Echocardiographic Evaluation of Right Heart in Patients of Chronic Obstructive Pulmonary Disease

Cardiac involvement in Chronic Obstructive Pulmonary Disease (COPD) is a significant cause of morbidity, mortality, and even death. We aimed to study the echocardiographic evaluation, especially of the right heart, in patients of COPD and to co-relate findings of echocardiography with the clinical profile and severity of COPD of such patients.METHODSWe performed a cross-sectional study for a period of 2 years. The patients were subjected to necessary investigations and transthoracic echocardiography for evaluating the right heart parameters. Data was entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A p value of <0.05 was considered statistically significant. RESULTSOf the 50 COPD cases studied, the majority (22) fulfilled GOLD stage IV criteria followed by 14 cases in GOLD stage II. Right atrial pressure was increased in 52% study subjects. Pulmonary artery systolic pressure had values of more than 25 mmHg in 68% of patients. RV thickness was >5 mm in 56% subjects. TAPSE was measured to be <17 mm in 50% COPD cases. A significant association was seen between severity of COPD and RA pressure, RV size, RV pressure/pulmonary artery pressure, RV thickness and TAPSE.CONCLUSIONSSignificant prevalence of right heart dysfunction is found in COPD and there was a significant association of cardiac parameters with severity of COPD. Thus it is recommended that all patients of COPD should undergo right heart evaluation by echocardiography so that treatment modalities can be changed to minimize morbidity and mortality

Morphometric analysis of the mandibular ramus and its clinical and medicolegal significance

Background: During natural calamities entire skeleton of single person could not be found. In such case, determination of sex with fragments of the bone available required range of data with proven accuracy. Hence this study is aimed at to provide range of data for minimum number of parameters of the ramus of the mandible.Methods: Three hundred dry mandibles of known sexes and bearing all teeth or intact alveolar margin were included in the study. Vertical height; maximum and minimum breadths of the ramus of the mandible were measured. All the data were analyzed for significance of the occurrence in relation to sex and laterality by means of paired t-test.Results: On the basis of all the three parameters together, we got 95% accuracy in determination of sex. Statistically significant differences were found in all parameters between male and female mandibles. The laterality distributions for all the parameters were found to be insignificant.Conclusions: Accurate determination of sex from the available bone fragments such as the ramus of the mandible required wide number of data from the least parameters that could be utilized medicolegally.

Study Of Pattern Of Distribution Of Mylohyoid Bridging And Their Clinical Implications

Background: The occurrence of mylohyoid bridges in mandible resulting compression of inferior alveolar andmylohyoid nerves, and vessels, is important cause of neuropathy in this region.Aim and objective: The present study was aimed at analyzing influence of sex and laterality in the occurrence ofmylohyoid bridging in Indian population, and establishing a clue to the underlying causes of paraesthesia ofidiopathic origin, in the territory of inferior alveolar and mylohyoid nerves.Methods: We studied 300 human mandibles (141 female and 159 male) for location and degree of mylohyoidbridging.Results: We found mylohyoid bridges in 15.66% mandibles. The proximal bridging was found more frequentlythan the distal bridging. The mylohyoid bridges were found in 7.8% female and 13.2% in male mandibles studied.We found mylohyoid bridges on 5% on right side and 5.66% on the left side, bilateral bridging was found in 5.33%mandibles.Conclusion: The frequency of occurrence of mylohyoid bridging was higher in male; however, laterality was not tobe significant amongst the mandibles studied. The location and degree of mylohyoid bridging are one of theimportant etiological factors of paraesthesia in the region of inferior alveolar and mylohyoid nerves distribution.

Profiling of Pro-Inflammatory Cytokines in Radiation Induced Oral Mucositis (RIOM) among Indian patients

Radiation-induced oral mucositis (RIOM) is aimed at evaluating the expression of NF-κß, IL-1α, IL-6, IL-8 and TNF-α in patients with RIOM so as to validate their role in the pathobiology of the disease. Blood samples were collected and serum of 45 patients isolated with clinical signs and symptoms of mucositis and 10 healthy controls were also included in the study. The expression level of NF-κß, IL-1α, IL-6, IL-8, TNF-α was investigated using ELISA. Mann Whitney U test was applied to find the significance of the expression of these markers in RIOM patients as compared to normal healthy controls and significant expression (P< 0.05) for NF-κß, IL-6, TNF-α and non-significant expression (P > 0.05) IL-1α and IL-8 was found. No significant change in the expression level of the cytokines was observed for patients undergoing chemotherapy and radiation therapy as well as those receiving only the radiation therapy as a part of their treatment. We have also found less expression in grade 1 of mucositis as compared to grade 4. Pro- inflammatory cytokines indeed play a vital role in the pathogenesis as well as progression of RIOM (AU)

Psammomatoid Type Juvenile Ossifying Fibroma of Mandible: A Rare Entity.

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous neoplasm that arises within the craniofacial bones. Two distinct histopathological variants have been described; trabecular JOF and psammomatoid JOF (PsJOF). The later occurs predominantly in craniofacial skeleton and rarely in jaws and more so in mandible (50% of the times than that in maxilla). Here we report a rare case of PsJOF in mandible body ramus region with its unique radiographic characteristics to help the diagnostician approach the diagnosis very closely for this rare entity. The tumor has been present since 1 year with unilocular radiographic appearance; having homogeneous ground-glass appearance with higher imaging, without any focal radio-opacity and inferior alveolar canal was displaced but still intact. Thus these lesions can expand to large sizes even without maturing to its radiopaque stages and without destruction of adjacent vital structures although displacing them.

A histological study of ovarian tumors in different age groups.

Background: Tumours are the most common type of lesion encountered in the ovary. With exception of these neoplasms, the ovary appears remarkably resistant to disease. There are numerous types of ovarian tumours, both benign and malignant. About 80% are benign and these occur mostly in younger women between the ages 20 and 45 years. The malignant tumours are more common in age groups between 40 and 65. Aims & Objective: To study the histopathology of ovarian tumors in different age groups. Materials and Methods: This retrospective study included all consecutive cases with histopathologically proven ovarian tumors, reported from Department of Pathology of N.H.L Municipal Medical College. These included those patients who were operated at V.S Hospital or were operated somewhere else but the specimen was processed in Department of Pathology of N.H.L Municipal Medical College, irrespective of the surgical procedure by which tumor was removed. World Health Organization classification of ovarian tumors was used for classifying the tumors. Hematoxylin and eosin is the routine method for histological study. Hematoxylin is used to define the nucleus by its blue-black colour and its finer details. Commonly used Eosin is Eosin 'Y'. Results: Out of 100 ovarian tumors included, 73% were benign and 27% were malignant. Surface epithelial tumors were most common (59%), followed by germ cell tumors (14%). Benign surface epithelial tumors comprised 80% (59/73) of all benign tumors whereas their malignant counterpart formed 70.37% (19/27) of all malignant tumors. Conclusion: Benign tumors are more common than malignant ones for all age groups. Surface epithelial tumors are most common class of tumors in both benign and malignant tumours. Serous cystadenoma is the most common ovarian tumor overall as well as most common benign tumor whereas serous cystadenocarcinoma is most common malignancy. Malignant ovarian tumors are more common above 40 years.

A Study of Interparietal Bone in 105 Human Skulls of Gujarat Population.

Introduction : The squamous portion of the occipital bone consists of two different parts: the upper interparietal and the lower supraoccipital. The interparietal part may remain separated from the supraoccipital by a suture; it is then called the interparietal or Inca bone. Aim : In this study, incidence of interparietal bone has been estimated and compared with the other observations. Methodology : Total 105 cadaveric dry human skulls were examined to determine incidence of interparietal bone. Observations : The skulls which were observed, displayed many variations in the occipital region. In 7 cases, single or multiple separated bones were observed. In 4 cases (3.81%), the lower edge of these additional bones was situated above the external occipital protuberance and such bones could be classified as interparietal bones. In 3 cases (2.86%), the lower edge of these additional bones was much higher (between the lambda region and the highest nuchal line). The later can be classified as preinterparietal. Importance : Knowledge of interparietal bone is important for the radiologists, neurosurgeons, anthropologists, orthopedics and forensic experts to avoid misdiagnosis.

Efficacy of Homeopathic Combination - BPA Drug in Prehypertension and Hypertension: A Pilot Study.

Aims and objectives: The primary objective of the study was to evaluate and document the evidence-based efficacy and safety of the study drug in lowering blood pressure (BP). The secondary objectives included efficacy of the study drug in improving symptoms, quality-of-life (QOL) and biochemical parameters including treadmill and Doppler echocardiography. Study design: Phase IV post-marketing/surveillance study. Material and methods: Thirty-five subjects with prehypertension and hypertension (Stage 1 and Stage 2), attending the OPDs and camps of Heart Care Foundation of India were enrolled for the nonplacebo-controlled prospective study. The subjects were given homeopathic combination BPA (study drug) in liquid dosage for 12 weeks. Baseline clinical and biochemical parameters, treadmill test and Doppler echocardiogram were compared with the same parameters at the end of 12 weeks. Sixteen subjects completed the study. Results: There was a mean fall in systolic BP (SBP) of 15.75 mmHg and mean fall in diastolic BP (DBP) of 10.31 mmHg without any side effects. This significant decline in BP was evident from 4th week onwards. There was an appreciable increase in the exercise tolerance as evident by the 8.6% increase in metabolic equivalents (METs) and 8.2% increase in exercise time. No significant changes were observed in systolic or diastolic function parameters on Doppler echocardiography at three months. There was decrease in blood sugar from 96.5 ± 13.938 at baseline to 92.56 ±12.329 at 12 weeks (p = 0.046). Serum uric acid levels also decreased from 5.681 ± 0.8998 at baseline to 6.031 ± 0.8822 at 12 weeks (p = 0.053) suggesting a beneficial effect of the combination on insulin resistance (IR). There were positive changes in the QOL as assessed by SF36 Questionnaire. The average Rand score improved from 54.53 ± 21.9991 to 77.55 ± 10.493 at 12 weeks (p < 0.001). All data are presented as mean ± standard deviation (SD). Conclusion: The results of the study showed that the study drug can be safely used as monotherapy in patients with prehypertension or hypertension with no complications.

Cervical rib.

Cervical rib is a supernumerary rib. It is one of the deformities of the musculoskeletal system. According to Terves and Keith, there is always a rudiment of a cervical rib in the fetus which usually disappears but in 1-2 %, it persists throughout life. Only a part of this percentage has symptoms. Genetic Factors may play a role. Clinical important: It causes pressure on brachial-plexus or subclavian artery. These structures are entrapped between the cervical rib and scaleneus muscle. There is positive Adson’s sign i.e. radial pulse is lost in the arm during abduction and external rotation of the shoulder. There is compression of brachial plexus which causes weakness of muscles of the hand near base of the thumb. This is known as THORACIC OULET SYNDROME. A supernumerary rib develops from anterior tubercle of cervical vertebra- like Meckel’s Diverticulum. Incidence 5 – 6 % .Mostly an incidental finding

Role of p53 and bcl2 as markers of vitamin A response in premalignant lesions of the oral cavity.

Oral cancer accounts for 40 to 50% of cancers diagnosed in India. Oral cancer is preceeded in most cases by pre malignant lesions-leukoplakia, submucous fibrosis and lichen planus. Stoppage of causative agents reverts premalignant lesions in some of the cases only. Thus anti oxidant therapy is being used to revert premalignant change to normal. Few studies available, have taken clinical parameters as indicators of response to therapy. Extensive medline search failed to reveal any study at the cellular level. This study attempts to investigate for the first time the role of p53 and bcl2 as markers of prognosis following vitamin A therapy. 24 cases of pre malignant lesions of oral cavity were studied. 1 lakh IU of vitamin A were given orally twice a week for 3 months. Biopsies were done before and after therapy. Haematoxylin and Eosin stain was done to confirm diagnosis. Immunostaining for mutant p53 and bcl2 was done on paraffin sections. 500 cells were counted over an average of 5 HPF and percentage positivity was calculated. Statistical analysis was done by applying the paired t tests. In 19 cases (79.2%) of premalignant lesions mutant p53 expression was zero before therapy, and remained unchanged even after the therapy. 3 cases (12.5%) had high mutant p53 values which reduced following therapy (p = 0.037). Therapy thus proved effective in these cases. However, in 2 cases (8.3%) pre therapy values of zero showed an increase after vitamin A therapy. These were the cases which had dysplasia and were chronic smokers. In 2 cases (8.3%) pre therapy values of bcl2 were zero and remained unchanged even after therapy and these cases did not stop smoking even during the vitamin A therapy. In 12 cases (50.0%) higher pre therapy values were reduced after therapy (p < 0.0001). Vitamin A therapy was effective in these cases. However, in 10 cases (42.0%) expression of bcl2 increased subsequent to therapy. Therapy failed in these cases because of chronic heavy smoking and tobacco chewing. Thus, in the majority of cases vitamin A was effective in preventing mutation of p53 (91.7%) and expression of bcl2 (58.0%). In effect, these two oncoproteins can be used as prognostic markers and follow up for anti oxidant therapy.

Ultrasound Evaluation of Gallbladder Disease in Pregnancy

The study was carried out to find out the incidence of gallbladder disease in pregnancy in patients reporting at SMGS Hospital, Jammu (J&K). A total of 200 pregnant females, 100 from symptomatic and 100 from asymptomatic group in the age range of 16-40 year were studied. The incidence of gallstones during pregnancy was found to be 6%. The incidence of gallstones in pregnancy in the asymptomatic group was found to be 3% while it was higher (9%) in the symptomatic group. Nine percent of patients from the asymptomatic group while 27% of patients from the symptomatic group had biliary sludge. The incidence of gallbladder disease was higher in patients with high parity, higher body mass index, having used oral contraceptives and with family history of gallbladder disease. Thus, young pregnant patients specially with risk factors mentioned above should be subjected to ultrasonographic examination to rule out gallbladder disease.

Meckel-Gruber Syndrome: Sonographic Detection.

Meckel-Gruber syndrome is a rare congenital foetal anomaly. We present a report of two cases where the diagnosis was made on antenatal ultrasound examination and confirmed later on when the pregnancies were terminated.