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There is a lot of diversity in the medical realm; where unspecified sign and symptoms might confuse and force even experienced clinicians to commit mistakes. Paper eating is presently included in pica, but certain rare compulsions may mimic this and cause confusion for unsuspecting observers. We report a case of paper eating as a manifestation of compulsion in a 15-year-old girl, and reiterate that missing on rare presentations might cause the patient sufferings from inadvertent pharmacological treatment efforts. [ABSTRACT FROM AUTHOR]

Purpose: Conventionally, keratoconus (KC) has been considered a noninflammatory corneal ectatic disorder. Recent evidence suggests a possible role of inflammation in the pathogenesis of KC. Hence, we analyzed the levels of inflammatory factors in the tear fluid of Indian KC patients.Methods: Tear fluid samples were collected from age- and sex-matched healthy controls and KC patients (with different grades). The levels of the inflammatory factors in tears were analyzed using cytometric bead array (Human Soluble Protein Flex Set System, BD Biosciences) for levels of interleukin-1α (IL-1α), IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-9, IL-10, IL-12p70, IL-23p40, IL-13, IL-17A, IL-17F, IL-21, interferon-α (IFNα), IFNγ, tumor necrosis factor-α, CCL2/monocyte chemotactic protein-1, CCL4/macrophage inflammatory protein-1β (MIP-1β), MIP-1α, CCL5/RANTES, CXCL10/IP10, ICAM1, CD62E, vascular endothelial growth factor and transforming growth factor β.Results: An increase in Kmax and Kmean, and a decrease in central corneal thickness was observed with increasing grades of KC. Tear analysis showed that most of the tear soluble factors, including cytokines, chemokines, growth factors and cell adhesion molecules were significantly elevated in the KC patients compared to the controls.Conclusion: Our findings suggest that inflammatory factors associated with KC may play a role in its pathogenesis. This opens the potential to explore anti-inflammatory strategies to either halt or delay the progression of KC. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics including the research that disproves the claim that alcohol consumption reduces the risk of stroke, the issue of confidentiality between patient and caregiver, and the study that proves the effectiveness of chlorhexidine in disinfecting.

This paper is an exploration into the practice of narrative medicine in the clinical setting guided by the theory and approaches of traditional Chinese medicine (TCM). By adopting the theory of TCM, the author attempted to provide the patients with systematic treatment from the perspective of society-psychology-biology under the guidance of both the unity of Heaven and Man, and the unity of Xing (Body) and Shen (Mind/Spirit) through his clinical practice. Guided by yin-yang and Wu Xing (Five Elements) theory and focusing on the social relations of the patients for any possible relationships between patients' social, psychological and biological state, the author took the patients' emotion management as a point of departure and helped the patients recover both physically and psychologically by promoting positive transformation in patients' social, psychological, and biological state. A clinical case was provided at the end of this paper to demonstrate how the above theory was put into practice. Narrative medicine under the guidance of TCM theory can supplement modern medical humanity practices as well as extend the scope of modern medical treatment from the perspective of the unity of Heaven and Man, by enriching the content of narrative medicine, and promoting the medical model from biological medical model toward social-psychological-biological model. [ABSTRACT FROM AUTHOR]

The article presents abstracts on psychiatric research which include to a study on the factors related to better treatment adherence of people with alcohol dependence syndrome, psychiatric comorbidity in alcohol dependence syndrome, and a comparative study between special and general population cases of substance use disorder in day camps.

The proper treatment of diseases has greatly benefited from dental technological advancements. The dentist may view, precisely measure, and create models of both hard and soft tissue using 3D printing. The most cutting-edge technique in dentistry is 3D printing; but it also lacks the user-training trainee. In this paper, we will demonstrate how it is employed in various dental procedures. [ABSTRACT FROM AUTHOR]

Objective: Radical mastectomy was first described by Halsted almost 130 years ago, and has been applied as a treatment strategy in Taiwan since the middle of the 20th century. However, due to the development of nonsurgical treatment modalities, the management of breast cancer has undergone tremendous change. This study examined Taiwanese publications between 1965 and 2020 to identify trends in the surgical management of breast cancer. Data Sources: We searched for papers published by authors from the Taiwan Breast Cancer Society and 18 tertiary referral medical centers in Taiwan. Study Selection: After excluding papers completely unrelated to surgery, there were 50 English language articles and 5 Chinese language articles available for historical review. Results: This nationwide survey of breast cancer over the past 40 years revealed the following trends in surgical management. (1) As detection rates of early-stage breast cancer increased, the amount of removed breast tissue decreased, with a corresponding reduction in percentage of total mastectomy. (2) Axillary sentinel node biopsy should be routinely performed in early breast cancer rather than axillary lymph node dissection without lymph node metastasis. (3) Since the development of gonadotropin antagonist, bilateral oophorectomy is no longer needed in the early stage in premenopausal population. Further pregnancy is allowed if the cancer is well controlled. (4) Breast reconstruction may be recommended, depending on the patients' preference, after total mastectomy for malignancy. Conclusion: Although this review of the literature may not be complete, the trends revealed in our analysis indicate that surgical management of breast cancer has become more patient-friendly, humanistic, and feasible in Taiwan. Currently, breast cancer may not have a poor outcome if the tumor can be detected at an earlier stage. [ABSTRACT FROM AUTHOR]

Background: Sealing ability is one of the most important features of endodontic sealers. The main goal of the present study was to compare sealing ability of mineral trioxide aggregate (MTA)-propylene glycol (PG) with two commonly used resin-based and MTA-based sealers. Materials and Methods: In This in vitro study Seventy extracted single-root teeth were used. Canal preparation was carried out using hand and RaCe rotary files. Ten teeth were used as control. The root canals in positive and negative control groups were left empty. Remaining 60 teeth were randomly divided into following four groups (n = 15): In Group 1, the canals were dried using paper cones and obturated using MTA-PG sealer. In Group 2, saline was removed from canal using a syring, but paper cones were not used. Obturation was done using MTA-PG sealer. In Groups 3 and 4, the canals were dried using paper cones and obturated with AH26 and MTA Fillapex, respectively. Two-chamber method was used to evaluate bacterial leakage using Enterococcus faecalis (ATCC 29212). Turbidity of the lower chambers was checked every day during 90 days. Chi-square, Kaplan–Meier analysis, and logrank tests were used to compare groups regarding leaked samples at the end of the study. The level of significance was set at 0.05. Results: There was no significant difference among groups regarding rate of leakage throughout the study. However, at the end of the study, the groups were statistically different regarding leaked samples (P = 0.034). MTA Fillapex and MTA-PG in dry canal showed the most and least leaked samples at the end of the study, respectively (P < 0.05). Conclusion: MTA mixed with PG has superior sealing ability than MTA Fillapex. [ABSTRACT FROM AUTHOR]

Introduction: Xeroderma pigmentosum, a rare genodermatosis, autosomal recessive disorder. Associated more commonly with consanguineous marriage. Affected individuals are unable to repair ultraviolet radiation (UVR)-induced DNA damage, leading to a variety of clinical manifestations: Dramatic increase in mucocutaneous malignancies, increased lentigines, extreme photosensitivity, and neurodegeneration. Oral manifestations usually involve the lips, anterior portion of the tongue, and buccal mucosa. The most common lesions include squamous cell carcinoma of lips, glossal telangiectasis, and leukoplakia. There is currently no known cure for xeroderma pigmentosum (XP), but preventive and therapeutic approaches that address problems as they arise, including malignancy, is inevitable. Case Report: The present case report illustrates the dental management of XP siblings. Elder child presented with atypical lesions on the tongue, lips, and dental caries. Younger child presented with multiple cavities and dentoalveolar abscess. This paper highlights necessary precautions that should be taken to protect the patient from any iatrogenic inadvertent photoexposures from dental source that may be deleterious to their present state. Clinical Significance: This case report describes the dental management of XP siblings and also discusses the important role of dental professionals when dealing with such children. It also emphasis parental and patient anticipatory education for maintenance of the oral hygiene and also to detect and report any new lesions in the soft tissues of the oral cavity to ensure early preventive and therapeutic approaches at the earliest. [ABSTRACT FROM AUTHOR]

Background: The duration of anti-tuberculous therapy in tuberculous meningitis is controversial. There is variation in recommendations by different societies and expert groups on this issue. Objective: To determine the strength of evidence for short-term therapy in tuberculous meningitis through review of literature and critical appraisal. Materials and Methods: Cochrane CENTRAL (Issue 4, 2010), TRIP database, and PubMed (from 1966 to present) were searched for relevant papers with keywords 'meningeal tuberculosis' and tuberculous meningitis' combined with 'chemotherapy'. A critical appraisal of a systematic review was done using standard criteria. Results: A total of 10 relevant papers were identified. All papers were included in a systematic review. The systematic review did not specify study design of studies to be included, had only case series but no randomised controlled trial, and unclear definition of endpoints. Conclusions: The evidence base for short-term therapy for tuberculous meningitis is weak. There is a need to conduct a randomised controlled trial with non-inferiority hypothesis of adequate sample size with well-defined end points and adequate follow-up. This is a challenge as well as opportunity for Indian neurologists. [ABSTRACT FROM AUTHOR]

Ancient science of pulse reading had existed from antiquity and still being practiced in some traditional medicine systems like Unani, Ayurveda and Chinese medicine etc. Examination of pulse still remains an integral part of these systems of medicine in disease diagnosis and monitoring the disease treatment. An experienced Unani physician can easily differentiate between normal and deranged temperament pulse through Unani metaphysics. As whole concept of disease and its management is based on temperament and its deviation under Unani system of medicine, therefore this unique and simple technique of pulse examination makes it easier to diagnose and treat any disease. In this article, it was tried to explore ancient history regarding knowledge base and practice of pulse reading and present various aspects of pulse examination described in Unani system of medicine and its interpretation through Unani metaphysics. This paper will be useful in generalizing the concept of pulse for better understanding. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease-19 (COVID 19) has left a trail of morbidity and mortality on a global scale because of the nature of the disease and its sequelae. One of the earliest drugs used to prevent the spiralling down of patients with the effects of cytokine syndrome were corticosteroids, reducing mortality. However, with the unfortunate injudicious use of steroids, opportunistic infections have created havoc even in recovered patients. COVID-associated rhino mucormycosis has seen a sudden spike in its prevalence presenting as an endemic in the midst of a pandemic. Case Presentation: Our paper reports a case of a COVID-recovered patient who presented with bilateral disease involving the maxillary sinus and palate on one side and the zygoma and orbit on the other. Discussion: Diagnosing and treating maxillary or orbital or cerebral extensions of rhino mucormycosis requires a thorough judicious approach. Imaging, meticulous intra-operative evaluation, and aggressive medical and surgical treatment are necessary. Conclusion: This case report highlights a peculiar case of an asymmetrical bilateral presentation of post-COVID mucormycosis involving different anatomical spaces. [ABSTRACT FROM AUTHOR]

Historically, most radiology, pathology, and clinical molecular biology information has been image-based and sequestered within each domain. This means that their information could not be combined to improve our knowledge of disease and treatment. This paper proposes the convergence of radiology, pathology, and clinical molecular biology through the integration of their digital data in powerful statistical models in order to create information synergies that can be used by trained models to improve risk estimation, diagnostic certainty, treatment effectiveness, and clinical outcomes. This advance will improve the quality and safety of medical care. Historically, most radiology, pathology, and clinical molecular biology information has been image-based and sequestered within each domain. This means that their information could not be combined to synergistically improve our knowledge of the disease and its treatment. This paper proposes the convergence of radiology, pathology, and clinical molecular biology through the integration of their digital data in a statistical model and the use of the trained model to improve the quality and safety of patient care. During the 20th Century radiology, pathology, and clinical molecular biology were independent clinical domains. Each existed in its own ocular realm - radiologists looked at structural and functional anatomic images, pathologists looked at tissue-based images, and clinical molecular biology looked at biochemical false-color microarray images. Each looked for features that could be used to determine the risk of disease, diagnose disease, and assess the severity of disease. Radiology viewed anatomic images generated by: (i) Röntgen-ray images and (ii) algorithmically constructed images created either from either digital molecular data (for example, magnetic resonance imaging) or from analog cellular data (for example, ultrasound). Pathology viewed enhanced (stains, antibodies, etc.) images of molecular/ cellular/multicellular material affixed to slides. Clinical molecular biology viewed analog false-color images of probedetected gene expression - which could be converted into numeric data, but the resulting numbers were imprecise because of the imprecision inherent in the false-color data. There are several issues related to the visual detection of image-based clinical information. One issue is additivity; each clinical domain possesses some information that is not contained in the other domains (orthogonality), but there was no way to combine the images across the imaging domains in order to create an additive model of the patient and disease. Another issue is observability; there is more information in the analog data than can be seen by an observer, therefore, from a cybernetic perspective, the visual assessment of images results in a loss of information. A third issue is subjectivity; the visual assessment of analog data (signal detection) is subject to high intra and inter-observer variability (error). This lowers predictive accuracy for the three types of prediction, namely, risk/prevention, diagnosis, prognosis/treatment) and, as a consequence, decreases the clinical utility of the information.[1] Fortunately, radiology, pathology, and clinical molecular biology data have become, or are rapidly becoming, digital. This means that the images will no longer be needed - they will be replaced by computational digital data. This transition from analog to digital data permits, for the first time, the convergence of the three domains. The union of these imaging domains will increase the amount, and quality, of clinically useful information through improvements in additivity and observability, and it will reduce error through the elimination of subjectivity. We can employ a conceptual framework, a set of variables and the relations among them that are thought to account for a phenomenon, to help us understand, and guide our modeling of, disease. [2] The body is a unitary, complex biological system[3] which has the following framework: (1) the body is an integrated, interdependent hierarchical organization that is composed of systems, each of which serves one or more biological functions, (2) the complete uncompensated failure of one of the body's necessary systems results in the body's failure - but the body has alternate systems for some functions and they may be able to take over for a failed system; (3) the body can be described in terms of fourdimensional, interconnected levels of analysis, including the molecular, cellular, and multicellular levels; (4) a level is defined in terms of its units and rules (the allowed interactions and activities) and the level's units and rules are the constituents of its functional systems at that level: (5) each level has different units and rules; (6) the levels are interrelated a hierarchical manner; (7) time is different at different levels, i.e., things occur at different rates at different levels, furthermore, body time is not equivalent to level time; (8) complex biological systems are dynamical in that their units are always interacting with each other in order to maintain homeostasis; (9) in terms of the functioning of complex biological systems, the inhibition of an activity is, many times, just as important as the existence of the activity; (10) the body's biological systems self-organize based on their constitutive units and rules; (11) complex biological systems have the ability to adapt to changes in their internal systems, their functions, and their external environment, which means that they evolve over time; (12) complex biological systems have the ability to maintain themselves, protect their existence, and to learn from experience; and (13) the functioning of a complex biological system depends on its present state, its environment, and its feedback and feedforward processes. Finally, higher biological/anatomical levels are constructed from four dimensional multicellular functional units (MFUs). MFUs have at least three characteristics: (1) they are composed of multiple cell types and their local environment, including the extracellular matrix, (2) their cells are co-dependent and spatiotemporally interact in an organized, cooperative manner and (3) they perform one or more biological functions that are required to maintain homeostasis. Biological systems are probabilistic (statistical) rather than deterministic (causal) because they are loosely coupled rather than tightly coupled systems. Tightly coupled means that what the system does in the future is not influenced by what it is currently doing. For example, a spring is governed by the rule of proportionality which means that its response to a stimulus is always proportional to the strength of the stimulus. Because tightly coupled systems are deterministic, they are inflexible, therefore, when conditions change they become maladapted and dysfunctional. Loosely coupled means that the forces affecting the present state of the system can determine, to a greater or lesser degree, the future state of the system. Biological systems are loosely coupled probabilistic systems that can adapt to changes in themselves, their functions, and their environment. For example, in physics, Newton and Einstein created deterministic systems whereas quantum mechanics (a type of statistics) is probabilistic.[4] Complex biological systems are loosely coupled to the extent that they do not jeopardize their existence. A deterministic system does not allow for choice, there is only one outcome, so there is no uncertainty. A probabilistic system always has choice, there is always has more than one possible outcome, so it is inherently uncertain. Since information is anything that reduces uncertainty[5] (uncertainty is mathematically equivalent to Boltzmann entropy) there is no information in a deterministic system. The amount of information in a probabilistic system is a function of its ability to reduce uncertainty. We are interested in the uncertainty related to the accuracy of our risk, diagnosis, and treatment predictions. For example, a patient's biomarker is informative if knowing its numerical value reduces our uncertainty regarding the patient's outcome (e.g., prognosis). Once we have a framework for complex biological systems, we can begin to understand non-traumatic disease. The homeostatic principle is necessary, but not sufficient, for the normal functioning of a biological system. An important homeostatic mechanism is deviation reduction (negative feedback) - which maintains the system's normal functioning. Disease is a biological system that violates the body's homeostatic principle through the use of deviation amplification (positive feedback) - it is this deviation amplification away from homeostasis that allows the disease to cause the body's failure. Disease has many of the characteristics of a chaotic system. Chaotic systems are a special class of loosely coupled systems that employ deviation amplification processes. In some situations, the body is able to contain the disease but, in other situations, the disease takes control of the body and destroys it. Our job is to help the body regain homeostasis through traumatic interventions, for example, surgery, and/or through molecular interventions, for example, medications. To accomplish this task, we must attend to Sir William Osler who said, "Medicine is the science of uncertainty and the art of probability" - in other words, our goal is to reduce uncertainty by creating statistical (probabilistic) models which integrate multilevel biological information in order to create accurate disease representations which help us understand and defeat the disease. It might be thought that the convergence of radiology, pathology, and clinical molecular biology is about the collapsing of three levels of analysis related to anatomic scale - from larger to smaller scale. But our levels of analysis are not related to scale, rather, they are the hierarchical levels related to the molecular, cellular, and multicellular systems and subsystems. These systems and subsystems are fantastically complex. Even the smallest subsystems are extremely complicated, for example, researchers are just beginning to try to model a single signal transduction pathway using supercomputers.[6] Modeling every system in the body is currently not possible, so what is the point of combining orthogonal biological information? The answer is that we are not going to model all the workings of normal biological systems, rather, we are going to model deviant biological systems (disease) - we are going enter the disease-related data into a statistical algorithm, let the statistical method learn the relevant-for-the-disease relationships (rather than all permissible biological system relationships), create a trained model that accurately represents the disease, and use that model of the disease to provide accurate probability estimates related to disease for risk/prevention, diagnosis, and prognosis/ treatment. In other words, we do not need to know all the aspects of a system in order to model those aspects related to the disease and to use that model to improve the quality and safety of patient care. Radiology, pathology, and clinical molecular biology provide the digital molecular, cellular, multicellular data we need to create our disease models. Radiomics is radiographic digital data at the molecular, cellular, multicellular levels.[7] Non-Röntgen-ray radiology is noninvasive and some modalities, such as magnetic resonance imaging, are inherently digital and they can operate at the molecular, cellular, multicellular levels. Pathomics, which is invasive, is the use of statistical algorithms to digitize and learn key features of pathology images and it can operate at the molecular, cellular, multicellular levels. [8] Proteogenomics, which is also invasive, is the acquisition of disease-related digital gene and protein information and, of course, it operates at the molecular, cellular, multicellular levels.[9] Radiomic, pathomics, and proteogenomic digital data can be combined with other digital data, including physiologic and laboratory data, to create an optimal statistical model of the disease. The resulting trained model acts as a surrogate for the disease: to the extent that the model is an accurate representation of the disease, it can inform us regarding the disease's natural course and it can tell us which treatment to select to slow or truncate the disease's progression. In order to select the best statistical method to model the disease we need to formally understand complex biological systems. One way to do so is through network theory, i.e., nodes (functional units) and their connections (the relationships and interactions between nodes). Biological systems can be represented as a multiplex network, i.e., the units at different levels are not separate entities, which means that the data cannot be compressed into a single level model or represented as an aggregated model. Furthermore, we are modeling a dynamical rather than structural network, therefore, a level's units interact with each other and they are constitutive within and across levels (the effects of one level pass through from one level to another), and they can be codependent.[10] Furthermore, we have to be aware of multilevel information redundancy, i.e., that the same information can be shared across levels.[11] Finally, we would like to use as few levels as possible to explain the phenomenon because the more levels there are the sparser the representation. These network characteristics of biological systems have important implications for the convergence of multilevel digital data. One implication is that the statistical method must be able to deal with multilevel, interactional data. Another is that the method must be able to learn from the data. Finally, the method should make few, if any, parametric assumptions. What is required is a universal classifier, one that can learn multilevel dynamical data, including capturing the nonlinearities and interactions, and that will converge on the correct solution which, in this case, is the creation of an accurate model of the disease. Fortunately, there is such a universal classifier, namely, the neural network.[12] A three-layer backpropagation neural network with an arbitrarily large number of sigmoidal hidden layer units can fit any real continuous function and, given that the solution is in the data and that there is sufficient data, it will find the correct solution.[13] The discriminative accuracy of the trained neural network is a function of how well it models the disease and it is measured by the receiver operating characteristic (ROC).[14] To be clinically useful a model's ROC should be at least 0.70.9. Our remaining task is to create clinical decision support systems (CDSS) that: (1) function in the prediction domains of risk/prevention, diagnosis, and prognosis/treatment; (2) contain powerful neural networks that use the patient's digital data to make accurate individualized patient predictions and that learn in order to improve their performance over time; and (3) effectively communicate to the clinician and patient in real time the individual patient clinical information and predictions required for better shared decision-making and optimal treatment. In summary, the transformation of the clinical domains of radiology, pathology, and clinical molecular biology from analog to digital data, and the integration of their digital data in powerful statistical models, will create information synergies that will improve risk estimation, diagnostic certainty, treatment effectiveness, and clinical outcomes. This advance will improve the quality and safety of patient care. [ABSTRACT FROM AUTHOR]

Since introduced in 1961, intralesional (IL) agent has become an essential part of the dermatological practice. The term IL referred to the direct delivery of agent percutaneously into skin lesions. This therapeutic approach is relatively safe, easy to perform and applicable for a broad range of dermatological conditions. On the other hand, immediate side effects, including pain during administration, bleeding, high risk of infection and allergic reaction, and subsequent side effects involving skin changes such as atrophy, telangiectasia, pigmentary changes, and striae are usually associated with this modality. This review paper highlights the pros and cons of IL agents in modern dermatology practice. [ABSTRACT FROM AUTHOR]

Background: Baastrup disease (BD) is characterized by the degenerative changes of spinous processes and interspinous soft tissues. It is more common among aged persons. This disorder is a relatively common cause of low back pain. Its incidence is underestimated. A few studies have investigated BD epidemiology and proposed treatment efficacy. The aim of this paper is to establish impact and outcome evaluations of managing the patients with Baastrup disease who have been treated by implementing of floating interlaminar device (FID). Materials and Methods: Between January 2015 and September 2017, 47 patients have been operated by implementing of FID for BD in our Department of Neurosurgery. Results: Of the 47 patients, 20 were female and 27 were male with an average age of 51.78. On average, we followed the cases up to 11 months. The most frequent level of disorder was L4–L5 followed by L3–L4 level. The condition of 45 patients improved after surgery according to Oswestry low back pain score and 39 patients could return to their work. Conclusion: The results from our study corroborate that implementing of FID is a good alternative treatment for patient chronic low back pain due to BD This technique contributes to improving a better living situation for the patients given the correct indications. [ABSTRACT FROM AUTHOR]

Background: Oral lichen planus (OLP) is a chronic disease without any definitive treatment. Local corticosteroids are often prescribed, but their efficacy has been questioned by many studies. The purpose of this study was to investigate the effect of nano-based triamcinolone acetonide gel (NT) and compare it with conventional triamcinolone gel (CT) on OLP. Materials and Methods: In this triple-blind randomized clinical trial study, 40 patients with Erosive OLP were divided into two groups receiving (CT) and (NT). The patients were requested to apply them four times a day for 2 weeks. The severity of pain was evaluated through visual analog scale, the size of lesions was measured with paper lace, and the appearance of lesions was examined adopting Thongprasom scale. Findings will be significant via independent t-test or Chi-square test with P < 0.05. Results: The severity of pain in NT group was 4.9 ± 0.7 cm before the treatment and 1.5 ± 0.9 after that, whereas in CT group, it was 4.9 ± 0.8 and 1.8 ± 0.9, respectively. The mean size of the lesions in NT group was 2.1 ± 1.1 cm before the treatment and 0.8 ± 1.1 afterward, whereas in CT group, was 2.2 ± 1.1 and 1.3 ± 1.1, respectively. The OLP appearance before and after the study in NT group was 4.5 ± 0.5 and 0.8 ± 0.6, respectively, whereas in CT group was 4.6 ± 0.5 and 0.9 ± 0.7 (P = 0.3). Among these variables, only Thongprasom scale on the 6th and 14th days had a significant reduction in NT group in comparison with CT group. Conclusion: NT has a better impact on OLP in comparison with CT, but this difference is not statistically significant. [ABSTRACT FROM AUTHOR]

Context: Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations. Aim: To describe a protocol for the treatment of neglected dislocation in the SACS. Settings and Designs: Retrospective case series and review of literature. Materials and Methods: Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review. Results: Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients. Conclusions: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment protocol for management of neglected dislocation in the SACS has been suggested in this paper. [ABSTRACT FROM AUTHOR]

New gas therapies using inert gases such as xenon and argon are being studied, which require in vitro and in vivo preclinical experiments. Examples of the kinetics of gas transport during such experiments are analyzed in this paper. Using analytical and numerical models, we analyze an in vitro experiment for gas transport to a 96 cell well plate and an in vivo delivery to a small animal chamber, where the key processes considered are the wash-in of test gas into an apparatus dead volume, the diffusion of test gas through the liquid media in a well of a cell test plate, and the pharmacokinetics in a rat. In the case of small animals in a chamber, the key variable controlling the kinetics is the chamber wash-in time constant that is a function of the chamber volume and the gas flow rate. For cells covered by a liquid media the diffusion of gas through the liquid media is the dominant mechanism, such that liquid depth and the gas diffusion constant are the key parameters. The key message from these analyses is that the transport of gas during preclinical experiments can be important in determining the true dose as experienced at the site of action in an animal or to a cell. [ABSTRACT FROM AUTHOR]

Pulmonary toxicity related to the use of pegylated interferon alpha-2a during treatment of hepatitis C infections is rare; nonetheless, some cases with fatal outcomes have been reported. Evaluating patients' pulmonary function is a key to diagnosis, follow-up and prognosis of several respiratory diseases, but case reports of respiratory manifestations related to the use of pegylated interferon alpha-2a have limited their findings to only baseline measurements. This paper examines the case of a 65-year-old woman with chronic hepatitis C virus infection who developed interstitial pneumonitis associated with pegylated interferon alpha-2a. Initial lung function evaluation revealed a marked reduction compared to an earlier assessment; the results were consistent with a moderate restricted pattern. Fortunately, over the ensuing 8 weeks of follow-up after discontinuing the drug, the patient recovered her lung function and experienced an overall improvement in her respiratory symptoms. [ABSTRACT FROM AUTHOR]

Background: Various methods have been used to stabilize the vertebra in cervical fractures, including the use of various orthoses and surgery. However, it is not cleared which type of orthosis is more suitable for the subjects with cervical fractures to best immobilize the vertebra and to decrease the associated side effects. Therefore, the aim of this study was to evaluate the efficiency of various orthoses based on the available literature. Materials and Methods: A search was done in some databases include PubMed, ISI Web of Knowledge, EBSCO, Embasco, and Google Scholar. The search was done with some key words such as: Cervical spine injuries; odontoid fractures; hangman's fractures; axis fracture; axis, atlas, cervical fractures; trauma; neck fracture; neck injury in combination with cervical orthoses. The quality of the studies was evaluated by use of Downs and Black assessment and Assessment of Multiple Systematic Reviews (AMSTAR) for original research and review articles, respectively. Results: Based on the aforementioned key words, 25 papers were selected. The quality of the studies varies 10-24. Most of the studies were on the use of the halo vest orthosis, its side effects and also on complications associated with various orthoses. Discussion: Halo orthoses provide a high degree of restriction and immobilization; however, there are some side effects associated with this orthosis, including swallowing, pin loosening, and infection. It should be emphasized that other types of orthoses fewer complications, with reasonable outputs on motion restrictions. [ABSTRACT FROM AUTHOR]

The median palatal cyst is a developmental cyst at the midline of the palate, usually presenting as an asymptomatic swelling, located just behind the maxillary central incisors. It is the most common non-odontogenic cyst of the jaws, but is rarely seen in children. The median palatal cyst has recently been identified as a possible posterior version of the nasopalatine duct cyst. The purpose of this paper is to report an unusual case of a median palatal cyst in a 7-year-old boy who presented with a slow-growing swelling in the anterior palatal region and management of the cyst. [ABSTRACT FROM AUTHOR]

Vital pulp therapy (VPT) is a biologic and conservative treatment modality to preserve the vitality and function of the coronal or remaining radicular pulp tissue in vital permanent teeth. A search was conducted via the Cochrane database, PubMed, MEDLINE, and Ovid for any articles with the criteria for “pulp-capping,” or “pulp-capping materials” and “VPT outcomes” from 1978 to mid 2014. All articles were evaluated and the valid papers were selected. The outcomes of various VPT techniques, including indirect pulp treatment, direct pulp treatment, partial pulpotomy, and complete pulpotomy in vital permanent teeth were extracted. Although various studies have different research approach, most studies noted a favorable treatment outcome. Mineral trioxide aggregate (MTA) appears to be more effective than calcium hydroxide (Ca(OH)2) for maintaining long-term pulp vitality after indirect and direct pulpcapping. However, it seems that the success rate for partial pulpotomy and pulpotomy with Ca(OH)2 is similar to MTA. [ABSTRACT FROM AUTHOR]

Hydrogen is a simple, colorless, and biologically active small molecule gas that can react with reactive oxygen species. Recent research suggests that hydrogen possesses several biological effects, including antioxidant, anti-inflammatory, and anti-apoptotic effects, while exhibiting an extremely high level of safety. Hydrogen application has shown promise in treating a range of acute and chronic diseases, both benign and malignant. Importantly, an increasing number of clinical studies on hydrogen have demonstrated its efficacy and safety in treating various diseases. This review highlights the beneficial effects of hydrogen in kidney diseases, summarizes potential mechanisms by which hydrogen may act in these diseases, and proposes several promising avenues for future research. [ABSTRACT FROM AUTHOR]

I would like to congratulate Gupta, et al., for their recent paper on surgical treatment for moyamoya disease (MD) which has added to the rather sparse literature on this subject among the Indian population.[[1]] Moyamoya vasculopathy (MMV) is characterized by progressive stenosis of the supra-clinoid internal carotid artery (ICA) and/or the proximal segments of anterior and middle cerebral arteries. Although this can be overlooked in light of the rarity of this condition, it does not support the author's conclusion that combined revascularization is the procedure of choice in all patients with MMV. Outcome Following Surgical Revascularization in Patients of Moyamoya Disease with Focus on Graft Patency and Angiographic Changes. [Extracted from the article]

Alopecia, a frequently reported problem, severely impacts the quality of life of patients and is often associated with loss of confidence and low self-esteem. Several conditions such as telogen effluvium (TE), anagen effluvium, diffuse type of alopecia areata, female pattern hair loss, hair shaft abnormalities, loose anagen hair syndrome, and congenital atrichia or hypotrichosis are associated with hair loss. The actual prevalence rate of TE is not reported since most cases are subclinical in nature. Further, since women get more distressed by hair fall and promptly seek treatment, they tend to be over-represented. However, both genders can suffer from this condition if triggering factors are present. This consensus paper was developed by taking into account opinions of renowned experts in the field and is hoped to serve as an evidence-based platform for selecting efficacious and safe therapy for patients with TE. This review presents a synopsis of the key opinions of experts on all aspects of treatment and effective management of this condition. [ABSTRACT FROM AUTHOR]

Background: Interest in using peritoneal dialysis (PD) shows global and national increase. However, it remains a challenge to prevent the progression of PD-associated fibrosis in clinical practice. Here, we assessed the status of scientific publications in prevention and management of PD-associated fibrosis in a scientometric study. Methods: We retrieved the bibliometric data by search terms "encapsulating peritoneal fibrosis," "treatment or prevention," and their synonyms in the Scopus databases until December 2, 2017. Data were analyzed using Scopus analysis tools, SPSS version 15 and Visualizing Scientific Landscapes viewer version 1.6.5. Results: Number of publications showed a steady significant increase (P < 0.001) reaching to 390 documents. Japan had the highest share (21.3%) followed by United Kingdom. Coauthorship network assessment assigned "Ikeda M." from Japan as the top author. The top source of documents was "Peritoneal Dialysis International." Most of documents were original articles focusing on prevention and management of malignant fibrosis of peritoneum (72.6%). The documents were cited totally 5636 times with average citations per article of 14.45, and relatively high H-index of 38. Conclusions: Despite the global increasing trend in scientific output in this field, contribution of our country is very small. Perhaps more national and international collaboration is required to encourage our researchers for producing more scientific products. [ABSTRACT FROM AUTHOR]

Context: Cleft patients with holoprosencephaly (HPE) provide a wide clinical spectrum. Besides accessory agenesis of facial tissue structures, spanning from a single central incisor to the columella, up to the entire prolabium-premaxilla complex, brain deformities with various functional deficits may prevail, just like normal brain development. Making a precise diagnosis, just like choosing the most appropriate treatment plan often is challenging. A literature and chart review comprising 85 HPE cleft cases at the Cleft Clinic of the University of Pretoria, South Africa, was performed. It yielded pertinent diagnostic criteria and collected information about pregnancy history, brain development and survival rate as well as the initial perioperative management and the course of postsurgical midfacial growth. Aims of Part 2: The aim is to highlight how the here presented classification system of HPE cleft patients according to their clinical picture may facilitate the most appropriate treatment protocol. Materials and Methods: The classification system elaborated in Part I due to diagnostic criteria facilitated establishing classification related treatment protocol for 85 cleft cases with HPE. Results: According to diagnostic criteria, HPE cleft cases can be subdivided into (1) columella complex agenesis (Ag-Colum), (2) prolabium-premaxilla-columella complex agenesis in cleft lip-alveolus deformities (Ag-CLA), (3) prolabium-premaxilla-columella complex agenesis in complete hard and soft palate clefts (Ag-CLAP), and (4) "standard" uni-or bilateral CLA or CLAP (HPE-Std-cleft), including cases with an atrophic premaxilla with or without single central incisors. Relevant treatment protocols according to the particular classification are highlighted with figures and intra-operative pictures. Conclusion: This paper addresses the following aspects in cleft patients with HPE: A subdivision into four groups, the 3-in-1 surgical approach, the anteriorly directed midfacial growth and maternal HIV infection. [ABSTRACT FROM AUTHOR]

Obsessive--compulsive disorder (OCD) is generally believed to follow a chronic waxing and waning course. The onset of illness has a bimodal peak -- in early adolescence and in early adulthood. Consultation and initiation of treatment are often delayed for several years. Studies over the past 2-3 decades have found that the long-term outcomes in OCD are not necessarily bleak and that at least half the treatment-seeking patients with OCD show symptomatic remission over long term. A short duration illness, of low severity that is treated early and intensively, with continued maintenance treatment over long term possibly has a good outcome. Recent studies have also identified neuroimaging and neuropsychological correlates of good outcome, but these need further replication. This paper presents an overview of conceptual issues and studies on long-term outcome of OCD and predictors of outcome. [ABSTRACT FROM AUTHOR]

Scimitar syndrome (SS) can be repaired by different surgical techniques including direct implantation, intracardiac rerouting, and in situ pericardial channel to direct the Scimitar vein (SV) to the left atrium. The presence of several anatomical variations such as remote infradiaphragmatic drainage of the SV and abnormal situs makes the repair more challenging with conventional repair techniques. In this paper, we present our experience in using an extracardiac-ringed polytetrafluoroethylene conduit in two pediatric patients (14 months and 2 years old) with SS. [ABSTRACT FROM AUTHOR]

We would like to present in this paper a patient with severe aortic valve stenosis referred to our department for surgical aortic valve replacement. In this patient, it was intraoperatively detected an unexpected heavily calcified porcelain ascending aorta. We present the treatment options in this situation, the difficulties affronted intraoperatively, the significance of the preoperative chest computed tomography scan and the use of the Perceval S aortic valve as ideal bioprosthesis implantation. This is a self-expanding, self-anchoring, and sutureless valve with a wide indication in all patients requiring aortic bioprosthesis. [ABSTRACT FROM AUTHOR]

We aimed to review the contributions by Indian researchers to the subspecialty of skeletal dysplasias (SDs). Literature search using specific keywords in PubMed was performed to retrieve all the published literature on SDs as on July 6, 2017. All published literature on SDs wherein at least one author was from an Indian institute was included. Publications were grouped into different categories based on the major emphasis of the research paper. Five hundred and forty publications in English language were retrieved and categorized into five different groups. The publications were categorized as reports based on: (i) phenotypes (n = 437), (ii) mutations (n = 51), (iii) novel genes (n = 9), (iv) therapeutic interventions (n = 31), and (v) reviews (n = 12). Most of the publications were single-patient case reports describing the clinical and radiological features of the patients affected with SDs (n = 352). We enlisted all the significant Indian contributions. We have also highlighted the reports in which Indians have contributed to discovery of new genes and phenotypes. This review highlights the substantial Indian contributions to SD research, which is poised to reach even greater heights given the size and structure of our population, technological advances, and expanding national and international collaborations. [ABSTRACT FROM AUTHOR]

Aim: Limited clinical and angiographic data exists for patients with traumatic cervico-cerebral pseudoaneurysms. In this paper, we present our limited experience with various management strategies for traumatic cervico-cranial pseudoaneurysms.Materials and Methods: We retrospectively analyzed 37 consecutive cases of traumatic pseudoaneurysms involving the cervico-cranial or the cerebral arteries diagnosed at our center from September 2009 to December 2014. The demographic data, etiology, clinical presentation, lesion location, treatment modality, and follow-up outcomes of these patients were reviewed. Among these 37 patients, 5 patients were treated by surgery, while 29 patients were treated by the endovascular approach and 3 received conservative treatment.Results: During the study period, 42 pseudoaneurysms were identified in 37 patients with a history of head or neck injury. Five patients underwent surgical exploration of the lesion with an uneventful postoperative course. Twenty-nine patients were treated by endovascular interventions with various embolization materials including coils, stents, detachable balloons, liquid embolic agents, and a combination of these agents. The angiographic follow-up imaging demonstrated complete exclusion of the aneurysm from the circulation with the patient being free from any additional neurological deficits.Conclusion: Proper selection of an appropriate approach is essential to address the management of traumatic cervico-cerebral pseudoaneurysms. The treatment of traumatic cervico-cerebral pseudoaneurysms should be selected according to the location and the clinical features of the pseudoaneurysms. The endovascular treatment is a safe and effective modality and should be the first-line choice for treatment of traumatic pseudoaneurysms. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to compare the efficacy of herbal mouthwash and chlorine dioxide mouthwash in reduction of plaque and gingivitis.Settings and Design: In a randomized clinical trial, forty patients were randomly selected and divided equally into two groups.Materials and Methods: After professional oral prophylaxis, the clinical parameters plaque index, gingival index, and modified sulcular bleeding index were recorded at baseline, 7th day, 14th day, and 21st day. The plaque samples were collected from gingival sulcus with an absorbent sterile paper point and were stored in a thioglycollate broth, then sent for microbiological examination. The microbial colony-forming units were assessed at baseline, 7th day, 14th day, and 21st day for Streptococcus mutans, Tannerella forsythia, and Fusobacterium nucleatum.Results: There was a statistical significant reduction in both clinical and microbiological parameters were observed with use of both the mouthwashes. However, herbal mouthwash was more effective in reducing the plaque and gingivitis than chlorine dioxide mouthwash.Conclusion: Herbal mouthwash was statistically efficacious in controlling plaque and gingivitis with potent antimicrobial activity. [ABSTRACT FROM AUTHOR]

Advanced nonsmall cell lung cancer (NSCLC) treatment is primarily based on platinum-based chemotherapy. Although epidermal growth factor receptor (EGFR) targeting has shifted the treatment paradigm toward personalized tyrosine kinase inhibitors (TKIs), resistance develops inevitably and EGFR T790M is the most common acquired resistance mechanism. Rebiopsy of resistant NSCLC cases can provide additional information on the underlying resistant mechanisms and therefore can help clinicians in taking better management decisions. An expert panel meeting of renowned cancer oncologists was held to discuss the management of advanced-stage NSCLC. The present paper is based on the recommendations made by the expert panel and is supported by an exhaustive literature search. It was suggested that identification of driver mutation leads to better treatment decisions. TKIs have proven to be better treatment option in EGFR-positive patients as compared to chemotherapy. Third-generation TKIs (osimertinib) promise to bring optimal and improved care for NSCLC cases failing first-line TKI treatment. [ABSTRACT FROM AUTHOR]

Cancer-related fatigue is a symptom of cancer where most patients or the general practitioners tend to misinterpret due to the insufficient understanding or knowledge of cancer-related fatigue (CRF). This paper will provide a better perspective for the patients and the health professionals on how to manage and handle CRF for both mild and severe fatigue patients. Articles were selected from the searches of PubMed database that had the terms "randomized controlled trials," "cancer," "fatigue," "pharmacologic treatment," and "nonpharmacologic treatment" using both Mesh terms and keywords. The authors have reviewed the current hypothesis and evidence of the detailed etiology of the CRF present in the literature for healthier management, directives, and strategies to improve the treatment of cancer-related fatigue. An algorithm has been blueprinted on screening, and management, of the CRF, and various kinds of effective treatments and assessment tools have been briefly studied and explained. Although many strategies seemed promising, the quality of randomized controlled trials is generally quite low in studies, making it difficult to draw conclusions about the effectiveness of each self-care strategies. Therefore, future studies require better design and reporting of methodological issues to ensure evidence-based self-care recommendations for people receiving cancer treatment. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis (NF) is a surgical emergency. It is often aggressive and characterized by the rapidly progressive inflammatory infection of the fascia that causes extensive necrosis of the subcutaneous tissue and fascia, relatively sparing the muscle and skin tissue. As the disease progresses, thrombosis of the affected cutaneous perforators subsequently devascularizes the overlying skin. The course indeed can be a fulminant one. The diagnosis of NF, especially in the early stages, is extremely challenging, and it can be very close in presentation to other skin and subcutaneous tissue infections. The primary site of the pathology is the deep fascia. Necrosis of the tissues and fascia may manifest as erythema without sharp margins, swelling, warmth, shiny, and exquisitely tender areas. Pain out of proportion to physical examination findings may be observed. The subcutaneous tissue may be firm and indurated such that the underlying muscle groups cannot be distinctly palpated. Eventually, as the overlying skin is stripped of its blood supply, skin necrosis ensues and hemorrhagic bullae form. Bacteremia and sepsis invariably develop when the infection is well established. This paper discusses some of issues related to the cutaneous signs found in NF and also provides a review the current, available literature on the subject matter. [ABSTRACT FROM AUTHOR]

Stroke and other cerebrovascular diseases are among the most common causes of death worldwide. Prevention of modifiable risk factors is a cost-effective approach to decrease the risk of stroke. Oxidative stress is regarded as the major flexible operative agent in ischemic brain damage. This review presents recent scientific advances in understanding the role of carotenoids as antioxidants in lowering stroke risk based on observational studies. We searched Medline using the following terms: (Carotenoids [MeSH] OR Carotenes [tiab] OR Carotene [tiab] OR "lycopene [Supplementary Concept]" [MeSH] OR lycopene [tiab] OR beta-Carotene [tiab]) AND (stroke [MeSH] OR stroke [tiab] OR "Cerebrovascular Accident" [tiab] OR "Cerebrovascular Apoplexy" [tiab] OR "Brain Vascular Accident" [tiab] OR "Cerebrovascular Stroke" [tiab]) AND ("oxidative stress" [MeSH] OR "oxidative stress"[tiab]). This search considered papers that had been published between 2000 and 2017. Recent studies indicated that high dietary intake of six main carotenoids (i.e., lycopene, <- and ®-carotene, lutein, zeaxanthin, and astaxanthin) was associated with reduced risk of stroke and other cardiovascular outcomes. However, the main mechanism of the action of these nutrients was not identified, and multiple mechanisms except antioxidant activity were suggested to be involved in the observed beneficial effects. The dietary intake of six major carotenoids should be promoted as this may have a substantial positive effect on stroke prevention and stroke mortality reduction. [ABSTRACT FROM AUTHOR]

Background: Enterococcus faecalis has been widely used as a valuable microbiological pathogen for in vitro studies due to its ability to successfully colonize the root canal in a biofilm-like style, invade dentinal tubules, and resist endodontic treatment procedures. The aim of this study was to compare the bactericidal efficacy of photodynamic therapy (PDT), 2% chlorhexidine, 2.5% NaOCl, and combination of PDT and 2.5% NaOCl against E. faecalis. Materials and Methods: Sixty single-rooted teeth had their canals contaminated with E. faecalis in brain heart infusion broth and were incubated for 48 hours. The canals were then subjected to 2% chlorhexidine, 2.5% NaOCl, PDT (red light emitting diode 625 nm+ Toludine Blue) and PDT + 2.5% NaOCl. Controls consisted of no treatment (positive control) and without inoculation of bacterium (negative control). Following treatment, the canal contents were sampled with sterile paper points. The samples were dispersed in transport medium, serially diluted, and cultured on blood agar to determine the number of colony forming units (CFU). Data were analyzed by Mann-Whitney U test at 5% significance level. The significance level for all analyses was set at P <.05. Results: Combination of PDT and 2.5% NaOCl achieved maximum reduction in recovered viable bacteria, no viable bacteria was observed after treatment of PDT + 2.5% NaOCl. Conclusion: Combination of PDT and 2.5% NaOCl simultaneously is effective in the elimination of E. faecalis from dentinal tubules under the conditions of this study. [ABSTRACT FROM AUTHOR]

Introduction: Direct visual internal urethrotomy (DVIU) followed by intermittent self-dilatation (ISD) is the most commonly performed intervention for urethral stricture disease. The objective of this paper is to outline the current scientific evidence supporting this approach for its use in the management of anterior urethral strictures. Materials and Methods: A Pubmed database search was performed with the words "internal urethrotomy" and "internal urethrotomy self-catheterization." All papers dealing with this subject were scrutinized. Cross-references from the retrieved articles were also viewed. Only English language articles were included in the analyses. Studies were analyzed to identify predictors for success for DVIU. Results: Initial studies showed excellent outcomes with DVIU with success rates ranging from 50% to 85%. However, these studies reported only short-term results. Recent studies with longer followup have shown a poor success rate ranging from 6% to 28%. Stricture length and degree of fibrosis (luminal narrowing) were found to be predictors of response. Repeated urethrotomies were associated with poor results. Studies involving intermittent self-catheterization following DVIU have shown no role in short-term ISD with one study reporting beneficial effects if continued for more than a year. A significant number of studies have shown long-term complications with SC and high dropout rates. Conclusions: DVIU is associated with poor long-term cure rates. It remains as a treatment of first choice for bulbar urethral strictures <1 cm with minimal spongiofibrosis. There is no role for repeated urethrotomy as outcomes are uniformly poor. ISD, when used for more than a year on a weekly or biweekly basis may delay the onset of stricture recurrence. [ABSTRACT FROM AUTHOR]

Objectives: Pelvic fracture urethral distraction defect (PFUDD) may be associated with disabling complications, such as recurrent stricture, urinary incontinence, and erectile dysfunction. In this article we review the current concepts in the evaluation and surgical management of PFUDD, including redo urethroplasty. Materials and Methods: A PubMed™ search was performed using the keywords "pelvic fracture urethral distraction defect, anastomotic urethroplasty, pelvic fracture urethral stricture, pelvic fracture urethral injuries, and redo-urethroplasty." The search was limited to papers published from 1980 to March 2010 with special focus on those published in the last 15 years. The relevant articles were reviewed with regard to etiology, role of imaging, and the techniques of urethroplasty. Results: Pelvic fracture due to accidents was the most common etiology of PFUDD that usually involved the membranous urethra. Modern cross-sectional imaging, such as sonourethrography and magnetic resonance imaging help assess stricture pathology better, but their precise role in PFUDD management remains undefined. Surgical treatment with perineal anastomotic urethroplasty yields a success rate of more than 90% in most studies. The most important complication of surgical reconstruction is restenosis, occurring in less than 10% cases, most of which can be corrected by a redo anastomotic urethroplasty. The most common complication associated with this condition is erectile dysfunction. Urinary incontinence is a much rarer complication of this surgery in the present day. Conclusions: Anastomotic urethroplasty remains the cornerstone in the management of PFUDD, even in previously failed repairs. Newer innovations are needed to address the problem of erectile dysfunction associated with this condition. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension is a serious and unrelenting pulmonary vascular disorder that affects the functional quality of patients and significantly decreases their life span. If diagnosed early, with the number of new therapeutic options that are available, a better quality of life can be provided for a protracted length of time. It is likely that the available treatment will change the natural course of the disease and perhaps prolong survival. As symptoms are often subtle in the early stages of the disease it is imperative that physicians are aware of the manifestations of this condition. A thorough investigation of patients suspected of this condition is essential so that appropriate treatment can be initiated promptly. The routine workup of a patient suspected to have pulmonary hypertension could easily be carried out in any well-equipped peripheral hospital in many affluent and advanced countries. However, it must be mentioned that in some less advanced countries the necessary work up can only be done in major teaching hospitals. Both pulmonologists and cardiologists should be aware of the pathophysiology of pulmonary arterial hypertension, the workup and the treatment options that are available. Patients with refractory pulmonary hypertension should be referred to these research centers for enrolment into any ongoing drug trials as well as for evaluation for heart-lung, single lung, or double lung transplantation. This paper is primarily aimed at pulmonologists and cardiologists taking care of these patients. Unless indicated otherwise this paper mainly deals with WHO group 1 pulmonary hypertension which is designated pulmonary arterial hypertension. Extensive review of the literature spanning the last 30 years was made through Medline using titles such as primary pulmonary hypertension, pulmonary arterial hypertension, secondary pulmonary hypertension, and pulmonary vascular diseases. [ABSTRACT FROM AUTHOR]

A disturbed eruption process creates a clinical situation that is challenging to diagnose and treat. The clinical arena of tooth eruption disorders includes both syndromic and nonsyndromic problems varying from delayed eruption to a complete failure of eruption or sometimes retained primary teeth. This paper reports a rare case of retained bilateral primary incisors on mandibular arch in a systemically healthy patient with eruption of the permanent central and lateral incisors bilaterally. [ABSTRACT FROM AUTHOR]

The author comments on the study on the use of transcatheter intervention in newborn infants and young infants with critical aortic coarctation (AC) and left ventricular dysfunction by Edwin Francis and colleagues published within the issue. The author notes that the paper addresses the problems encountered when treating AC in these group of patients. The author cites the failure of Francis and his colleagues to explain the reasons for choosing balloon angioplasty over stent. The author advises not to use stents in newborn infants and small infants.

This paper discusses the effects of curcumin on patients with Alzheimer's disease (AD). Curcumin (Turmeric), an ancient Indian herb used in curry powder, has been extensively studied in modern medicine and Indian systems of medicine for the treatment of various medical conditions, including cystic fibrosis, haemorrhoids, gastric ulcer, colon cancer, breast cancer, atherosclerosis, liver diseases and arthritis, It has been used in various types of treatments for dementia and traumatic brain injury. Curcumin also has a potential role in the prevention and treatment of AD. Curcumin as an antioxidant, anti-inflammatory and lipophilic action improves the cognitive functions in patients with AD. A growing body of evidence indicates that oxidative stress, free radicals, beta amyloid, cerebral deregulation caused by bio-metal toxicity and abnormal inflammatory reactions contribute to the key event in Alzheimer's disease pathology. Due to various effects of curcumin, such as decreased Beta-amyloid plaques, delayed degradation of neurons, metal-chelation, anti-inflammatory, antioxidant and decreased microglia formation, the overall memory in patients with AD has improved. This paper reviews the various mechanisms of actions of curcumin in AD and pathology. [ABSTRACT FROM AUTHOR]

The article presents a paper on primary healthcare in Hongkong. The objective of the paper is to demonstrate how primary healthcare is implemented in the country by showing the importance of primary healthcare, the usual obstacles that students encounter when learning about primary healthcare, and the necessity of adopting a primary healthcare approach. It is the paper's assessment that Hongkong gives greater weight to curative rather than the preventive aspect of healthcare. Thus, the paper advocates a more proactive and preventive healthcare approach. The paper credits the leadership elected in 2005 for adopting a democratic and citizen-based approach to the implementation of healthcare policy.

Breast conservation therapy is currently considered as a viable alternative to mastectomy in early breast cancer. Radiotherapy by virtue of its ability to reduce local recurrences is an integral component of breast conservation therapy. Apart from irradiating the whole breast, the tumor bed is usually delivered a boost dose in breast conservation therapy to increase the local control rate. One of the methods which has been adopted to selectively boost the tumor bed to high doses is the use of per-operative high dose rate interstitial implants. This particular paper deals with our department's experience with breast conservation therapy using per-operative template guided, High Dose Rate (HDR) interstitial implants in early breast cancer. Local control rates, disease free survival and cosmetic benefit with this technique will be discussed along with literature review. [ABSTRACT FROM AUTHOR]