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Mehuli Halder,1 Yogesh Chhaparwal,1 Vathsala Patil,1 Komal Smriti,1 Shubha Chhaparwal,2 Kalyana C Pentapati3 1Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; 2Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; 3Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, IndiaCorrespondence: Yogesh Chhaparwal, Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India, Tel +91 9986454730, Email yogesh.chhaparwal@manipal.eduBackground: Lingual plate thickness, density, and proximity to the tooth are linked as risk factors for various complications associated with third molar extraction. The present study aimed to assess the lingual plate thickness, and density in the mandibular third molar region using cone beam computed tomography and to estimate its correlation with type and level of impaction, number of roots, age, and gender as the risk factorsMethods: This was a retrospective study on CBCT images of 648 mandibular third molars. The lingual plate thickness at three different root levels – cervical, mid-root, and apex along with the position of the tooth, number of roots, density of lingual plate, age, and gender were evaluated. The measurements were done on Invivo 5-Anatomage software. Statistical comparison of the categorical variables was done by Chi-square test, and Fisher’s exact test, and univariate and multivariate analysis were done using binomial logistic regression.Results: Lingual plate thickness of the third molars at the cervical, mid root, and apex were 1.28 mm, 1.42 mm and .01 mm (mean). A significantly higher proportion of subjects with thin lingual plates at mid-root (p-value=0.01) and apex (p-value=0.05) were in the 21– 30 age group. Lingual bone density was significantly associated with the thickness of the lingual plate at the mid-root. A significantly higher proportion of thinner lingual plates at the mid-root level were associated with mesioangularly placed third molars (p-value=0.002).Conclusion: Our study presented that lingual plate thickness has a strong association with age, angulation, and the number of roots. Knowledge about these risk factors is imperative during the management of third molar impactions.Keywords: lingual plate, third molar, bone density, mandible, cone-beam computed tomography

RS Kumar,1 Manish Kumar Jain,2 Jitendra Singh Kushwaha,3 Santosh Patil,4 Vasanti Patil,5 Soumya Ghatak,6 Jayesh Sanmukhani,7 Ravindra Mittal7 1Department of Pulmonary Medicine, Government Medical College & Government General Hospital, Srikakulam, India; 2Department of Pulmonary Medicine, Maharaja Agrasen Superspeciality Hospital, Jaipur, India; 3Department of Medicine, Prakhar Hospital Pvt. Ltd, Kanpur, India; 4Department of ENT, Jeevan Rekha Hospital, Belgavi, India; 5Department of ENT, Rajarshi Chhatrapati Shahu Maharaj Government Medical College and CPR Hospital, Kolhapur, India; 6Department of ENT, College of Medicine and Sagore Dutta Hospital, Kolkata, India; 7Department of Clinical Research and Regulatory Affairs, Cadila Healthcare Limited, Ahmedabad, IndiaCorrespondence: Jayesh Sanmukhani, Department of Clinical Research and Regulatory Affairs, Cadila Healthcare Ltd, Ahmedabad, India, Tel +91 76000 12192, Email Jayesh_sanmukhani@yahoo.co.in; jayeshsanmukhani@zyduscadila.comObjective: To compare the efficacy and safety of a fixed dose combination of Fluticasone Furoate and Oxymetazoline Hydrochloride Nasal Spray 27.5/50 mcg (FDC) with Fluticasone Furoate Nasal Spray 27.5 mcg (Fluticasone) in the management of allergic rhinitis.Patients and Methods: A prospective, randomized, double-blind, two-arm, active-controlled, parallel, multicenter, comparative clinical study was conducted in patients with allergic rhinitis aged 18 years and above having moderate-to-severe nasal congestion.Results: A total of 250 patients were randomized (1:1) to receive either the FDC or Fluticasone alone in a dose of two sprays in each nostril once daily at night. There was a significantly (P< 0.001) greater reduction in night-time Total Nasal Symptom Score with the FDC as compared to Fluticasone at all the time points starting from as early as day 3 and sustained till the end of treatment (Day 28) (Day 3: − 3.1 vs − 2.2; Day 7: − 4.0 vs − 3.4; Day 14: − 5.7 vs − 5.0; Day 28: − 7.0 vs − 6.4). A significantly greater number of patients (P< 0.05) had complete relief in Nasal Congestion with the FDC (44.7%) as compared to Fluticasone (26.8%). Both the study medications were well tolerated by all the patients. The proportion of patients showing worsening of symptoms (rebound congestion/rhinitis medicamentosa) after stoppage of medication was similar in both groups (P> 0.05).Conclusion: The FDC was superior to Fluticasone alone in relieving the nasal congestion and reduction of Total Nasal Symptom Score in allergic rhinitis patients with moderate-to-severe nasal congestion when administered once daily in the evening. Oxymetazoline when used along with the nasal steroid in a once daily dose does not cause rebound congestion and rhinitis medicamentosa even after long-term continuous use of 28 days.Keywords: Fluticasone Furoate, oxymetazoline, nasal spray, allergic rhinitis, nasal congestion

Amar Pujari, Vinay Patil, Nidhi Chauhan, Rajeswari Thangavel, Swati Phuljhele, Rohit Saxena Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar Pujari, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comPurpose: To describe the clinical role of swept-source anterior segment optical coherence tomography in extraocular muscle imaging in various strabismic conditions.Study Design: Prospective observational study.Participants: A total of 1104 extraocular muscles of 150 subjects were imaged. Normal eyes (640 muscles), eyes undergoing re-operation (240 muscles), paralytic strabismic eyes (16 muscles), non-paralytic strabismic eyes (20 muscles), post-traumatic strabismic eyes (64 muscles), eyes with thyroid disease (64 muscles), and other atypical cases (60 muscles) were imaged. In all cases, up to four recti muscles were evaluated in a given eye depending on the need.Results: The mean age was 38.15 ± 16.25 years. Overall, muscle insertion was identified in over 90% of the subjects. Apart from normal muscles (n = 860, 93.68%), the location was identified in previously operated eyes (n = 54, 90%), in traumatic muscle slippage (n = 2, 11.11%), in ocular coat ectasia (n = 11, 91.66%), in thyroid muscle hypertrophy, in operated scleral fixated intraocular lens with strabismus, and other challenging cases. In all circumstances, clinically useful information was obtained from the anterior 4– 14 millimetres of the rectus muscle, which in turn helped in active surgical planning and overall management.Conclusion: The SS-ASOCT with its wider and deeper scanning abilities was able to locate the extraocular muscle insertion in a variety of strabismic conditions. Therefore, this tool can be used in the preoperative periods for optimal surgical planning and management.Keywords: swept source anterior segment imaging, extraocular muscle imaging, imaging in strabismus, ASOCT imaging of extraocular muscles

Shruti Kate,1 Anuradha Chougule,2 Amit Joshi,1 Vanita Noronha,1 Vijay Patil,1 Rohit Dusane,3 Leena Solanki,1 Priyanka Tiwrekar,2 Vaishakhi Trivedi,1 Kumar Prabhash1 1Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; 2Department of Molecular Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India; 3Department of Biostatistics, Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India Background: The significance of uncommon EGFR mutations in newly diagnosed advanced non-small-cell lung cancer (NSCLC) patients is incompletely known. We aimed to analyze the demographic profile, outcome, and treatment attributes of these patients.Patients and methods: We retrospectively surveyed 5,738 advanced NSCLC patients who underwent EGFR testing in our center from 2013 to 2017 by in-house primer probes on real time PCR platform. Descriptive data were accumulated from electronic medical records. Survival plot was calculated using Kaplan–Meier method and compared between groups using log-rank test.Results: Out of 1,260 EGFR mutation-positive patients, 83 (6.58%) had uncommon mutations in isolation or in various combinations. Uncommon mutations were more frequent in men, never-smokers, and adenocarcinomas. Overall, exon 18 G719X, exon 20 insertion, exon 20 T790M, exon 20 S768I, and exon 21 (L858R/L861Q) were present in 9.6%, 19.3%, 12%, 3.6%, and 3.6% patients, respectively. Dual mutation positivity was found in 50.6% patients. On classifying patients as per tyrosine kinase inhibitor (TKI) sensitivity, it was found that majority of the patients had a combination TKI sensitive and insensitive mutations. The median duration of follow-up was 13 months. Five patients were lost to follow-up. Median progression-free survival on first line therapy was 6.7 months (95% CI: 4.8–8.5). Median overall survival (OS) of patients who received TKI during the course of their disease was 20.2 months (95% CI: 11.4–28.9). Median overall survival (mOS) of the entire cohort was 15.8 months (95% CI: 10.1–21.5). Among all uncommon mutations, patients with dual mutations did better, with an mOS time of 22.6 months (95% CI: 8.2–37.0, P=0.005). It was observed that TKI sensitive/TKI insensitive dual mutations had a superior OS of 28.2 months (95% CI: 15.2–41.2, P=0.039) as compared to TKI sensitive and TKI insensitive EGFR mutations.Conclusion: Uncommon EGFR mutations constitute a heterogeneous group, hence, it is imperative to understand each subgroup more to define optimal treatment. Keywords: uncommon EGFR mutations, advanced NSCLC, tyrosine kinase inhibitors, complex EGFR mutations, dual EGFR mutations

In this paper, we study the magnetohydrodynamic (MHD) mixed unsteady flow over a vertical porous plate. The system of non-linear partial differential equations governing the physical model is transformed into a system of non-linear ordinary differential equations via Lie group analysis. Using the Runge-Kutta fourth order method along with shooting technique the numerical analysis is carried out to study the effect of associated parameters on the velocity, temperature and concentration distribution. Computed results for the velocity, temperature and concentration distribution are discussed graphically.

Alejandro Arenas,1 Burton J Tabaac,1 Galina Fastovets,2 Vinod Patil3 1Department of Clinical Sciences, American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten; 2Department of Surgery, Broomfield Hospital, National Health Service, Chelmsford, UK; 3Department of Anesthesia, Queens Hospital, National Health Service, Romford, UK Background: For years, undivided attention during the presurgical “timeout” has been utilized as a precaution to ensure patient safety. The information relayed during the timeout is presented in a confirmatory nature rather than a delegation of new information. However, it is a standard of practice in which all members of the operating theater provide their full and undivided attention. Standards of patient care should be contiguous throughout the preoperative, perioperative, and postoperative stages of surgery. In this manner, it is expected that the same undivided attention afforded during the timeout should be maintained when transferring the patient to the postanesthesia care unit. Methods: In this study, information was collected regarding handover of information during the transfer status postsurgical procedures. Data were collected via observing interactions between the anesthesiologist and the nurse during verbal patient transfers. Results: This study demonstrated that the presence of undivided attention during the handover of a surgical patient in the postanesthesia care unit has a direct correlation with improved recall of the information discussed during handover. Conclusion: Focus is on the quantity of information that can be recalled by the transferring nurse, and whether or not undivided attention affects the outcome. Analysis focuses on suggestions to better improve patient safety and recovery when being transferred in an anesthetic setting. The practice of patient handover should be standardized to better improve the safety and quality of medical care. Keywords: communication, continuous quality improvement, healthcare quality improvement, safety culture, undivided attention, patient care

Solid-pseudopapillary tumor (SPPT) of the pancreas is an uncommon low-grade exocrine pancreatic malignancy. An 11-year-old male child presented with pain in the abdomen. He had a history of fall 1-week back for which a computerized tomography (CT) scan was advised. A pancreatic mass was incidentally detected on CT scan and diagnosed as pancreatic pseudocyst. Explorative surgery was performed that revealed a solid-cystic tumor in the tail of the pancreas. The histopathological examination reported the features of pancreatic SPPT which was also the final diagnosis.

Vinayak W Patil1, Mukund B Tayade2, Sangeeta A Pingale1, Shubhangi M Dalvi1, Rajesh B Rajekar1, Hemkant M Deshmukh1, Shital D Patil1, Rajeev Singhai11Department of Biochemistry, 2Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, IndiaBackground: Combination chemotherapy is highly effective in locally advanced breast cancer. A negative expression of biomarker p53 indicates a higher chance of responding to this regimen. Patients' p53 status may be used as a biological cancer marker to identify those who would benefit from more aggressive treatments.Aims: The role of p53 in modulating apoptosis has suggested that it may affect the efficacy of anticancer agents. p53 alterations in 80 patients with locally advanced breast cancer IIIB undergoing neoadjuvant chemotherapy were prospectively evaluated.Materials and methods: Patients received three cycles of paclitaxel (175 mg/m2) and doxorubicin (60 mg/m2) every 21 days. Tumor sections were analyzed before treatment for altered patterns of p53 expression, using immunohistochemistry and DNA sequencing.Results: An overall response rate of 83.5% was obtained, including 15.1% complete pathological responses. The regimen was well tolerated with 17.7% grade 2/3 nausea and 12.8% grade 3/4 leukopenia. There was a statistically significant correlation between response and expression of p53. Of 25 patients who obtained a complete clinical response, only two were classified as p53-positive (P = 0.004, χ2). Of 11 patients who obtained a complete pathological remission, one was positive (P = 0.099, χ2).Conclusion: Immunohistochemical (IHC) analysis has been shown to be a prognostic factor for patients with breast cancer in India. Paclitaxel is one of the most promising anticancer agents for the therapy of breast cancer, where it has also shown activity in tumors resistant to doxorubicin.Keywords: breast cancer, doxorubicin, p53, paclitaxel, cancer tissue biomarkers, neoadjuvant chemotherapy, immunohistochemistry, infiltrating duct cancer

A case of lipofibromatous hamartoma of the median nerve in an adult is described in this article. A 33-year-old male presented with tingling, numbness and swelling in the palm of the left non dominant hand that had been present for a few months. Examination revealed that there was fullness in the volar aspect of the wrist and in the inter-thenar area. Another mass was present at the base of the index finger, which appeared to be involving subcutaneous tissues. The clinical diagnosis was carpal tunnel syndrome due to a space occupying tumor mass in the carpal tunnel. On exploration of the carpal tunnel, a large median nerve was seen 4 cm proximal to the wrist crease line and extending distally until it divided into its branches. Another mass was present at the base of the index finger, which was adherent to the skin. The radial digital nerve of the index finger was normal in size. For the enlarged nerve, an epineurotomy was performed and a biopsy was taken. Another biopsy was taken from the distal mass. His postoperative period was uneventful. In July 2004, at the end of 5 years, the patient had no symptoms and the size of the tumor had not increased.