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Background: Computed tomography (CT)-guided biopsy is emerging as a preferred and safe method for obtaining tissue samples in pleural diseases. Objective: This study aimed to evaluate the diagnostic yield and safety of percutaneous CT-guided biopsy in pleural diseases and to find CT findings predictive of malignant neoplastic pleural disease. Material and Methods: This retrospective study included 77 patients with pleural disease who underwent CT-guided pleural biopsies from July 2013 to May 2020. All procedures were performed with a coaxial semi-automatic biopsy device. Histopathology was performed in all cases, and additional tests such as immunohistochemistry (IHC) or microbiological analysis were carried out depending on clinical suspicion. The correlation of CT findings with final diagnosis was performed by Chi-square, Fisher's exact test and logistic regression analysis. Results: The overall technical success rate of CT-guided pleural biopsy was 100% with a diagnostic yield of 96.1%. No major complication was encountered, with minor complications encountered in the form of minimal pneumothorax and chest pain. Malignant pleural conditions constituted the largest group including metastatic adenocarcinoma as the most common (31.2%), followed by metastatic squamous cell carcinoma and mesothelioma. Tubercular pleural involvement was the second most common category (16.9%). The cartridge-based nucleic acid amplification test (CB-NAAT) assay had 90% sensitivity on pleural tissue in tubercular cases. CT features predictive of malignancy were irregular and nodular pleural thickening, mediastinal and diaphragmatic pleural involvement and mediastinal/chest wall invasion. There was a good correlation between higher pleural thicknesses with malignant outcome. Conclusion: Percutaneous CT-guided biopsy is a safe method for obtaining pleural tissue samples with high diagnostic yield. CT findings provide clues, which favour malignant pleural involvement. [ABSTRACT FROM AUTHOR]

Background and Aims: Intraoperative dexmedetomidine infusion decreases the concurrent anaesthetic and analgesic requirement. However, because of slow onset and offset, it is often used with other drugs. Opioids have a depressant effect on the cardiorespiratory system while ketamine has the opposite pharmacodynamics. Hence, it was hypothesised that ketamine will have a better intraoperative haemodynamic profile compared to fentanyl. This study compared the clinical effects and recovery characteristics of ketamine versus fentanyl when used as an adjuvant along with dexmedetomidine infusion intraoperatively. Methods: A total of 80 patients (18-60 years) undergoing major surgeries were divided into two groups: Group (D + K) received an intraoperative infusion of ketamine 0.5 mg/kg/h, while group (D + F) received fentanyl 0.5 µg/kg/h along with intravenous dexmedetomidine 0.5 µg/kg/h. Intraoperative heart rate (HR), mean blood pressure, and oxygen saturation were recorded at 0 min, 10 min of induction, and thereafter every 30 min throughout the procedure. Ramsay sedation score (RSS) and visual analogue scale (VAS) score were measured at the end of the surgery, at 2 hours, 4 hours, and 6 hours. Results: Reduction in HR and mean blood pressure was more with a tendency of developing hypotension in the fentanyl group compared to the ketamine group. Post-anaesthesia care unit (PACU) stay, need for muscle relaxant and VAS score for pain were also significantly lesser in the ketamine group. Conclusion: Dexmedetomidine with ketamine provided better haemodynamic stability and reduced PACU stay compared to dexmedetomidine with fentanyl. [ABSTRACT FROM AUTHOR]

Manual small-incision cataract surgery (MSICS) preserves its utility as a cost-effective and efficient strategy for mitigating cataract-associated blindness. Numerous techniques of nucleus delivery in MSICS have been described in the literature. The fish hook technique of nucleus extraction was advocated in 1997 and has been popular for high-volume surgery in limited pockets of the world. This article describes in detail the steps involved in the construction of a fish hook, tips of nucleus extraction with the help of a fish hook, and the pros and cons of fish hook-based MSICS through text, diagram, and video supplement. [ABSTRACT FROM AUTHOR]

Background: In the wake of the Covid-19 Pandemic, parts of the public health system at increased risk of reduced efficiency include healthcare services for women and children. This in turn could reverse all the progress achieved over the years in reducing maternal and child mortality. In this study, an attempt has been made to assess the indirect effect of the pandemic on maternal and child health services in public health facilities. Methods: Data pertaining to maternal and child health services being provided under specific Government programmes, were collected from public health facilities of District Sant Kabir Nagar in Uttar Pradesh, India. Comparative analysis of the data from the pandemic phase with data from the year 2019 was done to determine the impact on services. Results: Reduced coverage across all maternal and child health interventions was observed in the study. There was an overall decrease of 2.26 % in number of institutional deliveries. Antenatal care services were the worst affected with 22.91% decline. Immunization services were also dramatically decreased by more than 20%. Conclusion: The response of the public healthcare delivery system to the Covid-19 Pandemic is negatively affecting both the provision and utilization of maternal and child healthcare services. It is deterrent to the progress achieved in maternal and child health parameters over the years. Better response strategies should be put in place to minimize lag in service deliwvery. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to check the compliance of regulatory requirements of drug labeling in India according to guidelines given under the Drug and Cosmetic Rules (D & CRs) 1945, Section 96, 97; drug samples were collected from government drug supply and private practitioners (PPs). Materials and Methods: A total of 100 drugs were selected randomly from schedule H. They were divided into two groups, each containing 50 drugs: (1) drug samples from drug store of a government hospital, manufactured for Gujarat government and (2) drug samples from PPs which are given to them by pharmaceutical companies. Each drug label was checked according to the criteria given under the D & CRs 1945, Section 96, 97. Data entry was done in Microsoft Excel 2013 and analysis was done. Results: Major deficiencies were seen in criteria of pharmacopeia (absent in 8% samples from government supply [GS] and 64% in samples from PPs), schedule (absent in 18% GS samples and 32% in PP samples), warning of schedule (absent in 6% GS samples and 4% in PP samples), Rx (absent in 22% GS samples and 28% in PP samples), red line (absent in 14% GS samples), and drug warning (absent in 84% GS samples and 72% in PP samples). Conclusion: As the study results show lacunae in the contents of the labeling of prescribed drugs in samples from both the groups, there should be strict enforcement of D & CR 1945 and monitoring of drug labels for better and safer use of medicines. [ABSTRACT FROM AUTHOR]

Introduction: Japanese encephalitis (JE) is a vector-borne, viral illness caused by the Japanese Encephalitis Virus. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis; hence, JE is a cause of major public health concern. For the ease of diagnosis and facilitation of surveillance, National Vector Borne Disease Control Programme uses the term Acute Encephalitis Syndrome (AES). In this study, an attempt has been made to ascertain the status and trends of AES and JE in Uttar Pradesh, India. Methodology: This is a record-based retrospective study. The data were obtained from the Directorate of Medical and Health Services of Uttar Pradesh and analyzed using software SPSS version 24.0. Results: In Uttar Pradesh, there were 47,509 reported cases of AES from 2005 to 2018,. With yearly fluctuations, the average Case Fatality Rate of AES was 17.49% with highest in 2005 (24.76%) and lowest in 2018 (8%). Among the patients with AES, 9.98% were found positive for JE. The most commonly affected age group is 1-5 years for both AES and JE, closely followed by the age group of 5-10 years. Peak occurrence of both AES and JE was recorded in month of September. Among the AES-affected patients 53.8% were males and 46.2% were females. Conclusion: The most commonly affected age group was 1-5 years with peak occurrence in the month of September. Though there was a downward trend in CFR, awareness activities like "Dastak" campaign and intersectoral preventive activities, needs to be strengthened. [ABSTRACT FROM AUTHOR]

Background: According to Darwin's theory of evolution, complex creatures evolve from more simplistic ancestors. Dollo's law of irreversibility states that evolution is irreversible. However, cancer cells tend to follow anti-Dollo's law. Unfavorable conditions such as hypoxia, acidic pH and low nutrients cause the cancer cells to switch their lifestyle atavistically in order to survive. They start behaving like a unicellular organism. There is a switch from normal metabolism to Warburg effect and finally cannibalism. Cannibalism is a cell eating cell phenomenon. It is defined as a large cell enclosing a smaller one within its cytoplasm and is known by odd names such as "bird's eye cells" or "signet ring cells." Smaller tumor cells are found in the cytoplasm of larger tumor cells with crescent-shaped nucleus. Cannibalistic cells (CCs) are a feature of aggressive tumors. These cell types are vulnerable to metastasis.Aim: The aim of this study is to identify CCs in various histological grades of oral squamous cell carcinoma (OSCC) and to relate them with the pattern of invasion, lymphocytic response (LR), and mitotic figures (Mfs). The purpose of the article is to establish it as a marker of aggressiveness and metastasis and as an evidence of de-evolution and retroversion of multicellularity.Materials and Methods: Sixty-five histologically confirmed cases of OSCC were studied. Pattern of invasion, LR, number of CCs, and Mfs were recorded on 5 μ hematoxylin and eosin-stained tissue sections. ANOVA and t-test were applied; P < 0.05 was considered statistically significant.Results: CCs were more in sections with patchy LR, increased Mfs, and grade IV pattern of invasion.Conclusion: With increase in dedifferentiation, tumor cells start behaving like unicellular organisms with cell eating cell characteristics. [ABSTRACT FROM AUTHOR]

Background: The emergence of drug-resistant mycobacteria becomes a significant public health problem globally creating an obstacle to effective tuberculosis (TB) control. Gujarat, Maharashtra, and Andhra Pradesh DRS survey estimated that the proportion of multidrug-resistant TB (MDR-TB) is 2.1% (in new TB cases) and 15% (in previously treated cases). Programmatic management of MDR-TB implemented under Revised National Tuberculosis Control Programme in India in 2007. Objectives: The objective of this study is to evaluate treatment outcome and adverse drug reactions (ADRs) of category IV. Materials and Methods: A total of 108 MDR-TB patients were analyzed retrospectively who registered and received treatment during the year of 2014 and 2015 at district TB centre, Rajkot. MDR patients who died or transferred out or defaulter before completion of intensive phase were excluded from the analysis. Results: Of total 108 patients majority patients (64.81%) were in young (20-39 years) with m:f: 2:1. All MDR-TB patients were retreated cases and 69.44% were "undernutrition category". Culture conversion rate was 86.91% at 4 months of treatment. Cure rate was 50.93% while defaulter rate and died rate was same (17.59%). Failure rate was 18.51%. Weight improvement was significantly associated with cure rate. The incidence of ADR was 32.71%. Most frequent ADRs were related to gastrointestinal system (34.42%), ototoxicity (13.11%), and central nervous system (8.1%). Aminoglycosides, cycloserine, and ethambutol were discontinued due to ADR. Majority ADRs (77.04%) were "possible" category by causality assessment and "mild" in severity assessment. Ototoxicity was only severe ADRs observed. Conclusion: Cure rate was improved than previous years at same center. Attention should be paid for defaulters. [ABSTRACT FROM AUTHOR]

Background: Increased angiogenesis has been associated with neoplastic progression, metastasis and outcome in several studies and in a number of malignancies. Among the various host immune cells, mast cells have been implicated in tumor progression by promoting angiogenesis. The aim of this study is to examine the relationship between angiogenesis, mast cells with that of the normal oral mucosa (NOM) and oral squamous cell carcinoma (OSCC).Materials and Methods: The study was conducted using routine haematoxylin and eosin staining procedure and included immunohistochemical staining for microvessels and toluidine blue staining for mast cells.Results: The microvessel density (MVD) and mast cell density (MCD) of two groups (NOM and OSCC). The MVD and MCD in OSCC ranged from 59.18 to 263.31 microvessel/mm 2 and 41.65 to 193.28 cells/mm 2 respectively with mean (±standard deviation) 161.73 ± 48.27 microvessel/mm 2 and 83.59 ± 40.67 cells/mm 2. In both NOM and OSCC, the mean MCD was comparatively lower as compared to respective MVD (MCD < MVD) and comparatively lower in NOM as compared to OSCC (normal < OSCC).Conclusion: A significant correlation is present between MCD and MVD in OSCC and also that both these entities are significantly increased in the disease process when compared to that of the NOM. [ABSTRACT FROM AUTHOR]

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of oral squamous cell carcinoma with a predilection for the tongue and in other locations, such as floor of the mouth, palate, retromolar trigone, and gingival mucosa. Here, we present a case of BSCC of oropharynx in a 60-year-old male patient. [ABSTRACT FROM AUTHOR]

Background: Since its discovery in 1859, formalin has been considered as the "gold standard" in tissue fixation. As formalin is highly toxic and carcinogenic, the quest for its substitute has started recently. Literature search reveals very sparse studies on natural substitute for formalin. Here, it is an attempt to explore eco-friendly, economical, and readily available natural substance for formalin substitute. Aim: The aim of our study was to evaluate the efficacy of natural fixatives such as honey, sugar, jaggery, and water in comparison to the standard fixative used like formalin. Materials and Methods: Fresh goat tissues (tongue) were fixed separately with buffered 10% formalin (positive control), honey, sugar syrup, jaggery syrup, and distilled water (negative control). 24 h fixation was done at room temperature followed by conventional processing and routine H and E staining. The stained sections were assessed for cytoplasmic and nuclear detail by three pathologists under light microscope and were graded accordingly. Results: The results showed statistically significant differences between jaggery with other natural fixatives for both nuclear details and cytoplasmic staining. Conclusion: The preservation of tissue by honey, sugar, and jaggery syrup was comparable to that of formalin. Among the three natural fixatives, jaggery syrup excelled. Hence, it can be considered as an equally effective formalin substitute. [ABSTRACT FROM AUTHOR]

Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) requires the use of expensive and toxic second-line anti-tubercular drugs which are given for a longer duration. Adverse drug reactions (ADRs) of second-line antitubercular drugs affect compliance and thereby treatment outcome. We set out to analyze ADRs and treatment outcome of MDR-TB patients receiving directly observed treatments plus therapy. Materials and Methods: A retrospective study of registered MDR-TB cases at district tuberculosis center during 2010-2014 was performed. Data regarding sociodemographic profile, diagnosis, and treatment as well as ADRs were recorded and evaluated. ADRs were evaluated for causality, severity assessment, management aspects, and impact on treatment outcome. Results: In total 147 ADRs were reported among 72 cases. Most commonly observed ADRs were gastrointestinal (24.5%) followed by self reported weakness (21.23%), psychological (14.38%), joint pain (14.38%), and respiratory symptoms. Discontinuation of the drugs due to ADRs was required in 36 (24.48%) events. ADRs were significantly associated with nontreatment adherence and defaulter outcome. Cure rate was higher in MDR-TB cases with ADRs (59.72%) than MDR-TB cases without ADRs (30.18%). Conclusion: Attention needs to be paid for timely recognition and treatment of ADR with minimum modification of treatment regimen. Equal attention should be paid to MDR-TB without ADR cases to raise over all cure rate. [ABSTRACT FROM AUTHOR]

Invasive aspergillosis generally occurs during the first 1-6 months after heart transplantation. It has been rarely seen in the first 2 weeks postcardiac transplant. We herein describe a unique case of invasive pulmonary aspergillosis (IPA) diagnosed on day 9 postorthotopic heart transplantation. The known risk factors for IPA in cardiac transplant recipients were not identified in our case. The organ recipients from the same donor did not report Aspergillus infection. Hospital environmental samplings failed to demonstrate Aspergillus spores in the patient's room and his adjacent rooms. A diagnosis of early-onset de novo IPA was made. The patient initially received combined antifungal therapy (voriconazole plus micafungin), followed by voriconazole maintenance monotherapy with favorable clinical outcome. [ABSTRACT FROM AUTHOR]

Eosinophilic ulcer (EU) is a rare self-limiting chronic benign ulcerative lesion of the oral mucosa often misdiagnosed as oral malignancy. Its etiopathogenesis is ambiguous, but trauma plays an important role in the development. Microscopically, it is characterized by a polymorphic inflammatory infiltrate with a prominent eosinophilic component and large mononuclear cells extending deep into the submucosa, underlying muscle and salivary glands. We discuss a case of EU in a 55-year-old male, which presented with a symptomatic nonhealing ulcer on the right lateral border of the tongue and was further clinically misdiagnosed as malignant ulcer. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency (RF) is a minimally invasive target-selective technique that has been used with success for many years in the treatment of different pathologies, such as low back pain, trigeminal neuralgia, and others. Aim: The aim of this study is to compare different mode of RF - continuous RF (CRF) versus pulsed RF (PRF) along with steroid in the management of low back pain of discogenic origin. Setting and Design: Prospective, randomized, double-blind trial. Materials and Methods: Forty patients with chronic discogenic low back pain were randomized to receive CRF plus intradiscal triamcinolone 40 mg (Group 1) or to receive PRF plus intradiscal triamcinolone 40 mg (Group 2). Outcome measured includes immediate as well as long-term pain relief using visual analog scale, the Oswestry Disability Index and straight leg raising test. Statistical Analysis: The continuous variables were compared by one-way analysis of variance test. Discrete variables were compared by Fisher's exact test/Chi-square test/Student's t-test, whichever appropriate. The value of P < 0.05 was considered statistically significant. Results: There was a significant decrease in pain score after CRF without any added side effect. Pain relief after PRF was insignificant. Conclusion: CRF with steroid seems to be better for treatment of chronic discogenic low back pain than PRF with steroid. [ABSTRACT FROM AUTHOR]

Background: Mandibular nerve block reverses the trismus caused by pain and muscle spasm, thereby allowing for selection of a safer intubation technique. Aims: As ultrasonographic imaging has added newer dimensions to clinical anesthesia practice, we utilized this tool in performing mandibular nerve block and evaluated its efficacy in segregating trismus patients on etiological basis, to predict safer anesthetic induction. Settings and Design: Prospective, randomized controlled, outcome assessor blinded trial. Materials and Methods: Sixty-eight patients with unilateral mandibular fracture, acute pain, and trismus were randomized to receive mandibular nerve block by Vazirani-Akinosi approach (Group V) or the ultrasound-guided (USG) technique (Group U) before the general anesthetic induction for corrective surgery. Visual Analog Scale (VAS) score and inter-incisor distance was measured at intervals. Primary outcome measure was blocked failure (continued pain [VAS > 30] after the block procedure). Statistical Analysis Used: Mann.Whitney U.test and Wilcoxon signed rank test. Results: There was a significant decrease in pain score following the block procedure, except for six patients (block failure) in Group V. Inter-incisor distance increased to near-maximal levels after the nerve blockade, except for nine patients in Group V (including all block failures) and four in Group U having continued limited mouth opening. General anesthetic induction increased the inter-incisor gap in block failures (Group V) only. Conclusion: USG mandibular block appears to relieve reversible trismus more reliably, thereby allowing for a precise decision on a safer intubation technique. [ABSTRACT FROM AUTHOR]

Background: Vascular endothelial growth factor (VEGF) is capable of initiating angiogenesis in blood vessels and may act as mitogenic agent for epithelium of odontogenic cysts and tumors. This study was conducted to evaluate the role of epithelial VEGF expression in odontogenic cysts and ameloblastoma and its correlation with argyrophilic nucleolar organizer region counts to assess its role in their biological behavior. Materials and Methods: In this retrospective cross-sectional study, 45 histologically confirmed cases, 15 cases of each of keratocystic odontogenic tumors (KCOTs), dentigerous cysts, and ameloblastomas were examined for immunohistochemical expression for epithelial VEGF, and argyrophilic nucleolar organizer regions (AgNORs) (used as secondary marker in this study) staining was done for comparing the proliferative capacity with VEGF. Results: KCOT shows mild expression within the basal layers and strong expression in the suprabasal layer whereas, in dentigerous cysts, a majority showed no VEGF expression whereas ameloblastomas showed strong expression in all cases by stellate reticulum-like cells at the center of the follicles and suprabasal layers of epithelium. The results of AgNOR counts were higher in KCOTs as compared to ameloblastoma and least in dentigerous cysts. Conclusion: VEGF expression by the epithelium of odontogenic cysts and tumors may play a role in epithelial proliferation via autocrine mechanism as reflected by increased AgNOR counts. The angiogenic activity via paracrine pathway may be responsible for the difference in growth rate and neoplastic behavior of the lesions. [ABSTRACT FROM AUTHOR]

The article presents case study of a 58‑year old gentleman, who underwent a D5‑6 laminectomy and excision of the arachnoid web. It mentions that D5‑6 laminectomy blocks the cerebrospinal fluid (CSF) flow and causes focal compression of the spinal cord, and is a rare cause of progressive compressive myelopathy.

Background: Postoperative pain control after major abdominal surgery is the prime concern of anesthesiologist. Among various methodologies, epidural analgesia is the most preferred technique because of the excellent quality of analgesia with minimum side-effects. Aim: The present study was designated to compare postoperative analgesic efficacy and safety of epidural tramadol as adjuvant to ropivacaine (0.2%) in adult upper abdominal surgery. Settings and Design: Prospective, randomized-controlled, double-blinded trial. Materials and Methods: Ninety patients planned for upper abdominal surgery under general anesthesia were randomized into three equal groups to receive epidural drug via epidural catheter at start of incisional wound closure: Group R to receive ropivacaine (0.2%); Group RT1 to receive tramadol 1 mg/kg with ropivacaine (0.2%); and RT2 to receive tramadol 2 mg/kg with ropivacaine (0.2%). Duration and quality of analgesia (visual analog scale [VAS] score), hemodynamic parameters, and adverse event were recorded and statistically analyzed. Statistical Analysis: One-way analysis of variance test, Fisher's exact test/Chi-square test, whichever appropriate. A P < 0.05 was considered significant. Results: Mean duration of analgesia after epidural bolus drug was significantly higher in Group RT2 (584 ± 58 min) when compared with RT1 (394 ± 46 min) or R Group (283 ± 35 min). VAS score was always lower in RT2 Group in comparison to other group during the study. Hemodynamic parameter remained stable in all three groups. Conclusion: We conclude that tramadol 2 mg/kg with ropivacaine (0.2%) provides more effective and longer-duration analgesia than tramadol 1 mg/kg with ropivacaine (0.2%). [ABSTRACT FROM AUTHOR]

Background: Anesthetic agents should be chosen not only on the basis of safety-efficacy profile, but also on the economic aspect. Propofol and sevoflurane are commonly utilized anesthetic agent for general anesthesia. Aim: The present study was designated to compare cost-effectiveness and recovery profile between propofol and sevoflurane for induction, maintenance or both. Settings and Design: Randomized controlled, participant and data operator blinded trial. Materials and Methods: Ninety patients undergoing laparoscopic cholecystectomy were randomized into three equal groups to receive: Group P to receive injection propofol for both induction and maintenance; Group PS to receive injection propofol for induction and sevoflurane for maintenance; and Group S to receive sevoflurane for both induction and maintenance of general anesthesia, respectively. Cost analysis, hemodynamic parameter, and recovery profile were compared between these groups. Statistical Analysis: One-way analysis of variance test or Fisher's exact test/Chi-square test whichever appropriate. Results: Total cost of anesthesia was highest in Group P and lowest in Group S. Mean time to extubation and time to follow verbal commands was lowest in Group S than Group P or Group P/S. Hemodynamic parameter was more stable in Group S. Conclusion: We conclude that sevoflurane appears to be better anesthetic agents in terms of cost-effectiveness and recovery profile. [ABSTRACT FROM AUTHOR]

Background: Central venous cannulation (CVC) is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP). Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications. Aim: To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy. Setting and Design: An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center. Materials and Methods: Data was collected for all the adult patients (18-60 years) of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications. Results: The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683) × 109/L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing. Conclusion: Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality. [ABSTRACT FROM AUTHOR]

Ayurveda involves the use of drugs obtained from plants, animals, and mineral origin. All the three sources of drugs can be divided under poisonous and nonpoisonous category. There are various crude drugs, which generally possess unwanted impurities and toxic substances, which can lead to harmful health problems. Many authors have reported that not all medicinal plants are safe to use since they can bear many toxic and harmful phytoconstituents in them. Śodhana (detoxification/purification) is the process, which involves the conversion of any poisonous drug into beneficial, nonpoisonous/nontoxic ones. Vatsanābha (Aconitum species), Semecarpus anacardium, Strychnos nux-vomica, Acorus calamus, Abrus precatorius etc., are some of the interesting examples of toxic plants, which are still used in the Indian system of medicine. Aconite, bhilawanols, strychnine, β-asarone, abrin are some of the toxic components present in these plants and are relatively toxic in nature. Śodhana process involves the purification as well as reduction in the levels of toxic principles which sometimes results in an enhanced therapeutic efficacy. The present review is designed to extensively discuss and understand the scientific basis of the alternative use of toxic plants as a medicine after their purification process. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many oral squamous cell carcinomas (OSCCs) arise within regions that previously had premalignant lesion. Early diagnosis and prompt treatment of premalignant lesions offers the best hope of improving the prognosis in patients with OSCC. Exfoliative cytology is a simple and non-invasive diagnostic technique that could be used for early detection of oral premalignant and malignant lesions. This study was undertaken to evaluate the quantitative changes in nuclear area (NA), cytoplasmic area (CA) and nuclear-to-cytoplasmic ratio (NA/CA) in cytological buccal smears of oral leukoplakia with dysplasia (OLD) and OSCC patients while comparing with normal healthy mucosa. MATERIALS AND METHODS: A quantitative study was conducted over 90 subjects including 30 cases each of OLD, OSCC and clinically normal oral mucosa. The smears obtained were stained with Papanicolaou (PAP) stain and cytomorphological assessment of the keratinocytes was carried out. The statistical tools included arithmetic mean, standard deviation, Chi-square test, analysis of variance, Tukey multiple comparison. P < 0.001 was considered as significant. RESULTS: The mean NA of keratinocytes in the normal mucosa was 65.47 ± 4.77 μm(2) while for OLD it was 107.97 ± 5.44 μm(2) and 139.02 ± 8.10 μm(2) for that of OSCC. The differences show a statistically significant increment in NA (P < 0.001). There was significant reduction (P < 0.001) in the CA of keratinocytes from OSCC when compared with those from smears of OLD and normal mucosa with the values of 1535.80 ± 79.38 μm(2), 1078.51 ± 56.65 μm(2) and 769.70 ± 38.77 μm(2) respectively. The NA/CA ratio in the smears from normal oral mucosa, OLD and OSCC showed a mean value of 0.043 ± 0.004, 0.100 ± 0.008, 0.181 ± 0.015 respectively with a significant difference among the groups (P < 0.001). CONCLUSION: Evaluation of nuclear and CA of keratinocytes by cytomorphometry can serve as a useful adjunct in the diagnosis and prognosis of a dysplastic lesion which may lead to OSCC. [ABSTRACT FROM AUTHOR]

Background: In Ayurveda, Vrana (wound) has stated as tissue destruction and discoloration of viable tissue due to various etiology. In Sushruta Samhita, Sushruta described Vrana as a main subject. Most commonly Vrana can be classified into Shuddha and Dushta Vrana (chronic wound/nonhealing ulcers). Among the various drugs mentioned for Dushta Vrana, two of them, Neem (Azadirechta indica A. Juss) oil and Haridra (Curcuma longa Linn.) powder are selected for their wide spectrum action on wound. Aim: To compare the effect of Neem oil and Haridra in the treatment of chronic non-healing wounds. Materials and Methods: Total 60 patients of wounds with more than 6 weeks duration were enrolled and alternatively allocated to Group I (topical application of Neem oil), Group II (Haridra powder capsules, 1 g 3 times orally) and Group III (both drugs). Duration of treatment was considered until complete healing of the wound, whereas 4th and 8th week were considered for assessment of 50% healing. Wound size was measured and recorded at weekly intervals. Wound biopsy was repeated after 4 weeks for assessment of angiogenesis and deoxyribonucleic acid (DNA) analysis. Results: After 8 weeks of treatment, 50% wound healing was observed in 43.80% patients of Group I, 18.20% patients of Group II, and 70.00% patients of Group III. Microscopic angiogenesis grading system scores and DNA concentration showed highly significant effect of combined use of both drugs when compared before and after results of treatment (P < 0.001). Conclusion: Topical use of Neem oil and oral use of Haridra powder capsule used in combination were found effective for chronic non-healing wounds. [ABSTRACT FROM AUTHOR]

Mesenchymal Chondrosarcomas (MCs) are rare malignant connective tissue neoplasms representing approximately 1% of all chondrosarcomas (CSs) that can arise from both soft and hard tissues. They are distinct tumors arising in unicentric or multicentric locations. The tumor is most unusual as it has been described as a particularly aggressive neoplasm with a high tendency for late recurrence and delayed metastasis. It is a biphasic tumor with areas comprising of spindle cell mesenchyme having areas of chondroid differentiation. Here we report a case of 60-year-old male with mesenchymal CS of the mandible. [ABSTRACT FROM AUTHOR]

Background and Aim: Intravenous (IV) route for fentanyl administration is the gold standard for post-operative pain relief, but complications such as respiratory depression, bradycardia and hypotension have limited this route. The aim of this randomised controlled trial was to compare the efficacy of nebulised fentanyl with IV fentanyl for post-operative pain relief after lower abdominal surgery. Methods: In the post-operative care unit, at the time of first onset of pain( visual analogue scale- VAS score > 4) patients were randomised into three groups and fentanyl was administered either IV 2 μg/kg or by nebulisation of solution containing 3 or 4 μg/kg fentanyl over 8 min in 90 patients divided into three groups of 30 each. Observation were made for pain relief by visual analogue scale score 0-10. Adverse effects such as respiratory depression, bradycardia and hypotension were also recoded. Statistical analysis was performed using Medcalc software version 12, 2012. (MedCalc Software, Ostend, Belgium). Results: In the nebulisation group, it was observed that the analgesic efficacy of fentanyl was dose dependent with a delayed onset of analgesia (10 min vs. 5 min). Nebulisation with 4 μg/kg fentanyl produced analgesia at par to 2 μg/kg IV fentanyl with prolonged duration (90 min vs. 30 min) and with significantly less adverse effects. Conclusions: This study shows that nebulisation with 4 μg/kg fentanyl may be used as an alternative to IV 2 μg/kg fentanyl for adequate post-operative pain relief. [ABSTRACT FROM AUTHOR]

Aims: The study aimed to assess the diffused expression of p53 protein in patients with OSCC and its association with age at diagnosis (using 50 years as a cut point). Study Design: Ten normal oral mucosa and sixty OSCC lesions from age-distinct patient populations were immunohistochemically analyzed for the expression of p53 protein. Results: In OSCC cases, 31 out of total 60 cases (51.67%) showed positive expression for p53 protein and it was more common in older study group (56.67%) than in younger study group (46.67%) but the difference was not statistically significant. Moreover, there was also no significant difference in the p53 indices (percentage of p53 positive cells) between the two study groups (P = 0.827). Conclusion: The alteration rates were found to be slightly higher in older patients although not statistically significant. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore and identify the most potent antihyperglycemic fraction from the ethanol extract of Rhododendron arboreum (R. arboreum) flowers. Methods: Normal and streptozotocin induced diabetic rats were treated with all four fractions of R. arboreum flowers for short term and with fraction 3 for long term study. On completion of the treatment, a range of indicators were tested including fasting blood glucose, plasma protein, haemoglobin A1C, insulin secretion, body weight, blood lipid profile and carbohydrate metabolism regulating enzymes of liver. Results: In short term study, the fraction 3 (Active fraction) produced a significant (P < 0.000 1) reduction (73.6%) in blood glucose level at a dose of 200 mg/kg after the treatment in the diabetic rats. Administration of active fraction (200 and 400 mg/kg) once daily for 30 d in streptozotocin diabetic rats resulted in a significant (P < 0.001 to P < 0.000 1) fall in blood glucose level, hemoglobin A1C, serum urea and creatinine with significant but a increase in insulin level similar to standard drug glybenclamide. Further, the active fraction showed antihyperlipidemic activity as evidenced by significant (P < 0.001 to P < 0.000 1) decreases in serum serum total cholesterol, triglycerides, low density lipoprotein cholesterol and very low density cholesterol levels coupled together with elevation of high density lipoprotein cholesterol in the diabetic rats. Conclusions: The active fraction of R. arboreum flowers decreases streptozotocin induced hyperglycemia by promoting insulin secretion and glycolysis and by decreasing gluconeogenesis. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the antihyperglycemic and antihyperlipidemic properties of hydroalcoholic extract of fruits of Sapindus mukorossi Gaerten and its beneficial effect on haematological parameters with histopathological analysis in streptozotocin induced diabetic rats. Methods: Sapindus mukorossi fruits extract (250 and 500 mg/kg body weight) and standard drug glybenclamide (0.5 mg/kg body weight) were administered to diabetic rats. Effect of extract on hyperglycemia, hyperlipidemia and hematological parameters was studied in diabetic rats. Histopathological changes in diabetic rat pancreas were also observed after extract and glybenclamide treatment. Results: Daily oral administration of Sapindus mukorossi fruits extract (250 and 500 mg/kg body weight) and glybenclamide for 20 days showed beneficial effects on blood glucose level (P<0.01) and lipid level. The extract has a favorable effect on the histopathological changes of the pancreas in streptozotocin induced diabetes. Conclusion: These findings reveal that the hydroalcoholic extract of Sapindus mukorossi fruits extract possesses antihyperglycemic and antihyperlipidemic properties. In addition, the extract can prevent various complications of diabetes and improve some haematological parameters. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the hepatoprotective potential of ethanolic (50%) extract of Ziziphus oenoplia (L.) Mill (Z. oenoplia) root against isoniazid (INH) and rifampicin (RIF) induced liver damage in animal models. Methods: Five groups of six rats each were selected for the study. Ethanolic extract at a dose of 150 and 300 mg/kg as well as silymarin (100 mg/kg) were administered orally once daily for 21 d in INH + RIF treated groups. The serum levels of glutamic oxaloacetic transaminase (SGOT), glutamate pyruvate transaminase (SGPT), alkaline phosphatase (SALP), and bilirubin were estimated along with activities of superoxide dismutase, catalase, glutathione S-transferase, glutathione peroxidase, and hepatic melondialdehyde formation. Histopathological analysis was carried out to assess injury to the liver. Results: The considerably elevated serum enzymatic activities of glutamic oxaloacetic transaminase, glutamate pyruvate transaminase, alkaline phosphatase and bilirubin due to INH + RIF treatment were restored towards normal in a dose dependent manner after the treatment with ethanolic extract of Z. oenoplia roots. Meanwhile, the decreased activities of superoxide dismutase, catalase, glutathione S-transferase and glutathione peroxidase were also restored towards normal dose dependently. In addition, ethanolic extract also significantly prevented the elevation of hepatic melondialdehyde formation in the liver of INH + RIF intoxicated rats in a dose dependent manner. The biochemical observations were supplemented with histopathological examination of rat liver sections. Conclusions: The results of this study strongly indicate that ethanolic extract of Z. oenoplia has a potent hepatoprotective action against INH + RIF induced hepatic damage in rats. [Copyright &y& Elsevier]

US Food and Drug Administration has recently approved transoral robotic surgery for the treatment of some benign tumors and selected malignant tumors of the head and neck. Robotically-assistance in ear, nose and throat surgery is established and will play an increasingly large role in the future of surgical practice. Anesthesiologists need to modify their management and familiarize themselves with the upcoming robotic procedures to ensure better patient outcomes and improve patient safety [ABSTRACT FROM AUTHOR]

Pyogenic granuloma is an overzealously proliferative non-neoplastic lesion of connective tissue origin, found commonly in oral cavity and is secondary to chronic low grade local irritation, poor oral hygiene, and hormonal disturbances. The term is misnomer because a lesion is unrelated to infection. It is characterized by excessive and exuberant tissue repair response with varied inflammatory component. Since it is a benign lesion, choice of treatment is surgical excision with removal of underlying cause if any. This article aims at presenting a case of pyogenic granuloma in an extremely old patient which is unusual as it attained a very large size and also has caused mild resorption of underlying alveolar bone of mandible [ABSTRACT FROM AUTHOR]

Objective: To investigate standardized ethyl acetate fraction of Rhododendron arboreum (EFRA) flowers for antidiarrheal activity in experimental animals. Materials and Methods: A simple sensitive high performance thin layer chromatography (HPTLC) method was used for the determination of hyperin in EFRA. The standardized fraction was investigated for castor oil, magnesium sulfate-induced diarrhea, measurement of gastrointestinal transit using charcoal and castor oil-induced enteropooling. Results: The concentration of hyperin in flowers of R. arboreum was found to be 0.148% by HPTLC. Oral administration of EFRA at 100, 200 and 400 mg/kg exhibited dose-dependent and significant (P<0.05-0.001) antidiarrheal potential in castor oil and magnesium sulfate-induced diarrhea. EFRA at doses of 100, 200 and 400 mg/kg also produced significant (P<0.05-0.001) dose-dependent reduction in propulsive movement in castor oil-induced gastrointestinal transit using charcoal meal in rats. EFRA was found to possess an antienteropooling in castor oil-induced experimental animals by reducing both weight and volume of intestinal content significantly. Conclusion: These findings demonstrate that standardized ethyl acetate fraction of R. arboreum flowers has potent antidiarrheal activity thus justifying its traditional use in diarrhea and have great potential as a source for natural health products. [ABSTRACT FROM AUTHOR]

BACKGROUND: The protease-antiprotease hypothesis proposes that inflammatory cells and oxidative stress in chronic obstructive pulmonary disease (COPD) produce increased levels of proteolytic enzymes (neutrophil elastase, matrix metalloproteinases [MMP]) which contribute to destruction of parenchyma resulting in progressive decline in forced expiratory volume in one second. Doxycycline, a tetracycline analogue, possesses antiinflammatory properties and inhibits MMP enzymes. OBJECTIVES: To assess the effect of 4 weeks doxycycline in a dose of 100 mg once a day in patients of moderate to severe COPD with stable symptoms. METHODS: In an interventional, randomized, observer-masked, parallel study design, the effect of doxycycline (100 mg once a day for 4 weeks) was assessed in patients of COPD having stable symptoms after a run-in period of 4 weeks. The study participants in reference group did not receive doxycycline. The parameters were pulmonary functions, systemic inflammation marker C-reactive protein (CRP), and medical research council (MRC) dyspnea scale. Use of systemic corticosteroids or antimicrobial agents was not allowed during the study period. RESULTS: A total of 61 patients completed the study (31 patients in doxycycline group and 30 patients in reference group). At 4 weeks, the pulmonary functions significantly improved in doxycycline group and the mean reduction in baseline serum CRP was significantly greater in doxycycline group as compared with reference group. There was no significant improvement in MRC dyspnea scale in both groups at 4 weeks. CONCLUSION: The anti-inflammatory and MMP-inhibiting property of doxycycline might have contributed to the improvement of parameters in this study. [ABSTRACT FROM AUTHOR]

The term unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical, radiographic, or gross features of a jaw cyst, but on histologic examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. Although the histology suggests that cystic ameloblastomas follow a biologically low-grade course, recent evidence suggests that they may often behave clinically as aggressive tumors. This is supported by the high incidence of cortical perforation, tooth resorption, increase in lesion size, bony destruction, and a high rate of recurrence after simple enucleation. Here, the authors present a case report on unicystic variant of ameloblastoma in the maxilla. An attempt has been made to emphasize that it can involve the maxillary jaw, which is rarely affected and could be more aggressive than previously thought. A literature review on the topic has been added along with the case report. It is important to remember that a proper and timely diagnosis of the character and extent of a UA (with a thorough histopathologic examination of the entire specimen) can help in the overall long-term wellbeing of the patient. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the hepatoprotective potential of ethyl acetate fraction of Rhododendron arboreum (Family: Ericaceae) in Wistar rats against carbon tetrachloride (CCl4)-induced liver damage in preventive and curative models. Materials and Methods: Fraction at a dose of 100, 200, and 400 mg/kgwas administered orally once daily for 14 days in CCl4-treated groups (II, III, IV, V and VI). The serum levels of glutamic oxaloacetic transaminase (SGOT), glutamate pyruvate transaminase (SGPT), alkaline phosphatase (SALP), –glutamyltransferase ( -GT), and bilirubin were estimated along with activities of glutathione S-transferase (GST), glutathione reductase, hepaticmalondialdehyde formation, and glutathione content. Result and Discussion: The substantially elevated serum enzymatic activities of SGOT, SGPT, SALP, -GT, and bilirubin due to CCl4 treatment were restored toward normal in a dose-dependent manner. Meanwhile, the decreased activities of GST and glutathione reductase were also restored towardnormal. In addition, ethyl acetate fraction also significantly prevented the elevation of hepatic malondialdehyde formation and depletion of reducedglutathione content in the liver of CCl4-intoxicated rats in a dose-dependent manner. Silymarin used as standard reference also exhibited significant hepatoprotective activity on post-treatment against CCl4-induced hepatotoxicity in rats. The biochemicalobservations were supplemented with histopathological examination of rat liver sections. The results of this study strongly indicate that ethyl acetate fraction has a potent hepatoprotective action against CCl4-induced hepatic damage in rats. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculosis, which is transmitted by aerosolized saliva droplets among individuals in close contact with expelled sputum of a diseased patient. However, TB lesions of the oral cavity are often overlooked in the differential diagnosis. We report here a case of tuberculosis of oral cavity affecting the gingiva of a 24-year-old male. [ABSTRACT FROM AUTHOR]

A case of spontaneous subarachnoid pleural fistula following rupture of a thoracic meningocele into the pleural cavity is described in this article. The patient had symptoms of low-pressure headache and difficulty in breathing. The fistulous opening was closed near the foramina by rotating a vascularized muscle flap. After showing initial improvement the patient had a recurrence of symptoms after 6 weeks, with a small leak at the closure site. A lumbar thecoperitoneal shunt led to permanent cure. In this article we discuss the course of the disease, the symptoms, the diagnostic methods, and the various treatment modalities for subarachnoid pleural fistula. [ABSTRACT FROM AUTHOR]

The article discusses a survey of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS) to determine practice patterns among vitreoretinal (VR) surgeons. Topics discussed include development of vitreoretinal (VR) complications and posterior vitreous detachment after laser-assisted in situ keratomileusis (LASIK), results showing correction of myopia as an indication for LASIK, and lack of evidence to determine whether retinal lesions in myopic patients about to have LASIK.

Introduction: Glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin described in 1987 by Gardner et al., It is a cyst having an unpredictable and potentially aggressive behavior. It also has the propensity to grow to a large size and tendency to recur. This increased recurrence rate can be due to its intrinsic biological behavior, multilocularity of the cyst and incomplete removal of the lining following conservative treatment. Case Report: Here, we report a case of GOC in a 70-years-old female, with a painful swelling measuring about 2.3 x 1.3 x 1.0 cm on the left anterior region of the upper jaw (21-27), since 6 months. A well-defined unilocular radiolucency was observed in OPG. Summary: Glandular odontogenic cyst is a rare entity, generally observed in anterior mandibular region having male predominance and is asymptomatic. Here, we present a case of symptomatic GOC in a 70-year-old female, located in the anterior maxillary region. [ABSTRACT FROM AUTHOR]

Plants are used as medicine since ancient time, in organized (Ayurveda, Unani & Siddha) and unorganized (folk, native & tribal) form. In these systems, drugs are described either in Sanskrit or vernacular languages. Avartani ( Helicteres isora Linn.) is a medicinal plant which is used in several diseases. It is commonly known as Marodphali, Marorphali, Enthani etc. due to screw like appearance of its fruit. Avartani is used as a folk medicine to treat snake bite, diarrhoea and constipation of new born baby. In the research, antioxidant, hypolipidaemic, antibacterial and antiplasmid activities, cardiac antioxidant, antiperoxidative potency, brain-antioxidation potency, anticancer activity, antinociceptive activity, hepatoprotective activity, anti-diarrheal activity and wormicidal activity in this plant were reviewed. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Nebulised fentanyl for post-operative pain relief, a prospective double-blind controlled randomised clinical trial" that was published in a 2013 issue is presented.