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Background: Deep dentin tubular penetration of the sealer provides a three dimensional sealing of root canal space Aim: To evaluate the effect of final irrigant on depth of tubular penetration of resin based root canal sealer and bioactive sealers using Confocal Laser Scanning Microscope (CLSM) Materials and Method: Ninety- six freshly extracted human mandibular first premolar teeth were decoronated at 15 mm from the apex. Cleaning and shaping procedure was accomplished using Hyflex CM rotary files till F3. The sample were divided into three groups(n=32) according to final irrgant used : Group A (17 % EDTA), Group B (QMix 2 in 1), Group C (Distilled water). The final irrigation in each respective group was performed with EndoVac system. The samples were further subdivided into 4 subgroups (n=8) according to the type of sealer used for obturation with 6% guttapercha cones - Subgroup I (AH Plus), Subgroup II (Gutta Flow Bioseal), Subgroup III ( Endosequence BC ), Subgroup IV (EndoSeal MTA). Two mm horizontal sections were obtained at 2 mm (apical sections), 5 mm (middle sections) and 7 mm (coronal sections) from the root apex using CLSM to evaluate the maximum depth and percentage of sealer penetration into the dentinal tubules by using Kruskal-Wallis test for overall analysis and a series of Mann-Whitney U tests for pairwise comparison. Result: Endosequence BC showed maximum depth of penetration and penetrated percentage perimeter, while Gutta Flow Bioseal showed least values. Q Mix 2 in 1 showed better penetration values than EDTA and distilled water. Conclusion: Irrigants, nature of sealer and level of root canal affected sealer penetratio.

Although the pharmaceutical industry is a multi-billion-dollar business, it fails to save the lives of millions. Astronomical drug prices are not just an economic problem that can be settled through clever marketing strategies but a significant ethical issue. This article delves into the ethical health care paradigm, which can supplant the present economistic paradigm. Grounded in the ethical-philosophical argument for recognising an individual's right to be healthy, it asserts the practical proposal of cost rationalisation and universal availability of essential and lifesaving drugs. This is achievable by supporting research and development funding for drug innovation by the business establishment, and as such falls within the scope of corporate social responsibility.

Background: Perforation is the most serious, the most fatal and one of the commonest complication of all gastric and duodenal ulcers and occurs in about 10 to 15% of all recognized chronic peptic ulcers. Very low mortality and good results but it has not become popular till now. The objective was to correlate (Assess) the prognosis with “Grading scale” and to evaluate the factors affecting the prognosis and also to know the Incidence, Male/ Female sex ratio, and Social distribution.Methods: Study of 118 consecutive cases of peptic perforation, particularly dealing with their clinical manifestations and management. All cases were admitted in the Department of surgery of Hamidia Hospital Bhopal. The Permission from Institutional Ethics Committee was obtained. From each and every patient included in the study, initially informed individual consent was taken.Results: Average duration between onset of perforation and admission was: 38 hours 11 minutes. Average duration between admission and operation was: 7 hours 23 minutes. Average duration between onset of perforation and operation was: 45 hours 34 minutes.Conclusion: Benign ulcer perforations were most common in the age group of 30 – 39 years and 40 – 49 years. Close follow- up at interval of three months is recommended for every case of perforation treated by simple suture. In case of recurrence of ulcer symptoms failing to respond medical treatment, gastro- jejunostomy and truncal vagotomy is recommended.

Introduction: Acute mesenteric ischemia/occlusion is a life-threatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent loss of life. Despite progress in our understanding about the mesenteric ischemia, diagnostic modalities, and treatment options, the mesenteric ischemia remains a diagnostic challenge. This leads to delayed implementation of treatment and thus contributes to high mortality and morbidity. Methods: Here, we have presented a case report of superior mesenteric artery thrombosis. It discusses the various aspects of superior mesenteric artery occlusion, the etiology, the difficulty with diagnosis, and the best possible course of action. Results: The Superior Mesenteric Artery (SMA) supplies the whole of the small intestine except the superior part of the duodenum. It also supplies the caecum, ascending colon and most of the transverse colon. Acute mesenteric ischemia (AMI) is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. Conclusion: The acute mesenteric ischemia (AMI) comprises four different primary clinical entities, Non-occlusive mesenteric ischemia (NOMI), and occlusive mesenteric artery ischemia (OMAI).This OMAI is further subdivided into acute mesenteric arterial embolism (AMRE) and acute mesenteric arterial thrombosis (AMRT). The AMI as the venous disease takes the form of Mesenteric venous thrombosis. (MVT). The overall prevalence of AMI is 0.1% of all hospital admissions; venous thrombosis is found in approximately 0.001% of patients who undergo exploratory laparotomy. The risk factor for AMI includes arrhythmia, heart diseases, mitral stenosis, endocarditis, recent MI, and intra-abdominal malignancies.

Post pneumonectomy patients pose a challenge to the anaesthetist owing to the altered respiratory mechanics and decreased respiratory reserve. Performing laparoscopic surgery in such patients further deteriorates the already compromised lung functions. Authors report a case of laparoscopic cholecystectomy performed in post pneumonectomy patient. A clear understanding of respiratory mechanics and post pneumonectomy physiological changes helped us to administer a safe anaesthesia and safe perioperative outcome.

Background: The objective of the study was to discuss the appropriate course of action in cases of sigmoid volvulus. It becomes important due to its high morbidity and mortality and its acute emergency presentation.Methods: This is a retrospective study of sigmoid volvulus admitted in the department of surgery at Late SBRKM Government Medical College, Jagdalpur. The study period was from January 2017 to August 2019. A total of 27 cases were under study. On admission, they were examined, investigated and treated surgically and the outcome noted.Results: Out of 27 patients 25 were male and 2 cases were female. The mean age group was 65 years. The co-morbidities consisted of previous abdominal surgeries, diabetes mellitus, hypertension, and renal complications. The common factor was chronic constipation and purgative abuse. All underwent a definitive surgical procedure like sigmoidectomy and colorectal anastamosis or sigmoidectomy and colostomy. In the second group colostomy closure and end to end anastamosis carried on at a later date. We have lost 5 patients in the post-operative period.Conclusions: The sigmoid volvulus presents with the features of intestinal obstruction. The real danger is the gangrene of the bowel, as a consequence of ischaemia. It requires an early surgical intervention for the maximum benefit of the patient.

In the present study prevalence of sub clinical mastitis was assessed on organized dairy farms. The qualitative changes of milk in the cows with sub clinical mastitis were assessed on the basis of estimation of fat percent, solid not fat percent, protein percent and lactose percent. A Significant reduction in values of fat %, SNF %, protein %, lactose % was recorded in the sub clinically infected cows of groups as compared to the values of normal healthy cow on the day of screening. Sub clinical mastitis altered the composition of milk in cows which had significantly lower values of fat, SNF, protein, lactose. Simultaneously therapeutic efficacy of herbal paste/gel as topical application alone or in combination was also assessed in restoring the milk constituents. Therapeutic potential of herb alone and in combination as paste or gel was also undertaken. The therapeutic trial was based on the restoration of constituents of milk and the paste of herbal mixture was found to be the most efficacious in sub clinical mastitis.

Indian organizations are losing edge to China low-cost manufacturing practices and are facing turbulent marketing conditions. Emulation of Chinese practices is rare possibility because of vibrant Indian democracy. Indians have other avenues and opportunities to learn and apply Six Sigma methodology in their manufacturing endeavors to become resilient and profit making. Tremendous work has been done in lean manufacturing. Lean with Six Sigma amalgamation with customer centricity has great potential. It is evident that significant control on defect rates improves financial condition of the company. It further improves image of the company and enhances status among organization on the attribute of quality parameters. It is proven fact now that defect rates have direct impact on the success or failure of the company. It must be the predisposition of each organization to achieve Six Sigma levels and achieve zero defects. Research work is carried out to reduce the defect rate in an automobile parts manufacturing company of Himachal Pradesh, by implementing DMAIC methodology. It is found that lean with Six Sigma implementation defects is reduced to 0.9 % from 3.6 % with better surface finish by implementing right burnishing process. This is not the end of the story, further improvements are possible to reduce it below 0.25 %.

Over a period of 18 years, 39 cases of cardiac tumors were operated upon in the Department of Cardiothoracic Surgery at the Postgraduate Institute of Medical Education and Research, Chandigarh. These included 34 (87%) patients with benign tumors and 5 (13%) patients with primary malignant tumors. All the benign tumors were myxomas, of which 31 (91.2%) were in the left atrium and 3 (8.8%) in right atrium. Primary malignant tumors comprised 2 rhabdomyosarcomas, 1 angiosarcoma, 1 lymphoma and 1 case of pleomorphic malignant fibrous histiocytoma. The diagnosis was established by echocardiography, angiocardiography and computed tomography. In one case the diagnosis was made at autopsy. All myxomas, except tricuspid valve myxoma, were removed completely through right atrial or biatrial approach with the use of cardiopulmonary bypass. Four cases of primary malignant tumors were non-resectable. Near total resection of a malignant fibrous histiocytoma arising from the right middle pulmonary vein and left atrial junction was achieved. There were 2 operative deaths (5.1 %). The follow-up ranged from 3 months to 10 years with a mean of 5.7 years. There was 1 recurrence (2.9%) in the benign group. In the malignant group, 3 cases (60%) died within 5 to 8 months of surgery due to further local and metastatic spread of the tumor. The case of malignant fibrous histiocytoma was treated with postoperative radiotherapy to the right mediastinum and is doing well at follow-up 3 months after surgery.

Familial adenomatous polyposis (FAP) is the most common adenomatous polyposis syndrome. It affects all age groups and all races. Almost all patients with FAP develop colorectal cancers in the absence of surgery. A number of variants of FAP have been described, out of which Gardner syndrome is one subtype. Indian data on FAP or its rarer variants is scarce and limited to isolated case reports due to its low incidence. [1] We herein report five cases of FAP treated in our hospital and illustrate challenges in the management. The case series also highlights the interesting case of the fifth female who presented with synchronous duodenal adenocarcinoma and colonic adenocarcinoma in the background of multiple polyps in the entire colon. The case amply highlights the need of increased awareness of the syndrome and its variants while treating patients with polyposis-related conditions along with a center of referral where facilities for screening, counseling, genetic tests, surgery, and tumor banking and multidisciplinary facilities are available.

Chlorophytum arundinaceum, Asparagus adscendens and Asparagus racemosus are used in the Indian traditional system of medicine for improving the general state of health and for stress-related immune disorders. The effects of the methanol and aqueous extracts of the tuberous roots of these plants were examined in an experimental mouse model of stress, induced by swimming. The extracts were shown to exert an inhibitory effect on pro-inflammatory cytokines, namely interleukin 1β and tumour necrosis factor α, and on the production of nitric oxide in mouse macrophage cells RAW 264.7 stimulated by lipopolysaccharide in vitro. Similar inhibition was also observed in the production of interleukin 2 in EL 4 lymphoma cells stimulated by concanavalin A. Corticosterone levels in serum and adrenal glands were measured. The findings suggest that these plants may be beneficial in the management of stress and inflammatory conditions.

Background: Gastric cancer in India shows marked regional variation both in incidence and presentation. Highest incidence is seen in the north eastern states of India. Its also common in West Bengal. However data on various clinicopathological characteristics of our gastric cancer patients is limited. The aim of this study was to find out the epidemiological profile of gastric cancer patients attending a tertiary care government hospital in West Bengal. Methods: 50 cases of gastric cancer patients were included in the study. They were admitted from surgical OPD. Patient characteristics were obtained using pretested questionnaire. All relevant investigations like endoscopy, biopsy reports, HPE and operative notes were recorded. Results: Average age of the patients was 51.76 years. There were 41 males and 9 females (4.56:1). There were 35 Hindus and 15 Muslims (2.33:1). 56% of the patients came from rural areas while the rest (44%) resided in urban areas. Weight loss was the commonest symptom followed by dyspepsia and abdominal pain. Majority of them were smokers (76%). Antrum was the commonest site of involvement and most common type of lesion was ulceroproliferative type (50%). Most of the gastric cancers were poorly differentiated adenocarcinomas. Indeterminate type was the commonest histological subtype. 16% of patients deemed operable on preoperative workup had advanced unresectable cancers. Conclusions: Majority of the gastric cancer patients appear to be male and Hindu by religion, mostly with a rural background. The average age at diagnosis was 51 years. Commonest symptoms were weight loss and dyspepsia. A high percentage of the patients were smokers with a long duration of smoking. About half of the patients had poorly differentiated cancers and indeterminate histology. A significant number of cases presented late with advanced disease. There is a need for urgent screening protocol to identify patients at earlier stages of the disease.