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Zoological parks are the ex-situ conservation facilities to complement and strengthen the national efforts in conservation and strengthen the rich biodiversity of the country, particularly the fauna.[1]The architectural design or the map of the zoo depicting location and dimensions of the office,exhibit area, indoor holding area, visitor paths etc are some of the major components of Master (Layout) Plan of the Zoo. Central Zoo Authority is the competent authority to approve the Master (Layout) Plan of the recognized zoological parks recognized by CZA. This Master (Layout) Plan model design takes into account of 3 key parameters that one should keep in mind while designing the zoo: Animal welfare (i.e., making animal housing facility as comfortable as possible), seamless visitor experience and smooth working of zoo management personnel.

Split tooth is the type of crack or break in tooth, that has split vertically into two separate parts or in other words, with clinical features like pain, sensitivity, etc. although there are multiple causes for the split tooth but here in this case presentation, we are going to discuss about the split tooth in a diabetic patient due to carious tooth. Also, patient has many dental problems but here we are going to emphasize on the management of split tooth only and its restoration. Keywords: Split tooth, Pain, Caries, Diabetes.

Background: Dermatology is primarily an outpatient specialty. However, dermatology consultations play an important role in care of inpatients. Data on inpatient dermatological consultations in tertiary care settings is limited. Objectives: To evaluate clinical characteristics of inpatient dermatological consultations and effect on clinical outcomes in a tertiary care setting. Methods: This was a single-center retrospective study where the records of all dermatological consultations for patients admitted under various specialties, emergency services, and intensive care units (ICU) at our tertiary care institute over 2 years period were reviewed. The details of patients, primary care unit, dermatological complaints, diagnosis, investigations performed, treatment given, and follow-up were recorded and analyzed. Results: Total of 1717 dermatologic consultations (1000 males) were recorded, with mean age of study population being 33.6 ± 21.6 years (median - 32 years). Out of total 1717 patients, 136 (7.9%), 321 (18.7%), 1135 (66.1%), and 125 (7.3%) patients were infants, children, adolescents, adults, and elderly, respectively. The most frequent diagnostic group was infective diseases (586; 34.1%) followed by inflammatory diseases (442; 25.7%), mucocutaneous adverse drug reactions (160; 9.3%), and autoimmune diseases (65; 3.8%). Primary team's diagnosis was concordant with the dermatology consultation in 1112 (64.8%) patients and discordant observations were recorded in 605 patients (35.2%). Most discordant dermatological diagnoses included inflammatory disorders such as lichen planus, atopic dermatitis, bullous pemphigoid; mechanical disorders; nutritional deficiency disorders, and benign neoplasms. Conclusion: Common skin conditions account for a large majority of dermatologic consultations in a hospital setting. Inpatient dermatology consultations improve the diagnostic accuracy.

Opportunistic fungal infections account for a significant amount of morbidity associated with diabetic patients. Oral thrush is a condition in which the fungus Candida albicans accumulates on the lining of mouth. It is well known that Candida species are normal commensals of oral cavity in up to 50% of the healthy population but these commensals can cause opportunistic infection of the oral cavity, specially when person is having co-morbid disease that reduces the immune strength of patient as like in diabetes. Keywords: Oral thrush, Oral candidiasis, Diabetes, Anti-fungal, Poor Oral Hygiene.

Concept of dental ozone therapy is significantly becoming a trend nowadays, O3 is pure ozone gas has a soft sky-blue colour with a pungent smell extremely reactive, powerful oxidizing agent. It has a many biomedical properties like antibacterial, immune-stimulating, synthesis of Igs, etc. There are various uses of ozone in the field of dentistry, and the objective of this review is to shed light on clinical dental applications of ozone and summarize the research findings regarding the use of ozone in dentistry. Keywords: Ozone (O3).

For the better anti-inflammatory or analgesics effects of drugs; enzymes have been widely used in the medical field either it may be arthritis or fracture of the bone or it may be oedema. Along with antiinflammatory action these drugs have anti-oedema properties, healing properties and fibrinolytic properties as like trypsin-chymotrypsin. In this article we are going to discuss about the importance or applications of these enzymes either alone or in combination with other NSAIDS in the field of dental practice. Keywords: Antiinflammatory, Analgesics serratiopeptidases chymotrypsin oral cancer.

Removable complete denture till date exists as one of the treatment modality of choice to the edentulous patients. Complaints that are associated after delivery of complete denture is more of actual type and very less frequent of psychological type. In most of the cases education to the patient prior to the start of the procedure will help the clinician as well as the patient to understand the limitations associated with the use of complete denture. The most important thing is to motivate the patient to overcome these limitations. Keywords: Post insertion problems, Complete denture, Complaints.

Osseointegration was discovered in 1962 and coined as a term in 1977. Original definitions implied direct contact between foreign materials and bone without any interposed soft tissue layers. Today, osseointegration is regarded to be a foreign body response to separate foreign elements from bone. A new definition of the term is suggested in this paper; “Osseointegration is a foreign body reaction where interfacial bone is formed as a defense reaction to shield off the implant from the tissues”.

Onychocryptosis, or ingrown toenail, is a frequent, painful condition affecting young individuals. Controversies still exist regarding its etiopathogenesis and treatment options, including conservative and surgical techniques. The choice of treatment method depends on the stage of disease as conservative measures are mostly effective in early stages and surgical procedures are required in the later stages. Among surgical techniques, phenol cauterization of lateral nail matrix has been the most effective, safe, and commonly performed method. Other more destructive surgical procedures are rarely done nowadays. In this review, we briefly discuss the etiopathogenesis, clinical features, and different treatment options of ingrown toenail.

Introduction: Acquired dermal hyperpigmentation (ADMH) presenting on periorbital region has been described as individual case reports. We tried to characterize the features of periorbital ADMH. Materials and Methods: This was a retrospective case-control study among our patients who attended the pigmentary clinic during January 2016–December 2017. Clinical, dermoscopic, and histopathological features of subjects who were recruited during the study period were prospectively evaluated. Results: Total 19 subjects (11%) were identified among 177 ADMH patients. Periorbital ADMH patients had a relatively younger age of onset (23.26 ± 11.06 vs. 36.16 ± 13.41, P < 0.001). Dermoscopy of early periorbital ADMH showed only imperceptible speckled blue-gray dots that accentuated at outer-corner creases of eyes (the “outer-corner crease sign”). Clinicopathological features and prognosis of periorbital ADMH were similar to that of ADMH per se. Conclusion: Periorbital ADMH should be considered as a differential diagnosis of periorbital hyperpigmentation in children and young adults. Outer-corner crease sign on dermoscopy may help to rule out other differentials in its early presentation.

We purpose a theoretical analysis for the generation of efficient terahertz (THz) radiation by using the nonlinear interaction of Gaussian laser beam with vertically aligned anharmonic, and rippled carbon nanotubes (CNTs) array. This array of vertically aligned carbon nanotubes (VA-CNTs) is embedded on the base of the dielectric surface. The VA-CNTs have been magnetized by applying a static magnetic field mutually perpendicular to the direction of propagation of the Gaussian beam and length of CNTs. The Gaussian laser beam passing through the CNTs exerts a nonlinear ponderomotive force on the electrons of CNTs and provides them resonant nonlinear transverse velocity. This produces the nonlinear current which is further responsible for the generation of THz radiation. The anharmonicity plays a vital role in the efficient generation of THz radiation. The anharmonicity arises due to the nonlinear variation of restoration force on the various electrons of CNTs. This anharmonicity in the electrons of CNTs helps in broadening the resonance peak. We have observed that externally applied static magnetic field 110 kg to 330 kg) also paves the way for the enhancement of the normalized THz amplitude.

Management of chronic/recurrent erythema nodosum leprosum (ENL) is challenging. The majority of these patients become steroid-dependent and suffer from the adverse effects of long-term corticosteroid use. Minocycline has shown promising results in a small series of chronic/recurrent ENL patients. The aim of this study was to compare the efficacy and safety of minocycline and clofazimine in patients with chronic/recurrent ENL. In this prospective randomized clinical trial, 60 participants with chronic/recurrent ENL were randomized (1:1) to receive either minocycline 100 mg once daily or clofazimine 100 mg thrice daily for 12 weeks along with prednisolone according to WHO protocol and followed up for 6 months. The outcome measures were mean time for initial control of ENL, proportion of patients having a recurrence of ENL, mean time for recurrence after initial control, additional prednisolone requirement, and frequency of adverse events. Initial control of ENL was achieved earlier in the minocycline group as compared to the clofazimine group (2.97 ± 1.9 weeks vs. 4 ± 1.96 weeks, respectively; p-0.048). The number of participants having ENL flares/recurrences during the study period was comparable in both groups (71.4% in clofazimine vs. 55.2% in minocycline group; p-0.2). The participants in the minocycline group remained in remission for a longer duration after initial control of ENL as compared to the clofazimine group (p-0.001). Mean additional prednisolone dose required for control of ENL flares/recurrences was also comparable in both groups (p-0.09). The minocycline group had fewer side effects than the clofazimine group (p-0.047). Minocycline led to a rapid and sustained improvement of ENL episodes with fewer adverse events showing a superior efficacy to clofazimine.

The basic knowledge of sterilization and disinfection is the key to control the spread of infection from dentist to the patient, and vice versa from patient to the dentist. In the process of sterlisation complete removal of all the spores done where as complete removal of spores is not accomplished with the process of disinfection. Keywords: Sterlisation, Disinfection, Moist heat sterlisation, Autoclave, Infection control.

BACKGROUND Leprosy relapse/recurrence is a serious concern particularly in a leprosy-endemic nation such as India. It is believed that bacilli persisting even after multidrug therapy can cause relapse; recently, however, drug resistance as a cause for recurrences and chronic erythema nodosum leprosum (ENL) has been speculated. AIM To study drug-resistance patterns in cases of leprosy relapse and chronic/recurrent (c/r)ENL. METHODS This cross-sectional study conducted over a period of 1 year included patients diagnosed as having leprosy relapse and those with c/rENL. Skin biopsy specimens were examined by conventional PCR for resistance testing for rifampicin, dapsone and ofloxacin, respectively targeting the rpoB, folP and gyrA genes of Mycobacterium leprae. RESULTS In total, 61 patients (25 smear-negative) were included in the study. Of these, 37 were diagnosed as having leprosy relapse and 24 as having c/rENL. Drug resistance to at least one drug was identified in 10 cases (16.4%). Rates of drug resistance were 5.4% (2 of 37) for dapsone, 10.8% (4 of 37) for rifampicin and 2.7% (1 of 37) for ofloxacin among cases of relapse, whereas it was 12.5% (3 of 24) and 8.3% (2 of 24) for dapsone and rifampicin respectively among those with c/rENL. Multidrug resistance was seen in 3.3% patients (2 of 61). CONCLUSION Drug-resistance rate among those with c/rENL was almost equalled that of relapse. Smear-negative leprosy relapse cases also had resistance to bactericidal drugs. These findings call for modifications in criteria for testing under leprosy drug-resistance surveillance and all cases of relapse and those with recalcitrant c/rENL should be tested.

Purpose A case of anterior lenticular opacities in a patient of Costello Syndrome is reported. Observations Bilateral anterior capsular plaque along with anterior lens opacities (Anterior Segment Optical Coherence Tomography) has been demonstrated in a patient of Costello Syndrome presenting with atopic dermatitis. Conclusions All patients with Costello Syndrome require a detailed anterior segment examination and a close follow up, as even minute lenticular opacities cause visual impairment leading to amblyopia and may require an early surgical intervention.

This paper presents a scheme for strong self-focusing of a laser beam interacting with a cone-guided fast-ignition inertial confinement fusion target using cone pre-plasma filling as an optical medium for reducing the laser beam waist. The objective is to reduce the focal spot size at the interior of the tip of the re-entrant cone to that required for efficient coupling to the dense imploded fuel core. This is challenging to achieve in a large laser system using the standard optical components of a chirped-pulse-amplified (CPA) laser-beam chain where the spot sizes produced are often significantly larger than would be desirable for fast ignition. The approach described also makes use of the presence of pre-plasma in the cone. Such pre-plasma filling is difficult to avoid entirely when illuminating a cone with a high-energy CPA laser system due to the challenges of reducing laser pre-pulse to below the threshold for plasma production. For deriving the differential equation which governs the progress of the laser beam-width with propagation distance, paraxial theory in a WKB approximation has been used. A simulation is performed assuming strong self-focusing in accordance with the laser parameters and plasma density profile chosen.

The present analysis develops a novel theory of terahertz radiation generation by beating of two laser beams, incident obliquely on the array of vertically aligned carbon nanotubes (CNTs) in the presence of an external wiggler magnetic field. The array of CNTs behaves as nanoantenna to generate THz radiations. The incident lasers exert a ponderomotive force on the electrons of the CNTs to produce nonlinear oscillatory velocity, which beats with the applied wiggler magnetic field. This beating produces a nonlinear current at (ω2 − ω1, k2 − k1 + k0) which acts as an antenna to produce the THz radiation. We observe that when the beat frequency (ω2 − ω1) lies near the effective plasmon frequency of the CNTs, strong THz radiation is produced due to a resonant interaction of the laser with CNT electrons. The externally applied wiggler magnetic field enhances the efficiency of THz radiation of nanoantenna by providing the necessary momentum to the generated THz radiation. We explore the impact of radius and length of nanotubes on the efficiency of THz generation. The generated THz power is enhanced at an optimum angle of incidence of lasers with an array of CNTs.

This is an exciting phase of vitiligo research with the current understanding of vitiligo pathogenesis and its translation to successful treatment. The pathogenetic origin of vitiligo revolves around autoimmunity with supporting role from many other factors like oxidative stress, inherent melanocyte defects, or defective keratinocytes and fibroblasts. Vitiligo can be classified into segmental or non-segmental depending upon the clinical presentation, or it can be classified as progressing or stable based on the activity of the disease. Vitiligo treatments need to be stratified depending upon which type of vitiligo we are treating and at which phase the vitiligo patient presents to us. There are two different aims of treatment of vitiligo. The first involves rescuing the melanocytes from the damage to arrest the depigmentation. The second strategy focuses on replenishing the melanocytes so that successful repigmentation is achieved. It is also important to maintain the disease in a stable phase or prevent relapse. As stability in non-segmental vitiligo is a dynamic process, maintenance of the stability of repigmentation is also an important consideration in the management of vitiligo. In this review, we shall briefly discuss the current options and future insight into the management of vitiligo.

Placebo-controlled studies have reported the efficacy of apremilast in the management of palmoplantar psoriasis but studies comparing efficacy with a conventional agent are lacking. The objective of this article was to compare the efficacy and safety of apremilast and methotrexate in patients with palmoplantar psoriasis. In this prospective, randomized, active-controlled, observer-blinded clinical trial, conducted at a psoriasis clinic of a tertiary care institute in India from 1 July, 2019 to 1 June, 2020, 84 patients with palmoplantar psoriasis were randomized (1:1) to receive either methotrexate (0.4 mg/kg/week orally) or apremilast (30 mg twice daily). The treatment protocol was continued for 16 weeks or until achieving a ≥ 75% improvement in the Modified Palmoplantar Psoriasis Area and Severity Index (m-PPPASI 75), whichever was earlier. Changes in m-PPPASI and Dermatology Life Quality Index scores from baseline, the proportion of patients achieving m-PPPASI 75, and adverse events were assessed. Eighty-four patients were included (76 palmoplantar psoriasis and 8 palmoplantar pustulosis). The mean age (standard deviation) was 44.5 (12.9) years and 53 (63%) were women. The m-PPPASI score [median (interquartile range)] after 16 weeks of treatment showed a significant improvement from baseline in both apremilast [− 6.3 (10.9), p < 0.001] and methotrexate groups [− 8.5 (9.9), p < 0.001]. The estimated median difference between the groups was − 1.2 (p = 0.39, 95% confidence interval − 4.2 to 2.1). At 16 weeks, m-PPPASI 75 was achieved by 14/42 (33%) and 17/42 (41%) patients in the apremilast and methotrexate groups, respectively (p = 0.49). A significant reduction in the Dermatology Life Quality Index score [median (interquartile range)] was observed in both groups [apremilast: − 3.0 (6.0), p < 0.001; methotrexate: − 3.0 (6.3), p < 0.001] with an estimated median difference of 0.0 (p = 0.99, 95% confidence interval − 1.0 to 2.0). The proportion of patients experiencing adverse events was comparable (p = 0.49). Apremilast showed a comparable efficacy and safety profile to methotrexate in the management of palmoplantar psoriasis. CTRI/2019/06/019830, date of registration: 24 June, 2019; trial registered prospectively.

Noncultured epidermal cell suspension (NCES) is a well-established surgical treatment modality for stable vitiligo. The outcome of this procedure significantly depends on the method of recipient site preparation, a critical step to achieve cosmetically acceptable repigmentation. To compare the efficacy of recipient site preparation using three methods namely, dermabrasion, cryoblister, and dermaroller followed by NCES in stable vitiligo. In this single-center, prospective, intra-patient, randomized clinical trial; 36 participants having at least three vitiligo patches in same anatomic region with minimum lesional stability of 1 year were randomized 1:1:1 for recipient site preparation using manual dermabrasion, cryoblister, and dermaroller followed by NCES. Patients were followed up at 4, 8, and 12 weeks and assessment of extent and pattern of repigmentation, color match and patient satisfaction were done. Among 36 patients, 22 (61.1%) were females; mean (SD) age was 28.33 (9.4) years. Dermabrasion and cryoblister techniques showed equal efficacy with respect to extent of repigmentation (>75% repigmentation; 55.6% vs 47.2%; P = .63) and patient satisfaction score (20.2 ± 9.6 vs 19.9 ± 7.9, P = .194). However, dermabrasion was superior to cryoblister in terms of rapidity (65% vs 32.5% at 4 weeks, P = .04) and color match (47.2% vs 19.4%, P = .004). Dermaroller had poor repigmentation outcomes compared to both dermabrasion and cryoblister. Cryoblister as a method of recipient site preparation is equally effective as manual dermabrasion in NCES for attaining good to excellent repigmentation, but with risk of hyperpigmentation. However, dermaroller is inferior to both dermabrasion and cryoblister.

- Microorganisms and their by-products are considered to be the major cause of pulp and peri-radicular pathologies, and for the dis-infection of these canals we need proper shaping, cleaning of these canals with mechanical instruments and chemical irrigants. Here we are discussing about the chlorohexidine with a concentration of 2% in root canal treatment. It has been found that there is a highly significant reduction in the number of microorganisms in the chlorhexidine-treated specimens after instrumentation and irrigation. Here we will discuss the merits and de-merits of chlorhexidine and its use in root canal as an irrigant or medicaments.

LASER stands for light amplification by stimulated emission of radiation. Einstein was the ist to give the foundation for laser , however the first to give laser term was Gordon Gould. Invention of LASER has brought about a major revolution in the ways of life of people. The increasing use of laser in medicine has only been possible due to a better understanding of the interaction between laser light and living tissue. Reliably laser removes the needle, drill, and pain from the dental procedures & also reduces risk of contamination with respect to drills. Laser significantly reduces aerosols and Does not produce scratch material , thus causing less spread of debris outside the oral cavity. Blood free procedures for better recovery . Laser dentistry can be a precise and effective way to perform many dental procedures. Dental laser can be used to generate both hard and soft tissue laser energy, depending upon the patient’s needs.

Smokeless tobacco keratosis is a condition that causes thick white patches to form on mucosa with common sites are inner check , in between teeth & gums , appear wrinkled in texture usually develops in between 1-5 years of tobacco use. Educating and motivating a patient is very important in the prevention as well as cure of STK.

Oral submucous fibrosis (OSMF) is a premalignant condition caused by betel chewing. OSMF is a premalignant condition that can lead to oral cancer. A risk that is further increased by concomitant tobacco consumption. OSMF is a diagnosis based on clinical symptoms and confirmation by histopathology. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrotic band formation. Drug therapy include antifibrotic, anti-inflammatory, and antioxidants, homemade remedies including turmeric and tulsi . Prevention is most important in case of OSMF , because severe cases of OSMF are irreversible.

A subset of leprosy patients has clinical and histopathological activity in the form of persistent plaques and granulomas after completion of multidrug therapy (MDT) which can have significant impact on their quality of life. In the absence of clear guidelines regarding management of such patients, majority of the times they are treated either as late reversal reaction with corticosteroids or no active treatment is offered. We observed 11 patients of leprosy with persistent plaques after completing the 6/12-months MDT who were treated favorably with minocycline 100 mg once daily for 16 weeks. Complete clinical resolution was observed in 9/11 patients while two patients had partial improvement. Histopathological improvement in the form of disappearance of granulomas corroborated with the clinical improvement. All the patients tolerated the treatment well and hyperpigmentation was the only adverse effect noted. Minocycline may be considered as a useful and well tolerated therapeutic option for this subset of leprosy patients due to its immune modulatory and anti-inflammatory effects.

Background Despite advances in surgical management of vitiligo, lesions on acral areas and bony prominences remain treatment refractory. There is lack of literature on the treatment efficacy of various surgical modalities over these treatment refractory sites. Objective To compare the efficacy of three common methods of grafting in vitiligo in known resistant areas. Methods A single-center interventional clinical trial involving 30 patients of stable vitiligo (disease stability ≥1 year) located over bony prominences and acral areas. All patients were treated with noncultured epidermal cell suspension (NCES), suction blister epidermal grafting (SBEG), and mini punch grafting (MPG) on three separate patches. Extent of repigmentation was assessed at 12 and 24 weeks, color matching and patient satisfaction were evaluated at 24 weeks. Results Among 30 participants, 22 (73%) were females, mean age was 27.4 (±10.7) years, and the majority (93.3%) had nonsegmental vitiligo. At 12 weeks, repigmentation >75% was noted in 56.6, 60, and 16.6% of patches treated by NCES, SBEG, and MPG, respectively. At 24 weeks, results remained the same in both the NCES and SBEG groups, while the number of patches with >75% repigmentation increased to 23.3% in the MPG group. The difference in repigmentation rate between NCES and MPG as well as between SBEG and MPG achieved statistical significance. Color matching of treated area and patient satisfaction were better in NCES and SBEG groups compared to MPG. Conclusion NCES and SBEG are superior to MPG with reasonably good efficacy and can be offered as a therapeutic modality for stable vitiligo patches over these sites.

Vitiligo is an acquired disorder of depigmentation that is associated with immense stigma and psychological burden. Although there is a myriad of options available for therapy, the repigmentation is best achieved with surgical modalities for stable disease. Once the immune attack on melanocyte is halted, surgery can be undertaken. The principles of surgery may be to introduce artificial pigment, stimulate melanocyte proliferation and migration, removal of depigmented areas or repopulation of depleted melanocytes. Broadly these can be divided into grafting, non-grafting techniques, camouflage and excision. The grafting techniques are further divided into cellular and tissue grafts. The advantage of the former being a greater donor to recipient ratio, however with added cost and equipment requirement. Grafting techniques have undergone various innovations, be it in harvesting, recipient site preparation or dressing, each with their own advantages and disadvantages. New innovations continue to crop up, including the use of stem cells and regulatory T-cell modulation. A well performed surgery is incomplete if it was not done without proper patient selection, counseling and preparation. This review article briefly outlines the various techniques; pre, intra and post-operative intricacies and the innovations in each.

We present the numerical analysis of optimization of wiggler wave number for density transition based second harmonic generation during laser plasma interaction. Wiggler wave number required for phase matching increases with plasma density and the intensity of pump wave. It is due to the fact that wiggler magnetic field offers the additional angular momentum which is necessary to make the second harmonic generation process resonant. A considerable enhancement in the resonant second harmonic generation of an ultra-short pulse laser in plasma with density transition surrounded by a magnetic wiggler is observed. Density transition in plasma plays a key role in self-focusing which further enhances the harmonic generation of second order in plasma. Also we have examined the effect of magnetic wiggler on the harmonic generation of second order in plasma.

The propagation of a high power laser beam, with frequency ω 1 and wave vector k 1 z ˆ , through a semiconductor under chirped pulse effect has been investigated which results in the harmonic generation of second order. When a highly intense beam of laser propagates through a semiconductor under the impact of wiggler magnetic field, the transverse current density starts oscillating with a frequency which is twice of the laser field. Enhancement in the second harmonic generation of chirped pulse laser in semiconductor under the influence of wiggler magnetic field is seen. We have also examined the effect of chirped pulse on power conversion efficiency of the second harmonic generation which increases with the increase of the chirp parameter.

Resonant second harmonic generation of a relativistic self-focusing chirped pulse laser in plasma has been investigated. The second harmonic undergoes periodic focusing in the plasma channel created by the fundamental wave and the strength of focusing increases with the propagation distance. The normalized second-harmonic amplitude varies periodically with distance and attains maximum value in the focal region. A significant enhancement in the intensity of second harmonic on account of relativistic self-focusing of the chirped pulse laser is seen. We have also examined the effect of chirped pulse on the normalized amplitude of the second harmonic generation. A sharp increase in the normalized second harmonic amplitude is seen for positive chirp.

Tumour necrosis factor-alpha (TNF-α) inhibitors have been successfully used in the treatment of various immune-mediated inflammatory diseases. However, these agents are frequently associated with mucocutaneous adverse effects.1 Anti-TNF-α-induced lupus erythematosus (LE) represents an uncommon adverse effect and has implications on patient management.2 Herein, we report a female patient who developed cutaneous LE after treatment with adalimumab for her rheumatoid arthritis (RA). A woman aged 40 years presented with photosensitivity and painless oral ulcers of 1-month duration. On examination, ill-defined erythema was present over her nose extending to malar area. Well-defined erythematous ulcers were present over buccal mucosae, lips and hard palate (figure 1A,B). Chillblain-like lesions were present over both ears (figure 1C). Her medical history was significant for the presence of RA, for which she had received four doses of …

This paper presents a scheme for strong self-focusing of laser beam interacting at Deuterium-Tritium (DT) fusion target. Upward plasma density ramp in a plasma-loaded cone-guided ICF scheme is introduced. We put forward the idea to merge this upward plasma density ramp loaded cone to a pre-compressed DT target for permissible focusing of the laser beam to the core thereby enhancing growth in fusion. Experimentally validated modeling of plasma loaded cone is also discussed. The results obtained numerically signify that with increase in the initial spot size of the laser beam the self-focusing becomes stronger. Also, the presence of upward plasma density ramp inside plasma-loaded cone leads to the reduction in the spot size of laser beam thereby increasing the frequency of oscillations which leads to stronger self-focusing and hence increases the fusion gain.

Empty sella turcica is a condition in which the pituitary gland is absent completely or partially from the sella turcica or pituitary fossa. The patient may be asymptomatic with empty sella turcica as an incidental finding, or may have symptoms of pituitary hormones deficiency. Perioperative management of these patients depends on the symptoms and signs of hormonal deficiencies and the hormonal replacement treatment.

Background: Clinicodemographic and laboratory parameters predicting the outcome of Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) may vary among populations owing to genotypic and environmental variations. There is a scarcity of studies evaluating these parameters in Indian population. Aims: To analyze clinicodemographic and laboratory parameters predicting disease outcome in patients of SJS/TEN. Materials and Methods: Clinical records of patients admitted with a diagnosis of SJS/TEN from January 2014 to December 2018 were reviewed retrospectively with respect to data pertaining to clinicodemographic details, laboratory parameters, and disease outcome. Results: Of 51 patients included in the study, 24 (47.06%) were females. Anticonvulsants [phenytoin (19.6%), carbamazepine (13.7%), others (5.88%)] were the most commonly implicated drugs followed by NSAIDs (19.6%). The overall mortality was 21.6% [SJS (0%), SJS-TEN overlap (18.8%), and TEN (28.6%)]. The mean detached body surface area (BSA) (35.4% ± 10.4% vs. 25.7% ± 11.8%; P = 0.02) was significantly higher among patients with mortality. Blood urea nitrogen, serum HCO3− levels, and random blood sugar were significantly associated with mortality. Presence of sepsis during the disease course was associated with higher mortality (9/12 vs. 2/39; P = 0.001). Other components of SCORTEN like age and heart rate were not significantly associated with poor outcome in our study. None of our patients had associated malignancy. Conclusion: A higher detached BSA, presence of sepsis, higher blood urea nitrogen and random blood sugar, and lower serum HCO3− levels were associated with mortality. Refinement of scoring systems predicting the outcome of SJS-TEN is needed for better disease prognostication.