Search

Abstract Background We are exposed to different chemicals in various ways in our daily life, and these can be toxic at minute concentrations. The pesticides used for different purposes are also toxic and may pose threat to life by inducing oxidative stress. Dichlorvos (DDVP) is an organophosphate pesticide used for various purposes and is also reported to be toxic. In this study, the neurotoxicity of DDVP exposure was studied. The role of ginger, Zingiber officinale (ZO), was also evaluated against the neurotoxic effects of DDVP. Forty-eight Wistar rats of both the sexes were used in this study. The rats were exposed to DDVP and post-treatment with ZO was given. The oxidative stress in terms of lipid peroxidation (LPO), reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione reductase (GR) levels were estimated after exposure and treatment. Results DDVP resulted in oxidative stress, evidenced by enhanced LPO level. The simultaneous reductions in other non-enzymatic and enzymatic antioxidants were reported. The post-treatment with ZO led to a reduction in oxidative stress in rat brains. The levels of SOD, CAT, GSH, GR, and GPx were increased whereas declined levels of LPO were reported after treatment. Conclusion Hence, ginger can help mitigate the pesticide toxicity through the up-regulation of antioxidant levels.

Abstract Background The performance of transcatheter aortic valve replacement (TAVR) in patients with pre-existing prosthetic mitral valves is technically challenging due to the potential interference between both prosthetic devices. At present, there are no clear recommendations for this patient subset due to their exclusion from clinical trials. We report our experience of two cases with pre-existing prosthetic mechanical mitral valves who underwent TAVR. Case presentation The first case was a 57 year old man with severe aortic stenosis and type 2 diabetes mellitus who had a mitral valve replacement 32 years ago. Operative mortality risk assessed by the Society for Thoracic Surgery (STS) Score was 1.7%, but he was considered high risk in view of previous cardiac surgery. Pre-procedure CT evaluation revealed favorable aortic root and femoral access anatomy with the mechanical mitral valve located 6.3 mm below the aortic annular plane. He underwent TAVR with a Medtronic Evolut R 29 mm self-expanding transcatheter heart valve via the femoral approach. The second case was a 66 year old lady who presented with severe aortic stenosis, atrial fibrillation and a history of mitral valve replacement 17 years ago for rheumatic mitral stenosis. Her STS score was 3.5%. Pre-procedure CT showed favorable aortic root and femoral access parameters with a mitral-aortic distance of 3.6 mm. TAVR was performed with a balloon expandable Myval 21.5 mm transcatheter heart valve via a transfemoral access. Both procedures were done successfully. Conclusion This report highlights the feasibility of TAVR in post-mitral valve replacement patients provided careful pre-procedural evaluation, and planning is done.

Brucellosis is a rising veterinary and human health problem in India. It may manifest with a varied multisystem clinical presentation. In our case patient was of 72 years male with a complaint of abdominal pain for 2 months following COVID-19 infection. He was a known case of CAD (coronary artery disease) post PTCA status, on regular follow up & treatment. Patient had post COVID pulmonary fibrosis. When the patient admitted in our hospital with above mentioned complaints, necessary investigations along with blood culture by automated method was sent and patient was started on empirical doxycycline along with other symptomatic treatment. As the patient was not very sick and was reluctant to stay in hospital during the COVID-19 situation, he was discharged on request with a treatment and follow up plan. Blood culture was found to be positive for Brucella melitensis. When we got the blood culture report the patient was contacted telephonically and started Rifampicin along with Doxycycline for 6 weeks.

Butachlor is a herbicide that belongs to the acetanilide family. It is widely used as a granule-based post-emergence herbicide on rice in India. As a result of the ongoing usage of these synthetic substances, soil fertility and soil organisms are declining. Differential pulse voltammetry was used to determine butachlor herbicide in soil samples with a modified glassy carbon electrode voltammetric sensor with palladium-supported multiwalled carbon nanotubes (Pd@MWCNTs). Scanning electron microscopy, energy dispersive x-ray spectroscopy, and X-ray diffraction spectroscopy were used to investigate the morphology of Pd@MWCNTs, while cyclic and differential pulse techniques were used to investigate the voltammetric properties. The butachlor herbicide under voltammetric investigation involves irreversible, two-electron reduction based on the protonation of the carbonyl group (>C=O). The voltammetric method was developed for the determination of butachlor in phosphate buffer solution at pH 6.0 as a supporting electrolyte. A good linear response to butachlor in the concentration ranging from 0.10 μg⸳mL−1 to 32.0 μg⸳mL−1 was observed, and a limit of detection of 0.044 μg⸳mL−1 was obtained with the calculation based on signal/noise=3. The suggested method was efficaciously applied for the detection of butachlor in soil samples.

The colossal significance of nanostructured materials and their implications is a coherent incentive for the exploration of novel conventional techniques. This brings attention to the major problem in developing nanomaterials i.e. the hazardous nature of reactants used. The hazardous reactants are harmful to the environment. So here, biogenic synthesis of nanostructured materials utilizing natural herb extracts has enthralled prodigious implications owing to its rapid, clean, eco-friendly, non-toxic, cost-effective, and as a flipside pathway to several chemical and physiochemical approaches. Titanium oxide materials have been the cynosure for several propitious implications due to their low cost, availability, chemical stability, and biocompatibility. Herein, we developed an efficient green chemistry method for the synthesis of titanium oxide nanoparticles utilizing neem (Azadirachta Indica) extracts. The X-ray diffraction studies revealed the polycrystalline titanium oxide (rutile) structure. The spherical shape of the nanoparticles was observed in TEM and SEM images and their size ranged from 10 to 20 nm. UV–vis studies showed an exciton emission peak at about 380 nm while the IR transmission spectrum revealed the characteristic stretching modes of TiO2. It is envisioned that this novel route for the synthesis of TiO2 nanoparticles could be more beneficial in comparison to other conventional approaches. As the greener approach is being carried out in this paper, therefore, the toxic byproduct is not being released.

Background and aim: Myocardial infarction (MI) is one of the most common causes of death through the globe. Serum uric acid (SUA) is elevated in underlying tissue ischemia. This research conducted to establish the association of SUA extents with MI patients admitted to a tertiary care hospital and to compare SUA levels with Killip Classification as an early prognostic marker in these patients. Material and methods: Our study involved 100 consecutive AMI patients and 100 age- and sex-matched controls. SUA levels were estimated on the 0th, 3rd, and 7th days of MI and compared with the Killip class, indicative of the severity of heart failure. SUA was measured by the uricase method. Results: The present study has been undertaken to correlate serum uric acid level as a prognostic marker in patients with myocardial infarction. In myocardial infarction, the higher the uric acid level higher is the risk of mortality. In our study, MI and hypertensive patients had significantly higher SUA levels on days 0, 3, and 7. Also, our study showed SUA levels were significantly larger in patients who belonged to a greater Killip class (Killip III and IV). Among the ten patients who died, eight had SUA levels>7.0 mg/dL during the admission. Among those ten cases, nine patients were in the higher Killip class and one in Killip I class. Conclusions: Patients with a history of MI and hypertensive have higher SUA levels and are in the greater Killip class. A union of Killip class and SUA after AMI is a good predictor of mortality.

N, S co-doped graphene (NSG) has been synthesized by using graphene oxide, cyanamide and sodium sulphide as a source of C, N and S respectively. Due to its excellent electronic properties and stability, NSG has been used as an adsorbent for methylene blue (MB) removal from aqueous solution. Adsorption efficiencies of Graphene, N-doped graphene, S-doped graphene and NSG were compared during the study and it was found that NSG was the most efficient material for the adsorption of MB. The study was carried out in the UV-visible region by observing the changes in absorbance. NSG has excellent properties to adsorb the MB dye with a removal efficiency of 93.76±0.2%. Additionally, desorption studies were also carried out using 0.1 M cetylpyridinium chloride as cationic surfactant and the desorption% was found to be 50.28±0.1%, signifying its reusability as an adsorbent. This indicates that NSG opens a new window for the design of heteroatom-doped carbon material as well as its application in the adsorption studies. Accordingly, the synthesized material will be employed for wastewater treatment as a reusable adsorbent of MB in the near future with high efficiency and appreciable stability. In addition, the material has several other future applications such as electrode material for supercapacitor battery, sensor, adsorbent for metal ions and biomolecules, etc.

Abstract Brilliant green is a synthetic and toxic dye that is currently being utilized for various purposes, such as dying paper, leather, wool, and silk. The present study demonstrates the activated carbon preparation from waste banana peels as well as its usefulness to remove cationic dye brilliant green from aqueous medium. The dye removal was examined under a set of diverse conditions. The obtained results indicate that dye adsorption was maximum after 60 min of contact time. The removal of brilliant green dye enhances due to a rise in adsorbent dosage and becomes quantitative at 15 min of adsorbent dose. At a pH of 2, the uptake of dye by adsorbent was maximum, which decreases with the rise in pH. Langmuir isotherm was slightly better fitted than Freundlich model at varying temperatures. The experimental value of adsorption capacity was > 900 mg/g, which was observed quite close with pseudo-second-order model for brilliant green adsorption on the prepared adsorbent based on banana peel. Thermodynamic studies suggested exothermic, spontaneous, and favorable adsorption process for brilliant green dye. The adsorbent prepared in the present study can be incorporated for the treatment of wastewater contaminated with brilliant green as well as other toxic pollutants.

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

This paper presents design of a stand-alone hybrid photovoltaic (PV) energy system according to the daily electrical load demand of remote healthcare centre located in Madhya Pradesh, India. It employs an optimal design and sizing of hybrid PV energy system (PV generator, battery, inverter and diesel generator) according to load demand. An economic analysis has been presented for selection of an optimum hybrid PV energy system using a hybrid optimisation model for electric renewable (HOMER) software. Paper also presents comparison of environmental aspects of hybrid PV energy system with conventional system. The initial costs of PV–diesel–battery and diesel–battery systems are $2,418 and $879, respectively. Net present cost of PV system is $13,523 and diesel system is $20,515. Results show that hybrid PV–diesel–battery energy system is more economical and environmentally friendly energy system for remote healthcare centre. Hence, it can be concluded that the renewable energy systems is a better option for healthcare centre in remote areas. Abbreviation: PV: Photovoltaic; HOMER: Hybrid optimization model for electric renewable; IEA: International energy agency; RES: Renewable energy system; HES: Hybrid energy systems; BTS: Base transceiver station; NPC: Net present cost; COE: Cost of energy; OC: Operating cost; LCC: Life cycle cost; ALCC: Annualized life cycle cost; GHG: Greenhouse gases; DG: Diesel generator; NOCT: Nominal operating cell temperature; SOC: State of charge; CC: Capital cost; RC: Replacement cost; OM: Operation & management cost; BOS: Balance of system; CGE: Cost of generated electricity; DOD: Depth of discharge

Abstract Among various environmental pollutants, dyes have been reported to contaminate a large quantity of surface water. Rhodamine B, a widely applicable basic dye, is known for its hazardous impact on environment. The present study proposes the application of readily available waste banana peels for the remediation of water contaminated with Rhodamine B. The potential of prepared material to decontaminate Rhodamine B was examined as the function of various parameters. Variation in adsorption time, dose of adsorbent, pH value, and initial concentration has been observed under the influence of diverse condition. Quantitative adsorption was observed at a contact time of 60 min with an adsorbent dose of 12 mg. An increase in the initial dye concentration resulted in the enhancement of adsorption capacity of adsorbent. The value of enthalpy change was observed to be − 8.95 kJ mol−1. The negative value indicates the exothermic removal of Rhodamine B from water. Various models were applied to explain thermodynamics and kinetics of the process. Adsorption kinetics was better explained with pseudo-second-order model, whereas adsorption mechanism by intra-particle diffusion model reveals that pore diffusion was not only the rate-controlling step.

Abstract Background Data on intensive care unit (ICU) related psychiatric morbidity from Low Middle-Income Countries are sparse. We studied the ICU related posttraumatic stress symptoms (PTSS), anxiety, and depression symptoms in a cohort of patients from Eastern India. Methods We included adults admitted more than 24 h to a mixed ICU. PTSS, anxiety, and depression symptoms were assessed by telephonic or face to face interviews by using the Impact of Events-r (IES-r) and Hospital anxiety and depression (HADS), respectively, at 0, 7,14, 30, 90 and 180 days from ICU discharge. The loss to follow up was minimal. Demographic, socioeconomic, quality of life (QOL), and critical care related variables were studied. Results Of 527 patients, 322 (59.4%) completed 6 months’ follow up. The majority were male (60%), mechanically ventilated > 48 h (59.4%), mean age of 48 (+/− 16), mean acute physiology and chronic health evaluation II (APACHE II) at admission 9.4 (+/− 4.6), median length of stay 3 (2–28 days). The rates of ICU related clinical PTSS was

Demand of electrical energy is exponentially increasing causing environmental problems due to extensive use of fossil fuels. Hence, research has been promoted in renewable energy technologies to mitigate environmental pollution. Indian subcontinent is rich in renewable energy sources (RES). This paper describes potential of RES and region-wise installed capacity in India. Estimated potential of RES is 57 GW which is targeted to be 175 GW by 2022. A logical framework for our future research work has been presented. This includes performance optimisation of solar pumping system and reliability assessments of the designed system using reliability indices. Abbreviation: RES: Renewable energy resources; SHP: small hydro plants; GOI: Government of India; MNRE: Ministry of New and Renewable Energy; LHP: large hydropower; BCM: billion cubic metres; PEC: per-capita energy consumption; JNNSM: Jawaharlal Nehru National Solar Mission; DNI: direct normal irradiance; SPV: solar photovoltaic; UMPP: ultra mega green solar power project; GIS: geographic information systems; WMS: wind monitoring stations; MPWL: Madhya Pradesh windfarms Ltd.; MIB: mat river basin; SWAT: Soil and Water Assessment Tool; ROR: run of river; SMS: short message service; CDM: clean development mechanism; NIOT: national institute of ocean technology; LOLP: loss of load probability; CSO: Central Statistics Office; CEA: Central Electricity Authority; TERI: The Energy and Resources Institute; WPI: Wind Power India; IEA: International Energy Agency; EAI: Energy Alternatives India; BKP: Biomass Knowledge Portal; IRENA: International Renewable Energy Agency; GAIN: Global Agricultural Information Network; NITI: National Institution for Transforming India; NIWE: National Institute of Wind Energy; UP: Uttar Pradesh; J&K: Jammu and Kashmir; HP: Himachal Pradesh; NR: northern region; MP: Madhya Pradesh; WR: western region; TN: Tamil Nadu; AP: Andhra Pradesh; SR: southern region; ER: eastern region; NER: north eastern region; A&N: Andaman & Nicobar

Abstract Understanding the mechanism of precision sliding contacts with thin, adherent solid nano lubricating particle films is important to improve friction and wear behavior and ensure mechanical devices have long service lifetimes. Herein, a facile and multistep approach for the preparation of graphene oxide (GO) is presented. Subsequently, surface modification of as-synthesized GO with octadecyl amine (ODA) is performed to prepare hydrophobic GO-ODA and with 6-amino-4-hydroxy-2-naphthalenesulfonic acid (ANS) to prepare amphoteric GO-ANS through a nucleophilic addition reaction. X-ray diffraction and ultraviolet-visible, Fourier transform infrared, and Raman spectroscopy provide significant information about the reduction of oxygen functionalities on GO and the introduction of new functionalities in GO-ODA and GO-ANS. The effects of particle functionalization for the improved control of particle adhesion to the tribocontact have been studied. Wettability and thermal stability were determined using the water contact angle, and atomic force microscopy and differential scanning calorimetry (DSC) were used to characterize particle adhesion to the tribocontact. The tribological performances of the particles have been investigated using macro- and micro-tribometry using pin/ball-on-disc contact geometries. The influence of particle functionalization on the contact pressure and sliding velocity was also studied under rotating and reciprocating tribo-contact in ambient conditions. With an increase in the contact pressure, the functionalized particles are pushed down into the contact, and they adhere to the substrate to form a continuous film that eventually reduces friction. Amphoteric GO-ANS provides the lowest and most steady coefficient of friction (COF) under all tested conditions along with low wear depth and minimal plastic deformation. This is because particles with superior wetting and thermal properties can have better adherence to and stability on the surface. GO-ANS has a superior ability to adhere on the track to form a thicker and more continuous film at the interface, which is investigated by field emission scanning electron microscopy, energy dispersive spectroscopy, and Raman analysis.

Introduction: The purpose of the present study was to compare the results obtained by management of intra-articular fractures of distal end radius with closed reduction and external fixation versus open reduction and internal fixation with locking distal radius volar plate. Material and Method: The present study included 60 patients of distal intra-articular radius fractures. Patients were randomly divided into two groups: group I (close reduction and external fixator) and group II (open reduction and internal fixation with volar plating). Periodic clinical examination and x-ray review was carried out to find out functional outcome,range of motion, radiological outcome and complication. Patients were followed up for 6 month. Mean of all the quantitative variables was compared between two groups by unpaired 'T' test. Functional outcome was measured with Quick DASH score. Result: In present study palmer tilt,radial length and radial inclination was significantly greater in volar plate group.ulnar varience was more(-1.18mm) in volar plate group than external fixator group(-1.28mm). The mean QuickDASH scores and time to return to work were similar in patients treated with a locking plate and external fixator (QuickDASH score 2.4 ± 3.0 and 2.9 ± 5.4; 1.9 ± 0.5 months and 2.1 ± 0.7 months, respectively; P > 0.05).In present study Quick DASH score in ext fix group was 9.71 compaired to volar plating group 6.79 at the final followup. Complication rate were higher in close reduction and external fixation group as compared to open reduction and volar plating group. Conclusion: Open reduction and internal fixation with plate fixation had better functional outcome with less complication rate than close reduction and external fixation in management of intra-articular fractures distal end radius.

The use of L-cysteine modified silver nanoparticles (Cys-capped AgNPs) as a colorimetric probe for determination of vitamin B1 (thiamine) is described in the present work. This method is based on the measurement of red shift of localized surface plasmon resonance (LSPR) band of Cys-capped AgNPs in the region of 200–800 nm. The color of Cys-capped AgNPs was changed from yellow to colorless by the addition of vitamin B1. The mechanism for detection of vitamin B1 is based on the electrostatic interaction between positively charged vitamin B1, which causes the red shift of LSPR band from 390 nm to 580 nm. The interaction between Cys-capped AgNPs and vitamin B1 was theoretically explored by density function theory (DFT) using LANL2DZ basis sets with help of Gaussian 09 (C.01) program. The morphology, size distribution and optical properties of Cys-capped AgNPs were characterized by transmission electron microscope (TEM), UV-Visible spectrophotometry, Fourier transform infrared spectroscopy (FTIR) and dynamic light scattering (DLS) techniques. The method is linear in the range of 25–500 μg mL−1 with correlation coefficient (R2) 0.992 and limit of detection of 7.0 μg mL−1. The advantages of using Cys-capped AgNPs as a chemical sensor in colorimetry assay are being simple, low cost and selective for detection of vitamin B1 from food (peas, grapes and tomato) and environmental (river, sewage and pond) water samples.

Epidermoid cysts are common benign subcutaneous lesion also termed as epidermal cysts. Epidermoid cyst are commonly seen in hairy regions of body like scalp, face and scrotum, can be single or multiple, but rarely can occur in glabrous skin of palm and sole. They are known to result from progressive cystic ectasia of the infundibular portion of hair follicle but the pathogenesis in palmo-plantar epidermoid cyst differs that is traumatic sequestration of epidermal elements into dermis. Here, we report a case of 30-year-old female presented with complaints of swelling in her left sole. On examination a palpable firm swelling was noted just below the 2nd web space left foot plantar region, on X-ray foot no osseous lesion or foreign body was detected. Swelling was excised and sent for histopathological examination which confirmed it as epidermoid cyst.

Body size dependent mating patterns were investigated in an aphidophagous ladybird, Hippodamia variegata (Goeze), which was reared on mustard aphid, Lipaphis erysimi (Kalt.). Both males and females of varying body sizes were used to test the hypothesis that bigger is better. The costs of copulation on the life history traits of the mating partners were determined. Pairs of virgin beetles were allowed to mate once under controlled conditions and the duration of copulation of heavy beetles (504.00 ± 45.93 min) lasted significantly longer for than that of light beetles (270.00 ± 26.67 min). Body size was significantly positively correlated with duration of oviposition, fecundity and egg viability. When light individuals mated with heavy partners, copulation lasted longer between heavy males and light females (483.00 ± 54.73 min) than between light males and heavy females (378.20 ± 83.03 min). These results support the hypothesis that males determine the duration of copulation and that the reproductive success of large males is greater than that of small males. The longevity of heavy males was significantly shorter (37.40 ± 1.50 days) than that of light males (53.10 ± 2.84 days). This difference in the longevity of beetles of different sizes could contribute to the significant variation body size in H. variegata recorded both in the field and stock cultures, where light males outnumber heavy ones. Thus, although large males have a reproductive advantage over small males, other factors, such as reduced longevity, may constrain the evolution of even larger males.

Skin aging is an unavoidable aspect of human life. Premature skin aging can result from poor care, environmental pollutants, and ultraviolet radiation exposure. Wrinkles, lines, spots, uneven skin tone, and pigmentation are often indicators of skin aging. One cannot avoid aging but cosmetics and pharmaceutical approaches can minimize and delay the damage. Topical applications of biocompatible and biodegradable vehicles have been explored for delivering anti-aging compounds. Lecithin organogel (LO) is an effective vehicle for topical delivery of many bioactive agents used in aging treatment. Lecithin is cell component isolated from soya beans or eggs and purified to show excellent gelation in non-polar solvents when combined with water. LO can form a heat-stable, resistant to microbial growth, visco-elastic, optically transparent, and non-birefringent micellar system. It serves as an organic medium to enhance dermal permeation of poorly permeable drugs by effectively partitioning into the skin. Its ability to dissolve in hydrophilic as well as in lipophilic drugs makes it a dynamic vehicle, which can be explored as a carrier for anti-aging agents.

BACKGROUND AND PURPOSE: Liver dysfunction led hyperammonemia (HA) causes a nervous system disorder; hepatic encephalopathy (HE). In the brain, ammonia induced glutamate-excitotoxicity and oxidative stress are considered to play important roles in the pathogenesis of HE. The brain ammonia metabolism and antioxidant enzymes constitute the main components of this mechanism; however, need to be defined in a suitable animal model. This study was aimed to examine this aspect in the rats with acute liver failure (ALF). METHODS: ALF in the rats was induced by intraperitoneal administration of 300 mg thioacetamide/Kg. b.w up to 2 days. Glutamine synthetase (GS) and glutaminase (GA), the two brain ammonia metabolizing enzymes vis a vis ammonia and glutamate levels and profiles of all the antioxidant enzymes vis a vis oxidative stress markers were measured in the cerebral cortex and cerebellum of the control and the ALF rats. RESULTS: The ALF rats showed significantly increased levels of ammonia in the blood (HA) but little changes in the cortex and cerebellum. This was consistent with the activation of the GS-GA cycle and static levels of glutamate in these brain regions. However, significantly increased levels of lipid peroxidation and protein carbonyl contents were consistent with the reduced levels of all the antioxidant enzymes in both the brain regions of these ALF rats. CONCLUSION: ALF activates the GS-GA cycle to metabolize excess ammonia and thereby, maintains static levels of ammonia and glutamate in the cerebral cortex and cerebellum. Moreover, ALF induces oxidative stress by reducing the levels of all the antioxidant enzymes which is likely to play important role, independent of glutamate levels, in the pathogenesis of acute HE.

The meticulous knowledge of anatomic characteristics and their variations is essential for the clinician. Radix entomolaris (RE) is one such anomaly where an extra root is present on the distolingual aspect of the mandibular first molar. 18-year-old patient was referred for the root canal treatment of mandibular right and left first molars. Intraoral periapical radiograph revealed additional periodontal spacing crossing distal root of 36. A CBCT was advised and it confirmed the presence of extra roots both in 36 and 46. CBCT is useful in endodontics as it aids in the identification of essential anatomic structures and determination of radius and angle of root canal curvature which is linked to fracture of the instrument. The classical triangular access cavity was modified to a trapezoidal form to locate the extra canal. All canals were instrumented with controlled memory nickel titanium instruments and obturation was done with single cone technique.