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Background: Gustatory dysfunction associated with vestibular schwannomas (VS) is a poorly represented clinical presentation.Materials and Methods: One hundred and forty-nine cases operated from 1997 to 2005 where at least six-month follow-up was available were included. All patients were tested for taste sensations using four modalities of standard taste solutions. Apart from the taste sensations, any altered or abnormal taste perceptions were recorded both in the preoperative and postoperative period.Results: After applying the exclusion criteria, the taste dysfunction was studied in 142 patients. The evidence of decreased taste sensation was found in 58 (40.8%) patients prior to surgery. Preoperatively, taste disturbance was found in 29 (37.2%) giant, 28 (45.9%) large and one (33.3%) medium-sized tumors, respectively. There were no significant age or sex-related differences. The postoperative taste disturbances were found in 65 (45.8%) patients. Among patients with anatomically preserved facial nerve, postoperative taste disturbances were found in 55 (42.3%) patients whereas nine (6.9%) patients reported improvement in taste sensations.Conclusions: Taste dysfunction is common following vestibular schwannoma surgery. Patient counseling prior to surgery is necessary to avoid any distress caused by taste dysfunction. Taste dysfunction should be included in the facial nerve functional grading system while assessing outcome. [ABSTRACT FROM AUTHOR]

The risk of iatrogenic facial nerve injury increases in presence of Fallopian canal dehiscence during mastoid surgeries. This study aimed to find out the incidence, site, and size of Fallopian canal dehiscences and their pre-operative & intra-operative predictors. Prospective cross-sectional observational study. 46 patients of chronic otitis media (COM) undergoing canal wall down (CWD) mastoidectomy at a tertiary care centre in Uttarakhand, India. Fallopian canal dehiscence was encountered in 50% cases (23/46) and its most frequent site was the tympanic segment in 73.9% cases while the least frequent site was mastoid segment in 2.2% cases. Most of the dehiscences were more than 4 mm in size at 69.6%. Fallopian canal dehiscence was found in 100% of cases with preoperative facial palsy, 66.7% cases with aural polyps, 75% of cases with hearing loss > 90 dBHL, and in 100% of the cases with eroded dural plate and sinus plate on X Ray mastoid. Intraoperatively, Fallopian canal dehiscence was found in 70% of cases with LSCC fistula, and 66.7% cases of sigmoid plate erosion. Fallopian canal dehiscence is seen in 50% of cases undergoing CWD mastoidectomies, with most common site being the tympanic segment. Surgeons should be vigilant in cases of revision mastoidectomy, preoperative facial palsy, aural polyps, hearing loss > 90 dBHL, and cases with sinus plate and/or dural plate erosions on X Ray mastoid. The surgeon should be cautious to prevent facial nerve injury if they encounter a LSCC fistula, and sigmoid plate erosion intraoperatively., Competing Interests: Conflict of interestNot applicable., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: The most dreaded long-term complication of axillary lymph node dissection remains upper arm lymphedema. Our study has strategized the three most common identified causes of post treatment arm lymphedema, i.e., obesity, radiation, and neoadjuvant chemotherapy and tried to identify the histopathological and clinical or surgical factors which can predict arm lymphedema., Materials and Methods: This is a prospective observational study was conducted at a tertiary care referral centre in India, with strict inclusion criteria of BMI <30 kg/m 2 , age <75 years, presence of metastatic axillary node proven by FNAC, received anthracycline based neoadjuvant chemotherapy and postoperative nodal irradiation, and completed 24 months of regular follow-up., Results: Total of 70 patients were included in the study. The mean age of the patients was 50.3 years (±12.9). lymphovascular invasion, total number of lymph nodes removed from level III, total number of days drain was left in situ and maximum drain output were found to be significantly (p<0.05) associated with arm lymphedema., Conclusion: In patients undergoing modified radical mastectomy with level III dissection, and postoperative irradiation, the incidence of unilateral arm lymphedema is significantly influenced by several clinicopathological factors like the total number of lymph nodes removed in level III, higher maximal drain output, prolonged duration of drain placement and the presence of lymphovascular invasion., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2024 by the Turkish Federation of Breast Diseases Societies / European Journal of Breast Health published by Galenos Publishing House.)

Epistaxis or bleeding from nose, a commonly confronted condition in the department of otorhinolaryngology can be a disquietening experience and sometimes a life threatening emergency for the patient. The aim of this study is to study the clinical profile and aetiology in epistaxis patients. An observational prospective study carried out over a period of 12 months in the Department of Otorhinolaryngology, Head and Neck Surgery, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand. A total of 104 patients of all age groups and gender presenting with epistaxis were included in the study. Males formed majority of the patients (68.27%) as compared to female patients (31.73%). Most of the patients were in the age group of 51-70 years with majority being farmers (30.77%). The finding of variation with age was statistically significant ( p  < 0.05) with most patients in the age group of 51-60 years presenting in winter season. Local causes were observed to be more common (50.96%) among which trauma was the predominant cause (23.08%). Systemic causes formed 37.58% of cases, out of which hypertension was the commonest cause. In our study, non-surgical measures were most commonly employed treatment modality (85.58%) among which medical management was done in most patients. Trauma and hypertension contributed to the majority of patients presenting with epistaxis in our study with cold, dry winter months associated with increased incidence of epistaxis., Competing Interests: Conflict of interestThe author’s do not have any conflict of interest with any person individual or organization., (© Association of Otolaryngologists of India 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Adenotonsillar hypertrophy is one of the commonest causes of upper airway obstruction in children. It can cause hypoxic state by impairing pulmonary functions. Peak expiratory flow rate is a basic, convenient and reliable indicator of pulmonary function in children. To study the improvement in pulmonary functions by assessing Peak expiratory flow rate, before and after adenotonsillectomy in children., Design: Cross sectional, prospective, observational study., Setting: Department of otorhinolaryngology in tertiary care centre., Subjects: Included 40 children aged between 5 and 15 years, who had adenotonsillar hypertrophy and underwent adenotonsillectomy., Method: Diagnostic nasal endoscopy and X-ray, nasopharynx, was done to assess the grade of adenoid hypertrophy endoscopically and radiologically respectively. Peak expiratory flow rate was assessed using Mini Wright peak expiratory flow meter pre-operatively and 1 month post-operatively and both the readings were compared. Subjective improvement was also compared pre-operatively and post-operatively using visual analogue score. This study included 40 patients with male to female ratio of 1.6:1, 92.5% presented with mouth breathing. 92.5% presented with grade III tonsillar hypertrophy and 70% with grade III adenoid hypertrophy endoscopically. After adenotonsillectomy, improvement in Peak expiratory flow rate ranged from 16 to 25.3% which was statistically significant. Patients with grade III tonsillar and grade IV adenoid hypertrophy showed 25.3% improvement. Subjective improvement was 98.8% in the complaint of snoring. Adenotonsillectomy significantly improves pulmonary functions. This may help to improve physical and cognitive development in children and decrease chances of getting cardiopulmonary problems in later life., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2021.)

Consistent clinical observations of characteristic findings of COVID-19 pneumonia on chest X-rays have attracted the research community to strive to provide a fast and reliable method for screening suspected patients. Several machine learning algorithms have been proposed to find the abnormalities in the lungs using chest X-rays specific to COVID-19 pneumonia and distinguish them from other etiologies of pneumonia. However, despite the enormous magnitude of the pandemic, there are very few instances of public databases of COVID-19 pneumonia, and to the best of our knowledge, there is no database with annotation of abnormalities on the chest X-rays of COVID-19 affected patients. Annotated databases of X-rays can be of significant value in the design and development of algorithms for disease prediction. Further, explainability analysis for the performance of existing or new deep learning algorithms will be enhanced significantly with access to ground-truth abnormality annotations. The proposed COVID Abnormality Annotation for X-Rays (CAAXR) database is built upon the BIMCV-COVID19+ database which is a large-scale dataset containing COVID-19+ chest X-rays. The primary contribution of this study is the annotation of the abnormalities in over 1700 frontal chest X-rays. Further, we define protocols for semantic segmentation as well as classification for robust evaluation of algorithms. We provide benchmark results on the defined protocols using popular deep learning models such as DenseNet, ResNet, MobileNet, and VGG for classification, and UNet, SegNet, and Mask-RCNN for semantic segmentation. The classwise accuracy, sensitivity, and AUC-ROC scores are reported for the classification models, and the IoU and DICE scores are reported for the segmentation models., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To prospectively study the effectiveness and safety of clobazam as an add-on therapy in patients with epilepsy whose seizures are not adequately controlled with antiseizure medicine (ASM) monotherapy., Methods: We conducted a prospective, observational study at 28 neurology outpatient clinics in India from June 2017 to October 2019. Consecutive patients with epilepsy (older than 3 years) with inadequate seizure control with ASM monotherapy were initiated on clobazam. Patients were followed up at 1, 3, 6, 9, and 12 months. Seizure control and adverse events were assessed through personal interviews and seizure diaries., Results: Out of 475 eligible patients, data of 429 patients (men: 65.5%) were evaluated (46 excluded due to protocol deviations). The median age was 25 (range, 3-80 years) years and the median duration of epilepsy was 3 (0.1-30) years. The majority of patients had focal epilepsy (55.0%) and genetic generalized epilepsy (40.1%). The one-year follow-up was completed by 380 (88.5%) patients. At one-year follow-up, 317 (83.4%; N = 380) patients in the study remained seizure free. These 317 patients who were seizure free at 12 months comprised 73.9% of the evaluable population (N = 429). In 98.8% of patients, the primary reason for adding clobazam was inadequate control of seizures with treatment. During one-year follow-up, a total of 113 (22.6%) patients experienced at least one adverse event which included 103 (20.6%) patients who experienced 386 episodes of seizures., Conclusion: The study provides preliminary evidence that clobazam is effective and well-tolerated as add-on therapy for a period of one year among patients with epilepsy inadequately stabilized with monotherapy., Trial Registration Number: CTRI/2017/12/010906., Competing Interests: Declaration of interest Parthasarathy Satishchandra is on the Advisory Board of Sanofi India, Abbott India, and Eisai Pharma. Chaturbhuj Rathore has received speaker's honoraria from Sanofi India and Abbott India. Lokesh Lingappa is on advisory board for Sanofi, Abbott, and Dr. Reddy’s Laboratories. Sujatha Shetty and Deepa Chodankar are Sanofi employees and may hold shares and/or stock options in the company. All other authors declare no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Conventional chordomas occur most commonly in the sacral region. Currently, wide local excision remains the only hope for a cure in this disease. However, given the substantial morbidity caused by sacrectomy, a delicate balance needs to be established. This study elaborates our experience in managing these complicated cases with the help of a multidisciplinary team approach and outlines the various surgical and functional outcomes of sacrectomy. This was a retrospective observational study. Ten cases of biopsy proven sacral chordoma underwent en bloc resection by a posterior approach from 2011 to 2018 after multidisciplinary evaluation. Data collected and analyzed included demographics, extent of the disease, and operative parameters such as operative time, estimated blood loss, level of vertebral resection, level and number of the most caudal nerve roots preserved, surgical margins, soft tissue, or spinal reconstruction. Postoperative outcomes included time to recurrence and neurological function at 1 year. Mean size of the tumor was 116.1 mm. Three (30%) patients had positive margins. The median time to recurrence was 32 months. Four patients eventually succumbed to the disease due to local or distant recurrence. Bladder and bowel functions were excellent in those with preserved S3. Two patients remained wheelchair bound; the rest were able to walk with or without support. Management of sacral chordoma remains an onerous journey for both the treating surgeon and the patient. A multidisciplinary team approach, with careful preservation of sacral nerve roots, negative surgical margins, and excellent postoperative rehabilitation, can achieve optimum results., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© Indian Association of Surgical Oncology 2021.)

Locoregional recurrences from breast cancer represent a heterogeneous group of disease that poses a therapeutic challenge and needs a multidisciplinary team management. The incidence of local recurrence after breast conservation surgery ranges from 10 to 22% and 5-15% after mastectomy at 10-year follow-up. Management of locoregional recurrence depends on tumor biology, stage at presentation, and prior local and systemic therapy. With improvements in diagnostic, pathological, and surgical techniques, radiation and systemic therapy approach, outcomes in these patients have improved. In this review, we discuss the risk factors, prognostic factors, surgical and reconstruction options, re-irradiation, and role of systemic therapy to define a reasonable treatment approach without compromising oncologic safety and achieve good cosmetic and survival outcomes., (© Indian Association of Surgical Oncology 2021.)

Background: Amebic liver abscess is treated successfully with metronidazole or another nitroimidazole drug followed by a luminal amebicide. Metronidazole has long been preferred, but has been associated with several adverse effects including intolerance in certain clinical situations. Mechanisms of metronidazole resistance and mutagenic potential have been described. Effects of the use of drug in pregnant women and infants of lactating women are unknown. Nitazoxanide was proven to be efficacious in treating invasive intestinal amebiasis. Therefore, the present study was undertaken to assess the efficacy and safety of nitazoxanide as compared to metronidazole in patients with uncomplicated amebic liver abscess., Methods: Patients with clinical and ultrasonography features suggestive of liver abscess, positive amebic serology, and/or anchovy sauce appearance on aspiration of the pus were included in the study and randomized into two parallel treatment groups. Group M received metronidazole, 2-2.5 g/day intravenous (IV), for inpatients, or 2-2.4 g/day oral, for outpatients in three divided doses for 14 days. Group N received nitazoxanide 500 mg BD per oral for 10 days., Results: A total of sixty subjects fulfilling the inclusion criteria were randomized equally into two groups, group M and group N. Number of patients achieving symptomatic clinical response (SCR) was similar in the two groups (80% vs. 76.7%, p = 1.00), though time to achieve symptomatic clinical response was significantly lower in metronidazole group as compared to that in nitazoxanide group. Greater proportion of patients achieved early clinical response (ECR) in metronidazole group as compared to nitazoxanide group. Complete resolution of abscess, at 6 months, was noted in 18 (60%) patients in the M group and 22 (73.3%) patients in the N group (p = 0.273). Metronidazole was associated with significantly greater frequency of adverse effects than nitazoxanide., Conclusions: This study shows equivalent efficacy of nitazoxanide in uncomplicated amebic liver abscess as compared to metronidazole, with better tolerability and advantage of simultaneous luminal clearance, thus reducing chances of recurrence., Trial Registration: CTRI/2019/01/017249.

To understand the spread of SARS-CoV2, in August and September 2020, the Council of Scientific and Industrial Research (India) conducted a serosurvey across its constituent laboratories and centers across India. Of 10,427 volunteers, 1058 (10.14%) tested positive for SARS-CoV2 anti-nucleocapsid (anti-NC) antibodies, 95% of which had surrogate neutralization activity. Three-fourth of these recalled no symptoms. Repeat serology tests at 3 (n = 607) and 6 (n = 175) months showed stable anti-NC antibodies but declining neutralization activity. Local seropositivity was higher in densely populated cities and was inversely correlated with a 30-day change in regional test positivity rates (TPRs). Regional seropositivity above 10% was associated with declining TPR. Personal factors associated with higher odds of seropositivity were high-exposure work (odds ratio, 95% confidence interval, p value: 2.23, 1.92-2.59, <0.0001), use of public transport (1.79, 1.43-2.24, <0.0001), not smoking (1.52, 1.16-1.99, 0.0257), non-vegetarian diet (1.67, 1.41-1.99, <0.0001), and B blood group (1.36, 1.15-1.61, 0.001)., Competing Interests: SN, VS, RU, NB, RK, AB, SP, SP, RK, BR, KT, MA, GC, AL, SK, SM, MM, MS, SK, AS, BT, MV, GV, SV, AA, DG, PH, MP, GS, RV, AP, VA, AM, RS, AR, SA, PK, SV, HS, AK, RJ, AT, DP, AS, JK, VK, AM, IG, GR, PS, RC, GC, PK, RY, SS, DS, SS, PB, SA, VS, SV, DS, SS, SV, ST, FF, AS, AS, BS, MS, YP, VH, VP, DS, NT, PC, SM, DG, JS, SR, BK, KK, SG, PJ, RC, VJ, NK, DG, GT, US, PS, SC, RK, PG, AT, DS, RR, AD, MK, DS, MD, SD, RJ, AP, SM, AK, VW, RY, AK, MB, AC, SK, KK, SP, JK, NS, TP, PM, WR, PB, DO, RS, EB, RS, AN, PV, AP, AV, KC, SD, YM, VA, SD, AA, DD, SS No competing interests declared, (© 2021, Naushin et al.)

p16 is overexpressed in oral squamous cell carcinoma patients who are positive for human papilloma virus. The p53 tumor suppressor gene is commonly mutated in human cancer. The aim is to correlate clinical and pathological features with p16 and p53 expression. This is a prospective, observational study of 50 consecutive cases (43 males and 7 females) who underwent surgery for oral cancer. p16 and p53 were determined by immunohistological staining. The results were obtained and analyzed using chi-square test (Statistical Software SPSS 21.0 version); p value ≤ 0.05 was considered significant. Of the 50 cases, p16 and p53 were overexpressed in 30% and 54% of patients, respectively. Overexpression of p16 was not significantly associated with age, subsites of oral cavity, or degree of differentiation. However, smokeless tobacco was significantly associated with p16 expression ( p  = 0.012). Similarly, overexpression of p53 was not correlated with age, subsites of oral cavity, or degree of differentiation. Seventy-five percent of poorly differentiated cancers had overexpression of p53 though this did not reach statistical significance ( p  = 0.279). p53 was overexpressed in smokers (80.95%) and those consuming alcohol (60%)., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Indian Association of Surgical Oncology 2020.)

Histoplasma capsulatum is an opportunistic dimorphic fungus caused by inhalation of spores present in the soil. It is extremely rare in the northern Himalayan region of India and is usually asymptomatic. It may rarely progress to disseminated histoplasmosis which is usually observed in immunocompromised patients associated with malignancy, acquired immunodeficiency syndrome or diabetes. The present case is being reported because of unusual cutaneous presentation of disseminated histoplasmosis in an immunocompetent patient of non-endemic region. The case also highlights the importance of fine needle aspiration cytology for its precise early diagnosis and avoiding of further complications.

Background: Transfusion of allogeneic blood in breast cancer surgery is variable, and differences of transfusion incidence have been observed in the literature. Most hospital guidelines including ours dictate group and reserve policy of blood before breast surgery. Here, we aimed to audit the blood utilization in patients undergoing elective breast surgery in our hospital and thereby optimize the blood ordering schedule, economic burden, and loss of clinical resources., Materials and Methods: The study included 478 breast cancer surgeries over a period of 6 years. Patient and disease details were obtained from patient file and hospital information system. Blood samples sent to blood bank were subjected to compatibility test and reserved. All transfusions were documented, and statistical analysis was done., Results: Of the total 478 patients, most underwent wide local excision of the breast and modified radical mastectomy. A total of 16 patients received 71 units of blood and blood components in all categories of surgeries. Only 103 were younger women (≤40 years), with a mean age of 31 years. Nontransfused patients were significantly more than transfused ones ( P < 0.05). Frequency of blood transfusion was more in young patients (4.9%). Seven (22.6%) of the total 31 Stage IV patients received blood transfusions. Frequency of blood transfusion was more in patients undergoing surgery after chemotherapy (8.8%). A significant loss of time and loss of revenue was observed., Conclusion: We conclude that routine compatibility test is not justified for all patients undergoing breast surgery. A more targeted approach is needed to reduce blood demand and associated cost to patient and blood transfusion services., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Asian Journal of Transfusion Science.)

Study Design: Technical report., Objective: We describe the outcomes of percutaneous vertebroplasty in 3-columnar thoraco-lumbar fracture secondary to hyper-extension injury in 3 patients with ankylosing spondylitis (AS). Thoraco-lumbar hyperextension injuries in AS are generally unstable as they involve all 3 spinal columns and traditionally require long-segment posterior instrumented stabilization., Methods: Three cases of AS with severe medical comorbidities underwent percutaneous vertebroplasty for hyper-extension injury involving all 3 columns. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were documented preoperatively, postoperatively, and at the last follow-up., Results: Excellent improvements in VAS and ODI scores were achieved. The patients have no complaints and are independent and mobile at 2 years follow-up., Conclusion: Vertebroplasty is an excellent option in such medically unfit patients with similar diagnosis and should be performed as early as possible before profound instability or neurological insult sets in, which would necessitate bigger and morbid surgeries., Competing Interests: Disclosures and COI: There is no conflict of interest among the authors or the institution regarding the manuscript, the scientific work or data collection. The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in our country. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. There was no breach of ethical issues by any of the authors mentioned. The manuscript has been read and approved by the authors and each one of the authors treat their work trust worthy within all ethical parameters.

Systemic mastocytosis is a rare disease due to abnormal proliferation of mast cells (MCs). A case of indolent systemic mastocytosis is presented here. After anesthetic induction for elective thyroid swelling with propofol and atracurium followed by endotracheal intubation, a 57-year-old female patient developed acute hypotension, sinus tachycardia, red rashes, increased airway pressure along with difficult ventilation, and desaturation. She developed multiorgan failure subsequently. MC tryptase level was persistently high. Bone marrow study revealed mastocytosis. She required antihistaminic, steroid, and organ support. With treatment, organ functions recovered gradually. Atracurium precipitated anaphylactic shock causing severe morbidity in this patient., Competing Interests: There are no conflicts of interest.

Background: Association between hyperuricemia and hypertension has been recognized for many years. Whether hyperuricemia is the cause or the effect is debatable., Materials and Methods: This case control study was conducted to assess serum uric acid (SUA) levels in fifty newly diagnosed essential hypertensive patients and fifty normotensive controls which were matched for age and sex. Detailed anthropometric characteristics including height, weight, body mass index and waist hip ratio were measured. Hypertension was classified according to Joint National Committee (JNC) 7 criteria. Hyperuricemia was defined as SUA level of 6.8mg/dl or more in both men and women. SUA was measured by uricase method. Before collecting the blood samples, patients were advised to proceed on overnight fast of minimum eight hrs. Student's t‑test for mean of continuous variables and Chi‑square test for proportions were used for statistical significance., Results: Present study included 50 newly diagnosed cases of essential hypertension and 50 age and sex matched normotensive healthy volunteer. Prevalence of hyperuricemia was 24% among the cases and 6% among the controls (P < 0 .05). Odds ratio was 4.9 (Cl=1.3 to 18.8). The mean SUA was significantly higher in the cases (5.5±1.7 mg/dl) than in the controls (4.9±1.1 mg/dl; P< 0.05). Odds ratio in male hyperuricemic hypertensive versus hyperuricemic normotensive was 6(CI=1.0 to 33.2) and 4.46(CI=0.4 to 42.5) among female hyperuricemic hypertensive versus hyperuricemic normotensives., Conclusion: Strong positive association was observed between hypertension and hyperuricemia in both male and female patients in this study., (© Journal of the Association of Physicians of India 2011.)

Background: Lagerstroemia speciosa (SEL) leaves are a popular folk medicine for diabetes treatment due to presence of corosolic acid. It has low water solubility resulting poor absorption after oral administration. Self micro-emulsified drug delivery system is the way by which we can improve the oral absorption of drug., Objective: The objective of this study was to develop the self micro-emulsifying formulation of standardized extract of SEL leaves and evaluate its pharmacodynamic performance for antidiabetic activity., Materials and Methods: The SME formulation was prepared by using sefsol-218 as oil, cremophor-EL as surfactant and transcutol-P as co-surfactant. The ratio of surfactant and co-surfactant was determined by pseudoternary phase diagram. SME formulations were characterized for dilution at different pH, self emulsification, optical clarity, globule size and thermodynamic stability. Pharmacodynamic evaluation of formulations was assessed in Wistar rats by using parameters viz. blood glucose level and serum lipid profile., Results: SEL loaded SME formulation was successfully developed by using sefsol-218, cremophor-EL and transcutol-P with a droplet size 23.53 nm. Pharmacodynamic results showed a higher reduction in blood glucose by SME formulation than SEL without SMES respectively at 50 mg/kg dose while reduction produced at dose of 100 mg/kg was found significant and better on 15th day of study. The percentage reduction produced by SME formulation on serum lipid profile was also significant and was more prominent than SEL., Conclusion: This study confirms that the formulation elevates the pharmacodynamic performance of SEL approximately two fold., (Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.)

Self microemulsifying formulation is an approach used for enhancing the bioavailability of poorly soluble molecules due to their lipidic nature and small particle size. The objective of the present study was to evaluate the hepatoprotective activity of poorly soluble hydroxy- and polyhydroxy-organic phytomolecules rich Lagerstroemia speciosa leaves extract in modern formulation i.e. "Self microemulsifying System". Different doses of SME (Self microemulsifying) formulation of L.   speciosa leaves extract were evaluated for the hepatoprotective activity against carbon tetrachloride induced liver toxicity in rats. The parameters evaluated were (a) biochemical parameters like serum enzymes: aspartate aminotransferase (AST), serum glutamate pyruvate transaminase (ALT), serum alkaline phosphatase (ALP) and total bilirubin (b) liver antioxidant parameters as estimation of Lipid peroxidation (LPO), catalase (CAT), Superoxide dismutase (SOD) activity and concentration of reduced glutathione (GSH). Oral administration of SME formulation provided the significant protection in marker enzyme of treated group at 100 mg/kg, p.o. as AST (P < 0.001), ALT (P < 0.001), ALP (P < 0.001) and total bilirubin (P < 0.001) comparable to the group treated with silymarin. Treatment with SME formulation at the doses of 100 mg/kg, p.o. significantly prevented the rise in levels of LPO significantly (P < 0.001). The GSH, SOD and CAT contents had significantly (P < 0.001) increased in SME formulation treated groups whereas carbon tetrachloride intoxicated group had shown significant decrease in these parameters compared to control group. Formulation at the dose 100 mg/kg, p.o. has shown maximum protection which was almost comparable to those of the normal control and standard. The histological observations further uphold the results for hepatoprotective activity.

We present a case of anterior cruciate ligament stump entrapment in a 24-year-old gentleman who traumatically injured his knee. The anterior stump became entrapped in the intercondylar notch and after a process of inflammation and fibrosis, produced a mass similar to the more familiar cyclops lesion that may complicate anterior cruciate ligament reconstruction.

Introduction: Ultrasonography (USG) is considered as the primary imaging modality for confirmation of ovarian mass and to differentiate them in to benign or malignant., Aim: The present study was conducted with the aim to evaluate accuracy of B- mode USG and Doppler scan (Colour Doppler + Spectral Doppler) for ovarian lesions., Materials and Methods: The patients included in the study were from those referred with either palpable adnexal mass or incidentally detected adnexal masses. Total 250 women were evaluated by USG, Doppler scan. Only fifty patients who had true ovarian mass intraoperatively and on histopathology were included in study, rest masses were excluded. Study parameters were morphological indexing on B- Mode USG, flow study, vessel arrangement, and vessel morphology and vessel location in Colour Doppler and resistive index and pulsatility index in spectral Doppler., Results: Total 50 women were included in present study. Out of these 46% were pre-menopausal while 54% were menopaused women, 66.7% of post-menopausal women had malignant ovarian masses compared to 8.7% of premenopausal. Sensitivity, specificity, positive predictive value and negative predictive value of B-Mode USG for ovarian masses were 94.44%, 48.15%, 54.84% and 92.86% respectively, with p-value = 0.007, while sensitivity, specificity, positive predictive value and negative predictive value of Doppler scan were 85%, 90%, 85% and 90% respectively, with p-value = 0.0001., Conclusion: USG and its different techniques are accepted as the primary imaging modality for early stage diagnosis of an ovarian malignancy. Statistical analysis suggests that Doppler Scan (Colour + Spectral) was more accurate (88%) than B-Mode USG (67%), but author is in view that both of these modalities should be used in conjunction to screen the ovarian lesions.

We present the case of a 55-year-old woman with a presumed ganglion cyst associated with the anterior cruciate ligament (ACL), demonstrated by MRI. The ACL is an uncommon location for ganglion cysts to occur.

Purpose: To evaluate radiation dose reduction in patients undergoing transarterial chemoembolization with the use of a new image acquisition and processing platform., Materials and Methods: Radiation-dose data were obtained from 176 consecutive chemoembolization procedures in 135 patients performed in a single angiography suite. From January 2013 through October 2013, 85 procedures were performed by using our institution's standard fluoroscopic settings. After upgrading the x-ray fluoroscopy system with an image acquisition and processing platform designed to reduce image noise and reduce skin entrance dose, 91 chemoembolization procedures were performed from November 2013 through December 2014. Cumulative dose-area product (CDAP), cumulative air kerma (CAK), and total fluoroscopy time were recorded for each procedure. Image quality was assessed by three interventional radiologists blinded to the x-ray acquisition platform used., Results: Patient radiation dose indicators were significantly lower for chemoembolization procedures performed with the novel imaging platform. Mean CDAP decreased from 3,033.2 dGy·cm(2) (range, 600.3-9,404.1 dGy·cm(2)) to 1,640.1 dGy·cm(2) (range, 278.6-6,779.9 dGy·cm(2); 45.9% reduction; P < .00001). Mean CAK decreased from 1,445.4 mGy (range, 303.6-5,233.7 mGy) to 971.7 mGy (range, 144.2-3,512.0 mGy; 32.8% reduction; P < .0001). A 20.3% increase in mean total fluoroscopy time was noted after upgrading the imaging platform, but blinded analysis of the image quality revealed no significant degradation., Conclusions: Although a small increase in fluoroscopy time was observed, a significant reduction in patient radiation dose was achieved by using the optimized imaging platform, without image quality degradation., (Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.)

Background: Right adrenal vein (RAV) catheterization can be a very challenging step in adrenal venous sampling (AVS). Visualization of the inferior emissary vein (IEV) may be an indication of successful RAV catheterization., Purpose: To compare the rate of successful RAV sampling in the presence of the IEV., Material and Methods: Retrospective review of all consecutive patients with PA who underwent AVS between April 2009 and April 2012 was performed. A total of 30 patients were identified. Procedural images, cortisol, and aldosterone values obtained from sampling of the RAV and inferior vena cava (IVC) were reviewed. Cortisol measurements obtained from RAV samples were divided by measurements from the infra-renal IVC blood samples in order to calculate the selectivity index (SI). An SI >3 was considered indicative of technically successful RAV sampling., Results: RAV sampling was considered technically successful in 29 out of 30 cases (97%). In cases of successful RAV sampling (29 patients), the IEV was identified in 25 patients (86%). The IEV was visualized in isolation in 16 patients (64%), and in conjunction with visualization of the RAV or right adrenal gland stain in nine patients (36%). The IEV was not visualized in the one case of unsuccessful RAV sampling. Visualizing the IEV had a sensitivity of 86.2% for successful RAV sampling., Conclusion: The IEV may serve as a reliable landmark for the RAV during RAV sampling., (© The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

A 28-year-old male patient presented to Skin, V.D. and Leprosy outpatient with a single gray white plaque on the left side of the lower lip for last 8 months and multiple papulosquamous lesions all over the body for last 6 months. There was history of blood transfusion for anemia 1 year back. Histopathology of lip lesion and reactive VDRL and TPHA tests confirmed the diagnosis as syphilis. We report this rare case of Syphilis d' emblee.

Background & Aims: Drug-induced liver disease is the leading cause of acute liver failure in the United States. Accurate reporting of drug-induced liver injury is essential for early detection of hepatotoxicity and for developing reliable, interpretable literature. We assessed the extent to which published case reports of drug-induced liver disease include sufficient clinical data for interpreting the cause of toxicity., Methods: We developed a list of 42 predetermined, specific minimal elements necessary in evaluating causality of drug-induced liver injury. We then analyzed 97 published case reports or series studies of hepatotoxicity from 6 drugs (from 3 classes): amoxicillin/clavulanic acid (n = 35), troglitazone (n = 32), rosiglitazone (n = 10), pioglitazone (n = 8), zafirlukast (n = 8), and montelukast (n = 4)., Results: Patient age, sex, primary disease, and drug name were reported in most, if not all, published case reports. However, many elements were underreported; some publications did not mention initial bilirubin levels (12%), many did not provide initial alkaline phosphatase levels (58%), and others provided vague descriptions of how certain diagnoses were excluded, that is, tests for hepatitis A, B, and C were negative. Data on abnormal results from serial liver tests frequently were absent. Exclusions of competing viral etiologies were reported in less than 50% of the studies., Conclusions: Reports of drug-induced liver diseases often do not provide the data needed to determine the causes of the adverse effects. Efforts to promote and include a list of essential diagnostic elements in research articles could increase the quality and clinical utility of published case reports of drug toxicity., (Copyright (c) 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Cyanides are fast-acting poisons, can be lethal if exposed in excess. In spite of fact, cyanides are discharged as effluents in large scale from industries every year. Certain bacteria, fungi, algae and plants produce cyanides. It has been observed that microbes and plant systems can degrade cyanides to less toxic compounds. There are many enzymes, which are produced by microorganisms that utilize cyanides as substrate to make alanine, glutamic acid, alfa-amino-butyric acid, beta-cyanoalanine, etc. Present paper deals with different enzymes, their mechanisms and corresponding pathways with respect to the known biochemistry of enzyme and feasibility for the use in treatment of cyanides containing industrial effluents., (2009 Elsevier B.V. All rights reserved.)

We present a case of Strongyloides stercoralis hyperinfection in a 30-year-old HIV positive female who presents with diffuse alveolar hemorrhage. We discuss the relevant differential diagnoses and characteristic imaging findings.

We present a case of solitary fibrous tumor of pleura (SFTP) in a 63-year-old male. Clinical manifestations of this entity, including paraneoplastic syndromes, are discussed, albeit absent in our presented case. Furthermore radiographic findings and pathologic correlations are provided. SFTP remains a rare neoplasm for which radiographic features are suggestive yet nonspecific, and immunohistochemistry remains as the diagnostic method of choice.

Salvage of limbs affected by Buerger's disease has been a dilemma for surgeons. Palliative sympathectomy relieves vasospasm only in the early stages. Reconstructive procedures are usually not possible as graft patency rates are low. Limb amputation often is the only available management option left. We used the omentopexy technique to salvage these limbs. Omentopexy was performed in 273 patients with sympathectomy failure in end-stage Buerger's disease. The technique of omentopexy is presented. The outcome has been analyzed with respect to improvement of clinical symptoms, ulcer healing, and angiographic and color Doppler studies. Of the 273 patients, 250 available for follow-up were followed for a mean of 7.5 years (range, 1-19.5 years). One- to 5-years follow-up (n = 110 cases) revealed good results in 94% of patients. Long-term follow-up (5-15 years; n = 140 cases) showed good results in 85% of patients. A similar situation exists in the retina; pedicle omentopexy in the eye restored vision in retinal avascular diseases (retinitis pigmentosa).

We report on a previously undescribed form of skeletal dysplasia with rhizomelic, acromelic, and prominent mesomelic shortening, distal ulnar epiphyseal and pubic punctate calcifications (stippling), mega-epiphyses, platyspondyly, anterior beaking of the vertebrae, and sensorineural hearing loss. We compare this case to the other reported forms of skeletal dysplasias, particularly the mesomelic, acromesomelic, and mega-epiphyseal disorders., (Copyright 2005 Wiley-Liss, Inc.)

Salvage of limbs affected by Buerger's disease has been a dilemma for surgeons. Palliative sympathectomy relieves vasospasm only in the early stages. Reconstructive procedures are usually not possible because graft patency rates are low. Limb amputation often is the only available management option. We used the omentopexy technique to salvage these limbs. Omentopexy was performed in 273 patients with sympathectomy failure in end-stage Buerger's disease. The technique of omentopexy is presented. The outcome has been analyzed with respect to improvement of clinical symptoms, ulcer healing, and angiographic and color Doppler studies. Of the 273 patients, 250 available for follow-up were followed for a mean of 7.5 years (range, 1-19.5 years). One- to 5-years follow-up (n = 110 cases) revealed good results in 94% of patients. Long-term follow-up (5-15 years; n = 140 cases) showed good results in 85% of patients.

Eight healthy female adult camels were used to study the effect of long term dehydration on serum constituents in extreme climatic conditions viz. cold and hot. The dehydration phases were of 24 days in cold and 13 days in hot conditions. The changes in sodium, potassium, calcium and phosphorus were non significant (P > 0.05) while in chloride, glucose, total proteins, urea, bilirubin, cholesterol and creatinine were significant (P < or = 0.05) during dehydration phase. The mean values of all the constituents tended to return to normal as the rehydration phase advanced. Changes in sodium and potassium in dehydrated camels reflected that they were able to maintain the salt balance.

Acute appendicitis caused by Ascaris lumbricoides is an uncommon variant of a common disease. We describe a case in which sonography was used for preoperative diagnosis of ascaris appendicitis.

Two HPLC methods were developed: one for the quantitation of HBY 097 reverse transcriptase inhibitor and its metabolites M2 and M3 in human serum, and one for the quantitation of metabolite M5 in urine. The HPLC procedure for the quantitation of HBY 097 and its metabolites M2 and M3 in human serum involved protein precipitation with acetonitrile followed by automated on-line trace enrichment. The HPLC procedure for the analysis of metabolite M5 in urine involved enzymatic hydrolysis of urine with beta-glucuronidase to convert metabolite M5 (glucuronide of M3) to M3. Reverse phase chromatographic separation with gradient elution. UV detection at 335 nm, and internal standard were used to quantitate analytes in both procedures. The lower quantitation limits were 25 ng ml-1 for HBY 097 and metabolites M2 and M3 in serum, and 0.5 microgram ml-1 for the metabolite M5 in urine measured as metabolite M3 after hydrolysis. The HBY 097 and metabolite M3 concentrations were specific but metabolite M2 was semi-specific because the two diastereomers of M2 were not resolved by the present chromatographic procedure. Both procedures were applied to the quantitation of HBY 097 and its metabolites in serum and urine of HIV positive patients who were enrolled in a clinical study of drug safety and pharmacokinetics.