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Background: Despite the availability of various treatment modalities, the treatment of melasma is often incomplete, with a high recurrence rate. The present study was undertaken to assess the efficacy and safety of oral tranexamic acid (TXA), modified Kligman’s formula (MKF), and a placebo cream in melasma. Materials and Methods: Ninety cases of melasma of both sexes were enrolled, and divided into three groups of 30 patients each. The baseline severity of melasma was graded by Melasma Area Severity Index (MASI) score. Group A, B, and C patients were treated with oral TXA 250 mg twice daily, daily MKF cream at night, and daily placebo cream at night, respectively, for 12 weeks. Improvement in MASI score was calculated after 4, 8, and 12 weeks. At each visit, adverse effects, if any, were noted. Statistical analysis was done using Chi-square test. Results: Based on intention to treat analysis, at the end of 12 weeks, the reduction in MASI score in oral TXA, MKF, and placebo groups was 9.94(65.91%), 6.12(54.78%), and 2.07(17.22%), respectively (P = 0.00). The difference in reduction of mean MASI scores after 12 weeks between oral TXA group and MKF group was not significant (P = 0.29). The efficacy of oral TXA and MKB was significantly higher than that of the placebo group (P = 0.01 and P = 0.03, respectively). Adverse effects in all groups were mild and self-limiting. Limitations: A limited sample size, non-blinded design, and absence of dermoscopic evaluation were the study limitations. Conclusion: In view of its excellent safety profile, oral TXA may be considered as a better option for moderate to severe melasma.

Gastroduodenal artery (GDA) aneurysm is very rare, and it comprises around 1.5% of all visceral artery aneurysms. More common in male (male:female = 4:1) patients attributed to increased alcoholism and incidence of pancreatitis. In this case report, we describe a successful coil embolization of GDA pseudoaneurysm.

Abstract Vegetable oils are a highly promising alternative to produce various lubricants, owing to their biodegradability and eco-friendliness. In comparison to mineral oil, these oils possess a higher flash point and viscosity index, along with superior lubricating properties. Additionally, most of the vegetable oils are easily accessible in local markets in India. However, their industrial application is limited by poor thermal and oxidative stability, which can be addressed through chemical modification, the addition of appropriate additives, or by blending these oils. Greases, characterized by their semi-solid consistency, are widely used lubricants. Most of the grease production is based on mineral oils as base oil and lithium soap as a thickener. These materials are not only non-biodegradable but also scarce and have health implications. Consequently, biodegradable grease represents an eco-friendly and healthy alternative. Grease made using vegetable oils with the required properties has the potential to bring about revolutionary changes. The present work focuses on the feasibility of using chemically modified blended rice bran oil (RBO) and Calophyllum inophyllum oil (CIO) as a bio-lubricant. The oils undergo a two-step modification process, involving a transesterification reaction followed by epoxidation. Significant improvements have been observed in the chemical properties (acid, peroxide, and iodine values) of transesterified epoxidized rice bran oil Calophyllum inophyllum oil mixture–50:50 (ETRCIO) when compared with Unmodified Rice bran oil Calophyllum inophyllum oil mixture–50:50 (RCIO). The acid value, peroxide value, and iodine value improved by 91.66%, 87.08%, and 15.78% respectively. The rheological, tribological, and chemical properties of the blended samples have been evaluated and compared to pure oils using American Society for Testing and Materials (ASTM) and Indian Standards (IS). Additionally, ETRCIO was used to develop a bio-grease, and its tribological properties were extensively analyzed. The mean coefficient of friction (COF) and wear scar diameter (WSD) of the ETRCIO grease sample improved by 10.20% and 29.32% respectively when compared with that of commercially available grease. These findings indicate that the ETRCIO bio-grease exhibits superior tribological properties in comparison to commercially available grease.

Introduction: Congenital vascular malformations (CVMs) are malformed vessels developed due to arrested development at various stages of embryogenesis. Arterial venous malformations (VMs) are complex primitive networks of arterial and venous channels (a nidus) that bypass the normal capillary bed. The management of CVM remains challenging because of their unpredictable behavior, high recurrence rate, and need for multidisciplinary management. In this study, we report on the incidence and management of CVM in our institution and its outcome. Materials and Methods: This is a retrospective analysis of CVM patients who were admitted in our institute from January 2010 to June 2023. In this study, 321 patients who presented with CVM are considered. Once a CVM was diagnosed, all underwent angiographic confirmation as a roadmap for treatment. Embolization, sclerotherapy, and surgical procedures were instituted by the multidisciplinary team with periodic follow-up. Results: Out of the 321 patients analyzed, VM predominates with 202 cases (62.9%), out of which 105 (51.9%) were treated with sclerotherapy, 66 (28.21%) were treated with excision, 40 (19.8%) were managed conservatively. Among 108 arteriovenous malformation (33.64%), 33 (30.55%) patients were treated with excision followed by repair and flap cover/split skin graft, 32 (29.62%) were treated with glue Embolization, 7 (6.48%) were treated with embolization followed by excision, one patient presented with life-threatening bleeding was treated by emergency ECA ligation followed by elective excision, 21 (19.44%) were managed conservatively and 13 (12.03%) patients were not willing for surgery. Seven (2.1%) lymphovenous malformation and 4 (1.24%) lymphatic malformations patients were also treated. Conclusion: Diagnosis and management of CVMs by a multidisciplinary approach that integrates surgical therapy with embolization and sclerotherapy appear to improve the results and management.

Background: Vascular malformations (VMs) in the region of the head and neck are a complex group of lesions that present with serious challenges in diagnosis and management. We sought to study the efficacy and safety of a therapeutic algorithm emphasizing multimodal management in the treatment of head and neck VMs. Methodology: A retrospective study was conducted reviewing all the patient information from the database who were treated for VM of the head and neck at the institution. Patients who presented during the period between January 2012 and December 2022 were included in the study. Conservative care, sclerotherapy, embolization, surgical excision, or a combination of these techniques were among the management options based on the clinical profile of the patient as well as the characteristics of the lesion. Results: 91 VMs in the region of the head and neck included 45 (49%) males and 46 (51%) females, with an age range of between 4 years and 71 years (mean 23.9 ± 14.06 years). There were 53 low-flow vascular malformations (LFVMs), of which 6 (11.9%) were managed conservatively, 26 (49.05%) were treated with sclerotherapy, 20 (37.7%) underwent excision, and 1 (1.8%) was treated with combination therapy. Of the 38 high-flow vascular malformations (HFVMs), 12 (31.5%) were treated with arterial embolization, 13 (34.2%) were primarily resected, 2 (5.2%) with excision and reconstruction, 5 (13.1%) underwent embolization and excision, and 1 (2.6%) underwent emergency external carotid artery ligation. In the LFVM group, response to sclerotherapy led to improvements in 24 (92%) patients, while surgical resection led to improvements in 20 (100%) individuals. In the HFVM group, embolization therapy improved 9 (75%), combination therapy improved 5 (100%), and surgical resection improved 15 (100%) of the patients. Conclusions: In our experience, the implementation of a multimodal management algorithm has had favorable outcomes with an acceptable complication rate in head and neck VMs.

Objective: The main objective of this study was to review the clinical presentations, surgical management, and outcome of surgical procedures for arterial thoracic outlet syndrome (TOS). Methodology: This is a retrospective analysis of arterial TOS patients admitted in our department (Institute of Vascular Surgery, Madras Medical College, Chennai) from August 2012 to July 2022. Results: This study enrolled 81 patients, with mean age of 41.13 (12-65 years) and 50.61% male (41) and 49.39% female (40), associated with distal arterial lesions - 63 (77.77%), among which 50.61% - occlusion in the brachial artery (33), 24.69% in forearm arteries (15), and 24.69% in the axillary artery (15). About 95.06% of patients had cervical rib (77), 2.46% - first rib abnormality (2), 2.46% - soft-tissue compression (2), 59.25% was SCHER Stage III (48), 33.33% SCHER stage I (27), and 7.40% SCHER stage II (6). All patients had undergone a supraclavicular approach. The most common arterial lesions were subclavian artery (SCA) thrombus in 53.08% (43), occlusion in 17.28% (14), and dilatation in 29.62% (24) cases. The cervical rib excision with anterior scalenectomy in 95.06% (77), and 1st rib excision with anterior scalenectomy 2.46% (2) and soft tissue resection with anterior scalenectomy 2.46% (2) of patients. SCA intervention/reconstruction was done in 88.88% (72) of cases. Two patients had underwent above elbow amputation (2.46%) and no mortality and SCA patency was 100%. Conclusion: Cervical rib excision with anterior scalenectomy with or without thrombectomy is an effective procedure for arterial TOS cases.

Background and Aim of Study: Early childhood caries is a multifactorial disease process affecting children below 71 months of age and continues to be a global health problem. Stainless steel crowns (SSCs) are widely used and are very popular in pediatric dentistry due to its superiority and durability when compared with multisurface amalgam restorations. However, one of the major disadvantages with these crowns is the poor esthetics. Parents often request for a more esthetic alternative to the SSC. Zirconia crowns are one of the tooth-colored full crown restorations currently available for use in primary teeth. These are available as both preformed and custom-made crowns and show excellent esthetics. However, these require extensive tooth preparation with a subgingival finish lines, which would cause gingival trauma and bleeding during the preparation. The present study uses intraoral scanners for making the custom-made zirconia crowns, which will avoid the conventional impressions. Currently, there are no studies available in pediatric dentistry regarding CAD-CAM crowns. Hence, there is a need for the study. Aim: The aim of this study is to clinically evaluate the performance of preformed SSCs and custom-made zirconia crowns in primary molars. To elicit parental and patient satisfaction with respect to preformed SSCs and custom made zirconia crowns and to radiographically compare the interproximal bone height for 1 year. Methods: The patients were selected with purposive sampling. The tooth of interest was prepared according to the crown it would receive. The upper and the lower arch of the tooth receiving custom-made zirconia crown was scanned using an intraoral scanner. The crowns were cemented using Type 1 glass ionomer cement (GIC) (SSC) and resin modified GIC (custom-made zirconia crown). After the crown placement, the patient and the parent's satisfaction was scaled regarding the time taken, comfort, cost of crown, appearance of crown, etc., using a 5-point Likert scale. A baseline radiograph was taken after crown placement. The patient was recalled every 3 months till 1 year for evaluation (loss of retention, loss of proximal contact, gingival inflammation, opposing tooth wear, and marginal integrity). At the end of 1 year, radiographs were taken to check the interproximal bone. Results: After 1 year evaluation of custom-made zirconia crowns and preformed SSCs in primary molars, it was shown that both SSC and zirconia crowns showed good gingival scores but zirconia crown was better than SSC in improving the gingival health. SSCs showed better results with respect to the opposing tooth wear and marginal adaptability. Parents as well as patients preferred a tooth-colored crown as a treatment option. Conclusion: Custom-made zirconia crowns are comparable to the preformed SSCs and they show better gingival scores and excellent color match.

Introduction: The presence of unilateral symptoms or pathology should be regarded with extreme caution as sinonasal neoplasms in their early stages with subtle symptoms may mimic inflammatory pathology. It is always the otolaryngologist’s endeavour to diagnose a neoplastic pathology in the early stage to prevent further complications. Aim: To study the aetiopathological profile, age, and sex distribution of unilateral nasal masses presented at a tertiary care centre, Telangana, India. Materials and Methods: The present study was a hospital-based cross-sectional study consisting of 53 patients of all age groups, of both sexes, with unilateral nasal mass presenting to the Ear, Nose and Throat (ENT) Outpatient Department (OPD) at Krishna Institute of Medical Sciences, Secunderabad, Telangana, India from December 2020 to June 2021. A detailed history was recorded and the patient underwent a complete ENT check-up, and head-neck examination followed by Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and biopsy. Results: The mean age of the study population was 44 years and there were 47 males and six females. Nose block was the most common presenting symptom in 43 (81.1%). Middle meatus was the common site seen in 12 patients (22.6%). Inflammatory lesions was the most common observed in 24 (45.3%), followed by fungal sinusitis in 6 (11.3%), granulomatous lesions in 2 (3.8%), benign lesions in 15 (28.3%), and malignant lesions in 6 (11.3%). Conclusion: Unilateral nasal masses were found common in males than females, with a peak incidence in the 5th to 6th decades of life. Histopathologically inflammatory lesions are the most common followed by benign and then malignant lesions.Any unilateral nasal mass should be viewed with a high index of suspicion for malignant lesions and should be subjected to diagnostic nasal endoscopy, imaging, and histopathological examination after surgical excision of the mass.

Objective Determine the pharmacokinetics (PK) and exposure–response of hydroxychloroquine (HCQ) and desethylhydroxychloroquine (DHCQ) in paediatric SLE (pSLE).Methods We conducted an exploratory phase 2, direct-to-family trial. Children enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry with a diagnosis of pSLE were eligible if they were receiving HCQ as standard of care for ≥3 months. Biological samples were collected at up to four visits over a 6-month period. At each visit, plasma was obtained to measure the concentrations of HCQ and DHCQ, as well as cytokines. HCQ and DHCQ plasma PK data were analysed using a population PK modelling approach.Results Twenty-five subjects provided a total of 88 plasma concentrations for PK analysis. There was a poor linear fit between HCQ concentrations and total body weight (R2=0.03). There was a decline in both interferon (IFN)-alpha and IFN-gamma with higher concentrations of HCQ and DHCQ. Volume of distribution for HCQ in plasma was higher in children compared with published values in adults (73 000 L vs 44 000 L), but clearance values in children were similar to adults.Conclusions We report the first population PK model for HCQ and DHCQ in children using data from a novel direct-to-family clinical trial. We observed high interindividual variability in HCQ PK and found that weight-based dosing for HCQ is poorly correlated with drug concentrations, suggesting the need to use therapeutic drug monitoring to individualise dosing. Furthermore, our results suggest that the current weight-based dosing paradigm for HCQ may result in suboptimal drug exposures, particularly for children with obesity. Accordingly, additional studies of HCQ are needed in pSLE to determine the optimal drug concentration and dosing to reduce disease activity and improve outcomes.Trial registration number NCT04358302.

Hepatic artery aneurysms (HAAs) are extremely rare entities. Given the high mortality rates with rupture, they should be treated early with either open or endovascular repair. We present a case of a 60-year-old man with HAA treated successfully by open surgical repair.

Segmental zoster paresis is characterized by focal motor weakness affecting the myotome corresponding to the dermatomal distribution of the rash. Clinically, it presents as pseudohernia when it involves abdominal wall muscles. We report three cases of segmental zoster paresis presenting as pseudohernia of abdominal wall. All patients developed asymptomatic bulge in anterolateral side of abdomen between 10 and 15 days after appearance of vesicles. All patients developed post-herpetic neuralgia. One patient developed pseudo-obstruction of colon due to visceral involvement. Segmental zoster paresis of lower thoracic spinal segment often goes unnoticed due to its asymptomatic nature.

Background: Scorpion sting is a common medical emergency in rural India. Sparse published data are available regarding scorpion sting envenomation in adults from South India. Methods: We prospectively studied the clinical manifestations and two-dimensional echocardiography findings in fifty adult patients admitted with scorpion sting at a tertiary care teaching hospital in South India. Results: Their mean age was 34.8 ± 13.6 years; there were 28 (56%) males. Forty-one (82%) patients were stung over the limbs and the remaining over the rest of the body. Seventeen (34%) patients received prazosin within 5 h of sting; the remaining 33 (66%) received prazosin thereafter. Salient symptoms were pain over the sting area (n = 18, 36%), dyspnoea (n = 13, 26%), chest pain (n = 9, 18%), vomiting (n = 6, 12%), sweating (n = 5, 10%), nausea (n = 3, 6%), priapism (n = 7, 14%) and piloerection (n = 6, 12%). Common complications were accelerated hypertension (n = 12, 24%), pulmonary oedema (n = 10, 20%), myocarditis (n = 8, 16%), congestive heart failure (n = 6, 12%) and peripheral circulatory failure (n = 3.6%). Common electrocardiogram abnormalities were tachycardia (20%), T-wave inversion (10%), tall T-waves (10%), ST-depression (4%) and atrial fibrillation (2%). Mitral regurgitation was mild (Grade I) in 4 (8%) and moderate (Grade II) in 3 (6%) patients. Decline in left ventricular ejection fraction was noted (n = 14, 28%). Conclusion: Scorpion sting patients present with complaints of pain, palpitation, dyspnoea and paraesthesia. Complications such as hypertension, pulmonary oedema and sinus tachycardia are common. Early administration of prazosin is advocated for better outcome. Therefore, prudent knowledge on cardiovascular manifestations of the disease and timely management is pivotal for physicians.

One in two thousand neonates suffer from congenital limb deficiencies. Fibular hemimelia, a birth defect, has an estimated incidence of 5.7 to 20 cases per 1 million births. Fibular Aplasia, Tibial Campomelia and Oligo-Syndactyly (FATCO) syndrome is one such which is a triad of fibular hemimelia (aplasia/hypoplasia of fibula), tibial campomelia (bending of tibial bone) and oligo syndactyly. It is a syndrome of unknown genetic basis and inheritance. Very few cases on this condition have been reported so far. This article reports two cases on this condition, wherein the babies had considerable variability of limb malformations. The first is a newborn with FATCO, and the second is a two-month-old male infant with FATCO associated with right focal femoral deficiency. In view of paucity of the cases, there is a need to report every case which may help in creating awareness and a standardised management approach.

Introduction Direct-to-family clinical trials efficiently provide data while reducing the participation burden for children and their families. Although these trials can offer significant advantages over traditional clinical trials, the process of designing and implementing direct-to-family studies is poorly defined, especially in children with rheumatic disease. This paper provides lessons learnt from the design and implementation of a self-controlled, direct-to-family pilot trial aimed to evaluate the effects of a medication management device on adherence to hydroxychloroquine in paediatric SLE.Methods Several design features accommodate a direct-to-family approach. Participants meeting eligibility criteria from across the USA were identified a priori through a disease registry, and all outcome data are collected remotely. The primary outcome (medication adherence) is evaluated using electronic medication event-monitoring, plasma drug levels, patient questionnaires and pill counts. Secondary and exploratory endpoints include (1) lupus disease activity measured by a remote SLE Disease Activity Index examination and the Systemic Lupus Activity Questionnaire; and (2) hydroxychloroquine pharmacokinetics and pharmacodynamics. Recruitment of the initial target of 20 participants was achieved within 10 days. Due to initial recruitment success, enrolment was increased to 26 participants. Additional participants who were interested were placed on a waiting list in case of dropouts during the study.Discussion and dissemination Direct-to-family trials offer several advantages but present unique challenges. Lessons learnt from the protocol development, design, and implementation of this trial will inform future direct-to-family trials for children and adults with rheumatic diseases. Additionally, the data collected remotely in this trial will provide critical information regarding the accuracy of teleresearch in lupus, the impact of adherence to hydroxychloroquine on disease activity and a pharmacokinetic analysis to inform paediatric-specific dosing of hydroxychloroquine.Trial registration number ClinicalTrials.gov Registry (NCT04358302).

Neurofibromatosis (NF) with sphenoid wing dysplasia is a rare clinical entity. Herewith, we present a case of NF with sphenoid wing dysplasia which presented with pulsatile progressive proptosis. Other ocular symptoms or visual disturbances were absent. Diagnosis of the condition was not easy and the management was a challenging task which needed multidisciplinary approach as there were ocular, neurological, orthopedic, and dermatological manifestations. With neurosurgical intervention, reconstruction of the sphenoid wing was possible. Proptosis was corrected without any disturbance of vision.

Background: Anemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries. Anemia during pregnancy is commonly associated with poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus. Objective: The objective of the study was to estimate the prevalence of anemia among pregnant women and to determine its association with maternal and fetal outcomes. Settings and Design: This study design was a prospective, observational, community-based study. Subjects and Methods: Four hundred and forty-six pregnant women were included in the study from three primary health centers in Kolar district by multistage sampling technique and were followed up till 1 week after delivery. Statistical Analysis: The data were analyzed using SPSS version 22; correlation coefficient, Chi-square test, and logistic regression were used. Results: There was a significant overall improvement in the hemoglobin levels of pregnant during the follow-up (10.3–10.72 gm%). About 35.6% of the women had maternal or fetal morbidity. Anemia was one of the main pregnancy-related complications (62.3%), other complications include difficult labor (3%), postpartum hemorrhage, and preeclampsia 1.6% each abortions/stillbirths (3.5%). The fetal complications include low birth weight (25.5%) followed by premature delivery (0.2%) and birth asphyxia (0.5%). Conclusions: A high prevalence of anemia in pregnant women apparently increases the maternal and fetal risks. To improve maternal and fetal outcome, it is recommended that the primary health care has to be strengthened, prevention, early diagnosis, and treatment of anemia in pregnancy to be given priority.

Background and Objectives: Conservative caries removal has become an integral part of minimally invasive dentistry (MID). Polymer burs and chemomechanical caries removal are two feasible methods of MID. The objective of this study was to assess and compare the efficacy of polymer bur and chemomechanical caries removal agent clinically and microbiologically for selective removal of infected dentin. Methods: A total of fifty primary second molars with occlusal decay involving dentin were selected from 25 patients aged between 5 and 9 years. They were randomly allocated to Group A (polymer bur group) and Group B (Carie-Care group) for caries removal. Completeness of caries excavation was assessed clinically with the application of caries detector dye. Dentinal samples were collected before and after caries removal and cultured in Luria-Bertani Agar, and total viable count was assessed. All the teeth after caries excavation were restored with Type 2 glass ionomer cement. The data obtained was tabulated and statistically analyzed using paired t-test and Chi-square test. Results: There was a statistically significant reduction in the mean microbial count before and after treatment in polymer bur group and Carie-Care group. The reduction in mean microbial count was found significantly higher in polymer bur group compared to Carie-Care group. There was no significant association was observed between the two groups when efficacy was assessed clinically. Conclusions: Both polymer bur and Carie-Care were efficient caries removal agents when assessed clinically and microbiologically. Polymer bur was found to be more effective than Carie-Care when assessed microbiologically.

Alkaptonuria is an autosomal recessive disorder due to deficiency of homogentesic acid oxidase, an important enzyme in the catabolism of aromatic amino acids. Homogentesic acid is finally converted to fumarate and acetoacetate. Reduced activity of this oxidase causes accumulation of homogentesic acid in the cells and body fluids. Here we describe an interesting case of alkaptonuria in a 50-year-old man, previously diagnosed as osteoarthritis who succumbed to myocardial infarction, which is one of the complications of alkaptonuria.

Background: Superficial fungal foot infection (SFFI) in diabetic patients increases the risk of developing diabetic foot syndrome. Sixteen percent of urban population is suffering from diabetes in Sri Lanka. As the diabetes patients are more prone to get fungal foot infections, early intervention is advisable owing to the progressive nature of the infection. There is no data on the prevalence of SFFIs in diabetic patients in Sri Lanka. Objective: To determine the etiological agents causing SFFI in patients with type 2 diabetes. Materials and Methods : Three hundred eighty five diabetic patients were included. Nail clippings and swabs were collected from the infected sites using the standard protocol. Laboratory identification was done and pathogens were identified to the species level by morpho physiological methods. Results: Clinically 295 patients showed SFFI, of which 255 (86%) were mycologically confirmed for infection. Out of 236 direct microscopy (KOH) positives, 227 (96%) were culture positive. Two hundred and fifty one patients (98%) with SFFI had diabetes for more than 10 years. Of the patients with SFFIs 92% had >100 mg/dl FBS and 81% had >140 mg/dl PPBS levels and 80% had both elevated FBS and PPBS. Non-dermatophyte fungal species were the commonest pathogens followed by yeast and dermatophytes. Conclusion: Aspergillus niger was the commonest pathogen followed by Candida albicans. SFFIs were seen significantly with the increasing age, gender, duration of diabetes and with less controlled glycaemic level.

Background: The traditional methods of diagnosing premature rupture of membranes (PROM) have limitations, particularly in diagnosing equivocal cases. Hence, novel methods such as identification of biochemical markers in amniotic fluid, which can be detected in the setting of PROM, have been sought. a-foetoprotein (AFP) is one of such markers which has a high amniotic fluid concentration as compared to normal vaginal secretions. Objective: To evaluate the reliability of AFP levels in vaginal washing fluid for the diagnosis of PROM and to correlate it with the duration of onset of labour. Methods: Fifty pregnant women between 20 and 40 weeks of gestation with a history of leaking per vaginam (study group) and an equal number of gestation-matched pregnant women without leak (control group) were recruited from the antenatal clinic or labour room of Safdarjung Hospital, New Delhi. Speculum examination was done for all women to collect sample vaginal washings for AFP assay. The duration of PROM to onset of labour was recorded in the study subjects. Outcome measures: The primary outcome was the level of AFP to diagnose PROM. The secondary outcome was the correlation of AFP levels with the duration of PROM to onset of labour. Results: The vaginal washing concentration of AFP was significantly higher in the study group than in the control group (56.81±7.3 vs. 22.58±10.6 ng/ml; p=0.000). The cut-off level of AFP to diagnose PROM obtained from the receiver operating characteristics (ROC) curve was 45.9 ng/mL. The sensitivity, specificity, positive and negative predictive values, for AFP to diagnose PROM were: 98%, 94%, 94.2% and 97.9%, respectively. The correlation coefficient of vaginal washings AFP levels and duration of PROM to onset of labour was –0.757 (p=0.000). Conclusion: AFP is a reliable marker for diagnosing PROM and pregnant women with higher level of vaginal washings AFP had an earlier onset of labour.

One hundred and sixty human permanent central incisors were enlarged to a 120 file size after crown removal procedure to simulate immature teeth. The root canals were filled with calcium hydroxide and stored for 15 days (phase I), 30 days (phase II), 90 days (phase III), and 180 days (Phase IV). At the end of these selected time periods, calcium hydroxide was cleaned off the root canals of forty teeth that were randomly selected and obturated with gutta-percha points in the apical 2 mm of the root canals with a sealer. The specimens were further equally divided into four groups. Unrestored Group I served as control and the root canals of teeth in the other three group specimens were reinforced with resin modified glassionomer cement (RMGIC) (Group II), Flowable Compomer (Group III), and Flowable Composite (Group IV), respectively, using a translucent curing post. All specimens were subjected to compressive force using an Instron Testing machine, until fracture occurred. All the materials evaluated substantially reinforced the root specimens compared to the control. At the end of 180 days, Flowable composites showed maximum reinforcement compared to the other groups; however, no significant differences were found between the reinforcement capabilities of Flowable Compomer and RMGIC.

The purpose of this study was to investigate the implementation in government hospitals of the core package of the Thai universal health coverage policies, in terms of customer service, as measured by knowledge and understanding of the core package of the Thai universal health coverage plan, and the channels of communications for customer service. The study was undertaken in 5 large government hospitals of at least 500 beds belonging to medical schools or the ministry of public health. The period time for this study was between 15 September and 31 May 2007. The key informants were 8 persons who were responsible for implementing policies set by the director, with direct responsibility for the core package of the Thai universal health coverage scheme. The methodology of the study was qualitative research. The results of this study revealed that there were 3 main features of implementing the program. The fist was emphasizing team work in routine practice, the second was assigning a doctor who medical treatment consider with director of hospital, and the third was assigning a doctor who medical treatment is having decided person. All 5 hospitals of this study follow a policy of "patient safety". If a case is beyond the hospital's abilities then the patient is referred to a higher level hospital. The medical personnel of all hospitals are competent to deliver the core package of the health scheme, but some smaller hospitals may be unable to deal with complicated diseases or cases needing new medical treatments or techniques. As for the channels of communication, in cases where there were complaints they were usually about timely service or concerns about the most appropriate and beneficial services. The study found that the health care program can be successfully implemented by existing personnel, but the ministry should provide some guidance in ways to reduce the institutional expense of doing so, as this was revealed to be a widespread concern.

Abstract As computer programming becomes more central to the workforce, the need for better models of how it is effectively learned has become more apparent. The current study addressed this gap by recording electrophysiological brain responses as 62 Python programmers with varying skill levels read lines of code with manipulations of form (syntax) and meaning (semantics). At the group level, results showed that manipulations of form resulted in P600 effects, with syntactically invalid code generating more positive deflections in the 500–800 ms range than syntactically valid code. Meaning manipulations resulted in N400 effects, with semantically implausible code generating more negative deflections in the 300–500 ms range than semantically plausible code. Greater Python expertise within the group was associated with greater sensitivity to violations in form. These results support the notion that skilled programming, like skilled natural language learning, is associated with the incorporation of rule-based knowledge into online comprehension processes. Conversely, programmers at all skill levels showed neural sensitivity to meaning manipulations, suggesting that reliance on pre-existing semantic relationships facilitates code comprehension across skill levels.

Eruption of an odontoma is infrequent and here we report a rare case of an erupted odontoma which was associated with an impacted maxillary right lateral incisor which was confirmed by the histopathological report.

Work-related travel and transport by road is fundamental for industry, government and organisations. Traditionally, road safety interventions at societal level have focussed on improving road and vehicle engineering and changing road-user behaviour through transport laws and safety campaigns. Crash data indicate that significant numbers of road-user fatalities occur while driving to or for work. Therefore, workplace initiatives can improve both road and worker safety. This paper reviews regulatory approaches to work-related road safety (WRRS) in Australia, the United Kingdom and United States, identifying significant and consistent gaps in policy, management and research. In all three countries, responsibility for managing and regulating WRRS is spread across government agencies, without a single coordinating body. This paper makes the case that integrating management of WRRS into regulatory and non-regulatory occupational health and safety (OHS) initiatives would foster and support collaboration between research and practice communities, ensuring a comprehensive evidence base for future programs.

Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe three cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement (DFR). All the three patients presented early full weight-bearing mobilization (average time to first ambulation was five days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of ten days). According to our experience, primary arthroplasty with DFR could be a good therapeutic option for complex DFF in elderly patients. Resumen: La fractura femoral distal (FFD) compleja en el paciente anciano es infrecuente, pero su manejo es un desafío. En estos pacientes frágiles, la FFD se asocia a un elevado riesgo de complicaciones médicas y mortalidad. Su tratamiento óptimo sigue siendo controvertido. El objetivo del estudio es proponer nuestro tratamiento estándar, describir nuestros resultados y discutir su relevancia clínica. Reportamos 3 casos de pacientes ancianos y frágiles con múltiples comorbilidades que sufrieron una FFD compleja a causa de un traumatismo de baja energía. Fueron tratados con éxito mediante un reemplazo femoral distal (RFD). Los 3 pacientes presentaron una movilización precoz con carga completa (la media hasta la primera deambulación fue 5 días), buenos resultados funcionales (la media de rango de movimiento de la rodilla fue 103̊) y una estancia hospitalaria breve (media de 10 días). Según nuestra experiencia, la artroplastia primaria podría ser una buena elección terapéutica para las FFD complejas en los pacientes ancianos.

Resumen: La fractura femoral distal (FFD) compleja en el paciente anciano es infrecuente, pero su manejo es un desafío. En estos pacientes frágiles, la FFD se asocia a un elevado riesgo de complicaciones médicas y mortalidad. Su tratamiento óptimo sigue siendo controvertido. El objetivo del estudio es proponer nuestro tratamiento estándar, describir nuestros resultados y discutir su relevancia clínica. Reportamos 3 casos de pacientes ancianas y frágiles con múltiples comorbilidades que presentaron una FFD compleja a causa de un traumatismo de baja energía. Fueron tratadas con éxito mediante un reemplazo femoral distal. Las 3 pacientes presentaron una movilización precoz con carga completa (la media hasta la primera deambulación fue de 5 días), buenos resultados funcionales (la media de rango de movimiento de la rodilla fue de 103̊) y una estancia hospitalaria breve (media de 10 días). Según nuestra experiencia, la artroplastia primaria podría ser una buena elección terapéutica para las FFD complejas en los pacientes ancianos. Abstract: Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe 3 cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement. All the 3 patients presented early full weight-bearing mobilization (average time to first ambulation was 5 days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of 10 days). According to our experience, primary arthroplasty with distal femoral replacement could be a good therapeutic option for complex DFF in elderly patients.

Abstract Background Intensive endurance exercise may induce a broad spectrum of right ventricular (RV) adaptation/remodelling patterns. Late gadolinium enhancement (LGE) has also been described in cardiovascular magnetic resonance (CMR) of some endurance athletes and its clinical meaning remains controversial. Our aim was to characterize the features of contrast CMR and the observed patterns of the LGE distribution in a cohort of highly trained endurance athletes. Methods Ninety-three highly trained endurance athletes (> 12 h training/week at least during the last 5 years; 36 ± 6 years old; 53% male) and 72 age and gender-matched controls underwent a resting contrast CMR. In a subgroup of 28 athletes, T1 mapping was also performed. Results High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and a slight reduction of biventricular ejection fraction, as compared to controls in both genders (p

AbstractAn increasing body of research has investigated how bilingual language experience changes brain structure and function, including changes to task-free, or “resting-state” brain connectivity. Such findings provide important evidence about how the brain continues to be shaped by different language experiences throughout the lifespan. The neural effects of bilingual language experience can provide evidence about the additional processing demands placed on the linguistic and/or executive systems by dual-language use. While considerable research has used MRI to examine where these changes occur, such methods cannot reveal the temporal dynamics of functioning brain networks at rest. The current study used data from task-free EEGS to disentangle how the linguistic and cognitive demands of bilingual language use impact brain functioning. Data analyzed from 106 bilinguals and 91 monolinguals revealed that bilinguals had greater alpha power, and significantly greater and broader coherence in the alpha and beta frequency ranges than monolinguals. Follow-up analyses showed that higher alpha was related to language control: more second-language use, higher native-language proficiency, and earlier age of second-language acquisition. Bilateral beta power was related to native-language proficiency, whereas theta was related to native-language proficiency only in left-hemisphere electrodes. The results contribute to our understanding of how the linguistic and cognitive requirements of dual-language use shape intrinsic brain activity, and what the broader implications for information processing may be.

Increasingly, neuroimaging researchers are exploring the use of real-time functional magnetic resonance imaging (rt-fMRI) as a way to access a participant’s ongoing brain function throughout a scan. This approach presents novel and exciting experimental applications ranging from monitoring data quality in real time, to delivering neurofeedback from a region of interest, to dynamically controlling experimental flow, or interfacing with remote devices. Yet, for those interested in adopting this method, the existing software options are few and limited in application. This presents a barrier for new users, as well as hinders existing users from refining techniques and methods. Here we introduce a free, open-source rt-fMRI package, the Pyneal toolkit, designed to address this limitation. The Pyneal toolkit is python-based software that offers a flexible and user friendly framework for rt-fMRI, is compatible with all three major scanner manufacturers (GE, Siemens, Phillips), and, critically, allows fully customized analysis pipelines. In this article, we provide a detailed overview of the architecture, describe how to set up and run the Pyneal toolkit during an experimental session, offer tutorials with scan data that demonstrate how data flows through the Pyneal toolkit with example analyses, and highlight the advantages that the Pyneal toolkit offers to the neuroimaging community.

This article describes the data analyzed in the paper “Individual differences in the Simon effect are underpinned by differences in the competitive dynamics in the basal ganglia: An experimental verification and a computational model” (Stocco et al., 2017) [1]. The data includes behavioral results from participants performing three cognitive tasks (Probabilistic Stimulus Selection (Frank et al., 2004) [2], Simon task (Craft and Simon, 1970) [3], and Automated Operation Span (Unsworth et al., 2005) [4]), as well as simulationed traces generated by a computational neurocognitive model that accounts for individual variations in human performance across the tasks. The experimental data encompasses individual data files (in both preprocessed and native output format) as well as group-level summary files. The simulation data includes the entire model code, the results of a full-grid search of the model's parameter space, and the code used to partition the model space and parallelize the simulations. Finally, the repository includes the R scripts used to carry out the statistical analyses reported in the original paper.

The current experiment investigated bilingual language control within the dual mechanisms framework. In an fMRI investigation of morphosyntactic rule production, the presence or absence of target language cues was manipulated to investigate the neural mechanisms associated with proactive and reactive global language control mechanisms. Patterns of activation across nine regions of interest (ROIs) were investigated in seventeen early Spanish−English bilingual speakers. A cue by phase interaction in the left dorsolateral prefrontal cortex (DLPFC) and pre-supplementary motor area (Pre-SMA) was observed, suggesting that these regions were more active during cue phases, and less active during execution phases, when target language cues were presented. Individual differences analyses showed that variability in proactive control (informative > non-informative cued trial activation during preparation) in the basal ganglia was correlated with proactive control in the left DLPFC, left inferior frontal gyrus (IFG), and right precentral ROIs. In contrast, reactive control (non-informative > informative cued activation during execution) in the anterior cingulate was correlated with reactive control in the Pre-SMA and left orbital frontal ROIs. The results suggest that, consistent with the dual mechanisms framework, bilinguals differ in the degree to which they use cues to proactively prepare to use a target language.

We present, to our knowledge, the first demonstration that a non-invasive brain-to-brain interface (BBI) can be used to allow one human to guess what is on the mind of another human through an interactive question-and-answering paradigm similar to the "20 Questions" game. As in previous non-invasive BBI studies in humans, our interface uses electroencephalography (EEG) to detect specific patterns of brain activity from one participant (the "respondent"), and transcranial magnetic stimulation (TMS) to deliver functionally-relevant information to the brain of a second participant (the "inquirer"). Our results extend previous BBI research by (1) using stimulation of the visual cortex to convey visual stimuli that are privately experienced and consciously perceived by the inquirer; (2) exploiting real-time rather than off-line communication of information from one brain to another; and (3) employing an interactive task, in which the inquirer and respondent must exchange information bi-directionally to collaboratively solve the task. The results demonstrate that using the BBI, ten participants (five inquirer-respondent pairs) can successfully identify a "mystery item" using a true/false question-answering protocol similar to the "20 Questions" game, with high levels of accuracy that are significantly greater than a control condition in which participants were connected through a sham BBI.

We describe the first direct brain-to-brain interface in humans and present results from experiments involving six different subjects. Our non-invasive interface, demonstrated originally in August 2013, combines electroencephalography (EEG) for recording brain signals with transcranial magnetic stimulation (TMS) for delivering information to the brain. We illustrate our method using a visuomotor task in which two humans must cooperate through direct brain-to-brain communication to achieve a desired goal in a computer game. The brain-to-brain interface detects motor imagery in EEG signals recorded from one subject (the "sender") and transmits this information over the internet to the motor cortex region of a second subject (the "receiver"). This allows the sender to cause a desired motor response in the receiver (a press on a touchpad) via TMS. We quantify the performance of the brain-to-brain interface in terms of the amount of information transmitted as well as the accuracies attained in (1) decoding the sender's signals, (2) generating a motor response from the receiver upon stimulation, and (3) achieving the overall goal in the cooperative visuomotor task. Our results provide evidence for a rudimentary form of direct information transmission from one human brain to another using non-invasive means.

On the basis of comparative anatomy (including chimpanzees, gorillas and other primates), Darwin1 suggested that Africa was the continent from which 'progenitors' of humankind evolved. Hominin fossils from this continent proved him correct. We present the results of morphometric analyses based on cranial data obtained from chimpanzee taxa currently recognised as distinct subspecies, namely Pan troglodytes troglodytes and Pan troglodytes schweinfurthii, as well as Pan paniscus (bonobo). Our objective was to use a morphometric technique2 to quantify the degree of similarity between pairs of specimens, in the context of a statistical (probabilistic) definition of a species.3 - 5 Results obtained from great apes, including two subspecies of chimpanzee, were assessed in relation to same-scale comparisons between the holotypes of 'robust' australopithecine (Plio-Pleistocene hominin) taxa which have traditionally been distinguished at a species level, notably Paranthropus robustus from South Africa, and Paranthropus (Australopithecus/ Zinjanthropus) boisei from East Africa. The question arises as to whether the holotypes of these two taxa, TM 1517 from Kromdraai6 and OH 5 from Olduvai,7 respectively, are different at the subspecies rather than at the species level.

On the basis of comparative anatomy (including chimpanzees, gorillas and other primates), Darwin1 suggested that Africa was the continent from which 'progenitors' of humankind evolved. Hominin fossils from this continent proved him correct. We present the results of morphometric analyses based on cranial data obtained from chimpanzee taxa currently recognised as distinct subspecies, namely Pan troglodytes troglodytes and Pan troglodytes schweinfurthii, as well as Pan paniscus (bonobo). Our objective was to use a morphometric technique2 to quantify the degree of similarity between pairs of specimens, in the context of a statistical (probabilistic) definition of a species.3 - 5 Results obtained from great apes, including two subspecies of chimpanzee, were assessed in relation to same-scale comparisons between the holotypes of 'robust' australopithecine (Plio-Pleistocene hominin) taxa which have traditionally been distinguished at a species level, notably Paranthropus robustus from South Africa, and Paranthropus (Australopithecus/ Zinjanthropus) boisei from East Africa. The question arises as to whether the holotypes of these two taxa, TM 1517 from Kromdraai6 and OH 5 from Olduvai,7 respectively, are different at the subspecies rather than at the species level.

On the basis of comparative anatomy (including chimpanzees, gorillas and other primates), Darwin1 suggested that Africa was the continent from which 'progenitors' of humankind evolved. Hominin fossils from this continent proved him correct. We present the results of morphometric analyses based on cranial data obtained from chimpanzee taxa currently recognised as distinct subspecies, namely Pan troglodytes troglodytes and Pan troglodytes schweinfurthii, as well as Pan paniscus (bonobo). Our objective was to use a morphometric technique2 to quantify the degree of similarity between pairs of specimens, in the context of a statistical (probabilistic) definition of a species.3 - 5 Results obtained from great apes, including two subspecies of chimpanzee, were assessed in relation to same-scale comparisons between the holotypes of 'robust' australopithecine (Plio-Pleistocene hominin) taxa which have traditionally been distinguished at a species level, notably Paranthropus robustus from South Africa, and Paranthropus (Australopithecus/ Zinjanthropus) boisei from East Africa. The question arises as to whether the holotypes of these two taxa, TM 1517 from Kromdraai6 and OH 5 from Olduvai,7 respectively, are different at the subspecies rather than at the species level.

On the basis of comparative anatomy (including chimpanzees, gorillas and other primates), Darwin1 suggested that Africa was the continent from which 'progenitors' of humankind evolved. Hominin fossils from this continent proved him correct. We present the results of morphometric analyses based on cranial data obtained from chimpanzee taxa currently recognised as distinct subspecies, namely Pan troglodytes troglodytes and Pan troglodytes schweinfurthii, as well as Pan paniscus (bonobo). Our objective was to use a morphometric technique2 to quantify the degree of similarity between pairs of specimens, in the context of a statistical (probabilistic) definition of a species.3 - 5 Results obtained from great apes, including two subspecies of chimpanzee, were assessed in relation to same-scale comparisons between the holotypes of 'robust' australopithecine (Plio-Pleistocene hominin) taxa which have traditionally been distinguished at a species level, notably Paranthropus robustus from South Africa, and Paranthropus (Australopithecus/ Zinjanthropus) boisei from East Africa. The question arises as to whether the holotypes of these two taxa, TM 1517 from Kromdraai6 and OH 5 from Olduvai,7 respectively, are different at the subspecies rather than at the species level.

On the basis of comparative anatomy (including chimpanzees, gorillas and other primates), Darwin1 suggested that Africa was the continent from which 'progenitors' of humankind evolved. Hominin fossils from this continent proved him correct. We present the results of morphometric analyses based on cranial data obtained from chimpanzee taxa currently recognised as distinct subspecies, namely Pan troglodytes troglodytes and Pan troglodytes schweinfurthii, as well as Pan paniscus (bonobo). Our objective was to use a morphometric technique2 to quantify the degree of similarity between pairs of specimens, in the context of a statistical (probabilistic) definition of a species.3 - 5 Results obtained from great apes, including two subspecies of chimpanzee, were assessed in relation to same-scale comparisons between the holotypes of 'robust' australopithecine (Plio-Pleistocene hominin) taxa which have traditionally been distinguished at a species level, notably Paranthropus robustus from South Africa, and Paranthropus (Australopithecus/ Zinjanthropus) boisei from East Africa. The question arises as to whether the holotypes of these two taxa, TM 1517 from Kromdraai6 and OH 5 from Olduvai,7 respectively, are different at the subspecies rather than at the species level.

On the basis of comparative anatomy (including chimpanzees, gorillas and other primates), Darwin1 suggested that Africa was the continent from which 'progenitors' of humankind evolved. Hominin fossils from this continent proved him correct. We present the results of morphometric analyses based on cranial data obtained from chimpanzee taxa currently recognised as distinct subspecies, namely Pan troglodytes troglodytes and Pan troglodytes schweinfurthii, as well as Pan paniscus (bonobo). Our objective was to use a morphometric technique2 to quantify the degree of similarity between pairs of specimens, in the context of a statistical (probabilistic) definition of a species.3 - 5 Results obtained from great apes, including two subspecies of chimpanzee, were assessed in relation to same-scale comparisons between the holotypes of 'robust' australopithecine (Plio-Pleistocene hominin) taxa which have traditionally been distinguished at a species level, notably Paranthropus robustus from South Africa, and Paranthropus (Australopithecus/ Zinjanthropus) boisei from East Africa. The question arises as to whether the holotypes of these two taxa, TM 1517 from Kromdraai6 and OH 5 from Olduvai,7 respectively, are different at the subspecies rather than at the species level.

On the basis of comparative anatomy (including chimpanzees, gorillas and other primates), Darwin1 suggested that Africa was the continent from which ‘progenitors’ of humankind evolved. Hominin fossils from this continent proved him correct. We present the results of morphometric analyses based on cranial data obtained from chimpanzee taxa currently recognised as distinct subspecies, namely Pan troglodytes troglodytes and Pan troglodytes schweinfurthii, as well as Pan paniscus (bonobo). Our objective was to use a morphometric technique2 to quantify the degree of similarity between pairs of specimens, in the context of a statistical (probabilistic) definition of a species.3–5 Results obtained from great apes, including two subspecies of chimpanzee, were assessed in relation to same-scale comparisons between the holotypes of ‘robust’ australopithecine (Plio-Pleistocene hominin) taxa which have traditionally been distinguished at a species level, notably Paranthropus robustus from South Africa, and Paranthropus (Australopithecus/ Zinjanthropus) boisei from East Africa. The question arises as to whether the holotypes of these two taxa, TM 1517 from Kromdraai6 and OH 5 from Olduvai,7 respectively, are different at the subspecies rather than at the species level.