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BACKGROUND Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. According to sepsis - 3 criteria, sepsis is diagnosed by Sequential organ failure assessment (SOFA) score of more than two. Surviving sepsis campaign introduced a newer scoring system, quick SOFA (QSOFA) score which uses only clinical parameters to prognosticate sepsis bed side and at the earliest. The purpose of this study was to evaluate the QSOFA score and then compare it to SOFA score in prognostication of sepsis. METHODS This study was a prospective observational study conducted in R. L. Jalappa Hospital among 150 individuals. Assessment of SOFA and QSOFA score was done and its significance in predicting mortality and morbidity was compared. RESULTS There were 87 males and 63 females. Mortality rate was 38.7 %. The initial QSOFA score of 1, 2 and 3 had mortality rate of 5.2 %, 24.1 % and 70.7 % respectively. Initial SOFA score of < 4, 4 - 8 and > 8 had mortality rate of 5.2 %, 37.9 % and 56.9 % respectively. Interpretation - The SOFA score had statistically significant correlation in assessing need for ventilator support, QSOFA score had a significant relation assessing need for ventilator support, vasopressor support. CONCLUSIONS Both scores demonstrated good accuracy for predicting in-hospital mortality. The QSOFA scoring system can aid where the resources are limited. KEY WORDS Sepsis, SOFA Score, QSOFA Score, Septic Shock

Background: Current treatment with statins has become an integral part of vascular diseases but monotherapy has a significant residual event rate. Due to particularly one of the factor associated with atherogenic lipid phenotype that is characterized by a low high-density lipoprotein (HDL) cholesterol and increase in non-HDL cholesterol like Low-Density Lipoprotein (LDL). Omega-3 Fatty acids have demonstrated a preventiverole in primary and, particularly secondary cardiovascular diseases. Hence this study was planned to compare the efficacy of Atorvastatin alone with Atorvastatin and Omega-3 fatty acids in treatment in hyperlipidaemia patients. Methods: The study was comparative, randomized, and prospective and open labeled conducted in MI patients. A total of 100 patients were selected based on inclusion and exclusion criteria. They were divided randomly into two Groups (Group–A and Group-B). Group-A was given Atorvastatin 10mg/day and Group-B was given Atorvastatin 10mg/day and Omega-3 fatty acids 600mg/day for 6 months. Follow up was done every month and efficacy was measured by assessing the lipoprotein levels in serum. Results: The results were compared before treatment and after 6 months treatment.The levels were significantly decreased Total Cholesterol (TC), LDL, Low-Density Lipoprotein (VLDL), Triglycerides (TG) and HDL levels were increased in Group–A and Group-B. When these results compared between two Groups the HDL levels were increased also it shown high significance (

Zygomaticomaxillary complex (ZMC) fractures are relatively common. Zygomatic complex fractures with functional or aesthetic impairments often require surgical intervention. Treatment of ZMC fractures consists of reduction and fixation of the dislocated bone fragments to their original location. The zygomaticomaxillary complex functions as a major buttress for the face and because of its prominent convex shape, is frequently involved in facial trauma.1 ZMC fractures are also called tripod, tetrapod, quadripod, malar or trimalar fractures. They account for approximately 15 % - 23.5 % of maxillofacial fractures.2,3 The aetiology of zygomatic complex fractures primarily includes road traffic accidents (RTA), violent assaults, falls and sports injuries. They are the second most common facial fracture after nasal bone fractures.3-6 ZMC fractures are more common in men than women, and most commonly occur in the third decade of life.7-10 The main clinical features of zygomatic complex fractures include diplopia, enophthalmos, subconjunctival ecchymosis, extraocular muscle entrapment, cosmetic deformity, malocclusion and neurosensory disturbances of the infra-orbital nerve.10 The gold standard radiological investigation for evaluation of ZMC fractures is computed tomography (CT) scan. Surgical intervention is effective in cases of displaced and comminuted fractures involving functional and aesthetic defects, whereas a nonsurgical approach is often used for non-displaced fractures.11 Various surgical approaches and treatment strategies have been proposed to obtain a successful treatment outcome. Based on review of literature, it has been observed that the open reduction with internal fixation using mini plates and screws is the most commonly preferred treatment for displaced and comminuted fractures.10-12 Here, we report a clinical case of right zygomaticomaxillary complex fracture and its management.

BACKGROUND: The item analysis of multiple choice questions (MCQs) is an essential tool that can provide input on validity and reliability of items. It helps to identify items which can be revised or discarded, thus building a quality MCQ bank. METHODS: The study focussed on item analysis of 90 MCQs of three tests conducted for 150 first year Bachelor of Medicine and Bachelor of Surgery (MBBS) physiology students. The item analysis explored the difficulty index (DIF I) and discrimination index (DI) with distractor effectiveness (DE). Statistical analysis was performed by using MS Excel 2010 and SPSS, version 20.0. RESULTS: Of total 90 MCQs, the majority, that is, 74 (82%) MCQs had a good/acceptable level of difficulty with a mean DIF I of 55.32 ± 7.4 (mean ± SD), whereas seven (8%) were too difficult and nine (10%) were too easy. A total of 72 (80%) items had an excellent to acceptable DI and 18 (20%) had a poor DI with an overall mean DI of 0.31 ± 0.12. There was significant weak correlation between DIF I and DI (r = 0.140, p

In this work, Prediction of heart attack is very uncontrolled problem faced by doctor abnormally in every hospitals they have to make a killing review feedbacks from their patients. The ability of the sentiment analysis is needful work for machine to get results in the form of feedback i.e. positive or Negative feedback. Machine learning techniques assess necessary job in this area and in this zone of research work to construct a product this can assists the machine learning computations to input the option choice with respect to the fore cast and assess the expectation. Heart disease commonly occurred disease and it is the critical speculation for unexpectedly death these days. Nearest Neighbour (KNN) featureless is the most well-known, viable and productive calculation utilized for acknowledgment. In this paper, evaluate heart disease occurrences prediction by using machine learning strategies. Which will gives comfortable heterogeneous forecast model and it aid to discover best symptomatic for medicinal services framework for early prediction of symptomatic heart disease.

Introduction: Pulmonary fibrosis after pneumonia due to SARS-CoV-2 (COVID-19) is poorly understood. In patients who required transplantation, explant gene expression profiles are similar to those in patients with pulmonary fibrosis. Currently, two antifibrotic agents have been shown to reduce the rate of progression in other etiologies of lung fibrosis. Here, we describe our experience with antifibrotic therapy in COVID-19 patients. Case#1 A 45 year old male with metabolic syndrome presented with 4 days of worsening dyspnea. He failed initial therapy with high flow nasal cannula (HFNC) and noninvasive ventilation requiring intubation on hospital day 10. He received treatment with remdesivir, steroids and inhaled nitric oxide (iNO). He remained intubated for 21 days, complicated by pneumomediastinum. Total hospitalization was 75 days. Chest imaging throughout hospitalization had cystic changes and bronchiectasis. Pirfenidone was initiated at the time of discharge. On 6-month clinic follow up, he remained on oxygen. He denied any significant side effects to pirfenidone and had no lab abnormalities. Case#2 A 61 year old male with no past medical history (PMH) presented with week-long constitutional symptoms. HFNC for severe hypoxia was started but ultimately intubation was required. He was treated with remdesivir, steroids, iNO, an interleukin-6 inhibitor and convalescent plasma. Weaning from ventilatory support after tracheostomy tube placement was complicated by pneumomediastinum. He was discharged on nocturnal ventilation to long term acute care. He was started on pirfenidone during hospitalization and continued without incident. On subsequent clinic follow up, tracheostomy was decannulated and he could tolerate low flow nasal cannula. Case#3 A 64 year old male with no PMH was admitted with 10 days of worsening respiratory symptoms. The patient required HFNC. He received remdesivir, steroids, broad spectrum antibiotics and convalescent plasma. He was discharged after 13 days on supplemental oxygen. On one month follow up, chest imaging showed reticular and ground glass opacities and traction bronchiectasis. Nintedanib was initiated. One month later he was off supplemental oxygen. Follow up CT imaging showed resolution of ground glass and reticular opacities after 6 months. The patient denied any medication intolerance but abnormal liver function lead to dose reduction of nintedanib. Conclusion: COVID-19 pneumonia can lead to significant pulmonary fibrosis. Further analysis is needed to determine the long term incidence of persistent fibrosis and any risk factors predicting its development. Additionally, in those patients with established pulmonary fibrosis, the role of antifibrotic therapy should prospectively be investigated.

The Onodi cell is defined as the posterior-most ethmoid cell. Haller cells are defined as infraorbital ethmoid cells. HRCT scanning provides excellent bone detail and accurate soft tissue mapping. The aim of this study is to know the prevalence of Haller cells and Onodi cells and to find variations in them on HRCT. Also to find co-relation between HRCT findings and Intra operative findings. A Hospital based prospective and cross-sectional study which included 30 patients above 15 years of age coming to ENT OPD with complaints related to sinonasal disease and polyposis;willing for HRCT followed by operative procedures. A total of 30 patients are included in the study. The mean age was found to be 38.70 ± 14.37. Prevalence of haller cells and onodi cells was 30% and 33.3% respectively. Statistical significance was found between association of haller cells with sinusitis. Intra-operative findings corresponded to 8 out of 9 HRCT findings (p-value = 0.001). We conclude that the actual prevalence of haller cell and onodi cell is best noted on HRCT-PNS and this holds a significant role in imparting thorough knowledge of the anatomical variations of PNS and hence preventing intraoperative complications due to presence of these variant cells.

Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenoma is the most common salivary gland tumor, accounting for 60–80% of benign tumors of salivary glands, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumor can be explained on the basis of its epithelial and connective tissue origin. Usually they are found as solitary unilateral, firm and mobile, painless, slow growing mass. The tumor has a female predilection between 30 and 50 years of age. Utmost care is to be taken to preserve the facial nerve while performing superficial or total parotidectomy. We present 10 cases of pleomorphic adenoma of parotid gland over period of 2 years, highlighting the prognosis following surgical management.

Context: BRAF mutation has been extensively studied and associated with various tumors. Targeted therapeutic intervention against BRAF mutation is established modality against many such tumors. Various studies have estimated that the prevalence of BRAF mutation in colorectal carcinoma (CRC) is 5%–25%. Considering epidemiology differences from Western population and paucity of studies on BRAF mutation in CRC in Asian patients, the present study was done to study the BRAF mutation in CRC in Indian population. Aims: The aim is to study the distribution of BRAF mutation and its correlation with the American Joint Committee on Cancer (AJCC) stage, grade, and other clinicopathological parameters in CRC. Settings and Design: This was a cross-sectional study. Subjects and Methods: Immunohistochemistry study was done using BRAFV600E monoclonal antibody (Clone VE1) for 65 consecutive cases of CRC in a tertiary care center. The results were statistically analyzed using SPSS version 2.0. Results: This study found that BRAF mutation is not significantly present in CRC as only 4.6% of cases were positive for BRAFV600E mutation. However, there was statistically significant relation between increasing AJCC stage and BRAF mutation. Conclusions: This study concluded that BRAF mutation is not prevalent in Indian population with CRC. However, it is significantly related with advanced AJCC stages.

Context: Lymphangiogenesis correlates with poor prognosis in Invasive Ductal Carcinoma (IDC) breast. D2-40 antibody, a specific marker for lymphatic endothelium, differentiates lymphatic from vascular endothelium. Therefore, the aims of this study were to estimate lymphangiogenesis using D2-40 antibody and correlate with lymphatic invasion (LI) and axillary lymph node (LN) status and compare lymphatic mean vessel density (LMVD) with Tumor (T) and Node (N) stages and grade of tumor. Methods and Material: The study was conducted on fifty consecutive cases of IDC breast who underwent modified radical mastectomy (MRM) from Jan 2009 to March 2011. Hematoxylin-eosin sections and Immunohistochemistry (IHC) slides were studied along with their LN status. LMVD was counted after D2-40 immunostaining (100x magnification) in three hot spots in peritumoral areas and averaged. LI as opposed to vascular invasion (BVI), and LN status for all cases were assessed. Statistical Analysis: Statistical analysis was done using SPSS software (version 14.0 for Windows). Pearson's correlations, χ2 tests and Mann-Whitney U test were used. Results: Lymphangiogenesis varied from 0 to 58 with mean LMVD of 11. Of 50 cases, five showed no lymphatic vessels in peritumoral areas; of these five, three had positive LNs. 21/50 cases had LI. No statistical significant association was seen between lymphangiogenesis and LI. 34/50 cases had positive LNs. Mean LMVD was higher in patients with N2/N3 stage as compared to N0/N1 stage and was statistically significant (P = 0.013). Conclusions: D2-40 is specific marker for lymphatic endothelium. LI and lymphangiogenesis, as opposed to BVI, are better prognostic indicators in IDC breast.

PRESENTATION OF CASE A 65 years old female patient presented with odynophagia, fever, since 5 days and absolute dysphagia since 2 days. She had bronchial asthma and type 2 diabetes mellitus on oral hypoglycaemic agents since 15 years. On examination, there was a significant bulge in the posterior pharyngeal wall in midline extending to the left side, pushing the tonsil medially; supraglottis was oedematous obscuring the vocal cords. The patient appeared toxic and there was no external neck swelling. Haematological investigations showed raised total counts, HbA1c was 12.2 and there was presence of ketone bodies in urine. CECT scan of neck showed an irregular peripherally enhancing abscess in retropharyngeal space 3.1 cm x 3.1cm x 6.2cm dimension and extending more in the left paramedian from C1 to C4 levels. There was a mass effect and median bulge indenting the oropharyngeal air column. The abscess cavity was extending inferiorly to the supraglottic level, anteriorly to left posterior tonsillar pillar, laterally up to the level of styloid process, posteriorly up to pre-vertebral muscles. There was no evidence of rupture. Cervical spine and vertebral arteries were normal and there was no evidence of osteomyelitis.

The impact of a given neuronal pathway depends on the number of synapses it makes with its postsynaptic target, the strength of each individual synapse, and the integrative properties of the postsynaptic dendrites. Here we explore the cellular and synaptic mechanisms responsible for the differential excitatory drive from the entorhinal cortical pathway onto mouse CA2 compared with CA1 pyramidal neurons (PNs). Although both types of neurons receive direct input from entorhinal cortex onto their distal dendrites, these inputs produce a 5- to 6-fold larger EPSP at the soma of CA2 compared with CA1 PNs, which is sufficient to drive action potential output from CA2 but not CA1. Experimental and computational approaches reveal that dendritic propagation is more efficient in CA2 than CA1 as a result of differences in dendritic morphology and dendritic expression of the hyperpolarization-activated cation current (Ih). Furthermore, there are three times as many cortical inputs onto CA2 compared with CA1 PN distal dendrites. Using a computational model, we demonstrate that the differences in dendritic properties of CA2 compared with CA1 PNs are necessary to enable the CA2 PNs to generate their characteristically large EPSPs in response to their cortical inputs; in contrast, CA1 dendritic properties limit the size of the EPSPs they generate, even to a similar number of cortical inputs. Thus, the matching of dendritic integrative properties with the density of innervation is crucial for the differential processing of information from the direct cortical inputs by CA2 compared with CA1 PNs.SIGNIFICANCE STATEMENTRecent discoveries have shown that the long-neglected hippocampal CA2 region has distinct synaptic properties and plays a prominent role in social memory and schizophrenia. This study addresses the puzzling finding that the direct entorhinal cortical inputs to hippocampus, which target the very distal pyramidal neuron dendrites, provide an unusually strong excitatory drive at the soma of CA2 pyramidal neurons, with EPSPs that are 5–6 times larger than those in CA1 pyramidal neurons. We here elucidate synaptic and dendritic mechanisms that account quantitatively for the marked difference in EPSP size. Our findings further demonstrate the general importance of fine-tuning the integrative properties of neuronal dendrites to their density of synaptic innervation.

Although hippocampal CA1 pyramidal neurons (PNs) were thought to comprise a uniform population, recent evidence supports two distinct sublayers along the radial axis, with deep neurons more likely to form place cells than superficial neurons. CA1 PNs also differ along the transverse axis with regard to direct inputs from entorhinal cortex (EC), with medial EC (MEC) providing spatial information to PNs toward CA2 (proximal CA1) and lateral EC (LEC) providing non-spatial information to PNs toward subiculum (distal CA1). We demonstrate that the two inputs differentially activate the radial sublayers and that this difference reverses along the transverse axis, with MEC preferentially targeting deep PNs in proximal CA1 and LEC preferentially exciting superficial PNs in distal CA1. This differential excitation reflects differences in dendritic spine numbers. Our results reveal a heterogeneity in EC-CA1 connectivity that may help explain differential roles of CA1 PNs in spatial and non-spatial learning and memory.

Modifications of microvascular configuration are essential features encountered during the progression of breast tumors. Our objectives were to correlate morphometrically evaluated microvessel parameters (microvessel density [MVD], microvessel caliber [VC], microvessel cross-sectional area [VCSA], percentage of total VCSA [%TVCSA], and total microvessel boundary density [TVBD]) with histologic grades of invasive ductal carcinoma (IDC) of the breast and benign breast lesions. Sixty cases of IDC presented with modified radical mastectomy, and 20 benign breast fibroadenomas were evaluated for various microvessel parameters, using CD34-immunostained histologic sections by computerized image morphometry. Samples were divided into 4 histologic groups: benign, grade 1, grade 2, and grade 3; mean with SD and range was evaluated for each group. Histologic grades showed a strong positive correlation with %TVCSA (ρ=0.773) and TVBD (ρ=0.811) and a moderate positive correlation with MVD (ρ=0.607), VC (ρ=0.609), and VCSA (ρ=0.616) when analyzed for all samples of the 4 groups. Except MVD, all parameters including age was the lowest (P.001) for the benign group. Among the IDCs, differences of mean VC and VCSA were not significant; MVD, %TVCSA, and TVBD were the lowest in grade 1 and the highest in grade 3. Upper cutoff value of benign lesions for MVD was 155mm

Natural cellulose fibers were extracted from a fast growing perennial grass Eulaliopsis binata (commonly known as Sabai) and characterized for their structure and properties. The untreated sabai grass has been used as reinforcement for polypropylene composites and properties of the composites have been investigated. Although the composition of the sabai grass is typical to other lignocellulosic sources, there is a high content of flavonoids (630 mg/g) and phenols (510 mg/g) which provides high antibacterial, and antifungal properties to the fibers and composites developed. Fiber bundles extracted from the grass had tensile strength of 493 MPa and tensile modulus of 21 GPa, similar to common natural cellulose fibers. Both tensile and flexural properties of polypropylene composites increased with increasing ratio of sabai grass. Polypropylene composites reinforced with sabai grass show high noise insulation and thermal resistance properties suggesting their suitability for automotive and building applications.

Allergic rhinitis is a common and debilitating disease that has a major effect on the health related quality of life. The usage of corticosteroids topically and newer generation antihistamines have been the hallmark of recent advances in treatment of allergic rhinitis. Hence this study was taken to clinically evaluate the efficacy of lipid-based ointment and traditional antihistamine Rupatidine in treatment of moderate persistent allergic rhinitis. This study was designed to compare the efficacy of lipid-based ointment and traditional antihistamine in the treatment of moderate persistent allergic rhinitis. 60 Patients aged between 15 and 70 years with moderate to severe symptoms of allergic rhinitis were chosen after history taking, clinical examination and relevant lab investigations—nasal smear examination and serum IgE levels in specific. They were randomized into two groups and started on either lipid based ointment (to apply ointment to nasal vestibule twice daily) with tablet Rupaditine 10 mg OD and only tablet Rupatidine 10 mg OD alone. Patients were asked to observe the efficacy of their treatment on daily basis. Mean age of patients in lipid based ointment group with tablet Rupatidine was 33.53 years and only tablet Rupatidine group was 28.9 years. Positive family history was present in 13.3 % patients in group I with 26.6 % patients in group II. Symptoms score decreased from baseline in group I as compared to group II. Lipid based ointment with tablet Rupatidine is superior in relieving moderate allergic rhinitis compared to tablet Rupatidine alone.

Chennai is a rapidly growing metropolitan coastal city in southern India with several major sources of pollution. The complex coastal meteorology influences the pollutant transport in different seasons. In this study, the air quality pattern in Chennai with respect of NOX over different seasons are simulated with FLEXPART-WRF Lagrangian Particle Dispersion Model (LPDM) considering release inventory of industrial, vehicular and domestic sources of pollution from seven different locations in Chennai. The meteorological fields for dispersion calculation are simulated using Advanced Research WRF (ARW) mesoscale model at a high resolution (3 km). Air quality data in the study region available at six different places are used for comparing model outputs over 12 days in each season (winter, pre-monsoon, monsoon and post-monsoon). The Hanna diffusion scheme in FLEXPART-WRF is modified with new seasonal empirical turbulent intensity relationships derived as a function of atmospheric stability from turbulence data. Simulated concentrations are evaluated by varying the diffusion schemes (Hanna, modified Hanna) in FLEXPART and the planetary boundary layer (PBL) schemes [YSU, ACM2 and MYNN2] in ARW. Simulations revealed distinct seasonal variation of dispersion patterns of NOX due to seasonal flow-field variation in the study region. It is found that, the new turbulence intensity relationships provide better comparisons for concentrations of NOX relative to the default Hanna relationship. Further, simulations using ACM2 PBL significantly reduced the negative bias and errors in concentration due to capturing the flow-field and other meteorological variables well. The study demonstrates the utility of FLEXPART for air quality modeling in the coastal city.

Land surface processes in data scarce arid northwestern India and their influence on the regional climate including monsoon are now gaining enhanced scientific attention. In this work the seasonal variation of land surface parameters and surface-energy flux components over Lasiurus sindicus grassland system in Thar Desert, western India were simulated using the mesoscale WRF model. The data on surface fluxes from a micrometeorological station, and basic surface level weather data from the Central Arid Zone Research Institute’s experimental field station (26o59′41″N; 71o29′10″E), Jaisalmer, were used for comparison. Simulations were made for typical fair weather days in three seasons [12–14 January (peak winter); 29–31 May (peak summer), 19–21 August (monsoon)] during 2012. Sensitivity experiments conducted using a 5-layer soil thermal diffusion (5TD) scheme and a comprehensive land surface physics scheme (Noah) revealed the 5TD scheme gives large biases in surface fluxes and other land surface parameters. Simulations show large variations in surface fluxes and meteorological parameters in different seasons with high friction velocities, sensible heat fluxes, deep boundary layers in summer and monsoon season as compared to winter. The shortwave radiation is underestimated during the monsoon season, and is overestimated in winter and summer. In general, the model simulated a cold bias in soil temperature in summer and monsoon season and a warm bias in winter; the simulated surface fluxes and air temperature followed these trends. These biases could be due to a negative bias in net radiation resulting from a high bias in downward shortwave radiation in various seasons. The Noah LSM simulated various parameters more realistically in all seasons than the 5TD soil scheme due to inclusion of explicit vegetation processes in the former. The differences in the simulated fluxes with the two LSMs are small in winter and large in summer. The deep mixed layers are distributed in the northeastern parts in summer, northern areas in southwest monsoon and in southwestern parts during winter seasons and associated with the land-cover and vegetation dynamics. Our results present a baseline simulation study in this data scarce arid region.

The dermoid cyst is an uncommon clinicopathological lesion of developmental origin. The term dermoid cyst is used to describe 3 cysts that are closely related histologically: dermoid cyst, epidermoid cyst, and teratoma. Epidermoid and dermoid cysts are benign nature, which may occur anywhere in the body, but most predominantly in the ovary and scrotal regions. Only about 7% are found in the head and neck. The occurrence of such cysts in the oral cavity is extremely rare, with approximately 1.6% located in this area. The floor of the mouth is one of the most commonly affected area, however, these cysts can also be found in the tongue, lips, buccal mucosa and jaw bones. There is always a difficulty of making a correct diagnosis of these lesions with clinical examinations and conventional radiography. To achieve a diagnosis and to develop correct surgical strategy specialized imaging examinations such as ultrasonography (US), computed tomography (CT), Magnetic Resonance Imaging (MRI) and histopathological examination should be carried out. Treatment comprises total surgical excision the approach remains dictated logically by the cyst's location. Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential. When dermoid cysts occur on the floor of the mouth, they may enlarge to such an extent that they can interfere with deglutition and produce respiratory obstruction. Early diagnosis and treatment are essential for these cystic entities.

Aim: This study was conducted to clinically evaluate the effect of low-level laser therapy (LLLT) as a method of reducing pain reported by patients after placement of their first orthodontic archwires. Materials and methods: A sample of 10 patients with an age group of 12 to 26 years with moderate-to-severe anterior crowding was selected. Each patient was assigned to an experimental group (left quadrant with laser therapy) and a control group (right quadrant with no laser therapy). Low-level laser therapy was given immediately after the placement of initial archwire. All patients were instructed to fill up a survey form at home over the next 7 days. Results: The results revealed that the average onset of pain in the experimental group (16.10 hours) was significantly reduced when compared with the control group (3.10 hours). The most painful day was similar for both the groups. The pain ceased much sooner in the experimental group than in the control group. The intensity of pain was lesser in the experimental group when compared with the control group. Conclusion: Low-level laser therapy was an effective and noninvasive method for controlling pain in orthodontic patients after receiving their first archwires. The duration and intensity of pain reduced with the application of LLLT Clinical significance: Pain reduction during orthodontic procedures. Keywords: Low-level laser therapy, Nickel-titanium wires, Orthodontic pain.

Ten mononuclear Rhodium (I) complexes were synthesized by macrocyclic ligands having N4 and N2O2 donor sites. Square planar geometry is assigned based on the analytical and spectral properties for all complexes. Rh(I) complexes were investigated as catalysts in hydrolysis of Nitrile group containing pharmaceutical drug Letrozole. A comparative study showed that all the complexes are efficient in the catalysis. The percent yields of all the catalytic reaction products viz. drug impurities were determined by spectrophotometric procedures and characterized by spectral studies.

The presence of multiple Keratocystic odontogenic tumors (KCOTs) of the jaws in a patient must alert a clinician as to the possibility of a syndromic condition. The Gorlin Goltz syndrome (GGS), otherwise known as the Nevoid basal cell carcinoma (NBCC) syndrome, and as the Jaw cyst-Basal cell Naevus-Bifid rib syndrome is one such possibility, which is typically characterized by a classical triad as established by Gorlin and Goltz in 1960, comprising of multiple basocellular epitheliomas, keratocysts in the jaws and bifid ribs. A spectrum of other neurological, ophthalmic, endocrine and genital manifestations is known to be variably associated with this triad. Two cases of multiple KCOTs of the jaws have been presented, one syndromic, while the other, non-syndromic. A comparison of the essential and distinguishing features of both, along with the importance of a thorough medical evaluation and correct diagnosis for appropriate treatment have been highlighted. These investigations prompt an early verification of the disease, which is very important to prevent recurrence and better survival rates from the co-existent diseases.

Fibrous dysplasia, a benign fibro-osseous lesion, is a skeletal developmental anomaly of the bone forming mesenchyme that manifests as bony expansion or enlargement due to an abnormal osteoblastic and fibrous connective tissue proliferation and defective osteoblastic differentiation and maturation. Craniofacial fibrous dysplasia is a form of fibrous dysplasia affecting the cranial base, vault and the maxillofacial region to varying extents. Either of the jaws may be involved by the monostotic variety of fibrous dysplasia too. Histopathological examination of a biopsy specimen alone is inadequate to make a definitive diagnosis, but rather, correlation with the clinical features, biological behavior, radiographic appearance and intra-operative findings of these lesions is imperative, so that they can be distinguished from other fibro-osseous lesions and an appropriate treatment modality can be instituted.

SummaryObjective Endocrine diagnosis relies on a thorough history, examination and confirmatory biochemical tests. Previously, in our unit, tests were performed after new patients attended clinic. We proposed that diagnosis and management would be improved if this system was inverted. Design Clinicians and chemical pathologists reviewed available guidance and local practice to determine the key tests to confirm or refute most common endocrine disorders. A system was developed for clinicians to categorize new referrals into diagnostic groups: for example, nodular thyroid disease or possible polycystic ovarian syndrome. Standard letters were developed and sent to patients explaining the requirement for tests to be performed prior to first hospital appointment. The letters and requests for investigation sets were standardized for each diagnostic group and generated via a one-click automated method. After one year, clinical outcomes were audited and patients and staff surveyed. Results The time from referral to confirming diagnosis and starting treatment was halved: mean 11·8–5·7 weeks (P

Burning mouth syndrome (BMS), a chronic and intractable orofacial pain syndrome is characterized by the presence of burning sensation of the oral mucosa in the absence of specific oral lesion. This condition affects chiefly of middle aged and elderly woman with hormonal changes or psychological disorders. In addition to burning sensation, patient with BMS also complains of oral mucosal pain, altered taste sensation, and dry mouth. This condition is probably of multifactorial origin, often idiopathic and its exact etiopathogenesis remains unclear. So far, there is no definitive cure for this condition and most of the treatment approaches, medications remains unsatisfactory. An interdisciplinary and systematic approach is required for better patient management. The purpose of this article is to present a review of epidemiology, clinical presentation, classification, etiopathogenesis, diagnosis and management of BMS.

Background: NSAIDS are associated with side effects and research should continue for developing safer drugs. This study aims to evaluate newer thiazolidine-4-ones for their anti-inflammatory and ulcerogenic activities in wister rats.Methods: Five groups of wister rats, 6 in each were used. Anti-inflammatory and ulcerogenic activities of diclofenac (30mg/kg), nimesulide (50mg/kg), thia-1 (50mg/kg) and thia-2 (50mg/kg) are compared with control group (4% Gum Acacia). Carrageenin-induced paw edema, formaline induced acute peritonitis and cotton pellet-induced granulomatous tissue formation models were used for evaluating anti-inflammatory activity. After removing cotton pellets with granuloma on 8th day gastric ulcerogenicity was assessed by using macroscopic and microscopic scoring of ulcers.Results: Diclofenac, nimesulide and thia 2 reduced both paw edema and peritoneal exudate volume significantly (p 0.05). Nimesulide, thia-1 and thia-2 did not increase gastric ulcer score significantly (p >0.05). Diclofenac increased ulcer score significantly (p

BACKGROUND: The aim of this study was to evaluate the expression of p53, p16, Wilms tumor gene (WT1), and Mindbomb E3 Ubiquitin Protein Ligase 1 (MIB-1) index by immunohistochemical (IHC) staining in benign, low-grade, and high-grade serous ovarian tumors. METHODS: Forty-one cases of ovarian serous tumors were included in the study (benign serous tumor [n = 10], low-grade ovarian serous carcinoma [n = 8], and high-grade ovarian serous carcinoma [n = 23]). Expression of p53, p16, WT1, and MIB-1 by IHC was evaluated statistically with the grade of tumor. Semiquantitative scoring system for percentage (0–5) and intensity (1–3) of staining pattern was used to bring about objectivity. RESULTS: p53, p16, and WT1 showed significantly higher staining scores in ovarian serous carcinoma group than in the benign group (p

The role of preoperative embolization in alleviating intra operative haemorrhage in small to medium sized JNA is dubious. We report an unusual case of JNA who developed cerebral edema, hemiplegia and aphasia following glue embolisation and underwent frontotemporal craniectomy. This drastic aftermath of embolisation challenges the safety of preoperative embolisation in such lesions.

Renal Involvement in scleroderma is a known problem and the manifestations are well described. Renal involvement in systemic lupus erythematosus (SLE) is also well known. However, in scleroderma and SLE overlap syndrome, the renal findings may vary being a combination of features of immune complex mediated glomerulonephritis as well as thrombotic microangiopathy. We report a case in which the renal manifestation in such a situation was of a focal necrotising pauci-immune glomerulonephritis with crescents, anti-neutrophil cytoplasmic antibody negative. To the best of our knowledge, such manifestations have not been described before. Renal dysfunction in a normotensive setting in such a case should direct one towards evaluation for other causes and should prompt a kidney biopsy. This would be valuable in delineating the pathological process in the kidney and would help in guiding therapy.

The relationship between sensorineural hearing loss (SNHL) and Diabetes mellitus has been known since more than 150 years. The pathophysiology of diabetes related hearing loss is speculative. Hearing loss is usually, bilateral, gradual onset, affecting higher frequencies. This study aims at knowing the prevalence of SNHL in DM and its relation to age, sex, duration of DM and control of DM. A total of 50 type 2 diabetics of age group 30–65 years were involved in the study. FBS, PPBS, HbA1c of all the subjects were done and later subjected to PTA. The type and severity of hearing loss was noted. Occurrence of SNHL was later compared with age, sex, duration, and control of DM. Sensorineural hearing loss was found in 66 % of type II diabetic patients and 34 % were found normal. Out of 50 diabetes mellitus patients, 33 patients had SNHL. All cases of SNHL detected were of gradual in onset and no one had hearing loss of sudden onset. Normal hearing was found in 34 % of patients, whereas 54 % of patients had mild hearing loss and 12 % of patients had moderate hearing loss. Association of hearing loss of DM patients with sex of the patient is insignificant. However there is significant association between older age group, longer duration and uncontrolled DM with that of SNHL. In subjects with HbA1c more than 8 and duration of diabetes mellitus more than 10 years prevalence of SNHL is more than 85 %, which is statistically significant. Sensorineural hearing loss in diabetes mellitus is gradually progressive involving high frequency thresholds. Hearing threshold increases with increasing age duration of diabetes and also high level of HbA1c greater than 8 %.

Areteriovenous malformations are rare in the head and neck region and generally arise from intracranial vessels. We present one rare case with spontaneous arteriovenous malformations related to the nose.

The paper discusses the aspects of repair and retrofitting technique adopted for a damaged reinforced concrete beam-column joint specimen under cyclic loading. A specimen designed based on Indian Standard specifications with consideration of seismic load but without adopting ductile detailing (NonDuctile) was investigated under reverse cyclic loading. Then, the damaged nonductile specimen was repaired with epoxy mortar and grouted using low viscous polymer, and retrofitted using fiber reinforced plastic (FRP) wrapping in beam and column components and steel plate jacketing in joint region. The experimental results showed that the retrofitted specimen not only regained its original strength and stiffness but also has overcome the deficiencies of nonductile detailing. The present study shows that a proper repair and adequate retrofitting technique can be used for strengthening and improvement of damaged regions in reinforced concrete structures.

Intestinal Entamoeba Histolytica infection can lead to colitis, abscess formation, colonic perforation and rarely amoeboma. We report a case of colonic amoebiasis, in which the presenting symptoms and radiological findings closely resembled an obstructing right-sided colonic carcinoma, with liver metastases.

Background: Military population, by virtue of peculiarities of service conditions, such as congregation in living barracks or during exercises present a vulnerability to spread of contagious diseases. Institution of control measures during outbreaks becomes a challenge in Field areas due to operational commitments. The present paper highlights an outbreak investigation conducted in field and some lessons learnt. Methods: This investigation was conducted among troops who had arrived at a new location and soon after took part in training and area familiarisation and among whom chicken pox occurred. Constant troop movement resulted in challenges to institute control measures, which had to be tailored to suit the situation. Aggressive intervention measures such as segregation, contact tracing and strict surveillance resulted in control of the outbreak. Results: A non-immunised military population reported its first two cases during travel in military special train to the battalion′s new location. Subsequently cases kept occurring over two months and the constant movement of troops propagated the outbreak, resulting in total of twenty cases. Timely prevention measures successfully broke its runaway nature and controlled the outbreak. Conclusion: Early identification of cases and aggressive intervention measures were successful in effective control of outbreak.

The present paper describes the development of a reversed phase liquid chromatographic method for advanced intermediate of rabeprazole sodium (RBS-1) in the presence of its impurities. Successful separation of RBS-1 from the synthetic impurities achieved on a Inertsil ODS3V C18, 150 mm × 4.6 mm column. The developed LC method was validated with respect to linearity, accuracy, precision, specificity and ruggedness. To the best of our knowledge, a validated stability indicating LC method which separates all the impurities disclosed in this investigation was not published elsewhere.

The cellular and molecular mechanisms that underlie acquired changes in Ca(2+) dynamics of different neuronal compartments are important in the induction and maintenance of epileptiform activity. Simultaneous electrophysiology and Ca(2+) imaging techniques were used to understand the basic properties of dendritic Ca(2+) signaling in rat subicular pyramidal neurons during epileptiform activity. Distance-dependent changes in the Ca(2+) decay kinetics locked to spontaneous epileptiform discharges and back-propagating action potentials were observed in the apical dendrites. A decrement in the mean tau value of Ca(2+) decay was observed in distal parts (95-110 mum) of the apical dendrites compared with proximal segments (30-45 mum) in in-vitro epileptic conditions but not in control. Pharmacological agents that block Ca(2+) transporters, i.e. Na(+)/ Ca(2+) exchangers (Benzamil), plasma membrane Ca(2+)-ATPase pumps (Calmidazolium) and smooth endoplasmic reticulum Ca(2+)-ATPase pumps (Thapsigargin), were applied locally to the proximal and distal part of the apical dendrites in both experimental conditions to understand the molecular aspects of the Ca(2+) extrusion mechanisms. The relative contribution of Na(+)/Ca(2+) exchangers in Ca(2+) extrusion was higher in the distal apical dendrites in the in-vitro epileptic condition and this property modulated the excitability of the neuron in simulation. The Ca(2+) homeostatic mechanisms that restore normal Ca(2+) levels could play a major neuroprotective role in the distal dendrites that receive synaptic inputs.

A simple, economic, and time-efficient stability-indicating, reversed-phase high-performance liquid chromatographic method has been developed for analysis of rabeprazole in the presence both of impurities and of degradation products generated by decomposition. When rabeprazole was subjected to acid hydrolytic, oxidative, photolytic, and thermal stress, degradation was observed after acid hydrolysis, oxidation, and aqueous hydrolysis. The drug was found to be stable to other stress conditions. Successful chromatographic separation of the drug from impurities formed during synthesis and from degradation products formed under stress conditions was achieved on a C8 column with water–acetonitrile–triethylamine 55:45:0.25 (v/v), pH adjusted to 6.9 with trifluoroacetic acid, as mobile phase. The method was validated for linearity, accuracy, precision, specificity, and robustness and can be used for quality-control during manufacture and for assessment of the stability of samples of rabeprazole sodium. To the best of our knowledge, a validated stability-indicating LC method which separates all the impurities studied in this investigation has not been published elsewhere.

Background: An increase in number of melanocytes in the basal cell layer of the epidermis is an important feature in many disorders of hyperpigmentation. In this study, we attempted an objective evaluation of the linear density of melanocytes and keratinocytes, along with other epidermal characteristics, in periorbital hyperpigmentation using immunohistochemistry and morphometric techniques. Methods: Melanocytes and epidermal parameters were assessed by digital morphometry in 30 newly diagnosed cases of periorbital hyperpigmentation and 14 controls from the post-auricular region. Melanocytes were labelled with the immunohistochemical stains, Melan-A and tyrosinase. We studied the linear keratinocyte density, mean linear melanocyte density, ratio of melanocytes to keratinocytes, the ratio between inner and outer epidermal length, maximum epidermal thickness and minimum epidermal thickness. Results: Melan-A expression of melanocytes showed strong positive correlation (r = 0.883) with the tyrosinase expression. Mean linear melanocyte density was 24/mm (range: 13–30/mm) in cases and 17/mm (13–21/mm) in controls and this difference was statistically significant (P < 0.001). The mean ratio of melanocyte to keratinocyte was 0.22 (0.12–0.29) in cases and 0.16 (0.12–0.21) in controls; again, this difference was statistically significant (P < 0.001). There was a mild negative correlation with linear keratinocyte density (r = −0.302) and the ratio between inner and outer epidermal length (r = −0.456). However, there were no differences in epidermal thicknesses. Limitations: There were fewer control biopsies than optimal, and they were not taken from the uninvolved periorbital region. Conclusion: Mean linear melanocyte density and the ratio of melanocytes to keratinocytes is increased in cases with periorbital hyperpigmentation. It is, therefore, likely that increased melanocyte density may be the key factor in the pathogenesis of periorbital hyperpigmentation.

Collision tumour is the concrescence of two neighbouring independent neoplasm occurring in the same site. Collision tumours are rare and are reported in various organs. Collision tumours in breast are reported in various combinations. The treatment of these tumours is not tailored and prognosis depends on the histologic type and pathologic stage of the most aggressive component. We report a rare case of breast collision tumour of infiltrating ductal carcinoma and squamous cell carcinoma of skin overlying breast in a 44-year-old female.

Technological advances in radiation beam planning and linear accelerator based radiation delivery have led to the development of three dimensional conformal radiation therapy (3D-CRT). The 3D-CRT clinical treatment in our hospital was started in September 1998 and till December 2002, 51 patients with M0 stage prostate carcinoma were treated. Treatment method consisted of pelvis and leg immobilization, planning CT scan, marking of planning target volume and organs at risk and 3D beam plan using multileaf collimated beam shaping through beam′s eye view display. Network controlled 3D conformal radiation therapy was delivered with portal image verification. The median 3D-CRT dose was 72 Gy. Of the 51 patients, 35 were followed-up till December 2002 (minimum follow-up 2 years) in whom 32 were disease free and 3 had progressive disease. Eleven patients died, 8 of progressive disease, one due to second malignancy and two of intercurrent illness. Five patients were lost for follow up during 0 - 29 months period, after 3D-CRT. The acute rectal reaction (RTOG criteria) in 51 patients was grade 0 in 4, grade I in 31 and grade II in 16. None had greater than grade II rectal toxicity. The late rectal toxicity in 49 patients who had a minimum 6 months follow-up was grade 0 in 41, grade I in 3 and grade II in 5. Our experience suggests that a dose of 72 Gy by 3D-CRT can be safely delivered to the prostate and gastrointestinal tolerance during treatment and follow-up period was excellent.

In Gastrojejunostomy the gastric acid comes in contact with jejunal loop directly so the complication of anastomotic site like leak, hemorrhage stenosis are very common but the ulcer perforation is very rare and seldom reported in the available literature. We report a case of 55 year old male who developed perforation at the jejunal side of the anastomosis of the old gastrojejunostomy for gastric outlet obstruction secondary to peptic ulcer disease.