0.62%). Twenty-seven patients (59% of total revisions) underwent revision to THA, 14 (30%) to excision arthroplasty and 5 (11%) to revision hemiarthroplasty. Cumulative survival rate was 98% at 1 year and 95% at 5 years. Thirty-day mortality was 7.1%. One-year mortality was 28.1%.Conclusion: Current guidelines strongly favour cemented hemiarthroplasty. Recognition that fractured hip patients are a non-homogeneous group is important. In patients with limited life expectancy, an uncemented Thompson is a quick, simple, palliative solution to early mobilisation. Correct surgical technique avoids using cement in this cohort, which is most vulnerable to bone cement implantation syndrome. Cost-effective resource utilisation with an increasingly elderly population remains a surgical responsibility. [ABSTRACT FROM AUTHOR]

Background: Oral cancer being one of the most common malignancies in the low-income group in India. It usually presents in an advanced stage limiting treatment options. The mainstays of treatment being surgery and radiotherapy both being lifestyle changing procedures. Aims and objectives: The purpose of this study is to evaluate the quality of life for oral cancer survivors after surgery in comparison with radiotherapy using ICF questionnaire Materials and methods: Oral cancer patients who underwent surgery (25 patients) and Radiotherapy (25 patients) in Stanley medical college for stage 1 and stage 2 lesions of oral carcinoma for past 3 Years (2013-2015) were enrolled. Results: The study showed that surgery as primary therapy provided a better quality of life than radiotherapy alone in the treatment of oral cancer patients. Conclusion: After comparing the results primary surgery for oral malignancy seems to be the treatment of choice as long as the tumor is amenable to surgical resection. Radiotherapy though resulting in a lower quality of life is very efficacious for unresectable tumors. [ABSTRACT FROM AUTHOR]

Florid osseous dysplasia a rare benign fibro-osseous multiquadrant dysplastic lesion confined to the alveolar process of jaws, generally asymptomatic and usually detected incidentally during radiologic examination and requires no treatment unless symptomatic or cosmetically concerning. In this article, we present two rare cases of florid osseous dysplasia in Indian women with their clinical, radiographic and histologic findings and a brief review of literature is discussed. The first case was asymptomatic and the lesion was detected during routine radiographic examination and required no treatment whereas, the second case presented with features of osteomyelitis. Based on the clinical findings, the case was diagnosed as chronic suppurative osteomyelitis, but, after radiologic examination, diagnosis of florid osseous dysplasia with secondary osteomyelitis was made. Besides diagnostic challenge, management of the lesion is difficult due to poor vascularity. In our case, antibiotic prophylaxis along with surgical debridement and sequestrectomy was done with regular recall visits. [ABSTRACT FROM AUTHOR]

Objective: To test prospectively depolarisation and repolarisation body surface maps (BSMs) for mirror image reversal, which is less susceptible to artefact, in patients with acute ischaemic-type chest pain, and to compare these BSM criteria with previously published 12 lead ECG criteria.Methods: An 80 lead portable BSM system was used to map patients presenting with acute ischaemic-type chest pain and a 12 lead ECG with left bundle branch block (LBBB). Acute myocardial infarction (AMI) was defined by serial cardiac enzymes. Each 12 lead ECG was assessed by the criteria of Sgarbossa et al and Hands et al for diagnosis of AMI. Depolarisation and repolarisation BSMs were assessed for loss of mirror image reversal of QRS with ST-T isointegral map patterns and a change in vector angle from QRS to ST-T outside 180+/-15 degrees -findings typically seen in LBBB with AMI.Results: Of 56 patients with chest pain and LBBB, 18 had enzymatically confirmed AMI. Patients with loss of BSM image reversal were significantly more likely to have AMI (odds ratio 4.9, 95% confidence interval 1.5 to 16.4, p = 0.007). Loss of BSM image reversal was significantly more sensitive (67%) for AMI than either 12 lead ECG method (17%, 33%) albeit with some loss in specificity (BSM 71%, 12 lead ECG 87%, 97%). Patients with AMI compared with those without AMI had a greater mean change in vector angle outside the normal range (180+/-15 degrees ), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19 degrees v 9 degrees, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15 degrees had 61% sensitivity and 82% specificity for AMI (odds ratio 7.0, 95% confidence interval 2.0 to 24.4, p = 0.001).Conclusions: BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis refers to an acute inflammatory process of the pancreas, usually accompanied by abdominal pain and elevations of serum pancreatic enzymes. This syndrome is usually a discrete episode, which may cause varying degrees of injury to the pancreas, and adjacent and distant organs. Acute pancreatitis is a serious disease with high morbidity and mortality rates some 80% were mid attack which recovers rapidly with conservative management. The rest of 20% were severe, with protracted course that needs intensive care and specialized management. Materials and methods: It was a prospective study. First 50 patients attending the surgical emergency ward with clinical features of Acute Pancreatitis were evaluated clinically and subjected to laboratory and radiological investigations as per the designed Performa. Data pertinent to the scoring systems were recorded within 24 hours of admission to the hospital. For each of 50 patients included in the study, BISAP and MCTSI scores were calculated by the manner described by Knaus, et al. and Cardinal Health Database system. Results: BISAP and MCTSI was correlated well for mortality with high positive value of 0.904 which was highly significant (0.01). The ROC analysis for Mortality showed BISAP score had AUC of 0.904, P value (0.001) which was more than MCTSI score which had AUC of 0.845, P value (0.007). So BISAP was highly accurate with P value (0.001) and confidence interval of 0.873. BISAP score was highly sensitive (100%), specificity (60%) at score more than 3.5. MCTSI score sensitivity was 85%, specificity was 77% at score more than 7. Conclusions: BISAP score was found to have more sensitivity, specificity and Diagnostic accuracy than MCTSI score in prediction of assessing the severity of acute pancreatitis. Hence, BISAP score found to predict more number of patients and likelihood of progressing to severe disease. Larven, et al. stated the same in their study 42. Hence, BISAP is considered as better available score for assessing the severity than MCTSI score. [ABSTRACT FROM AUTHOR]

Introduction: I-TECH India established a warmline pilot in the year 2008 to provide mobile-based technical support on clinical management to doctors caring for HIV patients in antiretroviral therapy (ART) centers. Methods: Warmline was piloted from May to August 2008. Standardized call records were analyzed. Statistical analyses were performed using SPSS. Results: The service was used by 38 doctors. The study demonstrated the frequency of calls and the nature of questions raised by them. Of the calls, 139 were new calls (90.3%) and 15 were follow-up calls. The average number of calls per day was 2.6 (SD 1.6). Of the total number, 81% of the calls were from high-volume centers. Most of the calls were related to ARV toxicities, ART initiation, and the management of opportunistic infections (OI). Conclusion: The South Indian warmline pilot demonstrated a potential model of ongoing technical assistance to ART doctors in times of need. AIDS-control organizations may consider expanding this model of expert distance-mentoring clinical support as a resource in India and other countries. [ABSTRACT FROM PUBLISHER]

Aims: To compare the efficacy and safety of an escalating energy protocol with a non-escalating energy protocol using an impedance compensated biphasic defibrillator for direct current cardioversion of atrial fibrillation (AF). Methods and results: This prospective multicentre randomised trial enrolled 380 patients (248 male, mean (SD) age 67(10) years) with AF. Patients were randomised to either an escalating energy protocol (protocol A: 100 J, 150 J, 200 J, 200 J), or a non-escalating energy protocol (protocol B: 200 J, 200 J, 200 J). Cardioversion was performed using an impedance compensated biphasic waveform. First-shock success was significantly higher for those randomised to 200 J than 100 J (71% vs 48%; p<0.01) and for patients with a body mass index (BMI) >25 kg/m² (75% vs 44%; p = 0.01). In patients with a normal BMI there was no significant difference in first-shock success. There was also no significant difference between subsequent shocks or overall success. The use of a non-escalating protocol (protocol B) resulted in fewer shocks but with a higher cumulative energy. There was no difference in duration of procedure, amount of sedation administered or post- shock erythema between the groups. Conclusion: First-shock success was significantly higher, particularly in patients with a BMI >25 kg/m², when a non-escalating initial 200 J energy was selected. The overall success, duration of procedure and amount of sedation administered, however, did not differ significantly between the two protocols. [ABSTRACT FROM AUTHOR]

In Northern Ireland, as elsewhere, hypertension remains a leading cause of morbidity and mortality. Controversy has existed for many years regarding the optimal pharmacological agents for the management of this condition. However, in the UK, both historical and more recent data show that in clinical practice beta-blockers and diuretics are the most commonly prescribed first-line agents for blood pressure (BP) management. [ABSTRACT FROM AUTHOR]

Odontogenic cysts and tumors are well-recognized entities to the specialist oral pathologist and they seldom pose problems in differential diagnosis. This paper deals with an aggressive cystic lesion in the maxilla of a 65-year-old male that was characterized by a large radiographically multilocular lesion and a multicystic pattern microscopically. The categorization of this lesion was complicated by the presence of features suggestive of both glandular odontogenic cyst and cystic ameloblastoma with aggressive histologic phenotypes. [ABSTRACT FROM AUTHOR]

The original version of this article unfortunately contained a mistake. David Morley was not listed among the authors. [ABSTRACT FROM AUTHOR]

The article discusses glycoprotein IIb/IIIa inhibitors and acute coronary syndromes which constitute a spectrum of clinical conditions. It provides an overview of several multicentre trials that utilized parenteral GP IIb/IIIa inhibitors as primary treatment in acute coronary syndromes. It is also noted that GP IIb/IIIa inhibitor treatment has a low incidence of thrombocytopenia, but there is an increased risk if treatment is combined with heparin.

Crouzon syndrome is the most common syndrome among the craniosynostosis group. Crouzon syndrome accounts for about 4.8% of all of them. It commonly has autosomal dominant inheritance with complete penetrance and variable expressivity from subtle to severe forms and characterized by craniosynostosis, exophthalmos, and hypoplastic maxilla with relative mandibular prognathism. Mutation of the fibroblast growth factor receptor-2 gene is responsible for the occurrence of this rare genetic disorder. Our paper reports the diagnosis of this rare syndrome in a young female patient based on clinical and radiographical features. Prompt and timely management of the syndrome has enabled this patient to lead a normal life despite the syndrome. [ABSTRACT FROM AUTHOR]

A 36 year old male weight training enthusiast suffered several syncopal episodes. An electrocardiogram confirmed atrial fibrillation with normal ventricular response. The patient admitted to taking anabolic steroids and bromocriptine. The atrial fibrillation was considered to be due to bromocriptine misuse. [ABSTRACT FROM AUTHOR]

A transcutaneous technique used to deliver bipolar pulses to the heart through a battery free implant, for the treatment of atrial fibrillation, is reported. A single, symmetrical bipolar waveform with a duration of 3 × 3 ms and amplitude ±100 V was the most effective of a range of cardioversion protocols evaluated using rectangular, low-tilt pulses; the energy delivered was 1.27 J. [ABSTRACT FROM AUTHOR]

A 36 year old male weight training enthusiast suffered several syncopeal episodes. An electrocardiogram confirmed atrial fibrillation with normal ventricular response. The patient admitted to taking anabolic steroids and bromocriptine. The atrial fibrillation was considered to be due to bromocriptine misuse. This case is interesting in its presentation and highlights the risks associated with bromocriptine misuse. Also worrying is the extent to which body builders abuse prescription only drugs and the ease with which these and many other drugs are available to the general public thought the Internet without prescription.

The article presents a comparative study on the pap smear findings among HIV positive and negative women in India. The authors aim to correlate the Pap smear abnormalities among HIV positive women with their immune status. They indicate that there is a high percentage of inflammatory Pap smears among HIV positives, which is at 51.96 percent.

This article presents information on a medical case related to the accordion phenomenon in a 65 year old man. He had a history of non-insulin dependent diabetes, arterial hypertension, hyperlipidaemia and coronary artery bypass graft surgery, presented with crescendo angina. Salient features on angiography include a normal left ventricular function, occlusion of the mid left anterior descending (LAD) artery, and occlusion of the second marginal branch of the left circumflex artery. This case demonstrates the "accordion" or "concertina" phenomenon, caused usually by mechanical alteration of the geometry and curvature of a tortuous vessel by a stiff PCI wire, resulting in invagination and shortening of the vessel wall.