Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Abstract Background and aims: Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. Methods: Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. Results: All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). Conclusion: Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.

Universal slit-lamp–mounted mobile adapter with 20 D lens for fundus photography: “Litter to glitter”

Fundus photography is an arduous task as it involves using 90 D in one hand and a smartphone attached on an eyepiece of a slit-lamp biomicroscope in the other hand. Similarly, with a 20 D lens, the filming distance is adjusted by moving the lens or mobile forward or backward, which makes it difficult to adjust and focus the image in busy ophthalmology outpatient departments (OPDs). Moreover, fundus camera costs thousands of dollars. Authors describe a novel technique of performing fundus photography with a 20 D lens and a universal slit-lamp–mounted mobile adapter made from trash. By the use of this simple, yet frugal innovation, primary care physicians or ophthalmologists without a fundus camera can easily snap a fundus photo and subject it to digital analysis by retina specialists across the world. This will help in simultaneous ocular examination and fundus photos taken via mounted 20 D on a slit lamp itself and also reduce the need for unnecessary retina referrals to tertiary eye care centers.

An observational study on the presence of perilimbal conjunctival pigmentation in vernal keratoconjunctivitis

Purpose: To evaluate presence of perilimbal pigmentation (PLP) in Indian patients with vernal keratoconjunctivitis (VKC). Methods: A cross sectional study was conducted from 2019 to 2020 at a tertiary eye care center in Western Maharashtra, India. In this study, 152 cases of VKC were identified. The presence, type, color, and extent of PLP were recorded. The incidence of presence of PLP was calculated. Its correlations with severity and duration of VKC were analyzed using Wilcoxon–Mann–Whitney U test and Chi square test. Results: Of 152 cases, 79.61% were males. Mean age at presentation was 11.4 ± 5.6 years. The characteristic PLP was present in 81 cases (53.29%; 95% confidence interval [CI]: 45.03%–61.42%; P < 0.001), of which 15 cases (18.5%) had this pigmentation in all the four quadrants. There was a significant difference between the groups with respect to quadrants involvement in terms of the extent of PLP in clock hours (?2 = 73.85, P < 0.001). However, the extent did not correlate with age (rho = 0.08, P = 0.487), sex (P = 0.115), time since onset in months (rho = 0.03, P = 0.77), duration of VKC and type or color of PLP (P = 0.12). Conclusion: Perilimbal pigmentation seems to be a consistent clinical finding seen in a significant number of VKC cases. It may benefit ophthalmologists in treating VKC cases when the palpebral/ limbal signs are elusive.

Vision related quality-of-life among patients with traumatic or non-traumatic ocular disease and its association with the Rights of Persons with Disabilities Act: Unveiling-the-hidden

Purpose: To assess vision?related quality of life (VrQoL) in cases with visual loss after ocular trauma (OT) or non?traumatic ocular disease (NTOD) using the National Eye Institute’s 25?Item Visual Function Questionnaire 25 (VFQ?25) and its association with visual disability % (VD%) based on the Rights of Persons with Disabilities (RPwD) Act, 2016. Methods: This was a prospective observational study conducted among cases with ocular morbidity in either or both eyes with a visual acuity of ?6/24. VFQ?25 questionnaire was administered to measure QoL scores. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 23. P < 0.05 was taken as significant. Results: Eighty-eight respondents completed the questionnaire. Mean age of participants was 40.272 ± 9.35 years (range: 23–55 years). Forty?three (48.9%) and 45 (51.1%) participants had OT and NTOD, respectively. The most common cause was traumatic optic neuropathy (21.6%) followed by corneal causes (19.4%). Low visual QoL scores were reported in all the cases (57.52 ± 16.08). Between OT and NTOD, a significant difference in terms of age (P = 0.001) and general vision (P = 0.03) was seen. Lowest scores were for driving. Based on VD%, 77 cases had ?40 and the rest had >40% VD with a significant difference in overall mean scores (P = 0.03), specifically in domains of general vision (P = 0.00), near activities (P = 0.00), and driving (P = 0.007). QoL was decreased in each subscale of ?40%VD group, who faced the same predicament everywhere as by the cases with more disability. Conclusion: Ocular morbidity is associated with low QoL, predominantly in domains like general vision, near activities and driving. The RPwD Act leaves out a huge population with VD without any government benefits. One might need to consider other vision?related factors also to provide them with social, psychological, and employment benefits.

Lung ultrasonography as a tool to guide perioperative atelectasis treatment bundle in head and neck cancer patients undergoing free flap reconstructive surgeries: a preliminary observational study / Ultrassonografia pulmonar como ferramenta para orientar o tratamento perioperatório de atelectasia em pacientes com câncer de cabeça e pescoço submetidos a cirurgia reconstrutiva com retalho livre: um estudo observacional preliminar

Abstract Introduction: General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries. Objective: The purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma. Methods: Twenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO2/FiO2 ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied. Results: Among twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56±33.5min vs. 66.7±15.7min; p = 0.005). The change in lung ultrasound score significantly correlated with change in PaO2/FiO2 ratio (r = −0.56, p = 0.03). Elevated total leukocyte count >8200 ΜL and serum lactate >2.1 mmoL/L also predicted prolonged postoperative mechanical ventilation. Conclusion: This preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.

Resumo Introdução: A anestesia geral causa atelectasia pulmonar poucos minutos após sua indução. Isso pode ter um impacto significativo no resultado pós-operatório de pacientes com câncer submetidos a cirurgias reconstrutivas prolongadas. Objetivo: Avaliar o impacto das atelectasias perioperatórias detectadas por ultrassonografia na necessidade de suplementação pós-operatória de oxigênio, terapia broncodilatadora e fisioterapia respiratória assistida em pacientes com carcinoma de cabeça e pescoço submetidos a cirurgias com uso de retalho livre. Método: Foram submetidos a avaliações ultrassonográficas pulmonares bilaterais antes e após a cirurgia 28 pacientes com câncer de cabeça e pescoço. Os escores de ultrassonografia pulmonar, lactato sérico, razão PaO2/FiO2 foram medidos no início e no fim da cirurgia. Os pacientes foram avaliados na posição supina e o número de linhas B confluentes e únicas foi observado. Esses valores foram correlacionados com a necessidade de oxigenoterapia, necessidade de broncodilatadores e tempo total de desmame para predizer o resultado pós-operatório. Outros fatores que afetam o desmame também foram estudados. Resultados: Entre os 28 pacientes, sete apresentaram escore médio de ultrassonografia pulmonar ≥ 10,5, que se correlacionou com o tempo de desmame prolongado (144,56 ± 33,5 minutos vs. 66,7 ± 15,7 minutos; p = 0,005). A mudança no escore de ultrassonografia pulmonar correlacionou-se significantemente com a mudança na razão PaO2/FiO2 (r = −0,56, p = 0,03). A contagem total elevada de leucócitos > 8200 uLe o nível de lactato sérico >2,1 mmoL/L também previram ventilação mecânica pós-operatória prolongada. Conclusão: Este estudo preliminar detectou um nível significante de atelectasia perioperatória com ultrassonografia pulmonar no local de atendimento em pacientes com câncer de cabeça e pescoço submetidos a reconstruções cirúrgicas de longa duração. Escores mais altos de ultrassonografia pulmonar enfatizaram a necessidade de nebulizações broncodilatadoras frequentes e fisioterapia respiratória assistida e foram associados a desmame tardio. Propomos avaliações ultrassonográficas pulmonares mais frequentes no local de atendimento e o uso de manobras de recrutamento para reduzir o impacto das atelectasias pulmonares perioperatórias.

Effect of Atorvastatin and Rosuvastatin on the Glycemic Control in Patients with Type II Diabetes Mellitus: A Comparative, Randomized, Double-Blind Study

Objectives: To compare the effects of atorvastatin and rosuvastatin in type II diabetes mellitus (T2DM) patients with dyslipidemia. Materials and Methods: Eighty patients with history of T2DM of more than 3 months duration, glycated hemoglobin <7%, dyslipidemia, and normal electrocardiogram were included in the randomized double-blind trial. The patients received either tablet atorvastatin 20 mg or rosuvastatin 10 mg once a day along with metformin and glimepiride twice daily orally. Patients were evaluated by the change in estimated average glucose (eAG), lipid profile, and incidence of adverse drug reactions (ADRs). Results: Rise in fasting blood sugar (FBS), postprandial blood sugar, and eAG were significant in the atorvastatin group as compared to the rosuvastatin group where there was a significant increase only in FBS levels. Changes in lipid parameters and incidence of ADR were similar in both the groups. Conclusion: Rosuvastatin can be preferred to atorvastatin in T2DM with dyslipidemia due to less variation in the blood sugar parameters, effective control over lipid profile, pleiotropic effects, and less microsomal interactions.

A study of maternal outcome in term premature rupture of membranes in a tertiary care hospital

Background: Premature rupture of membranes (PROM) remains a subject of great clinical relevance. The present study was conducted to study maternal morbidity and its relationship with PROM-delivery interval in patients with term PROM as compared to patients without PROM.Methods: A prospective case control study was conducted in the department of obstetrics and gynecology, Kasturba Hospital, New Delhi. 100 pregnant patients presenting to the labor room with features of PROM at term (POG>37 weeks) were taken as cases and 100 term pregnant women (age and parity matched) with intact membranes were taken as controls and compared in terms of maternal outcome.Results: This study reported maternal morbidity rate of 21% in term PROM cases which was significantly higher than in control group (5%). The major cause was febrile morbidity which occurred in 16% of cases indicating ascending infection. Other complications were abdominal and episiotomy wound infection (4%), chorioamnionitis (2%), postpartum hemorrhage (2%) and puerperal sepsis (1%). There was an increased rate of operative delivery in the case group (33%) as compared to 18% in patients without PROM. Duration of PROM-delivery interval had a significant direct proportional impact on the maternal morbidity. The duration of combined hospital stay of mother and neonate was also increased.Conclusions: Patients with term PROM have significant maternal morbidity which was mainly due to infection. The duration of the hospital stay was also significantly increased.

Spectrum of Secondary Glomerular Diseases in Adult Nephrotic Syndrome.

Background: In developing countries like India, thecauses for end stage renal failure has been changingwith glomerular diseases occupying an important place.The trend of various primary and secondary causes ofNephrotic Syndrome (NS) over the past few decadeshas been debatable especially with reference togeographical locations. Aim and Objectives: This studywas intended to find out the histologic patterns ofglomerular disease associated with NS in South Indiaand analyze the corresponding clinical and biochemicalabnormalities associated with these conditions.Material and Methods: One hundred eighty eightpatients in the age group of 18-80 years with NS whounderwent renal biopsy between the periodst thfrom1 January 2018 to 30 September 2019 wereincluded in this study. Baseline investigations and otherinvestigations related to renal profile evaluationincluding complement levels and HIV antibody weredone. Results: Focal Segmental Glomerulosclerosis(FSGS) accounted for the majority (25.5%) amongprimary glomerular diseases while among thesecondary glomerular diseases Lupus Nephritis (LN)(51.19%) constituted the majority and a substantialcontribution from Human Immunodeficiency VirusAssociated Nephropathy (HIVAN). LN was seen onlyin female patients with a mean age of 33.36 ± 10.74years. Among LN, Class III was the most predominantwhile Class IIIC was less frequent. C3 and C4complement levels were less than normal in Class IVand Class variants of LN. Conclusion: This studyhighlights the spectrum of Lupus Nephritis and HIVassociated nephropathy as a cause for adult NS in atertiary care center in South India

Comparative feasibility of two World Health Organization partographs to predict prolonged labour: a randomized control trial

Background:One of the major causes of maternal mortality is obstructed labor. Identificationof abnormal labor at earliest and timely management can prevent prolonged labor and significantly reduce its sequel. Partograph is a useful tool in hands of labor caregiversto monitor labor course.The study was done to compare feasibility of two WHO partographs a composite partograph including the latent phase with a simplified one without the latent phase to predict prolonged laborin randomized control trial.Methods:A randomized controlled trial, with parallel arm design was conducted. Sample size was calculated as 404 pregnant women .They were randomly categorized in two groups,each group having 202 participants.Results:labor had crossed the alert line in 108 (53.4%) cases monitored by composite partograph and 38(18.8%) cases monitored with simplified partograph. The calculated P value was <0.0001. The odds ratio calculate was 4.95 and 95% confidence interval was 3.16 to 7.76. Labor crossing the action line was found in 16 (7.9%) in composite partograph whereas in simplified partograph, labor had crossed the action line in 18 casesin simplified group. Calculated P value was 0.72 (>0.05). The odds ratio was 0.8793and 95% confidence interval 0.43 to 1.77 which was not significant statistically .Most participants (70%) experienced difficulty with the composite partograph, but no participant reported difficulty while plotting the simplified partograph. Conclusions: WHO simplified partograph was found to be as good as WHO composite partograph in identifying maternal and perinatal outcomes and was more user friendly.

Epidemiology of Gallbladder Cancer in North India - a Radiological Descriptive Study

Introduction: Gallbladder cancer (GBC) is one of thecommonest cancers in North India. Despite the high incidence,very little data is available of the staging distribution ofGBC in this region. We aimed at getting a snapshot of thedistribution of GBC at a single high volume centre.Material and Methods: One hundred and forty sevenpatients who were evaluated between 1st July 2017 and 31stOctober 2018 for staging of GBC, were included in this study.Radiological staging was done according to the AJCC TNM8th edition using a standardized reporting format.Results: Majority of patients were females (70%). Fundus ofGB was the most common site of tumor (39.4%) and liver(76.8%) was the most common adjacent organ involved aswell as the most common site of metastatic disease (36%).Only 42 (28.5%) patients had non-metastatic disease.Biliary obstruction was present in 63 (42.8%) patients, withmajority being type 2 hilar blocks (65%). Loco-regional nodalinvolvement was present in 87.1% patients, station 12 nodalinvolvement being most common (76.1%).Conclusion: This is the first study to describe the distributionof GBC stages in the high incidence region of North India.This should provide information for future research andfunding for GBC related research.

Renal Pathologies in Medicolegal Autopsies (150 Cases)

The autopsy has for long been regarded as the gold standard as the most important tool for retrospective quality assessment of clinical diagnosis as well as a key education tool. In autopsy the kidneys are examined for disease, injury and other findings suggesting cause of death or related changes. Grossly some of the diseases may be easily noted on autopsy. Since kidney biopsy is usually avoided in critically ill patient ,histologic evaluation of autopsy of kidneys may be the first and the only opportunity to identify these diseases. Objectives: 1) To study the pattern of histological findings in kidney in minimum 150 autopsy cases based on the material received in Pathology department, GMC, Patiala. 2) To study the latent form of the disease, which couldn’t be diagnosed in lifetime, whenever full data is available. 3)To establish the exact cause of death on renal autopsy findings, wherever possible. 4) To find discrepancy with clinical diagnosis if the data are available. Methods: The present study is an observational study that was conducted over a period of two years. Postpartum renal specimens were received from August, 2016 onwards with a total of 150 cases. The specimens were preserved in 10% formalin immediately after autopsy and were received in fully sealed jars. A thorough gross examination of renal specimens including measurements, weights, consistency, cut surface, details of any lesions if preserved were recorded. Subsequently samples were processed for histopathology. The sections were thoroughly examined microscopically on 4x, 10x, and 40x power of the microscope for any pathology and the results were recorded. Results: In 57 cases (38%) microscopic findings were close to normal histology with no nephropathological diagnosis. 68 cases with tubular and interestial pathology included 43 cases of acute tubular necrosis (28.6%), 3 cases with acute pyelonephritis(2%), 2 cases with chronic pyelonephritis(1.3%) and 20 cases were noted to have cloudy swelling in the tubule(13.3%). Conclusion: In the present study majority of renal autopsies revealed histopathological pattern suggestive of tubular pathologies of which most common was acute tubular necrosis as a cause of sudden collapse of patient leading to death.

Genetic variants of chromosome 9p21.3 region associated with coronary artery disease and premature coronary artery disease in an Asian Indian population

Introduction Asian Indians have a propensity for premature, severe, and diffuse coronary artery disease (CAD). Several single-nucleotide polymorphisms (SNPs) in the ‘core CAD’ region of the chromosomal region 9p21.3 are known to be strongly associated with CAD. Objectives We aimed to study SNPs in the 9p21.3 region associated with CAD and premature CAD and identify their association with demographic and clinical characteristics in an Asian Indian population. Methods SNP genotyping was performed for 30 SNPs of the 9p21.3 region using MassARRAY® technology. Along with demographic and SNP data analysis, we also performed multivariate logistic regression analysis and multifactor dimensionality reduction analysis to study SNP–SNP and SNP–demographic/clinical variable interactions. Results Our results suggest that females are at a higher risk of premature CAD. We found that SNPs rs1333045 (CC), rs16905599 (AA), rs2383206 (GG), rs2383208 (AG), and rs4977574 (GG) were significantly associated with premature CAD. When adjusted for covariates/confounders, we found that rs2383206 showed the strongest risk association with CAD followed by rs16905599 and rs2383208. Further, SNPs rs1333049 (CC) and rs4977574 (GG) were found to be exclusively associated with premature CAD cases, suggesting their potential as genetic markers for premature CAD in the local population. Upon gender-based stratification, it was found that rs10757272 (TT and TC) is significantly associated with eightfold to ninefold CAD risk specifically among females. SNP rs7865618 (GG) is significantly associated with more than 2.5-fold CAD risk specifically among males. Conclusion Our study suggests that SNPs at the 9p21 risk locus may be used to generate a reliable genetic risk score along with markers at other loci.

A study of clinical profile of patients with organophosphorus poisoning

Background: Depression, a common mental disorder characterized by persistent unhappiness and lack of interest in daily activities, is one of the major important public health problems that are often comorbid with other chronic diseases like diabetes and can worsen the effect of the disease outcomes. Depression alone and/or as a comorbidity with diabetes is a common condition in the community. Aim of the study: To identify the prevalence of Depression among Type 2 Diabetes Mellitus patients and relationship between Depression and its effect on Drug Compliance among Type 2 Diabetes Mellitus patients, to determine the severity of Depression among Type 2 Diabetes Mellitus patients and the extent to which it affects Drug compliance. Materials and methods: The study was to be conducted in Rajah Muthiah Medical College and Hospital, Chidambaram in the year 2018-2019. A hundred patients with diagnosis of T2DM attending Diabetic OPD above 20 years of age were randomly selected. The Hamilton rating scale for depression by Hamilton is the most widely used rating scale to assess the symptoms of depression. The Ham-D is an observer-rated scale consisting of 17-21 items. Ratings are based on clinical interview. The items are rated on either a 0 to 4 spectrum or a 0 to 2 spectrum. The HAM-D also relies quite heavily on the clinical interviewing skills and the experience of rater in evaluating individuals with depressive illness. The strength of HAM-D is its excellent validation/research base, K.H. Mohamed Ibrahim, R. Gandhi Babu, M. Senthil Velan. Prevalence of psychiatric morbidity (depression) and its effect on drug compliance among patients attending diabetic outpatient clinic. IAIM, 2019; 6(11): 19-28. Page 20 and case of administration. Its use is limited in individuals who have psychiatric disorders other than primary depression. Results: Analyzing with HAMD score, 40 had no depression, mild depression in 24 cases, moderate depression in 21 cases, severe depression in 15 cases. MAQ score scale- low adherence in 41 cases, medium adherence in 37 cases, high adherence in 22 cases. MMAQ score scale and HAMD scorelow adherence with no depression were 9 cases (22.5%) mild depression were 6 cases (25%) moderate were 11(52.4%) severe depression were 15 cases (100%). MMAQ score scale and HAMD score - medium adherence with no depression were 23 cases (57.5%) mild depression were 9 cases (37.5%) moderate were 5(23.8%) severe depression were not seen. MMAQ score scale and HAMD score - Medium adherence with no depression were 8 cases (20%) Mild depression were 9 cases (37.5%) Moderate were 5(23.8%) severe depression was not seen. Pearson Chi-Square = 35.344**, p<0.001. Conclusion: Further, there was a significant association between the depression in Type 2 diabetes patients and medication adherence, where patients with depression had poor medication adherence as compared to those without depression and severity of depression correlates with worse adherence to diabetic medications

A questionnaire based study of adverse drug effects of antiepileptic drugs in a tertiary care hospital in Central India

Background: Epilepsy is a common disorder of brain function which affects around 1% of world population. Due to nature of chronicity of this disease, long term medical treatment with Anti-Epileptic Drugs (AEDs) is required to achieve control of the seizures. Antiepileptic drugs are responsible for 5% of ADRs among all of the prescribed drugs. Due to the significant number of adverse drug reactions spontaneous reporting and knowledge about ADRs have gained the importance. Knowledge(K), attitude (A) and practices (P) studies are preferred nowadays so as to have the better understanding and implication of the studies for the benefit of the patients. Therefore, this study was planned to evaluate Knowledge, Attitude and Practices (KAP) regarding Anti-Epileptic Drug (AEDs) therapy in epileptic patients and their relatives and to create awareness regarding the same.Methods: A questionnaire based study for assessment of KAP during a period of 2 months in patients of epilepsy and their relatives.Results: The maximum side effects were seen in central nervous system and functions (80%) followed by dermatological problems (6.57%), visual defects (5.19%), GIT complaints (4.84%) and lastly sexual function impairment (3.34%). Carbamazepine was most commonly prescribed drug followed by phenytoin. Certain gender and age specific adverse events were found. 95% patients were found to be compliant with medicines’ dose and schedule.Conclusions: The chronicity of epilepsy calls for long duration of treatment so consideration and addressing ADRs are essential to maintain compliance among patients.

Descriptive Evaluation of Cigarettes and Other Tobacco Products Act in a North Indian City.

Background: India is a signatory to Framework Convention on Tobacco Control and also enacted cigarettes and other tobacco products Act (COTPA) in 2003. Objectives: To undertake a comprehensive assessment (Section 4, 5, 6, 7, 8, and 9 under COTPA) of legislation against tobacco products in a North Indian city. Methods: An observational, crosssectional study was conducted at 108 public places which included educational institutions, offices, health institutes, transit sites, and hotels/restaurants. Structured checklists with compliance indicators for various sections under COTPA were used. Different brands of tobacco products were observed for pictorial warnings. Results: No active smoking was observed at 80.5% public places, while 54.6% places had displayed “No smoking” signage. About 68.5% public places were found free of evidence of smell/ashes of recent smoking, and 86.1% places had no smoking aids. Merely, one-third public places (36.1%) were complying with all Section 4 indicators. Around 42.3% point of sale had advertisements of tobacco products, and 73.1% had a display of tobacco products visible to minors. Around 60% educational institutions displayed signages as per Section 6b of COTPA, and 32.5% had tobacco shops being run within 100 yards of institution’s radius. There was minimal smoking activity within the campus. Health warnings were present in 80.8% of tobacco products, more with Indian brands as compared to foreign brands. Conclusion: The city of Chandigarh, which was declared the first smoke-free city of India, showed poor compliance with COTPA.

split mouth randomized clinical comparative study to evaluate the efficacy of gingival depigmentation procedure using conventional scalpel technique or diode laser

Introduction: dark or black coloured gingiva is an esthetic concern especially in subjects with high lip line or gummy smile. Gingival depigmentation procedure is a type of perioplastic surgery where the gingival epithelium is excised with various techniques to lighten the colour of the gingiva. The aim of this study was to compare the clinical efficacy of gingival depigmentation procedure with conventional scalpel technique and diode laser application

Methods: this split mouth randomized study was conducted on 12 subjects [18-40 years of age], exhibiting melanin hyperpigmentation of gingiva. The anterior labial sextant of maxilla and mandible were divided into two halves involving three anterior teeth i.e. central incisor, lateral incisor and canine on each side. The divided areas were randomly allotted for depigmentation procedure either with scalpel technique or diode laser operating at 980 nm wavelength. Various parameters such as bleeding, pain, difficulty of procedure and wound healing were assessed and compared between the two techniques. The level of melanin pigment was assessed with Dummette Gupta index and photographic analysis with the help of adobe software. The subjects were followed up to one year to see for recurrence of melanin pigmentation

Results: bleeding during surgery, pain score and difficulty of procedure assessed by the operator were statistically higher for scalpel technique as compared to laser technique. Wound healing did not show any statistical significant difference between both techniques. Gingival depigmentation procedures with scalpel as well as laser technique were effective when compared preoperatively and at consecutive postoperative visits, and this was statistically significant. Comparison of melanin depigmentation procedure between scalpel and laser technique did not show any significant differences at all postoperative intervals

Conclusion: the findings of the present study suggest that gingival depigmentation was effective with both scalpel and laser techniques. However, the laser treated sites showed reduced pain experienced by the patient and better operator comfort. Slight melanin repigmentation was observed in three subjects treated with scalpel depigmentation procedure at the end of one year

Retreatment Efficacy of Propoint and Guttapercha - A Cone Beam Computed Tomography Analysis.

Introduction: The present study aimed to evaluate the amount of residual material after retreatment of propoint (DRFP Ltd. Stamford, UK) and gutta-percha obturated using smart paste bio sealer (DRFP Ltd. Stamford, UK), considering gutta-percha and AH Plus (Dentsply Maillefer, Ballaigues, Switzerland) as the standard for comparison. Methods: Forty five single rooted teeth were instrumented using rotary files (F3, Protaper, Dentsply Maillefer, Ballaigues, Switzerland). Obturation was done with three different materials (n=15); group 1, Propoint with smart paste bio, group 2, gutta-percha with smart paste bio and group 3, gutta-percha with AH Plus. Teeth were scanned by cone beam computed tomography to measure the volume of obturation material. After three months of storage, retreatment was performed (Protaper universal rotary retreatment files, Dentsply Maillefer, Ballaigues, Switzerland). Second scan of cone beam computed tomography was taken to evaluate the residual filling material. Group comparisons were performed using one way ANOVA and Post-Hoc Tukey test HSD test (P=0.05). Results: There was no statistically significant difference between the three groups (P<.05), in the residual filling material. Conclusions: In conclusion, the results of this study indicate that the obturation material could not be removed completely in all the three groups. There was no significant difference in the retreatment efficacy between propoint and gutta-percha.

Morphometric Study of Thyroid Cartilages in Western India.

Background: Morphometrical evaluation of the larynx has always been interesting for both morphologists and the physicians. A good understanding of the anatomy and the knowledge of variations in the laryngeal cartilages is important Objective: Objective of the present study was to collect exact and reliable morphometric data of thyroid cartilage in adult human larynx of regional population. Methods: The totals of 50 thyroid cartilage specimens were studied. The cartilages were preserved in 5% formalin. Themeasurementswere takenwith the help of Digital Vernier Caliper. The cartilages wereweighed on Single pan electronic balance. For each of the parameters, the mean, standard deviation (S.D.) and range was calculated. Results: Mean depth of superior thyroid notch was 9.7± 3.36 mm. Asymmetry between the length of superior horn of thyroid cartilages in left and right sides can be seen, but difference was not statistically significant (p>0.05). It is observed that inner thyroid angle varies from55 to 1040and outer thyroid angle varies from53 to 990. In present study mean weight of thyroid cartilage was 6.70±1.55 grams. Conclusions: A fair amount of intersubject variability in the dimensions was observed. Bilateral asymmetry, though present in majority of specimens, was insignificant. Various dimensions of thyroid cartilages are smaller as compared to the western population.

Emergency obstetric hysterectomy: a retrospective study from a teaching hospital in North India over eight years

We sought to determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency peripartum hysterectomy in an easily accessible urban center. We conducted a retrospective, observational, and analytical study over a period of eight years, from August 2006 to July 2014. A total of 56 cases of emergency obstetric hysterectomy [EOH] were studied in the Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi. The incidence of EOH in our study was 30 per 100,000 following vaginal delivery and 270 per 100,000 following cesarean section. The overall incidence was 83 per 100,000 deliveries. Atonic postpartum hemorrhage [25%] was the most common indication followed by placenta accreta [21%] and uterine rupture [17.5%]. The most frequent sequelae were febrile morbidity [19.2%] and disseminated intravascular coagulation [13.5%]. Maternal mortality was 17.7% whereas perinatal mortality was 37.5%.A balanced approach to EOH can prove to be lifesaving at times when conservative surgical modalities fail and interventional radiology is not immediately available. Our study highlights the place of extirpative surgery in modern obstetrics in the face of rising rates of cesarean section and multiple pregnancies particularly in urban settings in developing countries

Morphological Variations of Muscle Plantaris: Anatomical and Clinical Insight.

Background: Plantaris is the largest muscle in mammals other than primates. Plantaris muscle has been a subject of much confusion and Evolutionists have speculated on its phylogenetic significance, as a vestigial organ, while surgeons have removed it ‘useless vestige’ to employ its tendon as a spare part for the surgical repair. In humans it is reduced greatly in size, power, and function and may even be absent. Aim: With this background the aim of the present work is to study morphology, describe the observed variations of the Plantaris muscle, and to discuss the functional significance of Plantaris muscle. Methodology: For the present work 84 limbs available in the department of Anatomy were dissected. The posterior aspect of the knee was dissected using standard surgical equipment and dissection techniques. The Plantaris muscle was isolated and length of fleshy belly and tendon were measured. Any variations in origin, insertion and size were recorded. Result: Variation in insertion of the Plantaris has observed like insertion along medial margin of tendocalcaneus on to calcaneus, in front of tendocalcaneus on to calcaneus, fused to tendocalcaneus and insertion of the Plantaris on deep fascia of leg at the level of ankle. Other variations noted were two bellies of the Plantaris one from lateral supracondylar ridge and other from deep surface of Gastrocnemius, two heads of Plantaris: Both bellies were fused in the lower part producing bipennate arrangement, thin & thick belly of the Plantaris muscle. Variations also observed in relation to origin that the muscle is originating from deep surface of lateral head of Gastrocnemius & in other case origin from capsule. Bicipital Plantaris was seen where one head was originating from capsule of knee joint and other from lateral condyle. Conclusion: In order to avoid any inadvertent injury during surgical operations, variation of the Plantaris must be borne in mind. Awareness of the insertion pattern of the Plantaris tendon is also important for clinicians in the diagnosis of muscle tears and for surgeons performing reconstructive procedures. Considering the above facts, the existence and importance of the Plantaris muscle cannot be undermined.