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Silver diamine fluoride (SDF) has garnered increasing attention in contemporary dental practice due to its unique properties and clinical applications. The minimally invasive nature, antimicrobial efficacy, and desensitization capabilities of SDF position it as a valuable tool in preventive and restorative dentistry. However, esthetic concerns associated with tooth discoloration and the need for further research to understand long-term outcomes underscore the importance of ongoing investigation and clinical integration. This article underscores the transformative potential of SDF in modern dental care and emphasizes the necessity of continued research and education to maximize its benefits., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

Background: To evaluate C-reactive protein (CRP) levels in peri-implantitis patients., Material and Methods: This study comprised a total of 100 participants. Fifty participants with a confirmed clinical and radiological diagnosis of peri-implantitis formed one group. Another group of 50 volunteers who came in for a normal health checkup served as healthy controls. All the patients were recalled in the morning. Fasting venous blood samples were collected. CRP concentrations in the laboratory were determined using an auto-analyzer., Results: In this study, there were 40 females and 60 males. Mean CRP levels among subjects of the peri-implantitis group and the control group were 0.615 and 0.201 mg/dL, respectively., Conclusion: It was observed that mean CRP levels were higher among subjects having peri-implantitis as compared to the controls., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

Background and Aims: Postoperative pain after laparoscopic cholecystectomy is very common complication hindering the early return of routine activity. Since agonist opioids are not easily available, the most common drug used for intraoperative analgesia is intravenous butorphanol in our institute. The purpose of our study is to compare the analgesic effect of intraperitoneal butorphanol and nalbuphine as additives with ropivacaine in laparoscopic cholecystectomy for postoperative pain., Setting and Design: Randomized, double-blind prospective study undertaken after approval from the Institutional Ethics Committee., Materials and Methods: In this study, 90 patients undergoing laparoscopic cholecystectomy were randomly divided into three groups: group A received intraperitoneal ropivacaine 0.2% of 20 mL with butorphanol 2 mg; Group B received intraperitoneal ropivacaine 0.2% 20 mL with nalbuphine 10 mg; and Group C received intraperitoneal ropivacaine 0.2% 20 mL with 0.9% normal saline. The primary outcome was to compare the analgesic efficacy of butorphanol with nalbuphine and the duration of postoperative pain relief. The secondary outcomes included the comparison of hemodynamic parameters, frequency of rescue analgesia, and complications among the three groups., Statistical Analysis: The data analysis was carried out with ANOVA and Chi-square test using the SPSS software version 26.0., Results: The mean of the Numeric Rating Scale pain score was insignificant in Group A versus B at all-time intervals indicating similar efficacy of butorphanol and nalbuphine in terms of pain relief postoperatively. However, the time to first rescue analgesia was significantly higher in Group A (5.70 ± 3.57 h), followed by Group B (3.95 ± 2.06 h) and Group C (2.50 ± 1.24 h)., Conclusion: Butorphanol is better analgesic than nalbuphine as postoperative pain-free period was relatively more with lesser complications., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Anesthesia: Essays and Researches.)

Background: Lifestyle disorders are on rise world over. Also, the role of doctors as leaders in propagating healthy lifestyles needs to get a reality check. Aims and Objectives: This study aimed to investigate the prevalence of lifestyle disorders, eating habits, nutrition patterns, and lifestyle of doctors by assessing health-related behaviours considering gender and other relevant demographic parameters. The objectives of the present study are to find out the relationship of lifestyle disorders among doctors and to study lifestyle disorders and related behaviour among male and female doctors and other subgroups., Materials and Methods: Online survey was conducted using Googledoc in June to August 2021. Descriptive statistical analysis has been carried out in the present study. The student's t-test (two tailed, independent) has been used., Results: About 50% rated a happiness quotient of 7 and 8. Surgeons had more diabetes and hypertension than physicians. Prevalence of hypertension was more in self-employed males versus males in job. About two-third participants scored ≥ 80% on healthy lifestyle score., Conclusion: Our results call for a well-thought strategy to overcome the financial and technological hindrances to accurately identify health risk factors and plan corrective interventions. A healthy lifestyle both in terms of diet and exercise should be incorporated into the schedules of doctors., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Mid-life Health.)

Introduction: This study investigated the role of diallyl disulfide (DADS) against glycerol-induced nephrotoxicity in rats. Moreover, the role of peroxisome proliferator activated receptor-γ (PPAR-γ) in DADS-mediated renoprotection has been explored., Materials and Methods: Male Wistar albino rats were challenged with glycerol (50% w/v, 8 mL/kg intramuscular) to induce nephrotoxicity. Kidney injury was quantified by measuring serum creatinine, creatinine clearance, urea, potassium, fractional excretion of sodium, and microproteinuria in rats. Renal oxidative stress was measured in terms of thiobarbituric acid reactive substances, superoxide anion generation, and reduced glutathione levels. Hematoxylin-eosin (H&E) and periodic acid Schiff staining of renal samples was done to show histological changes. Glycerol-induced muscle damage was quantified by assaying creatine kinase (CK) levels in rat serum., Results: Administration of glycerol resulted in muscle damage as reflected by significant rise in CK levels in rats. Glycerol intoxication led kidney damage was reflected by significant change in renal biochemical parameters, renal oxidative stress and histological changes in rat kidneys. Administration of DADS attenuated glycerol-induced renal damage. Notably, pretreatment with bisphenol A diglycidyl ether, a PPAR-γ antagonist, abolished DADS renoprotection in rats., Conclusion: We conclude that DADS affords protection against glycerol-induced renal damage in rats. Moreover, PPAR-γ plays a key role in DADS-mediated renoprotective effect., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Pharmacy and Bioallied Sciences.)

Background: Patients diagnosed with coronavirus disease 2019 (COVID-19) are often prone to developing systemic inflammation which eventually causes damage to the lungs and other important organs. Randomized open-label control trials carried out in the different parts of the world have highlighted the importance of corticosteroids for treating such patients., Materials and Methods: The current quasi-experimental study was based on COVID-19-infected patients with oxygen saturation <92% and evidence of pneumonia confirmed through radiological examination. Study participants in Group A received standard care, while those in Group B received standard care along with 6 mg intravenous dexamethasone for 10 days (or until discharge, if earlier). The clinical status of the study participants was assessed on day 7 and day 14 on a 6-point ordinal scale., Results: It was observed from the study that there was reduction in the intensive care unit (ICU) stay and mortality among the study participants requiring high-flow oxygen or noninvasive ventilation in Group B as compared to Group A. After 7 days of treatment, 50% of the study participants in Group B got discharged as compared to 15% of the study participants in Group A. The number of study participants requiring mechanical ventilation remained 1 in Group B as compared to 5 in Group A. After the completion of treatment schedule, 91% study participants were discharged. There was 1 case of mortality reported in Group B as compared to 6 cases of mortality in Group A., Conclusions: The current study highlighted that fewer number of COVID-19-positive study participants in Group B required high-flow oxygen supplementation and noninvasive positive pressure ventilation as compared to those included in Group A. The corticosteroid treatment also reduced the number of ICU transfer and mortality., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Anesthesia: Essays and Researches.)

Background: Controlled hypotension has been used to reduce bleeding and the need for blood transfusions and provide a satisfactory bloodless surgical field. In this double-blind, randomized controlled trial, we are comparing intravenous (i.v.) dexmedetomidine infusion and oral metoprolol as a premedication for controlled hypotension in functional endoscopic sinus surgery (FESS) for evaluating surgical field visibility., Subjects and Methods: A total of 90 patients undergoing FESS were randomly divided into three groups of 30 each. Group A received intraoperative i.v. infusion of dexmedetomidine (loading 1 μg.kg -1 over 10 min followed by the maintenance of 0.2-0.5 μg.kg -1 .h -1 ), Group B received oral metoprolol 50 mg on night and 2 h before surgery as a premedication, and Group C was taken as a control group and patients received oral placebo tablet as premedication and intraoperative normal saline infusion. General anesthesia was given using sevoflurane. Intraoperative target mean arterial blood pressure was set 55-65 mmHg. Various parameters were recorded and statistically compared., Results: The three groups were statistically comparable in demographics. Quality of surgical field was better in Group A compared to other two groups. Total blood loss was also less in Group A. The incidence of adverse reactions was more in Group A., Conclusion: Dexmedetomidine provides a better surgical field compared to oral metoprolol in FESS along with the desired hemodynamics with lesser blood loss and better outcome., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Anesthesia: Essays and Researches.)

Despite recent advances in treatment with multidrug chemotherapy regimens, outcomes of patients with advanced pancreatic ductal adenocarcinoma (PDAC) remain very poor. Treatment with targeted therapies has shown marginal benefits due to intrinsic or acquired resistance. Actionable mutations, while detected infrequently in patients with PDAC, are becoming increasingly used in personalized medicine. Here, we describe an epidermal growth factor receptor (EGFR)-activating mutation (E746&#95;T751>VP) to erlotinib, a first-generation tyrosine kinase inhibitor (TKI), in a patient with metastatic PDAC. After an initial partial response to erlotinib for 12 months, the patient's disease progressed with emergence of the EGFR A647T mutation. Certainly, the patient also progressed after switching therapy to a third-generation EGFR TKI (osimertinib). This case illustrates the posttreatment evolution of EGFR A647T-mediated resistance to the first- and third-generation TKIs. To our knowledge, this is the first case to report the aforementioned activating and resistance-mediated mutations. In summary, genomic analysis performed in this patient with PDAC on the tumor biopsy and peripheral blood provided tools to understand mechanisms of response and resistance to targeted therapy with EFGR TKIs., Competing Interests: None

Competing Interests: There are no conflicts of interest.

Aim and Objective: This study aimed to finding alternative ways for centers with nonavailability of ultrasonography or fluoroscopy for nonoperative pneumatic reduction of intussusceptions., Materials and Methods: A total of 48 cases of intussusceptions were included in the study in-between October 2016 and March 2018. We tried stethoscope-guided pneumatic reduction using locally assembled equipment. The intraluminal pressure was monitored and maintained below 100 mmHg. A total of two attempts of 3 min each were allowed. We compared our results with the control group who have been performing laparotomy for every case of intussusception., Results: There were 35 males and 13 females in our study. The average age of the patients was 7.5 months. Intussusceptions were reduced in 38 (80%) patients but could not be reduced in 10 (20%) patients. Majority of the intussusceptions had symptoms of at least 2 days. There were no complications such as perforation in our study., Conclusion: Stethoscope-guided pneumatic reduction seems to be a feasible and alternative effective method for the treatment of intussusceptions in children where availability of ultrasonography and skilled radiologist with overburden of work is a great issue., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Indian Association of Pediatric Surgeons.)

Introduction: A myriad of supraglottic airway devices (SADs) are developed over time to search the device that conforms to the anatomy of the human respiratory tract noninvasively, but these devices are associated with the risk of aspiration. Baska ® mask (BM) is the latest addition to the family of SADs to circumvent the incidence of aspiration., Aims of Study: The aim of the study was to compare the sealing pressure and rapidity of the insertion of BM with ProSeal laryngeal mask (PLM) airway and the incidence of laryngopharyngeal morbidity between two devices., Materials and Methods: A randomized prospective open-label study was done on sixty adult patients of the age group of 18-60 years after approval from the institutional ethical committee and registration of trial in the Clinical Trials Registry. The patients were randomly divided into two groups: Group I (BM) where BM was inserted after the induction of general anesthesia and Group II (PLM) where PLM was inserted after induction. The airway sealing pressure in BM was calculated. The mean time of insertion of respective SAD and the number of successful attempts were also recorded in both groups. For analysis of continuous variables, independent sample Student's t -test was applied, and for categorical variables, Chi-square test was used. P < 0.05 was considered statistically significant., Results: The rate of successful attempts of insertion was comparable in both the groups. The mean insertion time was 14.25 ± 3.82 s in BM group and 22.01 ± 2.64 s in PLM group, which was statistically significant. The airway sealing pressure was 30.25 ± 3.34 cmH 2 O in BM group and 23.50 ± 4.05 cmH 2 O in PLM group, which was also statistically significant., Conclusion: BM has better ease of insertion with adequate sealing pressure as compared to PLM airway, thus reducing the chances of aspiration and offering its potential application in securing airway in emergency situations., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Anesthesia: Essays and Researches.)

Competing Interests: There are no conflicts of interest.

Background: Promoter methylation of tumor suppressor genes (TSGs) is a well-reported portent in carcinogenesis; hence, it is worthy to investigate this in high-risk Northeast population of India. The study was designed to investigate methylation status of 94 TSGs in esophageal squamous cell carcinoma (ESCC). Further, the effect of OPCML promoter methylation on gene expression was analyzed by immunohistochemistry. Moreover, in silico protein-protein interactions were examined among 8 TSGs identified in the present study and 23 epigenetically regulated genes reported previously by our group in ESCC., Materials and Methods: Methylation profiling was carried out by polymerase chain reaction array and OPCML protein expression was examined by tissue microarray-based immunohistochemistry., Results: OPCML, NEUROG1, TERT, and WT1 genes were found hypermethylated and SCGB3A1, CDH1, THBS1, and VEGFA were hypomethylated in Grade 2 tumor. No significant change in OPCML expression was observed among control, Grade 1, and Grade 2 tumor. Conclusively, hypermethylation of the studied OPCML promoter in Grade 2 tumor produced no effect on expression. Unexpectedly, OPCML expression was downregulated in Grade 3 tumor in comparison to other groups signifying that downregulation of OPCML expression may lead to higher grade of tumor formation at the time of diagnosis of ESCC in patients. Significant interactions at protein level were found as VEGFA:PTK2, CTNNB1:CDH1, CTNNB1:VEGFA, CTNNB1:NEUROG1, CTNND2:CDH1, and CTNNB1:TERT. These interactions are pertinent to Wnt/β-catenin and TGF-β-Smad pathways., Conclusions: Deranged OPCML expression may lead to high-grade ESCC as well as epigenetically regulated genes, that is, CDH1, CTNNB1, CTNND2, THBS1, PTK2, WT1, OPCML, TGFB1, and SMAD4 may alter the Wnt/β-catenin and TGF-β-Smad pathways in ESCC. Further study of these genes could be useful to understand the molecular pathology of ESCC with respect to epithelial-mesenchymal transition (EMT) mediated by Wnt/β-catenin and TGF-β signaling pathways., Competing Interests: None

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Background and Aims: Ambulatory surgery is continually evolving specialty in the majority of surgical procedures. Dexmedetomidine and midazolam are newer adjuvants for sedation and reducing the dose of anesthetic agents. The aim of this study was to compare the sedative and propofol-sparing effect of dexmedetomidine and midazolam in minor gynecological day care surgeries. Observer's Assessment of Activity and Sedation, dose of additional propofol, Aldrete and street fitness score were studied as primary outcomes. Hemodynamic parameters and side effects were evaluated as secondary outcomes., Materials and Methods: A prospective randomized placebo-controlled study was conducted on 150 American Society of Anesthesiologists ASA physical status Classes I and II gynecological patients between 18 and 50 years and were allocated into three groups of fifty each. Group A received intravenous (i.v.) dexmedetomidine 0.1 μg/kg, Group B received i.v. midazolam 0.04 mg/kg, and Group C received normal saline 10 min before induction., Results: Sedation score was statistically highly significant between Group A and B ( P < 0.001). Between Group A and C, it was statistically significant ( P < 0.05); however, score was nonsignificant between Groups B and C ( P > 0.05). During recovery at 120 min after surgery, score 5 was achieved equally by all three groups which was found to be statistically insignificant ( P > 0.05). Mean dose of additional propofol used was less in Group A (14 ± 9.25) than B (25 ± 5.40) and C (53 ± 10.96). On intergroup comparison between all three groups, it was found to be statistically highly significant ( P < 0.001). Comparison of bispectral index (BIS) values between Groups A and C and Groups B and C were highly significant ( P < 0.001). However, it was statistically significant between Groups A and B ( P < 0.05). Aldrete scoring and street fitness scores were highly significant between Groups A and B, B and C, and also between Groups A and C ( P < 0.001). No significant hemodynamic derangements and side effects were noted in any of three groups., Conclusion: Dexmedetomidine had good sedation and better recovery characteristics than midazolam. BIS monitoring was helpful in maintaining the depth of anesthesia., Competing Interests: There are no conflicts of interest.

Purpose: The purpose of this study is to measure intraocular pressure (IOP) and evaluate the correlation between IOP and midnight plasma cortisol (MPC) level in patients with Cushing's disease (CD) and other endogenous Cushing's syndrome (ECS)., Methods: This is a cross-sectional study from a single center including newly diagnosed patients with CD or ECS. All patients underwent detailed ophthalmological evaluation. IOP was measured by Goldmann applanation tonometry in the morning and evening on two consecutive days. MPC value was obtained for each patient. The data were compared using paired and unpaired t-test, Mann-Whitney U-test, and Spearman's rank correlation coefficient., Results: Among 32 patients, 22 were CD (68.75%) and 10 patients were other ECS (31.25%). A total of 25 patients (78.12%) in our study group had normal IOP (<22 mmHg), and seven patients (21.88%) had increased IOP (≥22 mmHg). The percentage of patients with normal IOP was found to be significantly higher compared to percentage of patients with high IOP (P = 0.001) using one-sample Chi-square test. Mean MPC value was 468.6 ± 388.3 nmol/L in patients having IOP ≥22 mmHg and 658.5 ± 584 nmol/L in those with IOP <22 mmHg from both CD and ECS groups, but the difference was not statistically significant. No correlation was found between IOP and MPC (Spearman's rank correlation rho = -0.16 [P = 0.38])., Conclusion: In CD and ECS patients, IOP elevation is an uncommon feature, and high IOP in either group does not correlate with MPC level.

Objective: Surgical repair of hypospadias is challenging and problematic even for the most experienced specialists, and this is especially true when severe and complicated case is confronted. Many operations had been described for the management of this deformity., Materials and Methods: During the period from May 2004 to December 2015, we performed 700 cases with proximal hypospadias, at our institute in the Department of Pediatric Surgery by a single surgeon. Data were collected retrospectively and included patient's age at operation, degree of the hypospadias, degree of associated chordee, complications, and cosmetic outcome. All patients underwent 2 two-stage procedures with 9-12 months interval in between., Results: Seven hundred patients with proximal hypospadias were operated upon in a period of 11 years. Byars's 2 two-stage operation was used in all 700 cases. Neither complete disruption nor urethral diverticula occurred 2 two-stage procedures in the 700 patients. 677 (96.7%) patients had no complication. Fistula was present in 21 (3%) patients. There was no case of meatal stenosis in our study., Conclusion: Two stages procedure using the principles of Byar's technique is a versatile operation that can be used for 2 two-stage procedures the proximal hypospadias. It decreases the rate of fistula formation, disruption, and stenosis and gives a satisfactory cosmetic appearance., Competing Interests: There are no conflicts of interest.

Background: There are many adjuvant used along with bupivacaine for subarachnoid block, but fentanyl and clonidine are commonly used as adjuvant to intrathecal bupivacaine for prolonging both sensory and motor blockade as well as postoperative analgesia in patients undergoing lower abdominal surgeries., Objective: There is a paucity of studies comparing the efficacy of fentanyl and clonidine as adjuvant to intrathecal bupivacaine for improving intraoperative effect and postoperative analgesia in lower abdominal surgeries instigated us compare the effect of these drugs., Methods: This prospective, randomized study is conducted on 100 American Society of Anesthesiologists I or II patients between 18 and 65 years of age divided into two groups of 50 each. The patients were given 2.5 ml of 0.5% hyperbaric bupivacaine with either 50 μg of clonidine (BC Group) or 25 μg of fentanyl (BF Group) intrathecally. The onset and duration of sensory and motor block, sedation score, hemodynamic parameters, total analgesia time, and potential side effects were recorded and compared., Results: Both the groups were comparable in demographic data, onset and duration of sensory and motor blockade, hemodynamic parameters, but the duration of analgesia is significantly longer in clonidine group when compared with fentanyl group. Sedation score is more in clonidine group., Conclusion: Addition of clonidine to intrathecal bupivacaine offers longer duration of postoperative analgesia than fentanyl but with higher sedation., Competing Interests: There are no conflicts of interest.

Aims and Objectives: Supplementation of dexmedetomidine produces a dose-dependent sedation, anxiolysis and analgesia without respiratory depression. This study was conducted to evaluate the possible effect of dexmedetomidine as an adjuvant to levobupivacaine for supraclavicular brachial plexus block in upper limb surgery., Settings and Design: Tertiary care institute, Department of Anaesthesiology and Intensive Care, a placebo-controlled study., Materials and Methods: After obtaining Ethical Committee approval, a randomized, double-blind, placebo-controlled study was conducted on sixty American Society of Anesthesiologists physical status I and II patients in the age group of 18-60 years, divided randomly into two groups, Group I received 30 ml of 0.5% levobupivacaine with 1 ml of isotonic sodium chloride solution and Group II received 30 ml of 0.5% levobupivacaine and 1 ml (100 mcg) of dexmedetomidine for supraclavicular brachial plexus block. The onset and duration of sensory and motor blockade, duration of analgesia (DOA) and any adverse effects were noted. At the end of the study, data were compiled and analyzed using appropriate statistical tests. The value of P < 0.05 was considered significant., Results: Demographic profile was comparable in both the groups. The time to onset of sensory and motor block was 10.54 ± 2.333 min and 12.21 ± 2.529 min in Group I while it was 3.24 ± 0.951 min and 2.83 ± 1.197 min in Group II, respectively. The duration of sensory and motor block was 7.79 ± 2.007 h and 9.18 ± 1.701 h in Group I, and it was 16.31 ± 2.606 h and 17.52 ± 2.098 h in Group II, respectively. The DOA was 678.68 ± 20.492 min in Group I and 1273.79 ± 83.139 min in Group II. On statistical comparison, these values were highly significant ( P < 0.001). Side effects such as nausea, vomiting, hypoxemia, pruritis, or urinary retention were not observed in either of the groups., Conclusion: Dexmedetomidine shortens the onset time for sensory and motor block significantly and prolongs DOA as well when used with levobupivacaine for supraclavicular brachial plexus block, without increasing the incidence of any adverse effects.

Background: Radiofrequency (RF) is a minimally invasive target-selective technique that has been used with success for many years in the treatment of different pathologies, such as low back pain, trigeminal neuralgia, and others., Aim: The aim of this study is to compare different mode of RF - continuous RF (CRF) versus pulsed RF (PRF) along with steroid in the management of low back pain of discogenic origin., Setting and Design: Prospective, randomized, double-blind trial., Materials and Methods: Forty patients with chronic discogenic low back pain were randomized to receive CRF plus intradiscal triamcinolone 40 mg (Group 1) or to receive PRF plus intradiscal triamcinolone 40 mg (Group 2). Outcome measured includes immediate as well as long-term pain relief using visual analog scale, the Oswestry Disability Index and straight leg raising test., Statistical Analysis: The continuous variables were compared by one-way analysis of variance test. Discrete variables were compared by Fisher's exact test/Chi-square test/Student's t -test, whichever appropriate. The value of P < 0.05 was considered statistically significant., Results: There was a significant decrease in pain score after CRF without any added side effect. Pain relief after PRF was insignificant., Conclusion: CRF with steroid seems to be better for treatment of chronic discogenic low back pain than PRF with steroid.

Background: Mandibular nerve block reverses the trismus caused by pain and muscle spasm, thereby allowing for selection of a safer intubation technique., Aims: As ultrasonographic imaging has added newer dimensions to clinical anesthesia practice, we utilized this tool in performing mandibular nerve block and evaluated its efficacy in segregating trismus patients on etiological basis, to predict safer anesthetic induction., Settings and Design: Prospective, randomized controlled, outcome assessor blinded trial., Materials and Methods: Sixty-eight patients with unilateral mandibular fracture, acute pain, and trismus were randomized to receive mandibular nerve block by Vazirani-Akinosi approach (Group V) or the ultrasound-guided (USG) technique (Group U) before the general anesthetic induction for corrective surgery. Visual Analog Scale (VAS) score and inter-incisor distance was measured at intervals. Primary outcome measure was blocked failure (continued pain [VAS > 30] after the block procedure)., Statistical Analysis Used: Mann-Whitney U-test and Wilcoxon signed rank test., Results: There was a significant decrease in pain score following the block procedure, except for six patients (block failure) in Group V. Inter-incisor distance increased to near-maximal levels after the nerve blockade, except for nine patients in Group V (including all block failures) and four in Group U having continued limited mouth opening. General anesthetic induction increased the inter-incisor gap in block failures (Group V) only., Conclusion: USG mandibular block appears to relieve reversible trismus more reliably, thereby allowing for a precise decision on a safer intubation technique.

Background and Objective: Femoral fractures are extremely painful and pain invariably worsens on any movement. Anesthesia for fracture femur surgery is usually provided by spinal block. This study was undertaken to compare the analgesic effects of femoral nerve block (FNB) using nerve stimulator with 0.2% ropivacaine (15 ml) and intravenous (I.V.) fentanyl before patient positioning for fracture femur surgery under spinal anesthesia., Materials and Methods: A prospective, randomized, double-blind, comparative study was conducted on 60 American Society of Anesthesiologists I and II patients (18-60 years) scheduled for femur surgery under combined spinal epidural anesthesia. Patients in Group I (n = 30), were administered FNB using nerve stimulator with 0.2% ropivacaine (15 ml) and in Group II patients (n = 30), I.V. fentanyl 0.5 μg/kg was given as preemptive analgesia. Parameters observed included time to spinal anesthesia, intra-operative and postoperative visual analog scale (VAS) for any pain and postoperative epidural top-ups dosages., Results: Demographic profile was comparable in both the groups. VAS at 2 min in Group I was 5.63 and in Group II it was 8.00. Satisfaction score was better in Group I as compared to Group II patients. Time to administer subarachnoid block was 17.80 min in patients of Group I as compared to 25.03 min in Group II patients. Postoperatively, VAS scores were lower in Group I than Group II patients. The frequency of epidural top-ups was higher in Group II than in Group I patients., Conclusions: FNB is comparatively better in comparison to I.V. fentanyl when used as preemptive and postoperative analgesic in patients being operated for fracture femur.

Background: Postoperative pain control after major abdominal surgery is the prime concern of anesthesiologist. Among various methodologies, epidural analgesia is the most preferred technique because of the excellent quality of analgesia with minimum side-effects., Aim: The present study was designated to compare postoperative analgesic efficacy and safety of epidural tramadol as adjuvant to ropivacaine (0.2%) in adult upper abdominal surgery., Settings and Design: Prospective, randomized-controlled, double-blinded trial., Materials and Methods: Ninety patients planned for upper abdominal surgery under general anesthesia were randomized into three equal groups to receive epidural drug via epidural catheter at start of incisional wound closure: Group R to receive ropivacaine (0.2%); Group RT1 to receive tramadol 1 mg/kg with ropivacaine (0.2%); and RT2 to receive tramadol 2 mg/kg with ropivacaine (0.2%). Duration and quality of analgesia (visual analog scale [VAS] score), hemodynamic parameters, and adverse event were recorded and statistically analyzed., Statistical Analysis: One-way analysis of variance test, Fisher's exact test/Chi-square test, whichever appropriate. A P < 0.05 was considered significant., Results: Mean duration of analgesia after epidural bolus drug was significantly higher in Group RT2 (584 ± 58 min) when compared with RT1 (394 ± 46 min) or R Group (283 ± 35 min). VAS score was always lower in RT2 Group in comparison to other group during the study. Hemodynamic parameter remained stable in all three groups., Conclusion: We conclude that tramadol 2 mg/kg with ropivacaine (0.2%) provides more effective and longer-duration analgesia than tramadol 1 mg/kg with ropivacaine (0.2%).

Background: Anesthetic agents should be chosen not only on the basis of safety-efficacy profile, but also on the economic aspect. Propofol and sevoflurane are commonly utilized anesthetic agent for general anesthesia., Aim: The present study was designated to compare cost-effectiveness and recovery profile between propofol and sevoflurane for induction, maintenance or both., Settings and Design: Randomized controlled, participant and data operator blinded trial., Materials and Methods: Ninety patients undergoing laparoscopic cholecystectomy were randomized into three equal groups to receive: Group P to receive injection propofol for both induction and maintenance; Group PS to receive injection propofol for induction and sevoflurane for maintenance; and Group S to receive sevoflurane for both induction and maintenance of general anesthesia, respectively. Cost analysis, hemodynamic parameter, and recovery profile were compared between these groups., Statistical Analysis: One-way analysis of variance test or Fisher's exact test/Chi-square test whichever appropriate., Results: Total cost of anesthesia was highest in Group P and lowest in Group S. Mean time to extubation and time to follow verbal commands was lowest in Group S than Group P or Group P/S. Hemodynamic parameter was more stable in Group S., Conclusion: We conclude that sevoflurane appears to be better anesthetic agents in terms of cost-effectiveness and recovery profile.

Adolescence, derived from the Latin word "adolescere" meaning "to grow up" is a critical developmental period. During adolescence, major biological as well as psychological developments take place. Development of sexuality is an important bio-psycho-social development, which takes an adult shape during this period. During adolescence, an individual's thought, perception as well as response gets colored sexually. Puberty is an important landmark of sexuality development that occurs in the adolescence. The myriad of changes that occurs in adolescents puts them under enormous stress, which may have adverse physical, as well as psychological consequences. Understanding adolescent sexuality has important clinical, legal, social, cultural, as well as educational implications.

Aim: Scopolamine is known to produce amnesia due to blockade of the cholinergic neurotransmission. The present study investigated the potential of Convolvulus pluricaulis (CP) to attenuate scopolamine (2 mg/kg, i.p) induced increased protein and mRNA levels of tau, amyloid precursor protein (AβPP), amyloid β (Aβ) levels and histopathological changes in rat cerebral cortex., Materials and Methods: The study was conducted on male Wistar rats (250 ± 20 g) divided into four groups of eight animals each. Groups 1 and 2 served as controls receiving normal saline and scopolamine for 4 weeks, respectively. Group 3 received rivastigmine (standard) and group 4 received aqueous extract of CP simultaneously with scopolamine. Western blot and RT-PCR analysis were used to evaluate the levels of protein and mRNA of amyloid precursor protein (AβPP) and tau in rat cortex and ELISA was used to measure the amyloid β (Aβ) levels. Histopathology was also performed on cortical section of all groups., Result: Oral administration of CP extract (150 mg/kg) to scopolamine treated rats reduced the increased protein and mRNA levels of tau and AβPP levels followed by reduction in Aβ levels compared with scopolamine treated group. The potential of extract to prevent scopolamine neurotoxicity was reflected at the microscopic level as well, indicative of its neuroprotective effects., Conclusion: CP treatment alleviated neurotoxic effect of scopolamine reflects its potential as potent neuroprotective agent.

Objective: To investigate standardized ethyl acetate fraction of Rhododendron arboreum (EFRA) flowers for antidiarrheal activity in experimental animals., Materials and Methods: A simple sensitive high performance thin layer chromatography (HPTLC) method was used for the determination of hyperin in EFRA. The standardized fraction was investigated for castor oil, magnesium sulfate-induced diarrhea, measurement of gastrointestinal transit using charcoal and castor oil-induced enteropooling., Results: The concentration of hyperin in flowers of R. arboreum was found to be 0.148% by HPTLC. Oral administration of EFRA at 100, 200 and 400 mg/kg exhibited dose-dependent and significant (P<0.05-0.001) antidiarrheal potential in castor oil and magnesium sulfate-induced diarrhea. EFRA at doses of 100, 200 and 400 mg/kg also produced significant (P<0.05-0.001) dose-dependent reduction in propulsive movement in castor oil-induced gastrointestinal transit using charcoal meal in rats. EFRA was found to possess an antienteropooling in castor oil-induced experimental animals by reducing both weight and volume of intestinal content significantly., Conclusion: These findings demonstrate that standardized ethyl acetate fraction of R. arboreum flowers has potent antidiarrheal activity thus justifying its traditional use in diarrhea and have great potential as a source for natural health products.

Objective: The present study was designed to investigate the ameliorative potential and possible mechanism of hydroalcoholic extract of flowers of P. granatum in glycerol-induced acute renal failure (ARF) in rats., Materials and Methods: The rats were subjected to rhabdomyolytic ARF by single intramuscular injection of hypertonic glycerol (50% v/v; 8 ml/kg) and the animals were sacrificed after 24 hours of glycerol injection. The plasma creatinine, blood urea nitrogen, creatinine clearance, and histopathological studies were performed to assess the degree of renal injury., Results: Pretreatment with hydroalcoholic extract of flowers of P. granatum (125 and 250 mg/kg p.o. twice daily for 3 days) significantly attenuated hypertonic glycerol-induced renal dysfunction in a dose-dependent manner. BADGE (Bisphenol-A-diglycidyl ether) (30 mg/kg), a peroxisome proliferator-activated receptor (PPAR)-γ antagonist, and N(omega)-nitro-l-arginine-methyl ester (L-NAME) (10, 20, and 40 mg/kg), nitric oxide synthase inhibitor, were employed to explore the mechanism of renoprotective effects of Punica granatum. Administration of BADGE (30 mg/kg) and L-NAME (40 mg/kg) abolished the beneficial effects of P. granatum in glycerol-induced renal dysfunction., Conclusion: Hydroalcoholic extract of flowers of P. granatum has ameliorative potential in attenuating myoglobinuric renal failure and its renoprotective effects involve activation of PPAR-γ and nitric oxide-dependent signaling pathway.

Aim: To investigate the neuroprotective effect of Convolvulus pluricaulis aqueous extract (AE) against scopolamine (1 mg/kg body weight (bwt))-induced neurotoxicity in the cerebral cortex of male Wistar rats., Materials and Methods: The study was carried out on male Wistar rats (age matched, weight 250 ± 20 g). The present study investigated cognitive-enhancing property of AE using Elevated plus maze (EPM) (transfer latency [TL]) and Morris water maze (MWM). Besides evaluating the effect of extract on neurochemical enzymes, in vivo antioxidant and free radical scavenging activities were also screened. All the measured parameters were compared with rivastigmine tartrate (1 mg/kg bwt) which was taken as standard., Results: Pretreatment of rats with AE (150 mg/kg bwt) significantly reduced scopolamine-induced increase in the TL in EPM, whereas in MWM, administration of extract improved the impairment of spatial memory induced by scopolamine. The activity of acetylcholinesterase (AChE) was significantly inhibited by extract within the cortex and hippocampus. Reduced activities or contents of glutathione reductase, superoxide dismutase, and reduced glutathione within the cortex and hippocampus induced by scopolamine were elevated by the extract. Taken together, it could be postulated that extract may exert its potent-enhancing activity through both anti-AChE and antioxidant action., Conclusion: AE possesses neuroprotective potential, thus validating its use in alleviating toxic effects of scopolamine.

Objective: To evaluate the hepatoprotective potential of ethyl acetate fraction of Rhododendron arboreum (Family: Ericaceae) in Wistar rats against carbon tetrachloride (CCl(4))-induced liver damage in preventive and curative models., Materials and Methods: Fraction at a dose of 100, 200, and 400 mg/kg was administered orally once daily for 14 days in CCl(4)-treated groups (II, III, IV, V and VI). The serum levels of glutamic oxaloacetic transaminase (SGOT), glutamate pyruvate transaminase (SGPT), alkaline phosphatase (SALP), γ-glutamyltransferase (γ -GT), and bilirubin were estimated along with activities of glutathione S-transferase (GST), glutathione reductase, hepatic malondialdehyde formation, and glutathione content., Result and Discussion: The substantially elevated serum enzymatic activities of SGOT, SGPT, SALP, γ-GT, and bilirubin due to CCl(4) treatment were restored toward normal in a dose-dependent manner. Meanwhile, the decreased activities of GST and glutathione reductase were also restored toward normal. In addition, ethyl acetate fraction also significantly prevented the elevation of hepatic malondialdehyde formation and depletion of reduced glutathione content in the liver of CCl(4)-intoxicated rats in a dose-dependent manner. Silymarin used as standard reference also exhibited significant hepatoprotective activity on post-treatment against CCl(4)-induced hepatotoxicity in rats. The biochemical observations were supplemented with histopathological examination of rat liver sections. The results of this study strongly indicate that ethyl acetate fraction has a potent hepatoprotective action against CCl(4)-induced hepatic damage in rats.

Xanthomas are often a manifestation of underlying lipid abnormalities. A 50-year-old male presented to our hospital with the lesions of multiple tuberous xanthomas all over the body. Routine investigations and systemic examination were normal. Lipid profile was within normal range and serum protein electrophoresis showed normal pattern. Histopathology from a nodular lesion showed collection of foamy macrophages in the dermis. We present a case of normolipemic tuberous xanthomas, which is an uncommon occurrence.

This case report is an insight in to pediatric traumatology whereby bilateral greenstick fracture of condyle is used as a means to discuss the incidence and anatomic considerations for the management of the same, highlighting the fact that dental surgeons require a unique understanding of the anatomy, growth considerations, healing pattern and operative management involving minimal manipulation while managing pediatric facial fractures.

Background: It has been more than a decade, since the introduction of laparoscopic management of ventral and incisional hernia. The purpose of this article was to systematically review the literature, analyze the results of Laparoscopic repair of ventral and incisional hernia and to ascertain its role., Materials and Methods: Pubmed was used for identifying the original articles. Both incisional and ventral hernia repair were included. Out of 145 articles extracted from Pubmed, 34 original studies were considered for review. More than three thousand patients were included in the review. Variables analyzed in the review were inpatient stay, defect size, mesh size, hematoma, seroma, wound infection, bowel perforation, obstruction, ileus, recurrence and pain. Qualitative analysis of the variables was carried out., Results: Seromas (5.45%) and post operative pain (2.75%) are the two common complications associated with this procedure. Recurrence rate was found to be 3.67%. Overall complication rate was 19.24%, with two deaths reported., Conclusion: The results suggest laparoscopic repair of ventral and incisional hernia as an effective procedure. Faster recovery and shorter in patient stay - makes it a feasible alternative to open repair.

Fifty patients of depression and thirty normal subjects were assessed using clinical rating scales and also for the executive functions by Wisconsin Card Sorting Test (WCST). The depressed subjects demonstrated poor performance on WCST suggesting cognitive inflexibility and prefrontal dysfunction. More severe illness was associated with greater impairment in the executive functioning. This pattern of result in conjunction with previous studies supported the idea that depressed patients may have fixed frontally based dysfunction and calls for the use of cognitive assessment and rehabilitation in the patients with depression.

A 55 year old man presented with features of cauda equina syndrome. Magnetic resonance imaging (MRI) showed a well demarcated intradural extramedullary tumour at L2 vertebra. At surgery it was found to be well encapsulated and had no attachment to spinal cord or root. Histopathology including immunohistochemistry confirmed it to be a low grade astrocytoma.

Histopathologically and immunologically confirmed case of paraganglioma of cauda equina region is described.

A 60 year old man presented with chronic backache of six months duration, sciatica of three months duration, weakness of both lower limbs of two months duration, urinary retention and bowel incontinence of one month duration. Neurologically, he hadparaplegia with motor and sensory level at L1 dermatome. X-ray lumbar spine showed spondylotic changes with reduction of L1/L2 disc space.Myelography revealed an intradural mass. A diagnosis of intradural disc herniation was made and confirmed by surgery.However, neurological status remained unchanged at the time of discharge.