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Background: Because of its wide array of advantages, MRI has gained popularity in evaluation of the musculoskeletal system. The advantages include non-invasiveness, lack of ionizing radiations, superior soft-tissue imaging and direct multiplanar imaging. Excellent visualization of cartilage, ligaments, tendons and bones can be achieved by the high resolution images of MRI. MRI can provide a comprehensive evaluation of ankle, including soft tissue and bone pathology. The soft tissue contrast resolution of MRI is superior to that of CT, and MRI is as good as or better than CT for most bone pathology. MRI is more sensitive than CT in the detection of stress fractures and trabecular bone injury.[4] Aim & Objective: 1.To study the normal anatomy of ankle joint on MRI.2 To assess acute traumatic injury patterns of ankle joint.3.To study the role of MRI in the evaluation of traumatic injuries of ankle joint..4 To study the chronic sequelae of ankle injuries. Methods: Study setting: Cross sectional study Tertiary care center. Study duration: 2 years ( from October 2019 to March 2021). Study population: The study population included all the cases with traumatic ankle injury referred to the Dept. of Radiodiagnosis our institute for MRI scan with or without X-ray ndings admitted at a tertiary care center such cases were included in the study. 50 Majority of cases found in 20-30 years age group 18( 36% Sample size: Results: ) followed by 40-50 group 12 cases (24%), 9 cases in 30-40, 7 cases in >50 and 4 cases in 10-20. Males contributing 34 (68%) and females 16 (32%). Deltoid ligament injuries are observed in 12 patients. However, isolated injuries are not seen. Deltoid ligament injuries are associated with bone, other ligamentous and tendon injuries. Anterior compartment tendon injuries were not observed in this study. 16 patients had a history of acute inversion injury. MRI plays an important role Conclusions: for planning further management and to decide whether the patient will require conservative or surgical management. Even though anatomical variants and technical artefacts can mimic a tear on MRI, it is still considered the primary imaging modality for optimal depiction of internal derangement in ankle injury. Common injuries observed in our study are - anterior talo- bular ligament injury, deltoid ligament injury, tenosynovitis, bone contusions and joint effusion.

To compare the efficacy of platelet-rich plasma (PRP) injection vs dry needling (DN) for management of trigger points in the masseter muscle in myofascial pain syndrome (MPS) patients.This randomized controlled trial included 30 clinically confirmed cases of myofascial trigger points (MTrPs) in the masseter muscle who were randomly and equally (1:1) assigned to the test (PRP) and control (DN) groups. Both groups were evaluated for pain (visual analog scale [VAS]), range of functional movements, need for pain medication, patient satisfaction (Likert scale), and sleep (VAS) at baseline and 2-week, 1-month, and 3-month follow-ups. VAS pain and Likert score were also obtained at 6-month intervals.The use of PRP solution in MTrPs in MPS patients had a better effect on pain and patient satisfaction compared to DN.PRP appears to be a more effective treatment modality compared to DN in the management of MTrPs in MPS patients.

There is a new public health crises threatening the world with the emergence and spread of 2019 novel corona virus (2019-nCoV) The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province, China in December 2019.It caused a total of 80,868 confirmed cases and 3101 deaths in Chinese mainland until March 8, 2020. This novel virus spread mainly through respiratory droplets and close contact. According to the current pandemic situation the worldwide report of death due to COVID-19 is 165,877,654, cases confirmed and 3,445,463 death and 146,583,420 recovered. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some, usually the elderly and those with comorbidities, it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. As COVID-19 has triggered enormous human casualties and serious economic loss posing global threat, an understanding of the ongoing situation and the development of strategies to contain the virus's spread are urgently needed. Currently, various diagnostic kits to test for COVID-19 are available and several repurposing therapeutics for COVID-19 have shown to be clinically effective. In addition, global institutions and companies have begun to develop vaccines for the prevention of COVID-19. Here, we review the current status of epidemiology, diagnosis, treatment, and vaccine development for COVID-19.

COVID- 19 is a horrifying pandemic which affected all countries with significant involvement of population leaving the whole world helpless and in distress and grief. Scientists in the entire universe are working to get the healing solution to get rid of this terrific Corona Virus. Though vaccination against this infection has provided an apt relief but still the fight is on against the developing mutant stains. Numerous positive Covid cases have been presented with varied oral manifestations, which are important for dental surgeons to comprehend. The present review article highlighted oral lesions in patients with COVID- 19 disease.

We hereby report an unusual case which presented as a routinely encountered reactive lesion on the palate, whilst the radiological examination revealed a radiolucent cystic lesion underneath. After the investigations from radiography to histopathology, it was finally diagnosed as a peripheral ossifying fibroma coexisting with a nasopalatine duct cyst.

Objective: To develop a decision support system (DSS) for the prediction of the postoperative outcome of a kidney stone treatment procedure, particularly percutaneous nephrolithotomy (PCNL) to serv...

Jatropha integerrima Jacq. (Euphorbiaceae), is grown in many tropical and subtropical countries and used to treat eczema, herpes, ringworm, rheumatism, pruritus, scabies, toothaches, tumors and warts. Its latex is toxic. A methanolic extract of the roots was chromatographed over silica gel column packed in petroleum ether. The column was eluted with petroleum ether, chloroform and methanol successively in order of increasing polarity to isolate n-pentadecanyl oleate (1), α-D-glucopyranosyl-(2→1')-O-α-D-glucopyranoside (α-D-diglucoside,2), n-hexanoyl-O- α -D-glucopyranosyl-(2a→1b)-O- α -D-glucopyranosyl-(2b→1c)-O- α -D-glucopyranosyl-(2c→1d)-O- α -D-glucopyranosyl-(2d→1e)-O- α -D-glucopyranoside (n-caproyl O-α-D-pentaglucoside,3), n-hexanoyl-O-β-D-glucopyranosyl-(2a→1b)-O-β-D-glucopyranosyl-(2b→1c)-O-β-D-glucopyranosyl-(2c→1d)-O-β-D-glucopyranosyl-(2d→1e)-O-β-D-glucopyranosyl-(2e→1f)-O-β-D-glucopyranoside (n-caproyl O-β-D-hexaglucoside,4), α -D-glucopyranosyl-(2→1a)-O- α -D-glucopyranosyl-(2a→1b)-O- α -D-glucopyranosyl-(2b→1c)-O- α -D-glucopyranosyl-(2c→1d)-O- α -D-glucopyranosyl-(2d→1e)-O- α -D-glucopyranoside (α-D-hexaglucoside5) and α -D-glucopyranosyl-(2→1a)-O- α -D-glucopyranosyl-(2a→1b)-O- α -D-glucopyranosyl-(2b→1c)-O- α -D-glucopyranosyl-(2c→1d)-O- α -D-glucopyranosyl-(2d→1e)-O- α -D-glucopyranosyl-(2e→1f)-O- α -D-glucopyranoside (α-D-heptaglucoside,6) . The structures of these compounds have been established on the basis of spectral data analysis and chemical means

Objective The purpose of the study was to evaluate the clinical, imaging and histopathological features of orofacial cysticercosis. Materials and method This study is a retrospective analysis of orofacial cysticercosis that was diagnosed in the Department of Oral Medicine and Radiology, PGIDS, Rohtak during the period from January 2012 to December 2014. A total of 16 cases were analyzed for their clinical, imaging, histological features and management. Result From all the 16 evaluated patients 68.75% were females and 31.25% males. Age ranged from 10 years to 55 years with a mean of 25.69 years. In all the patients, the chief complaint was a nodular swelling of variable duration with a wide variation in the location. Most of the cases were diagnosed on ultrasonography alone except for one case that needed MRI. All the patients were managed medically with only five out of 16 patients requiring surgical intervention. Conclusion Cysticercosis should be included in the differential diagnosis of all the nodular swellings of head and neck region. Ultrasound is an economic, easily accessible, safe and noninvasive method that can be used with a considerable reliability in the diagnosis of cysticercosis along with histopathological examination. Clinical relevance Cysticercosis is a rare disease difficult to diagnose clinically due to nonspecific presentation and inconclusive investigations. This study, to the best of our knowledge, is the first compilation of 16 cases of orofacial cysticercosis. Dentist may play a key role in diagnosis, which may have more widespread implications.

Allergies have recently become the most prevailing problem after all the technological and industrial development. Human body system has reached the limit where it cannot adapt to such high degrees of pollution and even the natural things at times. Understanding the responsibility of being the most superior race on this planet, humans have implemented technology and its various aspects for the betterment of other species whether it be plant species or animal species. Humans are trying to move towards advancements and taking other living beings with them. At the moment humans have created problems for themselves by destroying the natural flora and fauna. This is debatable that humans did it for everyone or for their selfish sake but no one can deny that damage has been done. The consequences being diseases and allergies all such health issues have increased with time. Now, something had to be done to come over it after all humans are most superior. Again technology came to the rescue and humans implemented systems that can predict weather and climatic changes so that a person can be ready with all the precautionary measures. This paper discusses allergy forecast system. Allergy prediction system will work on a similar principle of data collection and using that data for predicting possible health issues that might occur as a result of the climatic condition in that area. The system collects information from weather forecast system to show possible health problems based on climate and also uses data from social media (i.e. social media analysis) to predict possible problems based on updated form different regions.

An electromyogram (EMG) signal acquisition system capable of real time classification of several facial gestures is presented. The training data consist of the facial EMG collected from 10 individuals (5 female/5 male). A custom-designed sensor interface integrated circuit (IC) consisting of an amplifier and an ADC, implemented in 65nm CMOS technology, has been used for signal acquisition [1]. It consumes 3.8nW power from a 0.3V battery. Feature extraction and classification is performed in software every 300ms to give real-time feedback to the user. Discrete wavelet transforms (DWT) are used for feature extraction in the time-frequency domain. The dimensionality of the feature vector is reduced by selecting specific wavelet decomposition levels without compromising the accuracy, which reduces the computation cost of feature extraction in embedded implementations. A support vector machine (SVM) is used for the classification. Overall, the system is capable of identifying several jaw movements such as clenching, opening the jaw and resting in real-time from a single channel EMG data, which makes the system suitable for providing biofeedback during sleeping and awake states for stress monitoring, bruxism, and several orthodontic applications such as temporomandibular joint disorder (TMJD).

Data entry has been a hectic job since the era of data accumulation started. Apparently, that is why there is a full-fledged career in data entry. Data entry method varies with requirements. Early days of computers relied on punch cards and gradually keyboards and mouse came into picture which we still use. Touchscreens didn't take much time to replace the physical keyboard inputs and now as the result of human intelligence and innovation, the era of the optical input is here. Where the user does not even have to take the pain of thinking about entering data but can simply use an optical reader or scanner to input data. Using the computational power the individual elements like text, images, and special characters can be distinguished. OCR-Optical Character Recognizer does the work. OCR works similar to humans when it comes to character recognition as it maintains a database of characters and compares all the scanned elements with the database which makes it really simple to understand. This paper explains the working of an OCR in its different stages. That study helps in finding the various drawbacks of the conventional system. The paper also tells about how those shortcomings can be eliminated and how a better OCR that is future ready can be achieved.

Least Significant Bit-first (LSB-first) algorithm is suitable for low-activity signals as it reduces DAC activity and the number of bit-cycles required per conversion. However, certain code transitions degrade performance by requiring large switching energy and number of bit-cycles even when the code change over previous code is small. This paper addresses it by a new algorithm called Recode then LSB-first (RLSB-first) that reduces the switching energy required for all cases of small code change across the full range of possible previous sample codes. The energy reduction is achieved while maintaining a low number of bit-cycles per conversion.

Background India has a high prevalence of cardiovascular disease (CVD), diabetes mellitus (DM), tuberculosis (TB), human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) and hepatitis B. United States-based studies indicate provider and patient support for medical screening in the dental setting. We assessed patient attitudes towards, and willingness to participate in, medical screening in the dental setting in India. Method A 5-point Likert scale survey (with scores ranging from 1 = very important/willing to 5 = very unimportant/unwilling) was given to a convenience sample of adult patients visiting five university-based dental clinics (clinic group) and one private-practice setting (private group). The Mann–Whitney U-test was used to compare mean response scores between patient groups. Logistic regression was used to assess factors associated with a favourable outcome. Results Both patient groups felt it important for dentists to identify increased risk for medical conditions (89.3% vs. 94.9%, respectively; P = 0.02). The majority of patients were willing to have a dentist screen for the specified conditions: CVD (80.6% clinic and 84.5% private); DM (84.5% clinic and 77.5% private); TB (76.7% clinic and 73.2% private); hepatitis (73.3% clinic and 67.5% private); and HIV/AIDS (71.0% clinic and 70.5% private). The majority of patients were willing to participate in chairside screening that yielded immediate results (84.6% clinic and 86.1% private), discuss results immediately (85.8% clinic and 87.2% private) and pay 150 Indian rupees (55.9% clinic and 91.7% private). Younger patients (

A low-voltage, ultra-low power sensor interface for electromyogram (EMG) signal acquisition is presented. The sensor interface consists of an amplifier and a SAR ADC that work from a 0.3V supply. The low-voltage amplifier topology provides a noise level of 26μVrms, 40dB gain and a state-of the art power efficiency factor (PEF) of 2.2 from a 20–425Hz bandwidth. Low-voltage supply improves the power efficiency of the amplifier compared with previous ultra-low power work. Together with the ADC, the prototype implemented in 65nm CMOS process consumes 3.8nW and has an area of 0.22mm2, which makes the sensor interface suitable for wearable IoT nodes as well as implantable devices.

Jatropha integerrima Jacq. (Euphorbiaceae) is grown in many tropical and subtropical countries and used to treat eczema, herpes, ringworm, rheumatism, pruritus, scabies, toothaches, tumors and warts. Its latex is toxic. A methanolic extract of the roots was chromatographed over silica gel column packed in petroleum ether. The column was eluted with petroleum ether, chloroform and methanol successively in order of increasing polarity to isolate n-pentadecanyl oleate (1), α-D-glucopyranosyl-(2→1')-O-α-D-glucopyranoside (α-D-diglucoside, 2), n-hexanoyl-O- α-D-glucopyranosyl-(2a→1b)-O- α-D-glucopyranosyl-(2b→1c)-O- α-D-glucopyranosyl-(2c→1d)- O- α-D-glucopyranosyl-(2d→1e)-O- α-D-glucopyranoside (n-caproyl O-α-D-pentaglucoside, 3), n-hexanoyl-O- β-D-glucopyranosyl-(2a→1b)-O-β-D-glucopyranosyl-(2b→1c)-O-β-D-glucopyranosyl-(2c→1d)-O-β-D- glucopyranosyl-(2d→1e)-O-β-D-glucopyranosyl-(2e→1f)-O-β-D-glucopyranoside (n-caproyl O-β-D- hexaglucoside, 4), α-D-glucopyranosyl-(2→1a)-O- α-D-glucopyranosyl-(2a→1b)-O- α-D-glucopyranosyl- (2b→1c)-O- α-D-glucopyranosyl-(2c→1d)-O- α-D-glucopyranosyl-(2d→1e)-O- α-D-glucopyranoside (α-D- hexaglucoside 5) and α-D-glucopyranosyl-(2→1a)-O- α-D-glucopyranosyl-(2a→1b)-O- α-D-glucopyranosyl- (2b→1c)-O- α-D-glucopyranosyl-(2c→1d)-O- α-D-glucopyranosyl-(2d→1e)-O- α-D-glucopyranosyl-(2e→1f)-O- α-D-glucopyranoside (α-D-heptaglucoside, 6) .The structures of these compounds have been established on the basis of spectral data analysis and chemical means.

Background: COVID-19 and associated lockdown have had some detrimental effects on the health care professionals. With the maximum fear of getting infected and further transmitting the infection, dentists are suffering from the psychological meltdown along with the physical changes due to altered lifestyle. Aim and Objectives: To evaluate the psychological and physical effects of COVID-19 and consequential lockdown on dentists and to understand the possible reasons for the problems they were facing amidst lockdown due to the changes in their lifestyle. Settings and Design: A questionnaire-based survey to evaluate disaster mental health and analysis of musculoskeletal symptoms was designed and sent to the various groups of dentists. A total of 453 respondents completed the survey. Materials and Method: Cluster sampling method was used and the dentists were segregated into four groups. The responses were evaluated for Post-traumatic stress disorder, Depression, Anxiety and Pain or discomfort. Statistical Analysis: Chi Square test was applied to statistically assess the association of responses. Results: Out of 453 respondents 65.1% were females and 34.9% were males. Based on profession, 23% were academicians, 18.8% private practitioners, 16.8% post-graduate students and 41.5% undergraduates. Females were significantly affected and showed a tendency towards Post traumatic stress disease (PTSD) and potential depression along with pain and discomfort. All the three groups except undergraduate students showed potential symptoms. Conclusion: COVID-19 and the lockdown exhibited significant psychological and physical effects on the dentists. Counselling centers or helplines/portals need to be set up to avoid any grave consequences and untoward losses.

Vertex epidural hematomas (VEDHs) are well-known subtype of extradural hemorrhage, their clinical presentation can be misleading and these lesions may be missed by routine CT axial scanning. In the presented case we describe a case of 35-year man who had a large hyperdense collection with horse shoe shaped distribution on axial images. Sagittal and coronal reconstruction of the images showed greater details of the vertex extradural hematoma. 3D CT reconstruction showed diastasis of the coronal suture with fracture lines involving parietal bones. While the patient was waiting for the surgery he developed weakness of both lower limbs. The patient underwent evacuation of extradural hematoma in emergency. It is recommended to obtain CT slices until the bone of vertex in head injury patients so the diagnosis of VEDH should not be missed.

Global atmospheric electrical parameters such as atmospheric conductivity, air-earth current density, atmospheric electric field, and atmospheric potential have been calculated for eighty different orographically important places of India under the influence of cosmic ray modulation factor due to Forbush decrease assuming fair weather conditions. The results have been compared with the earlier work of Kumar et al. (1998) and show that the correlation between cosmic rays and global atmospheric electrical parameters near the earth surface depends upon the relative magnitudes of galactic cosmic ray particles.

Cysticercosis is a common healthcare problem, especially in developing countries. Orofacial presentation of the disease is rare. It usually manifest as an asymptomatic nodular swelling that is difficult to differentiate clinically, from other orofacial swellings. Diagnosis of cysticercosis is usually not possible clinically owing to its rarity and asymptomatic presentation in orofacial region. Ultrasonography (USG) is the initial and most reliable diagnostic modality for cysticercosis. This review discusses the various oral manifestations, differentials and investigations for oral cysticercosis.

A number of herbs belonging to the genus Jatropha of Euphorbiaceae family are noted for their medicinal benefits. The genus Jatropha is one of the prospective biodiesel yielding crops. The plants which have been so far explored include J. curcas, J. gossypifolia, J. glandulifera, J. multifida and J. podagrica. Although, the plants of this genus are widely distributed, there is an exiguity of scientific literature proclaiming the medicinal benefits of the plants belonging to genus Jatropha. The present paper is a pragmatic approach to accrue the findings on this very significant genus.

Haematemesis and malena are the two most important symptoms of upper gastrointestinal bleeding . The most common cause of upper gastrointestinal bleeding is due to a peptic ulcer. In this paper, the authors research the cause of bleeding. Contrary to previous studies, results favor esophageal varices, e.g., alcoholism or cirrhosis liver post necrotic, as the most common cause of bleeding rather than a peptic ulcer. The authors’ study is based on an observational retrospective protocol with records of 50 consecutive patients with GI bleeding, attending the emergency room from February 2007 until September 2009. Results show that the treatment of UGI bleeding has made important progress since the introduction of emergency endoscopy and endoscopic techniques for haemostasis. The application of specific protocols significantly decreases rebleeding and the need for surgery, whereas mortality is still high. The data highlight the decreasing trend of peptic ulcer as the sole cause of bleeding, as shown in previous literature, ascertaining that varices are now the most common variable.

Security has always been the main concern in data communication and networking. Mobile Networks are highly vulnerable to security attacks and pose a great challenge for the wireless networks being used today. Since the mode of communication is open, these networks do not carry any inherent security and hence are prone to attacks. The present day algorithms have shown limitations to meet the security requirements of transmission. DNA cryptography is a new and promising direction in the field of cryptography. This paper proposes DNA-based Cryptography as an approach to ensure highly secure environment for transmission of data across mobile networks.

Diabetes is most common endocrine disease which exists globally and interests about 6 % of the world population. The recommen dation of W . H . O . about diabetes has led to a rise in investigation of medicinal plants for hypoglycemic agents. D ecoction prepared from roots of Jatropha gossypifolia Linn is used in the treatment of diabetes and its associated complications. The aim of this study was to evaluate the hypoglycemic effect of successive extracts of the roots of the plant in comparison to metfor min. Petroleum ether (60 - 80°C), chloroform, methanol and aqueous extracts (250 and 500 mg/kg body weight) were orally administered to alloxan - induced diabetic mice for 7 days. Change in body weight and plasma glucose levels were estimated after the treatme nt. Methanol extract exhibited significant reduction in plasma glucose level as compared to diabetic control, followed by aqueous extract. Chloroform and petroleum ether extracts were comparatively less active. The results confirm the folklore use of the plant in management of diabetes.

Granulomatous cheilitis is a rare, idiopathic, inflammatory disorder which usually affects young adults. It is characterized by persistent, diffuse, nontender, soft-to-firm swelling of one or both lips. Various treatment modalities have been suggested. In spite of the best treatment, recurrence of the disease is very common. We report two cases of granulomatous cheilitis treated with a combination of steroids, metronidazole, and minocycline with no signs of relapse at one-year follow-up.

Haematemesis and malena are the two most important symptoms of upper gastrointestinal bleeding . The most common cause of upper gastrointestinal bleeding is due to a peptic ulcer. In this paper, the authors research the cause of bleeding. Contrary to previous studies, results favor esophageal varices, e.g., alcoholism or cirrhosis liver post necrotic, as the most common cause of bleeding rather than a peptic ulcer. The authors’ study is based on an observational retrospective protocol with records of 50 consecutive patients with GI bleeding, attending the emergency room from February 2007 until September 2009. Results show that the treatment of UGI bleeding has made important progress since the introduction of emergency endoscopy and endoscopic techniques for haemostasis. The application of specific protocols significantly decreases rebleeding and the need for surgery, whereas mortality is still high. The data highlight the decreasing trend of peptic ulcer as the sole cause of bleeding, as shown in previous literature, ascertaining that varices are now the most common variable.

Introduction: Oral medicine and radiology (OMR) as a subject requires in-depth knowledge for its application in every wake of academic and clinical life. It becomes the duty of teachers in this field to continuously appraise the subject for its betterment. Ironically the subject of OMR is becoming less popular among the students. Aims and Objectives: To assess undergraduate curriculum by obtaining feedback evaluation from interns and to evaluate the utility of this curriculum in clinical practice. Materials and Methods: A sample size of 220 students was selected among interns. They were asked to fill up the questionnaire given to them for the evaluation of the curriculum. Results: 25% respondents found the subject interesting whereas 46% of them thought it stimulated further reading. 62.72% found it easier to understand. Temporomandibular joint (TMJ) disorders were considered as the most difficult topic. Extra-oral radiography along with panoramic radiography were considered as topics which required in-depth explanation. 72.72% did not feel the need for inclusion of any other topics in the curriculum and felt that it was sufficient for them. 81.36% were completely satisfied by the audio-visual content as well. Conclusion: The curriculum should be designed to accommodate more of clinical skills and have a formative educational role. These modifications according to the needs of the students can actually enlighten the path towards betterment of the subject and acceptability from the student's perspective.

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder, which affects various internal organs and has a tendency for bleeding. It has a classic triad of mucocutaneous telangiectasias, recurrent hemorrhages and positive familial history of first-degree relative. Epistaxis or gastrointestinal telangiectasia can be fatal in a small number of cases. Case Report: A 44-year-old woman came with complaints of recurrent episodes of hematemesis and epistaxis. Patient had a family history of similar complaints. Patient underwent esophagogastroduodenoscopy (EGD), which revealed telangiectasia in the stomach. Imaging of the abdomen showed features suggestive of arteriovenous shunting. Conclusion: HHT can remain undiagnosed for a long time, and is rarely being reported in the literature with management needing a multidisciplinary approach with early inputs from a gastroenterologist.

Background: Maternal and neonatal outcome is an index of quality of health and life in human society. To predict serious outcomes in pregnancy various parameters are being researched so that pregnant women who are at risk are identified early and measures taken to ensure a good outcome of pregnancy. Studies have shown an association between microalbuminuria and adverse pregnancy outcome. This study was undertaken to compare obstetric outcome in pregnant women with and without microalbuminuria. Materials and Methods: A prospective cohort study was performed on 69 pregnant women between 20 and 28 weeks of gestation. Urine tests for albuminuria and creatinine measurements were performed in all women and the albumin to creatinine ratio was calculated. The women with microalbuminuria and those without microalbuminuria were monitored until the end of their pregnancy and compared for pregnancy outcome. Results: The age distribution in the two groups was found to be similar and comparable. Preterm labor was strongly associated with microalbuminuria group (P = 0.001**)strongly significant. Incidence of maternal complications were more with microalbuminuria group (P < 0.001**). Fetal complications were significantly more in terms of intrauterine growth restriction, prematurity, low birth weight, low Apgar score and more incidence of neonatal intensive care unit admission with microalbuminuria group (P = 0.010*)moderately significant. Conclusion: It was found that fetal complications were more associated with babies of pregnant women with microalbuminuria. Though maternal complications were more associated with microalbuminuria group, individual events like premature rupture of membrane, preterm premature rupture of membrane had no statistically significant association with microalbuminuria except preterm labor. However, occurrence of pre-eclampsia was more with microalbuminuria, though it didn’t carry any statistical significance.

Acute-on-chronic liver failure (ACLF), a newly recognized clinical entity seen in hospitalized patients with chronic liver disease including cirrhosis, is associated with high short- and medium term morbidity and mortality. None of the definitions of ACLF proposed so far have been universally accepted, the two most commonly used being those proposed by the Asia-Pacific Association for the Study of Liver (APASL) and the European Association for the Study of Liver - Chronic Liver Failure (EASL-CLIF) consortium. On paper both definitions and diagnostic criteria appear to be different from each other, reflecting the differences in cut-off values for individual parameters used in diagnosis, the acute insult or precipitating event and the underlying chronic liver disease. Data directly comparing these two criteria are limited, and available studies reveal different outcomes when the two are applied to the same set of patients. However a review of the literature suggests that both definitions do not seem to identify the same set of patients. The definition given by the APASL consortium is easier to apply in day-to-day practice but the EASL-CLIF criteria appear to better predict mortality in ACLF. The World Gastroenterology Organization working party have proposed a working definition of ACLF which will identify patients from whom relevant data can be collected so that the similarities and the differences between the two regions, if any, can be clearly defined.

Background: In recent times, transcutaneous electrical nerve stimulation (TENS) therapy and placebo drug therapy have been studied widely in the management of temporomandibular joint (TMJ) pain; but at the individual level. Thus, it was required to compare the efficacy of TENS and placebo drug therapy in patients with TMJ pain disorders. Aims: To determine the effectiveness of TENS therapy and placebo drug therapy in the treatment of TMJ pain disorders and to compare the efficacy of both. Settings and Design: A comparative study was done with 40 subjects reporting with the chief complaint of TMJ pain by dividing them into two groups through randomization. Materials and Methods: Subjects of either sex in the age group of 18-60 years and diagnosed with TMJ pain disorders were considered and divided into two equal groups of 20 patients each as Group I and Group II. Group I patients were advised TENS therapy once in a week for 4 weeks and were followed up in the fifth week. In Group II, placebo was given once daily for 4 weeks and follow-up was done in the fifth week. TMJ pain before, during, and at the completion of the treatment was measured in terms of Visual Analogue Scale (VAS). Statistical Analysis: Z-test for proportion and one-way analysis of variance (ANOVA) were used. Results: A significant improvement in the tenderness of muscles and TMJ and for maximum mouth opening bilaterally was observed in Group I during different visits. It was also observed that the average values for pain and tenderness of the muscles and TMJ in TENS therapy for the different visits including follow-up were less compared to the values in placebo drug therapy. Conclusion: TENS therapy proved to be one of the widely and most effectively used treatment modalities with its multifaceted approach toward the treatment of the TMJ pain disorders as compared to placebo therapy.

A 59-year-old male exhibited anemia for evaluation. Endoscopy was diagnostic of gastric antral vascular ectasia. He was given a trial of thalidomide after informing about the adverse effects. After starting thalidomide at 100 mg/day, his hemoglobin (Hb) improved. Post 1 month of therapy his Hb normalized, but he developed xerosis. He was given symptomatic treatment, but did not improve. Thalidomide was suspected to cause xerosis, it was discontinued for a month and post-discontinuation of drug he is symptom free for past 8 months. This paper reports a rare case of thalidomide induced xerosis with dermatological and neurological involvement.

A young female presented with complaint of swelling of the parotid region for one year. She was diagnosed as a case of primary tubercular parotiditis. The diagnosis was confirmed by fine needle aspiration cytology. She was managed with antitubercular drugs. After completing the course the swelling resolved completely and there was no recurrence.

Dear Sir, Neglected spinal injuries, either secondary to overlooked diagnosis [1] or due to circumstantial and socio-economic factors [2], are not uncommon but discussed infrequently in the literature [1,2]. A 72-year-old male had history of a slip and fall episode three years ago in a construction field. At that time, he had weakness of all four limbs with bowel and bladder involvement. He was managed conservatively because of financial instruments. He recovered completely over a period of six months. Now, he presented with mild persistent neck pain. On examination, except mild spasticity, there were no motor or sensory deficits. Initial magnetic resonance imaging of the cervical spine showed dislocation of C5 over C6, and the spinal cord was stretched over the dislocated vertebral bodies (Fig. 1). There was no evidence of cord edema or cord contusions. He had one follow up X-ray of the cervical spine at one year after the injury, and it showed a fusion of the C5 and C6 vertebral bodies (Fig. 2A). Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies (Fig. 2B). In view of the solid fusion and no neurological deficits, the patient continued with conservative management with analgesics. Fig. 1 Initial magnetic resonance imaging of cervical spine showing dislocation of C5 over C6 and the spinal cord was stretched over the dislocated vertebral bodies. Fig. 2 (A) One follow-up X-ray of the cervical spine at one year after the injury showed fusion of C5 and C6 vertebral bodies, and (B) Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies. Patients with neglected spinal injuries can present with neck pain, restricted neck movements, or clinical features of progressive myelopathy [2-4]. Treatment of neglected spinal injuries needs to be individualized, depending on patient's age, medical condition, severity of myelopathy, and stability spine [5-8]. Aggressive surgical treatment is reserved for younger patients with progressive myelopathy, secondary to dynamic instability [9]. Conservative approach has been suggested for elderly patients with stable, non-progressive deformity [5-8]. In the present case, the reactive new bone formation around the fractured segments might have helped in preventing abnormal movements and development of myelopathy. Neglected spinal injuries are defined as injuries not treated in a timely fashion and found late when options for care are limited [1]. Also, neglected spinal injuries may result when the comprehensive management is not initiated in a timely fashion [2]. These lesions have a much higher incidence of complications, which are more severe and difficult to manage, requiring longer hospitalization, adding to the costs and adversely affecting the functional outcomes [1,2]. In summary, for neglected spinal injuries, either untreated or inadequately treated with progressive deformity, persistent pain and late presentation are more often seen in the developing countries [1]. In rare circumstances (as in present case), neglected complete fracture-dislocations patients can make excellent recovery without neurological deficits [10].