Third trimester HbA1c as a prognostic indicator in the prediction of large-for-gestational age babies in South Indian women with gestational diabetes mellitus: A cross-sectional study

Background: The prevalence of hyperglycemia first detected during pregnancy is showing an escalating increase in recent years contributed by the increasing obesity prevalence, advanced maternal age at delivery, and the universal screening protocol during the first antenatal visit. There exists a very little data on the role of HbA1c in pregnancy and the results remain inconsistent. There is a need to define diagnostic criteria to predict the adverse perinatal outcomes in gestational diabetes mellitus (GDM). Aims and Objectives: This study was aimed to assess the role of HbA1c as a prognostic indicator of third trimester mean blood glucose in GDM pregnancies and in predicting the birth of large for gestational age (LGA) babies. Materials and Methods: 200 pregnant women with GDM and 200 pregnant women without GDM and their neonates participated in this analytical cross-sectional study. Maternal age, height, weight, BMI, and neonatal birth weight were recorded. Third trimester maternal HbA1c level was analyzed by high-performance liquid chromatography. The association between HbA1c and LGA births was analyzed. Results: The mean HbA1c levels and percentage of LGA births were high in GDM group. Multiple logistic regression analysis showed association between high HbA1c values and LGA births in GDM. A Receiver operating characteristic curve was drawn to derive the optimal cut-off value, sensitivity, and specificity of HbA1c in predicting birth of LGA neonates in GDM. Conclusion: This study shows that high third trimester HbA1c levels in GDM increase the risk of LGA births. Further studies are needed to define standard cut-off values of glycated Hb in each trimester of pregnancy.

Effect of age and menopause on anthropometric parameters in non-obese and obese South Indian women

Background: Men and women show differences in the distribution of body fat. Women tend to store more fat subcutaneously compared to men. Fat distribution changes in postmenopausal women. Understanding the changes in anthropometry with age and menopausal status is important in the context of deriving population, age, and gender-specific cutoff levels for obesity indices. Aims and Objectives: This study was conducted with the objectives of measuring Waist Circumference (WC), Waist-Hip Ratio (WHR), and Waist-Height Ratio (WHtR) in South-Indian women and determining the effect of age and menopause on the anthropometric parameters in non-obese and obese women. Materials and Methods: 290 women between the age group of 30 to 70 years participated in this analytical cross-sectional study. Age and menopausal status were recorded. Anthropometric parameters such as weight, height, WC, and hip circumference were measured. Body-mass index, WHR, and WHtR were derived. The data were analyzed to compare mean values of anthropometric parameters between premenopausal and postmenopausal women using unpaired t-test. The difference in anthropometric status was also compared between those with Body mass index (BMI) in the non-obese range and those with BMI in the obese range in relation to menopausal status. Results: A higher proportion of women were classified as having abdominal obesity based on WHtR cutoff compared to classifying using WC cutoff. Postmenopausal women showed higher mean values of all measured anthropometric parameters, but the difference was significant only for WHR. When the study subjects were analyzed based on BMI categories, a significant difference between pre and post-menopausal women was recorded in WHtR values in the non-obese BMI group, but not in the obese BMI group when analyzed by unpaired t-test. Conclusion: Anthropometric parameters show an increasing trend as age advances. There is a difference in mean values of all parameters between pre and post-menopausal women, though statistical significance was seen only for WHR and WHtR in different sub-groups based on BMI. Further studies are needed to decide on the need for separate cutoff values for postmenopausal women.

Abdominal fat distribution and its relationship to sagittal abdominal diameter (SAD) and SAD-height ratio – An analytical cross-sectional study in the South Indian population

Background: The prevalence of obesity is increasing in developing countries like India. This will place a great burden on the health infrastructure of the country. Early identification and intervention are the keys to managing this important problem. Since Asians tend to have more visceral body fat for any given body mass index (BMI), lower cut-off values have been suggested for different anthropometric parameters. Studies determining the correlation of Sagittal abdominal diameter (SAD) and SAD-height ratio (SADHtR) with total visceral fat volumes measured by computed tomography (CT) scan abdomen quantification are limited in the South Indian population. Aims and Objectives: This study was conducted with the objectives of measuring BMI, SAD, SADHtR, and comparing the correlation of the measured anthropometric parameters with visceral and subcutaneous abdominal fat volumes measured using CT scan abdomen in both the genders in South Indian population. Materials and Methods: This analytical cross-sectional study was done in a hospital setting with a sample size of 566 (276 men and 290 women-aged 30–70 years). Weight, height, and BMI were measured. SAD was measured electronically from a CT image at the L4–L5 level. SADHtR was derived. Total abdominal fat volumes, subcutaneous abdominal fat volumes, and visceral abdominal fat volumes were measured in cm3 from the dome of the liver to the pubic symphysis using software for CT-based quantification of fat volumes between ?190 and ?30 Hounsfield units threshold limits. The data were tabulated and analyzed to compare mean values between men and women and to find the correlation between the anthropometric parameters and visceral fat volume using Pearson’s correlation test. Results: The difference in mean values of BMI, SAD, and SADHtR between the sexes was statistically significant. SAD showed the highest correlation with visceral fat volume in both genders. BMI showed a higher correlation with subcutaneous adipose tissue volume than with visceral adipose tissue volume. Conclusion: Both SAD and SADHtR can be used as simple and reproducible anthropometric tools to identify the presence of increased visceral fat volume in both genders in our population.

The Effect of Head Loading on Cervical Spine in Manual Laborers

Methods@#The study comprised 62 subjects. Of this number, 32 subjects (group A) were unskilled laborers from the construction industry; the other 30 subjects (group B) were in the control group and had never previously carried heavy weights on their heads. Cervical spine radiographs were taken for all the 62 subjects. Subjects in group A were asked to carry a load (approximately 35 kg) on their heads and walk for about 65 m, with their cervical spine radiographs taken afterward. @*Results@#The mean ages of patients in groups A and B were 27.17 and 25.75 years, respectively. The mean cervical lordosis observed in group A (18.96°) was dramatically less compared with group B (25.40°), showing a further decrease in head loading (3.35°). Five subjects had a reversal of lordosis (−5.61°). A statistically significant reduction in disc height and listhesis was observed when the load was carried on the head with a further decrease after walking with the load. Accelerated degenerative changes, particularly affecting the upper cervical spine, were observed in head loaders. @*Conclusions@#Carrying a load on the head leads to accelerated degenerative changes, which involve the upper cervical spine more than the lower cervical spine and predisposes it to injury at a lower threshold. Thus, alternative methods of carrying loads should be proposed.

Clinical correlation of cardiac functions and troponin I and CPK-MB in dengue fever in children

Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the World. The spectrum of manifestations includes mild fever to severe and life-threatening disease, though uncommon complications such as myocarditis have also been reported in many cases. We conducted this study to analyze association between Clinical Profile, Cardiac Functions and Troponin I and CPK-MB (cardiac biochemical markers) in children with Dengue Fever. Aims and objectives of the study was the association between Clinical Profile, Cardiac Functions and Troponin I and CPK-MB (cardiac biochemical markers) in children with Dengue Fever.Methods: This was a prospective observational study in which 80 paediatric patients who were hospitalized anddiagnosed to be having Dengue fever were included. All patients were stratified into either of the 3 groups- Dengue without warning signs, Dengue with warning signs and severe Dengue. A detailed history and thorough clinical examination were done for all patients. A complete blood count, electrolytes, hepatic and renal function tests were done in all children. Cardiac function was assessed by 2D Echo, CPK-MB and Troponin-I, p value less than 0.05 was taken as statistically significant.Results: Of the 80 studied cases there were 53 (66.25%) males and 27 (33.75%) females with a M:F ratio of 1.9:1. Dengue with and without warning signs was seen in 27.5% and 60% cases respectively whereas severe dengue was seen in 12.5% cases. The ejection fraction was comparable across the 3 groups. On 2D echo ejection fraction was 62.95%, 63.21% and 65.1% in cases with warning signs, without warning signs and severe dengue respectively. Additionally, ECG abnormalities were seen in 8.75% patients. All 80 patients had a normal CPK-MB and Troponin-I levels.Conclusions: Cardiac markers (CPK-MB and Troponin-I) remain unaffected during Dengue illness and do not have significant correlation between Dengue without warning signs, Dengue with warning signs and severe Dengue.

Morphological Changes in the Ligamentum Flavum in Degenerative Lumbar Canal Stenosis: A Prospective, Comparative Study

Methods@#Forty patients were prospectively recruited and divided into two groups: group 1 included 20 patients with degenerative LCS aged >55 years and group 2 included patients with LDH aged <35 years. The ligament flava were collected during the patients’ surgery. The features noted on histopathological examination included the fibrosis score, the loss of elastic fibers, calcification, chondroid metaplasia, mucinous degeneration, vascularization, long septa, clefts, granulation tissue, and ganglion-like cysts. The features noted on electron microscopic examination included the elastic fiber thickness, the quality of elastic fibers, the elastic:collagen ratio, calcification, melanin fibers, remnants of necrotic cells, and electron-dense material in the LF. All parameters were compared between group 1 and group 2. @*Results@#On histopathological examination, the two groups exhibited significant differences regarding three parameters: chondroid metaplasia, long septa, and ganglion-like cysts. On electron microscopy examination, significant differences were observed between the two groups regarding two parameters: the quality of elastic fibers and the elastic:collagen ratio. @*Conclusions@#Characteristic morphological changes may be noted on histopathological and electron microscopic examination that mark the degenerative changes in the LF that contribute to the occurrence and pathogenesis of degenerative LCS.

Morphological Changes in the Ligamentum Flavum in Degenerative Lumbar Canal Stenosis: A Prospective, Comparative Study

Methods@#Forty patients were prospectively recruited and divided into two groups: group 1 included 20 patients with degenerative LCS aged >55 years and group 2 included patients with LDH aged <35 years. The ligament flava were collected during the patients’ surgery. The features noted on histopathological examination included the fibrosis score, the loss of elastic fibers, calcification, chondroid metaplasia, mucinous degeneration, vascularization, long septa, clefts, granulation tissue, and ganglion-like cysts. The features noted on electron microscopic examination included the elastic fiber thickness, the quality of elastic fibers, the elastic:collagen ratio, calcification, melanin fibers, remnants of necrotic cells, and electron-dense material in the LF. All parameters were compared between group 1 and group 2. @*Results@#On histopathological examination, the two groups exhibited significant differences regarding three parameters: chondroid metaplasia, long septa, and ganglion-like cysts. On electron microscopy examination, significant differences were observed between the two groups regarding two parameters: the quality of elastic fibers and the elastic:collagen ratio. @*Conclusions@#Characteristic morphological changes may be noted on histopathological and electron microscopic examination that mark the degenerative changes in the LF that contribute to the occurrence and pathogenesis of degenerative LCS.

Risk Factors and Surgical Treatment for Recurrent Lumbar Disc Prolapse: A Review of the Literature

We aim to present the current evidence on various risk factors and surgical treatment modalities for recurrent lumbar disc herniation (rLDH). Using PubMed, a literature search was performed using the Mesh terms “recurrent disc prolapse,” “herniated lumbar disc,” “risk factors,” and “treatment.” Articles that were published between January 2010 and May 2017 were selected for further screening. A search conducted through PubMed identified 213 articles that met the initial screening criteria. Detailed analyses showed that 34 articles were eligible for inclusion in this review. Sixteen articles reported the risk factors associated with rLDH. Decompression alone as a treatment option was studied in seven articles, while 11 articles focused on different types of fusion surgery (anterior lumbar interbody fusion, posterior lumbar interbody fusion, open transforaminal lumbar interbody fusion [TLIF], and minimally invasive surgery-TLIF). Management of the rLDH requires consideration of the possible risk factors present in individual patients before primary and at the time of second surgery. Both, minimally invasive and conventional open procedures are comparably effective in relieving leg pain, and minimally invasive techniques offer advantage over the other technique in terms of tissue sparing. Non-fusion surgeries involve the risk of lumbar disc herniation re-recurrence, and the patient may require a third (fusion) surgery.

First Report of Agrobacterium rhizogenes-induced Hairy Root Formation in Selaginella bryopteris: a Pteridophyte Recalcitrant to Genetic Transformation

Abstract we report A. rhizogenes-induced hairy root formation in S. bryopteris, a medicinally and commercially important plant. A. rhizogenes strain LBA1334 co-cultivated with explants (root, rhizophore, stem portion near the root, and stem with intact fronds) for 24 and 48 h after transformation for induction of hairy roots. The induction of hairy root was observed after 6 days of infection in case of 48 h co-cultivation only. PCR with rolA and virC gene specific primers confirmed the induced hairy roots were due to Ri T-DNA integration and not due to contaminating A. rhizogenes. The root network as explants showed the maximum transformation efficiency. We tested different media like MS, SHFR (Stage Hog Fern Root) and KNOP's during transformation for hairy root induction. The SHFR based media showed good response in transformation as well as propagation. Further, transformation efficiency was enhanced by addition of TDZ (2 mg/L) and Bevistin (0.1%) in SHFR media. The present work would be helpful in hairy roots-based in vitro production of secondary metabolites and on aspect of functional genomics of S. bryopteris.

A novel, new generation drill coating for osteotomy site preparation

Background: Implant success and survival rate ranges from 93% to 97%; however, failures are not very uncommon. These failures can be caused due to a variety of reasons out of which increased heat during drilling of osteotomies is a major contributor.Aim: The aim of this study was to develop a new generation diamond-coated drill and compare the thermal changes between commercially available drills and the experimental diamond coated drill during implant site preparation in artificial bone. Material and Methods: Three types of drills were selected for the study; Group A (Carbide), Group B (Stainless Steel), and Group C (Experimental). A total of 60 implant site preparations were performed with all the drills in artificial bone using a surgical unit linked to a testing device, in order to standardize implant drilling procedures. Bone temperature variations were recorded when drilling at a depth of 10 mm. A constant irrigation of 50 ml/minute and drilling speed of 800 r.p.m. was maintained. Results: The mean temperature of Group A, Group B, and Group C was 35.57°C, 36.83°C and 34.23°C, respectively. The results were assessed and statistically analyzed using ANOVA test and post hoc Bonferroni test. Statistically significant higher temperatures were obtained with stainless steel drill and carbide drill when compared with the experimental diamond coated drill. (P = 0.000). Conclusions: Diamond coated osteotomy drills have shown promising results in reducing heat generation at the osteotomy. Further studies need to be conducted to maximize the potential use of diamond as components of drills in implant dentistry.

Does the Surgical Timing and Decompression Alone or Fusion Surgery in Lumbar Stenosis Influence Outcome in Cauda Equina Syndrome?

STUDY DESIGN: A retrospective comparative analysis of 64 patients with cauda equina syndrome (CES), who underwent either decompression alone (NF) or fusion (F) surgery. PURPOSE: We compared the outcomes and timing effects. OVERVIEW OF LITERATURE: CES can cause loss of autonomic control of vesicular function and lower limb neurological deficits. Prompt diagnosis and emergency surgery markedly improve outcome. Although decompression only is a mainstream technique, there is guarded recovery of vesicular dysfunction. Decompression ventrally in a narrow window requires manipulation of neural tissue in an already jeopardised critical canal and may accentuate irreversible damages. In F surgery, the adequate exposure leads to a lower neural manipulation. METHODS: Until January 2008, we treated CES with decompression (laminectomy and/or discectomy). However, from that month forward, all our single-level CES patients have received a fusion operation. In this study, characteristic categorical variables and outcomes were analysed. RESULTS: In a retrospective analysis of 64 patients, NF (n=37) and F (n=27) who received treatment, we found that both groups improved significantly on follow-up in all objective parameters. Although, the comparison of clinical and functional outcome data between the two groups was statistically insignificant, the average value of objective outcome such as vesicular function, low back pain (LBP), and complications was better for patients in F group compared with NF group. However, the patient satisfaction for the F group was also lower, in view of their residual symptoms and disabilities. Contrary to common perceptions, we found that the timing of surgery does not influence the recovery rate for either approach. CONCLUSIONS: Although both the techniques appear to be equally effective, the fusion approach overall showed a definite edge over non-fusion, with respect to reduced incidence of iatrogenic dural tears, LBP, and overall outcome, even despite the lower patient satisfaction.

An Interesting Case Of Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis can be difficult to diagnose because there are no specific diagnostic tests and arthritis is often not evident early in the course. We present a case of systemic juvenile idiopathic arthritis involving multiple small and large joints along with flexion contractures. Investigations revealed iron deficiency anemia and a positive rheumatoid factor. Patient was started on DMARDs, corticosteroids and iron supplements.

Cost Effective Pilot-scale Ajmalicine Production by Catharanthus roseus Cell Suspension Cultures in a 100 Lit Bioreactor

Aims: The cosmic production of biomass and bioactive compounds at pilot scale with minimum production costs is an important task to achieve feasible production process of corresponding secondary metabolites at a commercial level. Materials and Methods: The cell suspension cultures of Catharanthus roseus in MS medium supplemented with 2, 4-dichlorophenoxyacetic acid (9.05 µM), kinetin (4.52 µM) were scaled up in a pilot plant bioreactor (100 lit). The cost of production was reduced by addition of substitute carbon source in a basal medium which hardly costs 30% in the medium. Preliminary studies were performed in the 7-lit bioreactor. A 100 lit stainless steel bioreactor equipped with helical impeller top mounted was used for scale-up of C. roseus suspension cultures and ajmalicine production. Results: The culture medium reduced the cost by 36% by addition of commercial grade sugar whereas medium consist of tissue culture grade sucrose costs 53 USD per 100 lit. The suspension cultures were cultivated in a 100 lit bioreactor containing MS medium fortified with cost-effective carbon source produced ajmalicine 73.18 mg/l DW and achieved 36 kg of fresh biomass on day 20. Conclusion: The results of the present finding demonstrated the feasible and cost-effective production process of ajmalicine at pilot scale.

Inhibition of TNFα-interacting protein α (Tipα)-associated gastric carcinogenesis by BTG2(/TIS21) via downregulating cytoplasmic nucleolin expression

To understand the regulation of Helicobacter pylori (H. pylori)-associated gastric carcinogenesis, we examined the effect of B-cell translocation gene 2 (BTG2) expression on the biological activity of Tipα, an oncoprotein secreted from H. pylori. BTG2, the human ortholog of mouse TIS21 (BTG2(/TIS21)), has been reported to be a primary response gene that is transiently expressed in response to various stimulations. Here, we report that BTG2 is constitutively expressed in the mucous epithelium and parietal cells of the gastric gland in the stomach. Expression was increased in the mucous epithelium following H. pylori infection in contrast to its loss in human gastric adenocarcinoma. Indeed, adenoviral transduction of BTG2(/TIS21) significantly inhibited Tipα activity in MKN-1 and MGT-40, human and mouse gastric cancer cells, respectively, thereby downregulating tumor necrosis factor-α (TNFα) expression and Erk1/2 phosphorylation by reducing expression of nucleolin, a Tipα receptor. Chromatin immunoprecipitation proved that BTG2(/TIS21) inhibited Sp1 expression and its binding to the promoter of the nucleolin gene. In addition, BTG2(/TIS21) expression significantly reduced membrane-localized nucleolin expression in cancer cells, and the loss of BTG2(/TIS21) expression induced cytoplasmic nucleolin availability in gastric cancer tissues, as evidenced by immunoblotting and immunohistochemistry. Higher expression of BTG2 and lower expression of nucleolin were accompanied with better overall survival of poorly differentiated gastric cancer patients. This is the first report showing that BTG2(/TIS21) inhibits nucleolin expression via Sp1 binding, which might be associated with the inhibition of H. pylori-induced carcinogenesis. We suggest that BTG2(/TIS21) is a potential inhibitor of nucleolin in the cytoplasm, leading to inhibition of carcinogenesis after H. pylori infection.

Establishment of CT diagnostic reference levels in select procedures in South India

Background: to suggest South India CT diagnostic reference levels [DRLs] by collecting radiation doses for the most commonly performed CT examinations

Materials and Methods: a pilot study investigated the most frequent CT examinations. 110 CT sites were asked to complete a survey booklet to allow the recording of CT parameters for each of 3 CT examinations during a 1 year time period. Dose data such Volumetric Computed Tomography Dose Index [CTDI[v]] and Dose length product [DLP] on a minimum of 50 average-sized patients in each category were recorded to calculate a mean site CTDI[vol] and DLP value. The rounded 75[th]percentile was used to calculate a DRL for each site and the region by compiling all results. Results are compared with international DRL data

Results: data were collected for 16,500 patients. All equipment had multislice capability [2-256 slices]. DRLs are proposed using CTDI[vol] [mGy] and DLP [mGy.cm] for CT head [47 and 1041 respectively], CT chest [10 and 445 respectively], and CT abdomen [12 and 550 respectively]. These values are lower than current DRLs and comparable to other international studies. Wide variations in mean doses are noted across the region

Conclusion: baseline figures for South India CT DRLs are provided on the most frequently performed CT examinations. It was noted that there was a wide variation in mean doses among the CT scanners used during diagnosis. The differences in CT doses between CT scanner departments as well as identical scanners suggest a large potential for optimization of examinations

Investigation of Immune Biomarkers Using Subcutaneous Model of M. tuberculosis Infection in BALB/c Mice: A Preliminary Report

Evaluation and screening of vaccines against tuberculosis depends on development of proper cost effective disease models along with identification of different immune markers that can be used as surrogate endpoints of protection in preclinical and clinical studies. The objective of the present study was therefore evaluation of subcutaneous model of M.tuberculosis infection along with investigation of different immune biomarkers of tuberculosis infection in BALB/c mice. Groups of mice were infected subcutaneously with two different doses : high (2x10(6) CFU) and low doses (2x10(2) CFU) of M.tuberculosis and immune markers including humoral and cellular markers were evaluated 30 days post M.tuberculosis infections. Based on results, we found that high dose of subcutaneous infection produced chronic disease with significant (p<0.001) production of immune markers of infection like IFNgamma, heat shock antigens (65, 71) and antibody titres against panel of M.tuberculosis antigens (ESAT-6, CFP-10, Ag85B, 45kDa, GroES, Hsp-16) all of which correlated with high bacterial burden in lungs and spleen. To conclude high dose of subcutaneous infection produces chronic TB infection in mice and can be used as convenient alternative to aerosol models in resource limited settings. Moreover assessment of immune markers namely mycobacterial antigens and antibodies can provide us valuable insights on modulation of immune response post infection. However further investigations along with optimization of study protocols are needed to justify the outcome of present study and establish such markers as surrogate endpoints of vaccine protection in preclinical and clinical studies in future.

Spontaneous emergence of overgrown molar teeth in a colony of Prairie voles (Microtus ochrogaster) / 国际口腔科学杂志·英文版

Continuously growing incisors are common to all rodents, which include the Microtus genus of voles. However, unlike many rodents, voles also possess continuously growing molars. Here, we report spontaneous molar defects in a population of Prairie voles (Microtus ochrogaster). We identified bilateral protuberances on the ventral surface of the mandible in several voles in our colony. In some cases, the protuberances broke through the cortical bone. The mandibular molars became exposed and infected, and the maxillary molars entered the cranial vault. Visualisation upon soft tissue removal and microcomputed tomography (microCT) analyses confirmed that the protuberances were caused by the overgrowth of the apical ends of the molar teeth. We speculate that the unrestricted growth of the molars was due to the misregulation of the molar dental stem cell niche. Further study of this molar phenotype may yield additional insight into stem cell regulation and the evolution and development of continuously growing teeth.

A randomized controlled clinical trial of Ocimum sanctum and chlorhexidine mouthwash on dental plaque and gingival infl ammation.

Background: Periodontal diseases are ubiquitous, affecting all dentate animals. Regular methods for controlling it have been found to be ineffective, which have paved the way for the use of herbal products as an adjunctive to mechanical therapy as they are free to untoward effects and hence can be used for a long period of time. Ocimum sanctum is a plant which has the greater medicinal value and enormous properties for curing and preventing disease. Objective: In the present study we assessed the effectiveness of Ocimum sanctum on dental plaque, gingival infl ammation and comparison with gold standard chlorhexidine and normal saline (placebo). Materials and Methods: A triple blind randomized control trial was conducted among volunteered medical students. They were randomly allocated into three study groups: (1) Ocimum sanctum mouthwash (n = 36); (2) Chlorhexidine (active control) (n = 36); (3) normal saline (negative control) (n = 36). Assessment was carried out according to plaque score and gingival score. Statistical analysis was carried out later to compare the effect of both mouthwash. ANOVA (Analysis of variance) and post-hoc LSD tests were performed using software package used for statistical analysis (SPSS) version 17. P ≤0.05 was considered as statistically signifi cant. Results: Our result showed that Ocimum sanctum mouthrinse is equally effective in reducing plaque and gingivitis as Chlorhexidine. The results demonstrated a signifi cant reduction in gingival bleeding and plaque indices in both groups over a period of 15 and 30 days as compared to control group. Conclusion: The results of the present study indicate that Ocimum sanctum mouthrinse may prove to be an effective mouthwash owing to its ability in decreasing periodontal indices by reducing plaque accumulation, gingival infl ammation and bleeding. It has no side effect as compared to chlorhexidine.

Use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenopathy

<p><b>INTRODUCTION</b>This study assessed the clinical utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of suspected granulomatous mediastinal lymphadenopathy.</p><p><b>MATERIALS AND METHODS</b>Retrospective chart review of all patients who underwent EBUS-TBNA for suspected granulomatous mediastinal lymphadenopathy at Singapore General Hospital between December 2008 and December 2011 inclusive.</p><p><b>RESULTS</b>Over a period of 3 years, a total of 371 patients underwent EBUS-TBNA of whom 33 (9%) had the procedure performed for evaluation of suspected granulomatous mediastinal lymphadenopathy - 18 for suspected tuberculosis (TB) and non-tuberculous mycobacterial (NTM) lymphadenitis, and 15 for suspected sarcoidosis. EBUS-TBNA was diagnostic in 9 of the 13 patients with a final diagnosis of TB/NTM. EBUS-TBNA cultures were positive in 6 of them (46%), 1 showed acid-fast bacilli (AFB) although cultures were negative, and 2 had necrotising granulomatous inflammation from EBUS-TBNA biopsies and sputum cultures grew TB. EBUS-TBNA was diagnostic in 9 of the 14 patients with a final diagnosis of sarcoidosis through histology showing non-caseating granulomatous inflammation. The sensitivities of EBUS-TBNA for diagnosis of TB/NTM, sarcoidosis and overall granulomatous mediastinal lymphadenopathy were 69%, 64%, 64%; the negative predictive values were 56%, 17%, 33%; and accuracies were 78%, 67%, 70%, respectively.</p><p><b>CONCLUSION</b>EBUS-TBNA can be useful in the diagnosis of suspected granulomatous mediastinal lymphadenopathy with sensitivities and accuracies of >60%.</p>

Two-Stage Surgical Management of Multilevel Symptomatic Thoracic Haemangioma Using Ethanol and Iliac Crest Bone Graft

This article presents a 56-year-old obese female who presented with back pain and progressive weakness in her lower limbs for three months. She was bed-ridden for one week before reporting to our hospital. Plain radiographs showed vertical striations in multiple vertebrae classical of haemangioma. Magnetic resonance imaging (MRI) spine revealed multiple thoracic and lumbar vertebral haemangiomas. Extra osseous extension of haemangioma at T12 was causing spinal cord compression. Two-stage surgery was performed with absolute alcohol (ethanol) injection followed by pedicle screw fixation and decompression with tricortical iliac crest bone graft into the vertebral body. Postoperatively rapid neurological improvement was seen. After three weeks, she could walk independently. One year later, computed tomography showed complete incorporation of bone graft and maintained vertebral body height. MRI showed complete resolution of the cord edema at T12. These findings indicated diminished vascularity of the tumor.