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A 37-year-old man presented to the ENT outpatient clinic with progressive dysphagia and breathlessness on exertion for a year. The patient was tachypnoeic, with mild inspiratory stridor and orthopnoea. The neck had a generalised swelling, but no mass was clinically palpable. Indirect laryngoscopy

Environmental and individual risk factors make leishmaniasis an important public health problem. Presently, there are several medicines existing for the cure of leishmaniasis, but a major problem associated with them is their adverse effects. The affinity to the fucose receptor increases the phagocytosis of ligand-bound carriers and simultaneously targets the delivery of the antileishmanial agent. Paromomycin sulphate-bearing nanostructured lipid carriers (NLCs) were formulated by a double emulsion solvent evaporation technique, and then chemistry of ring opening trailed by the reaction of fucose's aldehyde groups was analyzed for conjugation. The NLCs and conjugated-NLCs were examined in terms of average size, entrapment efficiency of drugs, polydispersity index, zeta potential, and in vitro drug release. Hemolytic toxicity was measured on whole human blood, and percent hemolysis by drug-loaded fucosylated-NLCs is reduced from 21.09 ± 1.5% to 5.81 ± 0.9 compared to the plain drug. Macrophage uptake of fluorescein isothiocyanate (FITC)-loaded plain NLCs and fucosylated-NLCs showed that mean FITC measured intensity increases in macrophage cell lines. MTT cytotoxicity assay ensured that NLCs could be beneficial as a biocompatible drug carrier for biomedical and pharmaceutical use. BALB/c mice were used for in vivo studies. Qualitative uptake of fucosylated-NLCs was observed by fluorescence microscopy, and the access of fucosylated-NLCs to the liver was revealed. Similar results were obtained by biodistribution studies. Therefore, fucose-conjugated nanoparticulate carriers can be designed to target macrophages with antileishmanial agents against the Leishmania parasite.

Gmelina arborea is a fast-growing tree, which grows on different localities and prefers moist fertile valleys with 750–4500 mm rainfall. It does not thrive on ill-drained soils and remains stunted on dry, sandy or poor soils; drought also reduces it to a shrubby form. The tree attains moderate to large heights of up to 30 m, with a girth of 1.2 to 4 m. It has a chlorophyll layer just under the outer bark, which is pale yellow on the outside and white inside.Gmelina arborea wood is pale yellow to cream-coloured or pinkish-buff when fresh, turning yellowish brown on exposure and is soft to moderately hard, light to moderately heavy, lustrous when fresh, usually straight to irregular or rarely wavy grained and medium course textured. Flowering takes place during February to April when the tree is more or less leafless whereas fruiting starts from May onwards up to June. The fruit is up to 2.5 cm long, smooth, dark green, turning yellow when ripe and has a fruity smell. The fruit is edible and has a bitter-sweet taste.4 This tree is commonly planted as a garden and an avenue tree; growing in villages along agricultural land and on village community lands and wastelands. It is light demander, tolerant of excessive drought, but moderately frost hardy. It has good capacity to recover from frost injury. Gamhar trees coppices very well with vigorous growth. Saplings and young plants need protection from deer and cattle. Gmelina arborea grows naturally throughout India, Myanmar, Thailand, Laos, Cambodia, Vietnam and in southern provinces of China

Aegle marmelos (Bilva) is being used in Ayurveda for the treatment of several inflammatory disorders. The plant is a member of a fixed dose combination of Dashamoola in Ayurveda. However, the usage of roots/root bark or stems is associated with sustainability concerns. Bael (Aegle marmelos (L.) Corr.) is an important medicinal plant of India. Leaves, fruits, stem and roots of A. marmelos have been used in ethno medicine to exploit its' medicinal properties including astringent, antidiarrheal antidysenteric, demulcent, antipyretic and anti-inflammatory activities. Compounds purified from bael have been proven to be biologically active against several major diseases including cancer, diabetes and cardiovascular diseases. Preclinical studies indicate the therapeutic potential of crude extracts of A. marmelos in the treatment of many microbial diseases, diabetes and gastric ulcer. This review covers the biological activities of some isolated chemical constituents of A. marmelos and preclinical studies on some crude extracts and pure compounds to explore novel bioactive compounds for therapeutic application. Aegle marmelos (L.) is a seasonal fruit that contains significant amounts of bioactives like, phenolic acids (gallic acids, 2,3-dihydroxy benzoic acid, chlorogenic acid, p-coumaric acid, vanillic acid), flavonoid (rutin), organic acids (oxalic acid, tartaric acid, malic acid, lactic acid, acetic acid, citric acid, propionic acid, succinic acid, fumaric acid), vitamin C, vitamin B group (thiamine, niacin, pyridoxine, pantothenic acid, biotin, cobalamins, riboflavin), tocopherols (α-tocopherol, β-tocopherol, γ-tocopherol, δ-tocopherol), carotenes (α-carotene, β-carotene, γ-carotene, δ-carotene) and also rich in essential minerals (potassium, calcium, phosphorus, sodium, iron, copper, manganese). Hence the use of aegle plays important role as anti-inflammatory.

ObjectivePrevious studies suggest a link between high serum type I interferon (IFN) and lupus nephritis (LN). We determined whether serum IFN activity is associated with subtypes of LN and studied renal tissues and cells to understand the effect of IFN in LN.MethodsTwo hundred and twenty-one patients with systemic lupus erythematosus were studied. Serum IFN activity was measured by WISH bioassay. mRNA in situ hybridization was used in renal tissue to measure expression of the representative IFN-induced gene, IFN-induced protein with tetratricopeptide repeats-1 (IFIT1), and the plasmacytoid dendritic cell (pDC) marker gene C-type lectin domain family-4 member C (CLEC4C). Podocyte cell line gene expression was measured by real-time PCR.ResultsClass III/IV LN prevalence was significantly increased in patients with high serum IFN compared with those with low IFN (odds ratio 5.40, P = 0.009). In multivariate regression models, type I IFN was a stronger predictor of class III/IV LN than complement C3 or anti-dsDNA antibody, and could account for the association of these variables with LN. IFIT1 expression was increased in all classes of LN, but most in the glomerular areas of active class III/IV LN kidneys. IFIT1 expression was not closely colocalized with pDCs. IFN directly activated podocyte cell lines to induce chemokines and proapoptotic molecules.ConclusionSystemic high IFN is involved in the pathogenesis of severe LN. We did not find colocalization of pDCs with IFN signature in renal tissue, and instead observed the greatest intensity of the IFN signature in glomerular areas, which could suggest a blood source of IFN.

Introduction: Needlestick injuries (NSIs) as defined by accidentally puncture the skin by needles. The occupational exposures to NSIs are considered to be much higher in the developing world and multiple risk factors eg. improper use of protective equipment (like failure to use suitable-sized gloves), working in surgical or intensive care units, insufficient work experience, young age, needle recapping, unsuitable needle disposal, intravenous cannulation may contribute to NSIs. Aim: To determine the occurrence/ prevalence of needle stick and sharp injuries (NSIs) among healthcare workers working in a tertiary care hospital and the factors responsible for NSIs. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital among HCws in the hospital over a period of one year Jan 2020-December 2020. Results: Nursing staffs are most frequently reported NSI. Among the groups, most common cause of NSIs was found to be recapping of needle followed by cleaning, HGT and procedure. The most common cause of NSI among housekeeping staffs found to be needle lying on the floor and accidental mixing of sharp biomedical waste with other waste. The HCWs from critical care unit eg. ICUs are the most commonly reported NSIs Conclusions: HCWs are always at high risk of attaining NSIs. The nursing staffs followed are the most vulnerable group who gets the sharp/NSI and require extra attention. As a preventive measures regular training and education of nursing staffs and all other categories of health care workers to be ensured in healthcare settings. Keywords: Needle stick injury, Recapping, Healthcare worker, Risk factors

Introduction: Screening for coronavirus disease 2019 (COVID-19) exposure, coupled with engaged decision making to prioritize cancer treatment in parallel with reducing risk of exposure and infection, is crucial in the management of COVID-19 during cancer treatment. After two reported case studies of imaging findings during daily computed tomography (CT)-based image-guided radio-therapy (RT) scans, a call for submission of anonymized case reports was published with the objective of rapidly determining if there was a correlation between the onset of new pulmonary infiltrates found during RT and COVID-19. We hereby report the results of the aggregate analysis. Methods: Data of deidentified case reports for patients who developed biochemically confirmed COVID-19 during RT were submitted through an online portal. Information requested included a patient's sex, age, cancer diagnosis and treatment, and COVID-19 diagnosis and outcome. Coplanar CT-based imaging was requested to reveal the presence or absence of ground-glass opacities or infiltrates. Results: A total of seven reports were submitted from Turkey, Spain, Belgium, Egypt, and the United States. Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included for a total of nine patients for analysis. All patients were confirmed COVID-19 positive using polymerase chain reaction-based methods or nasopharyngeal swabs. Of the nine patients analyzed, abnormalities consistent with ground-glass opacities or in- filtrates were observed in eight patients. Conclusions: This is the largest case series revealing the potential use of CT-based image guidance during RT as a tool for identifying patients who need further workup for COVID-19. Considerations for reviewing image guidance for new pulmonary infiltrates and immediate COVID-19 testing in patients who develop new infiltrates even without COVID-19 symptoms are strongly encouraged. (c) 2021 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Dermatophytes are keratinophilic fungi responsible for dermatophytoses which are superficial mycoses affecting skin, hair and nails. The aim of the study was to isolate dermatophytes from clinically suspected cases of superficial fungal infections. This study was carried out at the Department of Microbiology, Grant Government Medical College & Sir J.J Group of Hospitals, Mumbai. A total of 279 clinically suspected cases of superficial fungal infections were included in the present study. The specimens like skin scraping, nail and hair were collected with all aseptic precautions and were first examined under microscope on KOH mount and then inoculated on to duplicate slopes of Sabouraud dextrose agar (plain) and SDA (Chloramphenicol and Cycloheximide). Lactophenol cotton blue preparations were made of each fungal growth and were identified using specific tests like slide culture, hair perforation and urease test. Out of the 279 clinically suspected cases of superficial mycoses, maximum involved the skin (65.23%) and a total of 216 (77.42%) cases were of clinically suspected dermatophytoses. KOH mount examination alone could detect 144 (66.66%) cases out of the 216 clinically suspected cases of dermatophytoses. A total 162 isolates were confirmed in which maximum dermatophytes 122 (75.30%) were found. Amongst the dermatophytes, T. rubrum was the commonest pathogenic species isolated followed by T. mentagrophytes. Other species isolated were T. tonsurans, M. gypseum, E. floccosum, T. verrucosum and M. audouinii, T. rubrum and T. mentagrophytes were mainly isolated from Tinea unguium followed by Tinea corporis cases. M. gypseum was isolated only from Tinea capitis cases whereas M. audouinii was isolated only from Tinea unguium cases. Dermatophytoses are the most common types of superficial cutaneous fungal infections. The incidence of Dermatophytoses is increasing in India due to widespread and indiscriminate use of corticosteroids and antifungal agents without performing appropriate microbiological investigations.

Traditionally, plantar warts or verrucae are often diagnosed by visual appearance and the lateral squeeze test. At times, these methods are not able to elucidate the difference between a plantar wart and a callus. The use of the dermatoscope can not only distinguish the difference between a wart and a callus, which ultimately helps to customize treatment plans to increase efficacy, but also be used to follow the therapeutic effects of treatment. The dermatoscope is a tool that can be used in the diagnosis of plantar verrucae and in assessment of the success of therapy.

Background Polyetheretherketone (PEEK) is a new material that was introduced for the fabrication of implants and their superstructure along with other available materials. It is not yet known whether the carbon fiber-reinforced polyetheretherketone (CFR‑PEEK) material can be used as an implant and its superstructure in place of titanium (Ti). Objectives The study evaluated stress distribution around CFR‑PEEK implants and Ti implants with 5 different prosthetic crowns. Material and methods A three-dimensional (3D) model of a bone block was created to represent the right maxillary premolar area with a bone-level implant system with 100% osseointegration, using the Ansys Workbench software, v. 15.0. In total, 10 3D finite element analysis (FEA) models were created. The models were divided into 2 groups according to the type of implant: the CFR‑PEEK group (n = 5); and the Ti group (n = 5). Each group was subdivided to imitate 5 different restorative crown materials (PEEK, zirconia, porcelain fused to metal (PFM), metal, and acrylic resin). Each implant model was loaded vertically (200 N) and obliquely (100 N). Stress distribution in the implants, the abutments, the cement layers, and the crowns was evaluated using the von Mises stress analysis. Maximum and minimum principal stress analyses were used to determine the stress generated in the bone. Results The CFR‑PEEK implants bore more stress in vertical and oblique loading as compared to the Ti implants. The stress generated in the bone with the CFR‑PEEK implants was similar to that generated with the Ti implants under vertical loading. Under oblique loading, less stress was transferred to the bone with the CFR‑PEEK implants as compared to the Ti implants, showing better adaptation of the CFR‑PEEK implants to lateral stress. Conclusions In this FEA study, the amount of stress generated within the bone in the case of the CFR‑PEEK implants with different restorative crowns was smaller in comparison with the Ti implants in oblique loading. This could help reduce lateral stress on implants as well as crestal bone loss.

We report a case of a 40-year-old male patient who developed a fever one week after recovering from severe COVID-19 illness that had needed treatment with injectable corticosteroids and Tocilizumab. The patient had had maculopapular lesions on his trunk months before contracting COVID-19, but the skin lesions progressed along with the post-covid fever. Detailed workup and biopsy from skin lesions on the face, trunk, and bone marrow revealed Histoplasmosis. This case highlights the possibility of flaring up of Histoplasmosis in COVID-19 patients who have been treated with immunosuppressants. In our case, the plausible reason for reactivation and growth of Histoplasma may be the suppression of IL6 action by Tocilizumab.It may be prudent to screen patients for Histoplasma and other fungal infections like aspergillus before administering an immune-suppressive regimen in patients with a moderate or severe COVID-19 illness. Urinary Histoplasma antigen may be used for screening in these patients. J Microbiol Infect Dis 2021; 11(3):170-173.

Aim and objective The purpose of this systematic review is to analyze the suitability of the zirconia crowns for restoration of damaged primary teeth in children. Background This systematic review has been conducted in line with the preferred reporting items for systematic reviews (which is also called as PRISMA) guidelines. A search for the relevant articles of zirconia crowns in deciduous teeth has been made in electronic database of PubMed and a study design (meta-analysis), i.e., PICOS framework. The words used in the search are "zirconia crowns" and "primary molars," "zirconia crowns" and "primary incisors," "zirconia crowns" and "children," "zirconia crowns" and "primary teeth." Review results The database search showed 44 studies of which 20 articles were excluded as they were irrelevant, duplicates, and data were not available. In the present systematic review, the remaining 24 articles were included. Conclusion Zirconia crowns have been proved with better results than other crowns in terms of gingival and periodontal health, esthetics, and crown fractures. However, the quantity of tooth preparation and the wear of antagonist tooth are reported to be more in case of zirconia crowns. Future randomized control studies should be carried out in primary teeth due to less number of randomized studies on this topic. Clinical significance Zirconia crowns are now widely used in dentistry and there is an increase in the number of studies, so a systematic review evaluating and comparing results is warranted. How to cite this article Ajayakumar LP, Chowdhary N, Reddy VR, et al. Use of Restorative Full Crowns Made with Zirconia in Children: A Systematic Review. Int J Clin Pediatr Dent 2020;13(5):551-558.

Hospitalization of COVID- 19 patients may lead to the development of varied levels of anxiety, depression, and sleep disturbances. The present study was conceptualized to investigate the effect of guided meditation on anxiety, depression, and sleep quality among the hospitalized Covid-19 patients in a tertiary care facility. Materials and Methods: A total of 60 COVID-19 patients were conveniently enrolled and randomized to experimental (30) and control arms (30) using a computer-generated random table and opaque sealed envelope technique in a selected COVID unit of a tertiary care facility. The subjects were enrolled in accordance to the inclusion criteria. Intervention: The guided meditation was an audio recording of Sri Sri Ravi Shankar of 20 minutes duration. The intervention was provided twice a day to the experimental group for consecutive 5 days. A close watch was kept on the vital signs of the subjects during the intervention using a pulse oximeter. At the same time, the control group continued to receive the standard routine care. Results: There was a significant difference observed in the post-test anxiety and depression scores in the experiment and control groups (4.83±3.68 vs. 12.37±3.9 p=0.001 and 7.90±2.41 vs.12.67±2.65 p=0.001). A significant difference was also observed in the global sleep quality index (median (IQR)) in the experimental and control groups (11(9-14) vs. 15(10.75-17) p= 0.01). Conclusion: The guided meditation was effective in improving the global sleep quality index and alleviating the anxiety and depression to great extent as compared to the standard routine care provided to COVID-19 patients admitted in a tertiary care facility.

BACKGROUND Superovulation with intrauterine insemination (IUI) increases the probability of pregnancy by increasing number of oocytes and sperm density. The main oral agents used for superovulation are clomiphene citrate and letrozole. Clomiphene citrate a selective estrogen receptor modulator with predominant antiestrogenic action has adverse effects on endometrium and cervical mucous. Letrozole an aromatase inhibitor acts by reducing estrogen production by blocking androgen conversion to estrogen in ovary and peripheral tissues without affecting endometrium and cervical mucous. We wanted to compare the efficacy of letrozole v/s clomiphene citrate as first line ovulation induction drug in infertile patients undergoing IUI. METHODS Based on the inclusion and exclusion criteria, we included 160 patients in our study. They were divided into two groups of 80 each based on the drug given for ovulation induction. The drug was given for 5 days from D3 to D7 of menstrual cycle. IUI was done 38 - 40 hours after trigger and after confirmation of ovulation by sonography. RESULTS The mean age, body mass index (BMI), duration of infertility, type and cause of infertility in both groups were similar. Ovulation rate was 85 % in letrozole group and 71.25 % in clomiphene citrate group, which was statistically significant (P0.035). There was no statistically significant difference between endometrial thickness and total days till ovulation between two groups. Monofolliculogenesis and clinical pregnancy rate were statistically significantly higher in letrozole group. CONCLUSIONS Our study shows that letrozole has better pregnancy rate in comparison to clomiphene citrate (C. C.) in IUI cycles with less risk of anovulation, thin endometrium and multi follicular growth. KEY WORDS Clomiphene Citrate (C.C.), Letrozole (LTZ), Ovulation Induction (OI), Intrauterine Insemination (IUI)

The purpose of this review is to provide up-to-date literature on post-traumatic headache (PTH) and define a clear nomenclature for variable clinical presentations. This review discusses an evidence-based approach to the prognostication and treatment of PTH, which are further described in two clinical cases. As significant morbidity is associated with PTH, recent literature has focused on improved identification. Accurate diagnosis has led to targeted treatment that incorporates a multi-modal approach including pharmacological and nonpharmacological interventions. A detailed history and physical exam are key in recognizing the presenting phenotype of this secondary headache, which may be migrainous, tension-type, trigeminal autonomic cephalalgia, cervicogenic, or another PTH classification. Clinicians should clearly define the headache phenotype to provide effective management with a multi-modal approach targeting the namesake primary headache. This is crucial for successful recovery. Further research is needed to establish best practice guidelines for prognosis, as presentation, treatment and outcomes continue to vary.

Background Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized. Objective We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care. Methods Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001–2010, vs post-ACA, 2011–2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system. Results Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, P < .001) and specialty care (+1.49%/year to +2.07%/year, P = .005). Specialty care growth outpaced primary care pre-ACA (P < .001) but not post-ACA (P = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, P < .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, P = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, P = .011). Specialty care income growth outpaced primary care pre-ACA (P < .001), but not post-ACA (P = .22). Conclusions We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.

Spontaneous spinal epidural hematoma is a rare predominantly idiopathic entity which can prompt acute neurologic symptoms and if not managed in time can lead to devastating outcomes. High index of suspicion is required for early diagnosis on MRI for a prompt management of patients showing sudden neurologic deficits. Our patient was 42-year-old female who presented with sudden onset of numbness followed by weakness in both lower limbs and urinary retention without any comorbidity or any medication. MRI whole spine done within 14 hours of symptom onset showed ventral epidural hematoma without any vascular malformation. Immediate decompressive laminectomy with evacuation of hematoma improved power in both lower limbs with regaining bowel and bladder function. The key here is timely surgical decompression of the hematoma for a favorable neurosurgical outcome. Although there is a recent development towards non–surgical treatment, it needs to be well established yet and require such approach on case-to-case basis.

Background and Purpose: Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population. Methods: This prospective observational study included patients with ischemic stroke or transient ischemic attack, a baseline National Institutes of Health Stroke Scale (NIHSS) score 0 to 5, presenting within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale score of 0 to 1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16, and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase. Results: A total of 1765 participants were included from 100 Get With The Guidelines-Stroke participating hospitals (age, 65±14; 42% women; final diagnosis of ischemic stroke, 90%; transient ischemic attack, 10%; 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid recipients, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, and extremity weakness. Similar outcomes were noted for the alteplase-treated and untreated groups. Alteplase-treated patients were younger (64±13 versus 67±1.4) with higher NIHSS (2.9±1.4 versus 1.7±1.4). After adjusting for age, sex, race/ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an association with Stroke Impact Scale-16 in the restricted sample of baseline NIHSS score 3–5. Few symptomatic intracerebral hemorrhages were recorded ( Conclusions: A large proportion of stroke patients presenting with low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort, but a suggestion of efficacy was noted in the NIHSS 3–5 subgroup. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02072681.

Vikas Patel,1 Don Kovalsky,2 S Craig Meyer,3 Abhineet Chowdhary,4 Julie LaCombe,4 Harry Lockstadt,5 Fernando Techy,6 Casey Langel,7 Robert Limoni,8 Philip Yuan,9 Andy Kranenburg,10 Daniel Cher,11 Gabriel Tender12 1Department of Orthopedics, University of Colorado, Aurora, CO, USA; 2Orthopaedic Center of Southern Illinois, Mt. Vernon, IL, USA; 3Columbia Orthopaedic Medical Group, Columbia, MO, USA; 4Overlake Medical Center, Bellevue, WA, USA; 5Bluegrass Orthopaedics, Lexington, KY, USA; 6ClinTech Center for Spine Health, Johnstown, CO, USA; 7The B.A.C.K. Center, Melbourne, FL, USA; 8BayCare Clinic Orthopedics & Sports Medicine, Green Bay, WI, USA; 9Memorial Orthopaedic Surgical Group, Long Beach, CA, USA; 10South Oregon Orthopedics, Medford, OR, USA; 11SI-BONE, Inc, Santa Clara, CA, USA; 12Department of Neurosurgery, Louisiana State University, New Orleans, LA, USACorrespondence: Vikas Patel Tel +1 303 724-8936Email Vikas.Patel@CUAnschutz.eduBackground: Strong evidence supports minimally invasive sacroiliac joint (SIJ) fusion using triangular titanium implants (TTI) for chronic SIJ dysfunction.Objective: To report safety and effectiveness of SIJF using a 3D-printed TTI at 24 months.Methods: SIJF with TTI was performed in 51 subjects. Structured follow-up occurred at 3, 6, 12 and 24 months. Both quality of life questionnaires and functional tests were performed at all study visits.Results: 84% of subjects were available for 24-month follow-up. Observed were rapid and persistent improvements in dysfunction due to pain (Oswestry Disability Index [ODI], mean 52.8 at baseline and 28.3 at 24 months, p< 0.0001) and SIJ pain ratings (mean 78.5 at baseline [0– 100 scale] to 21.5 at 24 months). Opioid use for SIJ pain decreased markedly from baseline. Physical function tests impaired by SIJ pain showed persistent improvements compared to baseline. There was no evidence of device breakage, migration or subsidence and few late adverse events occurred attributable to the device.Conclusion: In this prospective study, SIJF using 3D-printed TTI resulted in immediate, marked and persistent improvements in pain and quality of life, with improved physical function, reduced opioid use and a low rate of late device-related adverse events.Level of Evidence: Level II.Keywords: sacroiliac joint pain, sacroiliac joint arthrodesis, chronic low back pain, triangular titanium implants

Context Dyslipidemia is a multifactorial disease in which lipoproteins play an important role as one of the early markers for coronary heart disease (CHD). Mixed dyslipidemia is common in people with diabetes mellitus, but nondiabetic dyslipidemics (NDD) remain unidentified for the risk of developing dyslipidemia and eventually CHD. Objectives This pilot study attempts to analyze the genetic basis of lipid metabolism alterations, emphasizing the association between fatty acid-binding protein-2 (FABP2-Ala54Thr) and apolipoprotein-C3 (APOC3-rs5128) genetic polymorphism, as a risk for developing dyslipidemia and CHD in NDD. Methods and Design Total 90 subjects—30 DD, 30 NDD, and 30 apparently healthy subjects representing Central India—were included. Biochemical analysis and DNA genotyping were done by polymerase chain reaction restriction fragment length polymorphism. Statistical Analysis The biochemical parameters were reported as means ± standard deviation. One-way analysis of variance test was used to compare biochemical parameters of three groups. Chi-squared test was done to compare genotype distributions. The strength of association was assessed by odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analysis was done using SPSS-PC software and Graph Pad. Results In NDD, maximum polymorphism was observed followed by DD and least polymorphism was observed in controls. There was a significant association of APOC3 G allele with occurrence of hypertriglyceridemia (p 0.05). Logistic regression analysis revealed APOC3 polymorphism to be significantly associated with dyslipidemia (OR = 2.6667, 95% CI = 1.0510–6.7663, p = 0.0341); no such association was found for FABP2 polymorphism (OR = 0.4643, 95% CI = 0.1641–1.3136, p = 0.1347). The triglyceride and cholesterol values in individuals with homozygous genotype indicate that genetic study is comparable to the biochemical findings in carriers of polymorphic allele than noncarriers, especially in NDD patients. Conclusions Pilot study indicates that the presence of APOC3 gene polymorphism is associated with pro-atherogenic dyslipidemia in nondiabetic patients and may raise risk of CHD. This information could be used for preventive strategies in NDD group that may otherwise go unnoticed.

The study explored people’s life experiences, mental health, and well-being during the lockdown phase of the coronavirus pandemic. It discusses people’s inclination and motivation for travel post-C...

Background: Malaria is caused by parasites of genus Plasmodium. It remains a major public health concern around the world. Though various diagnostic tools are available, there is an urgent need to use a more sensitive diagnostic method for early diagnosis to prevent unwanted outcomes. Objectives: (i) To assess the prevalence of malaria in a tertiary care hospital in Mumbai (ii) To detect and speciate Plasmodium by Peripheral Blood Smear (PBS), Rapid Diagnostic Test (RDT) and real-time Polymerase Chain Reaction (PCR) and to compare their performance characteristics. Methodology: A hospital-based diagnostic study was carried over a period of 18 months. A total of 550 non-duplicated blood samples from clinically suspected cases of malaria were collected and subjected to three tests- PBS by Field’s staining, RDT and PCR to detect Plasmodium species. The agreement and the differences between the three tests were analyzed and the statistical significance was assessed using Chi-square test. Results: Out of the 550 samples, 166 (30.2%) were positive for malaria by either of the three tests, of which 92 (55.42%), 119 (71.69%) and 161 (96.99%) samples were positive by PBS, RDT and PCR, respectively. P. vivax was the predominant Plasmodium species. The most significant finding was PCR detected mixed infections in 8.43% of cases whereas PBS and RDT could detect 0% and 1.20% of mixed infection, respectively. Considering PBS as gold standard, sensitivity of RDT and PCR was 100% and 97.83% and specificity was 94.10% and 84.50% respectively. Conclusions: In this study, 30% of the population was infected with malaria with P. vivax being the predominant Plasmodium species. PCR helped identify more mono and mixed infections than conventional methods and would be a helpful adjunct for malaria diagnosis in tertiary care setup.

Background Treatment-resistant dermatophytosis caused by Trichophyton mentagrophytes/interdigitale complex has emerged as a global public health threat, particularly in endemic countries like India and has spread to many other countries. This veritable spread is alarming due to increase in resistance to terbinafine, which targets the ergosterol biosynthetic pathway by inhibiting the enzyme squalene epoxidase (SQLE). About two third of studies worldwide have reported amino acid substitutions Phe397Leu and Leu393Phe in the SQLE protein to be responsible for high terbinafine MICs. Objectives We evaluated the efficacy of the newly developed DermaGenius® Resistance real-time PCR assay to rapidly identify Trichophyton isolates harbouring most common SQLE mutant (Phe397Leu and Leu393Phe) conferring high terbinafine resistance from wild-type susceptible isolates. Methods A total of 97 Trichophyton isolates confirmed by ITS sequencing as T. mentagrophytes/interdigitale (recently named T. indotineae n = 90), T. rubrum/T. soudanense (n = 3), T mentagrophytes (n = 2) and T tonsurans (n = 2) were analysed to evaluate DermaGenius® Resistance real-time PCR assay. All 40 T. indotineae isolates exhibiting amino acid substitutions Phe397Leu or Leu393Phe identified by SQLE gene sequencing were evaluated for detection of non-wild-type strains by real-time PCR. Antifungal susceptibility testing for terbinafine was done by CLSI microbroth dilution method. Results All terbinafine-resistant isolates harbouring amino acid substitutions Phe397Leu or Leu393Phe in SQLE gene were correctly recorded as SQLE mutants by the DermaGenius® Resistance real-time PCR assay. Conclusions The DermaGenius® Resistance real-time PCR assay effectively identified Trichophyton species and distinguished wild-type from SQLE mutant genotype that harbour Phe397Leu and Leu393Phe amino acid substitutions.

Background Paroxysmal sympathetic hyperactivity (PSH) is a grave entity affecting patients following traumatic brain injury (TBI). It presents with cyclic and simultaneous fever, posturing, and other symptoms of sympathetic hyperactivity. Lack of diagnostic tests or biochemical markers and its propensity to mimic other common causes of fever in the neurotrauma intensive care unit (ICU) result in clinical dilemmas and management delay. Case Descriptions We present a case series of four patients (two adults and two pediatrics) with TBI who developed PSH during ICU stay. These patients presented with fever along with variable symptoms of sympathetic hyperactivity. However, the value of serum procalcitonin (PCT) was not elevated, and management of PSH was started. Serial monitoring of PCT helped in differentiating fever due to PSH from sepsis and thus the institution of appropriate and timely treatment of PSH and also helped to use antibiotics rationally. Conclusion The use of serum PCT in differentiating sepsis from systemic inflammatory reaction and its role in the initiation and titration of antibiotics are well described. PSH is a common entity after TBI, causing episodic fever and sympathetic hyperactivity, often confused with infectious pathology. Our report proposes the role of serum PCT in differentiating PSH from infectious etiology and management of two different clinical entities. How to cite this article Bindra A, Chowdhary V, Dube SK, Goyal K, Mathur P. Utility of Serum Procalcitonin in Diagnosing Paroxysmal Sympathetic Hyperactivity in Patients with Traumatic Brain Injury. Indian J Crit Care Med 2021;25(5):580–583.

A previously fit and well 30-year-old man presented with palpitations, fever, and pleuritic chest pain. Multimodality imaging and histopathology confirmed the diagnosis of primary cardiac angiosarcoma. We present the details of the presentation, diagnostic process using multimodality imaging, and clinical management. (Level of Difficulty: Beginner.), Central Illustration

Background: The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before. Methods: Thirty adults (men:women 25:5) with allergic contact dermatitis were divided into three groups of ten patients each for patch testing by Finn chamber® method using Indian standard patch test kits having expiry in 2016, 2015 and 2014. The results were compared with those from a new kit with 2018 expiry. Results: Ten patients in group-1, eight patients in group-2 and seven patients in group-3 developed positive reactions of identical intensities and mostly from identical allergens from all four kits. The major contact allergens eliciting positive reactions of identical intensities were parthenium in nine, five and three patients, colophony in four, one and zero patients, fragrance mix in three, three and one patients, thiuram mix in three, one and one patients, and paraphenylene diamine in two, one and three patients from group-1,-2, and -3, respectively. Limitations: Small number of patients in each group remains the major limitation of the study. Whether or not these results can be extrapolated with patch test results from other similar patch test kits available across countries also needs confirmation. Conclusion: The patch test allergens can be used beyond labeled expiry dates but needs confirmation by a few large studies and using other available patch test kits. This is important as the relevance of patch test results for individual allergen in this scenario may remain debatable requiring careful interpretation.

Aim & objectives Clinical trials had concluded a significant relationship between implant failure and bruxism. A three-dimensional (3D) finite element analysis (FEA) was done to evaluate the stress distribution in straight and angled abutments around titanium and carbon fiber-reinforced polyetheretherketone (CFR-PEEK) implant with 2 different prosthetic crowns under parafunctional loading. Materials and method Twelve 3D models of bone block were created representing the maxillary right premolar area with osseointegrated implants. The models were divided in two group; CFR-PEEK implant (n ​= ​6) and group titanium implant (n ​= ​6).Each group was subdivided based on implants with three different abutments (straight, 15°, 25° angled abutments) and having two different prosthetic crowns: porcelain fused to metal (PFM) and polyetheretherketone (PEEK). A vertical load of 1000 ​N was applied to the central fossa and an oblique load of 500 ​N (30°) was applied to the buccal incline of the palatal cusp. The von Mises stresses and principal stresses were analyzed using ANSYS software. Results CFR-PEEK and titanium implants produced similar stress in bone under vertical and oblique loading. Straight abutment showed better results than 15° and 25° angled abutments in all the groups. PEEK crown produced lesser stress than PFM crown under vertical and oblique loading. Conclusion The study concluded that straight abutment along with PEEK crown could be given in patients with bruxism to reduce the stress concentration in bone, thus preventing possible implant failure. Titanium and CFR-PEEK implants with straight abutments if given, then it should be provided with an occlusal splint.

Background Cardiac diffusion tensor imaging (cDTI) allows for in vivo characterization of myocardial microstructure. In cDTI, mean diffusivity and fractional anisotropy (FA)-markers of magnitude and anisotropy of diffusion of water molecules-are known to change after myocardial infarction. However, little is known about regional changes in helix angle (HA) and secondary eigenvector angle (E2A), which reflects orientations of laminar sheetlets, and their association with long-term recovery of left ventricular ejection fraction (LVEF). Purpose To assess serial changes in cDTI biomarkers in participants following ST-segment elevation myocardial infarction (STEMI) and to determine their associations with long-term left ventricular remodeling. Materials and Methods In this prospective study, 30 participants underwent cardiac MRI (3 T) after STEMI at 5 days and 3 months after reperfusion (National Institute of Health Research study no. 33963 and Research Ethics no. REC17/YH/0062). Spin-echo cDTI with second-order motion-compensation (approximate duration, 13 minutes; three sections; 18 noncollinear diffusion-weighted scans with b values of 100 sec/mm2 [three acquisitions], 200 sec/mm2 [three acquisitions], and 500 sec/mm2 [12 acquisitions]), functional images, and late gadolinium enhancement images were obtained. Multiple regression analysis was used to assess associations between acute cDTI parameters and 3-month LVEF. Results Acutely infarcted myocardium had reduced FA, E2A, and myocytes with right-handed orientation (RHM) on HA maps compared with remote myocardium (mean remote FA = 0.36 ± 0.02 [standard deviation], mean infarcted FA = 0.25 ± 0.03, P < .001; mean remote E2A = 55° ± 9, mean infarcted E2A = 49° ± 10, P < .001; mean remote RHM = 16% ± 6, mean infarcted RHM = 9% ± 5, P < .001). All three parameters (FA, E2A, and RHM) correlated with 3-month LVEF (r = 0.68, r = 0.59, and r = 0.53, respectively), with acute FA being independently predictive of 3-month LVEF (standardized β = 0.56, P = .008) after multivariable analysis adjusting for factors, including acute LVEF and infarct size. Conclusion After ST-segment elevation myocardial infarction, diffusion becomes more isotropic in acutely infarcted myocardium as reflected by decreased fractional anisotropy. Reductions in secondary eigenvector angle suggest that the myocardial sheetlets are unable to adopt their usual steep orientations in systole, whereas reductions in myocytes with right-handed orientation on helix angle maps are likely reflective of a loss of organization among subendocardial myocytes. Correlations between these parameters and 3-month left ventricular ejection fraction highlight the potential clinical use of cardiac diffusion tensor imaging after myocardial infarction in predicting long-term remodeling. © RSNA, 2021 Online supplemental material is available for this article.