Efficacy of pulmonary telerehabilitation on exercise tolerance, fatigue, perceived exertion, depression, and quality of life in COVID-19 survivors / Eficácia da telereabilitação pulmonar na tolerância ao exercício, fadiga, percepção de esforço, depressão e qualidade de vida em sobreviventes de COVID-19

INTRODUCTION: Telerehabilitation advanced significantly with the emergence of COVID-19 and the recommendation of limiting physiotherapist-patient contact time whenever practicable. The effectiveness of telerehabilitation on those who had a longer stay in hospital and on oxygen support following discharge is still under question. OBJECTIVES: To evaluate the effects after six weeks of pulmonary telerehabilitation on exercise tolerance, fatigue level, perceived exertion, symptoms of depression and quality of life in patients surviving COVID-19. MATERIALS AND METHODS: A quasi-experimental study was conducted on 25 post-COVID-19 patients following discharge in a home environment setting. The participants were advised to prepare equipment such as oxygen concentrator, B-type oxygen cylinder (backup), lengthy oxygen tubes, finger pulse oximeter, mini static pedal exerciser, incentive spirometry, weight cuffs or water bottles and sandbags. After six weeks of telerehabilitation, the patients underwent assessments including initial oxygen saturation (SPO2), heart rate, peak oxygen demand during exercise to maintain baseline SPO2, peak heart rate, maximum drop in SPO2, recovery time to baseline SPO2 measured with a pulse oximeter and stopwatch, peak perceived exertion using the Borg Dyspnea Scale, peak fatigue score using the visual analog scale (VASF), quality of life assessed with the SF-36 questionnaire, and mental health status evaluated with the Hamilton Depression Scale (HAMD). One-way repeated measure ANOVA and paired t-test were used. RESULTS: Significant improvements following the intervention on the initial SPO2 (F (2.12, 23.13) = 21.0, p< 0.05) and quality of life also showed significant improvement (mean difference =29.92, p< 0.05). CONCLUSION: Six weeks of comprehensive pulmonary telerehabilitation with simple equipment improved tolerance to exercise, fatigue, perceived exertion, symptoms of depression and quality of life for post-COVID-19 patients.

INTRODUÇÃO: A telereabilitação avançou significativamente com o surgimento da COVID-19 e a recomendação de limitar o tempo de contato entre fisioterapeutas e pacientes sempre que possível. A eficácia da telereabilitação em pacientes que permaneceram mais tempo no hospital e necessitaram de suporte de oxigênio após a alta ainda está em questão. OBJETIVO: Para avaliar os efeitos após seis semanas de telereabilitação pulmonar na tolerância ao exercício, nível de fadiga, percepção de esforço, sintomas de depressão e qualidade de vida em pacientes sobreviventes de COVID-19. MATERIAIS E MÉTODOS: Foi realizado um estudo quase-experimental com dezesseis pacientes pós-COVID-19 selecionados de um hospital multispecializado. Os participantes foram orientados a preparar equipamentos como concentrador de oxigênio, cilindro de oxigênio tipo B (reserva), tubos de oxigênio longos, oxímetro de pulso, exercitador de pedal estático, espirômetro incentivador, pesos de tornozelo ou garrafas d'água e sacos de areia. Após seis semanas de telereabilitação, os pacientes foram submetidos a avaliações, incluindo saturação inicial de oxigênio (SPO2), frequência cardíaca, demanda máxima de oxigênio durante o exercício para manter a SPO2 basal, frequência cardíaca máxima, queda máxima na SPO2, tempo de recuperação para SPO2 basal medido com um oxímetro de pulso e cronômetro, esforço percebido máximo usando a Escala de Dispneia de Borg, pontuação máxima de fadiga usando a escala analógica visual (VASF), qualidade de vida avaliada com o questionário SF-36 e estado de saúde mental avaliado com a Escala de Depressão de Hamilton (HAMD). RESULTADOS: Melhorias significativas após a intervenção foram observadas na SPO2 inicial (F (2,12, 23,13) = 21,0, p <0,05) e na frequência cardíaca (F (1,839, 20,23) = 43,73, p <0,05), demanda máxima de oxigênio durante o exercício para manter a SPO2 basal (F (1,487, 16,36) = 8,96, p <0,05), esforço percebido máximo (F (5, 55) = 112,51, p <0,05), pontuação máxima de fadiga (F (1,755, 19,30) = 67,44, p <0,05), frequência cardíaca máxima (F (1,798, 19,78) = 50,99, p <0,05), queda máxima na SPO2 (F (2,467, 27,14) = 41,46, p <0,05) e tempo máximo de recuperação para alcançar a SPO2 basal (F (5, 55) = 78,89, p <0,05). A análise de seis semanas pós-intervenção nos sintomas depressivos (diferença média = 11,25, p <0,05) e na qualidade de vida também mostrou melhoria significativa (diferença média = 29,92, p <0,05). CONCLUSÃO: Seis semanas de telereabilitação pulmonar abrangente com equipamentos simples melhoraram a tolerância ao exercício, a fadiga, a percepção de esforço, os sintomas de depressão e a qualidade de vida em pacientes pós-COVID-19.

Removal and identification of a subconjunctival parasite by light and scanning electron microscopy

Background: Ophthalmic dirofilariasis is an uncommon zoonotic parasitic infection caused by species of Dirofilaria, a dog tapeworm that is transmitted to human by mosquitoes. Man is a dead?end host for the parasite. Ophthalmic involvement is rare and includes periorbital, subconjunctival, subtenon, and intra?ocular involvement. We report the removal of a subconjunctival worm and identification by light microscopy (LM) and scanning electron microscopy (SEM). Purpose: A 62?year?old female presented with complaints of redness, discharge, and foreign body sensation with difficulty in opening eyes in the left eye for the last 3 days. The patient is a non?vegetarian. On examination, her best corrected visual acuity in both eyes was 20/20. On slit lamp examination, there was a long, thin, round, coiled white subconjunctival live worm in the left eye superiorly. The rest of anterior segment evaluation, intra?ocular pressure, and fundus was normal in both eyes. The parasite was removed under local anesthesia from subconjunctival space [Video]. External surface morphology under LM revealed fine transverse cuticular striations with tapered cephalic and caudal ends. Uterus was long and coiled with indistinguishable masses inside. The finding was also confirmed by SEM. Synopsis: A subconjuctival parasite was removed and identified as Dirofilaria repens by characteristic LM and SEM findings. Highlight: Dirofilaria species may lodge in many tissues of human bodies including eye and adnexa. Dirofilaria is a natural parasite of carnivorous animals, mostly dogs, cats, and foxes.[1] The most common mode of transmission to human is usually by bite of mosquitoes like Culex and Aedes, which are considered as vectors, and it is often thought that parasitemia is because of accidental conduction.[1] Simple surgical removal of the worm is curative. After removal, the worm should be visualized directly under LM. All the internal structures of the transparent worm could be seen and compared with those under SEM.

Clinical Profile and Short-Term Outcome of Children with Acute SARS-CoV-2 Infection During the First and Second Waves of the Pandemic

Objectives To compare the clinical profle and short-term outcome of children admitted with acute SARS-CoV-2 infection during the frst and second waves of the Coronavirus Disease (COVID-19). Methods This retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confrmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients’ demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay. Results One thousand and twenty-four children were recruited, 592 of the frst wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR=3.38) and neurological manifestations (OR=4.61). There was a higher requirement of intensive care (OR=4.2) and invasive mechanical ventilation (OR=4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the diference was not statistically signifcant. Children with neurological comorbidities (OR=8.73), malnutrition (OR=3.01), and preterm babies (OR=6.8) were associated with severe COVID. Conclusion The clinical profle of the second wave of COVID-19 in children was diferent from the frst wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a signifcant increase in the incidence of severe infections requiring ICU care was observed.

KMT2B-Related Dystonia in Indian Patients With Literature Review and Emphasis on Asian Cohort

Objective@#aaMutations in the KMT2B gene have been identified in patients previously diagnosed with idiopathic dystonia. Literature on KMT2B-related dystonia is sparse in the Indian and Asian populations. @*Methods@#aaWe report seven patients with KMT2B-related dystonia studied prospectively from May 2021 to September 2022. Patients underwent deep clinical phenotyping and genetic testing by whole-exome sequencing (WES). A systematic literature search was performed to identify the spectrum of previously published KMT2B-related disorders in the Asian subcontinent. @*Results@#aaThe seven identified patients with KMT2B-related dystonia had a median age at onset of four years. The majority experienced onset in the lower limbs (n = 5, 71.4%), with generalization at a median duration of 2 years. All patients except one had complex phenotypes manifesting as facial dysmorphism (n = 4), microcephaly (n = 3), developmental delay (n = 3), and short stature (n = 1). Magnetic resonance imaging (MRI) abnormalities were present in four cases. WES revealed novel mutations in the KMT2B gene in all patients except one. Compared to the largest cohort of patients with KMT2B-related disorders, the Asian cohort, comprising 42 patients, had a lower prevalence of female patients, facial dysmorphism, microcephaly, intellectual disability, and MRI abnormalities. Protein-truncating variants were more prevalent than missense variants. While microcephaly and short stature were more common in patients with missense mutations, facial dysmorphism was more common in patients with truncating variants. Deep brain stimulation, performed in 17 patients, had satisfactory outcomes. @*Conclusion@#aaThis is the largest series of patients with KMT2B-related disorders from India, further expanding the clinico-genotypic spectrum. The extended Asian cohort emphasizes the unique attributes of this part of the world.

A KMT2B Frameshift Variant Causing Focal Dystonia Restricted to the Oromandibular Region After Long-Term Follow-up

KMT2B-linked dystonia (DYT-KMT2B) is a childhood-onset dystonia syndrome typically beginning in the lower limbs and progressing caudocranially to affect the upper limbs with eventual prominent craniocervical involvement. Despite its recent recognition, it now appears to be one of the more common monogenic causes of dystonia syndromes. Here, we present an atypical case of DYT-KMT2B with oromandibular dystonia as the presenting feature, which remained restricted to this region three decades after symptom onset. This appears to be the first reported case of DYT-KMT2B from Southeast Asia and provides further supporting evidence for the pathogenic impact of the KMT2B c.6210_6213delTGAG variant.

Distribution and Association of Lip Print Pattern, Finger Print Pattern and ABO Blood Groups in Relation to Gender and Family Among South Indian Population

Background: Positive identification of living/ deceased using distinct traits is a cornerstone of forensic science. According to Locard’s principle “When two objects come into contact, there is always transfer of material from one to another”. The finger prints, lip prints and blood remains are the evidence for forensic identification. Aim: To study the frequency, distribution and association of ABO blood groups, finger print pattern, lip print pattern among gender and also the inherent nature of patterns among family members. Materials and Methods: A total of 200 Subjects (100 males, 100 females) within the age range of 17- 30 years and 20 families were randomly selected and aggregated as groups. Lip prints and finger prints were collected using dusting technique with fine carbon powder. ABO blood group was determined by slide agglutination method. Results: Ulnar loop - Males - Vertical, Radial loop - Males - Branching, Whorl - Females - Branching, Arch - Males - Intersecting; Females - Vertical. O positive, B positive - Loop - Branching, A positive - Loop - Vertical and Intersecting, AB positive - Whorl - Branching and Intersecting. Among 20 families, 14 families showed 100 percent pattern resemblance. High percentage of similar pattern was observed between father to daughter (70%) in finger prints and mother to son in lip prints (71%). Conclusion: Correlating the uniqueness of these physical evidence helps in personal identification as it can narrow the search & to substantiate the facts where there is little evidence

Community voices around COVID-19 vaccine in Chennai, India: A qualitative exploration during early phase of vaccine rollout

Background & objectives: Globally, vaccination is considered as an important public health strategy to mitigate the impact of the COVID-19 pandemic. The purpose of the current study was to conduct an in-depth inquiry to explore perceptions of community members around COVID-19 vaccines in the southern city of Chennai, Tamil Nadu. This was conducted during the early phase of the vaccine rollout programme in India. Methods: A qualitative investigation was conducted between January-February 2021 through in-depth interviews. Healthcare workers, religious leaders, community influencers, local administrators and representatives of marginalized communities were included. The key informant interview guides and probes explored five domains; (i) vaccine availability, (ii) trust in COVID-19 vaccines, (iii) vaccine-related concerns, (iv) health/risk balance and (v) vaccine prioritization. Transcripted interviews were coded using a thematic approach and analyzed manually as well as with the help of ATLAS.ti 9 software. Results: Eagerness to receive COVID-19 vaccines amongst some of the respondents was linked with freedom from fear, possible restoration of normalcy, protection of family and ability to travel and work abroad. Concerns around threat of emergence of new variants, damage caused by such viral mutants and trust in policymakers were other facilitatory influencers for vaccine uptake. On the other hand, doubts surrounding safety and fear of side effects of COVID-19 vaccine were the feeders to vaccine hesitancy. Lack of accurate information, sensational media reports and rumours exacerbated this fear and provoked anxiety among people. Apprehensions around COVID-19 vaccine in the wake of its rapid development and approval for use and reluctance to take it during the declining phase of the epidemic were identified as other inhibitory factors. Participants underlined the importance of having responsive communication strategies in place focussing on vaccine safety. Making vaccines available to people free of cost and ensuring wider access were other programmatic suggestions. Interpretation & conclusions: In conclusion, our study findings suggest that it is essential to remain engaged with communities and execute evidence-based information dissemination strategy about the safety and efficacy of the vaccines. We identified that it is also imperative to sensitize and train media professionals on how to report side effects related to vaccines. Responsive communication strategies will thus have the potential to serve as a key public health approach pertaining to future pandemic preparedness as well as to manage the demands of clinical and public health issues in an ongoing pandemic situation.

Methyl-CpG-binding protein 2 gene mutations and its association with epilepsy: a single centre study from the Indian subcontinent

Rett syndrome (RTT) is an X-linked disorder caused by mutations in MECP2 in majority of cases. It is characterized by arrested development between 6 and 18 months of age, regression of acquired hand skills and speech, stereotypic hand movements, gait abnormalities and seizures. There are a very few studies in India which illustrates mutation spectrum in RTT. None of the studies have correlated seizures with the genotype. This study describes the phenotype and genotype spectrum in children with RTT syndrome and analyses the association of epilepsy with various clinical features and molecular findings. All children with RTT in our cohort had global developmental delay. Genetic diagnosis identified mutations of the MECP2 in all 25 children where RTT was suspected. We have identified point mutations in 20 patients, one insertion and four deletions by Sanger sequencing, namely c.1164_1207 (44 bp), c.1165_1207 (43 bp), c.1157_1197 (41 bp) del and c.1157_1188 (32 bp). Clinically, none of the patients with deletion had seizures. We identified one novel insertion variant c.337_338 (p.S113Ffs*9). All the deletions were located in the C-terminal region. Majority of the mutations (22/25) were identified in exon 4 which comprised of nonsense and missense types. Screening of hotspot mutations in exon 4 should be the first line evaluation in diagnosis of RTT. Molecular testing could help in specific management of seizures in RTT.

Chikungunya in infants: a descriptive study in a district hospital

Background: To define the clinical profile of Chikungunya in infants admitted at a District Hospital in South India.Methods: All infants admitted in Government District Headquarters Hospital, Namakkal from January 2019 to December 2019 with fever (defined as axillary temperature > 99.6 F) and any one of the following features; seizure, loose stools, peripheral cyanosis, skin manifestations or pedal edema in children less than one year with chikungunya IgM ELISA positive were included in this study. Details of disease from onset of illness till admission were noted. This was a descriptive observational study.Results: Fifty-six (46) infants were included in this study, out of it 27(58.69%) were males and 19(41.30%) were females. 7(15.21%) infants were less than 1 month of age, 21(45.65%) were 2-6 months old and 18(39.13%) were 7-12 months old. Fever was invariably present but associated constitutional symptoms in infants consisted of lethargy or irritability and excessive cry. The most characteristic feature of the infection in infants was acrocyanosis and symmetrical erythematous rash were noted in most infants. Erythematous macules and patches were observed which later progressed to morbilliform rashes.Conclusions:Atypical clinical manifestations of chikungunya infection in infants as compared to older children to be carefully observed for its proper management. The morbidity and mortality of the disease may be avoided by the rational use of drugs and close monitoring of all infants.

Clinical profile of dengue fever in children admitted in a district hospital of South India

Background: To assess the clinical profile of dengue fever in children.Methods: In this Prospective observational study 110 patients who admitted in Government District Headquarters Hospital, Namakkal between 1st August 2019 to 31st December 2019 were included. Those patients with confirmed dengue, with IgM dengue antibody positive were included in this study. Detailed history was taken, and clinical examination was performed, and laboratory investigations were done.Results: In this study 110 patients were studied, majority were males. Fever was present in 100% of patients followed by headache, myalgia. The common signs and symptoms of dengue infection were fever, headache, body ache, retro-orbital pain, bleeding manifestations, and rash in 100%, 97.27%, 92.72%, 77.27%, 8.12%, and 60.90%, respectively. In 90 cases platelet count was less than 100,000/cumm of which bleeding manifestation was found in 9 patients. Pleural effusion and ascites were observed in 25 and 15 cases respectively. Hepatomegaly was noted in 19 cases and splenomegaly in 10. Leucopenia was present in 52 cases whereas raised liver enzymes were present in 51 cases. The mortality rate was 0.9%.Conclusions: Dengue epidemic has increased in recent past probably due to unplanned urbanization with rapid construction activities, unhygienic condition and poor sanitation facilities contributing fertile breeding soil for mosquitoes. Early diagnosis and management can decrease mortality and morbidity of illness. Platelet transfusions have little role in management of dengue patients.

Predictors Of Functional Outcomes In Traumatic Brain Injury At 4 Months Post Injury In South Indian Population

Background: Goals of Rehabilitation after Traumatic Brain Injury (TBI) focus on preventing complications and improving the level of functional independence. The expectation of TBI survivors and family members following rehabilitation are focused on the quality of outcomes such as reintegration into the community, return to work, and maximal functional capacity. Multiple factors may affect recovery after TBI when interacting with the primary condition and predicting the degree of recovery helps in framing realistic goals. The purpose of this study was to analyze the factors influencing the functional outcome in TBI patients at four months post-injury. Methodology: This observational study was carried out in the Neurosurgery outpatient department when TBI patients returned for review at four months post-injury. 50 TBI patients who were able to follow commands participated in this study. Factors like Admission Glasgow coma scale (GCS), Discharge GCS, Length of Hospitalization, Associated fractures of the upper and lower limb, Co-morbid conditions like Diabetes and Hypertension were obtained from the discharge summary of the patient. Caregiver literacy was obtained from the person who took care of the patient completely. Admission CT scan was graded using the Marshall CT classification. Finally, all these factors were compared to the functional status of the patient evaluated using the Barthel Index. Results: Logistic regression was used to predict the factors affecting the functional outcome. Beta value of Caregiver literacy, Discharge GCS, and Co-morbid conditions was .561, .369 and .234, respectively which influences the functional outcome of TBI patients at four months post-injury. Conclusion: The study concludes that caregiver literacy, Discharge GCS, and Co-morbid conditions influence the functional outcome of TBI patients, which emphasizes the need for awareness and education of the caregiver and along with post-discharge rehabilitation program specific exercises addressing the co-morbid conditions would enhance the recovery.

Exploration of population ecological factors related to the spatial heterogeneity of dengue fever cases diagnosed through a national network of laboratories in India, 2017

Background & objectives: Dengue virus (DENV) transmission is known to be influenced by the environmental conditions. During 2017, the Viral Research and Diagnostic Laboratories (VRDLs) tested 78,744 suspected dengue fever (DF) patients, of whom, 21,260 were laboratory confirmed. The objectives of the study were to evaluate the hypothesis that spatial heterogeneity existed for DF patients and to identify significant determinants of DENV transmission in various districts across the Indian States during 2017. Methods: Laboratory confirmed DF cases were analysed from 402 districts spread across the Indian States. The determinants for DF transmission included in the model were population density, proportion of population living in rural areas, proportion o f forest cover area to the total geographical area, proportion of persons not able to read and write and who were aged greater than seven years; the climatic variables considered were minimum, maximum and average temperature, precipitation and cumulative rainfall. The spatial heterogeneity was assessed using spatial regression analysis. Results: DF cases showed strong spatial dependency, with Moran's I=4.44 (P <0.001). The robust measure for spatial lag (6.55; P=0.01) was found to be the best model fit for the data set. Minimum temperature and cumulative rainfall were significant predictors. Interpretation & conclusions: A significant increase in the number of dengue cases has occurred when the minimum temperature was 23.0-25.8癈 and the cumulative rainfall 118.14-611.64 mm across the Indian districts. Further in-depth investigations incorporating more number of demographic, ecological and socio-economic factors would be needed for robust conclusions.

The Malaysian Movement Control Order (MCO) Impact And Its Relationship With Practices Towards Coronavirus Disease 2019 (Covid-19) Among A Private University Students In Selangor

@#A novel strain of coronavirus was first detected in Wuhan, China in December 2019. It is the causative agent of a respiratory disease known as the Coronavirus Disease 2019 (COVID-19). On 12th March 2020, it was declared as a global pandemic by the World Health Organization. The aim of the study was to study the impact of MCO in terms of the academic performance and finance on the student population and to measure the level of knowledge, attitude and practice towards prevention of coronavirus disease 19 (COVID-19) among a private university students in Malaysia. On 22nd April until 30th April 2020, a cross-sectional study using a convenient sampling method was conducted among 401 students using a self-administered online questionnaire survey. It was found that 272 (67.8%) of the respondents had a less negative impact of MCO while 129 (32.3%) of the respondent had a more negative impact of MCO. The findings show also 229 respondents (57.1%) have adequate knowledge. As for the attitude, about 237 respondents (59.1%) have an adequate attitude and only 191 respondents (47.6%) have adequate practice towards the prevention of COVID-19. There was a significant relationship between knowledge, attitude, and practice with family income, a significant relationship between knowledge and practice, a significant relationship between knowledge and attitude, a sig. relationship between knowledge, attitude, practice with university faculties, the relationship between knowledge and source of information. The MCO showed significant association with knowledge level and with practice, also MCO was less negatively impact on the medical faculty students with p-value 0.004. The MCO was more negatively impacting those with less family income. The study findings concluded that the majority of the participants had a fair level of knowledge, attitude, and a lesser level of good practice towards the prevention of COVID-19. However, the COVID-19 is still considered a global pandemic and has not resolved yet. Therefore, to minimize the risk of future COVID-19 cases current efforts to educate the public towards knowledge, attitude, and practice towards prevention of COVID-19 in public health should be done.

A study on adverse drug reactions in hospitalized pediatric patients in a Tertiary Care Hospital

Pediatric populations are the most vulnerable group with regard to rational drug prescribing since many new drugs aremarketed without any proper pharmacovigilance study, thereby increasing the risk of toxicity. The study was aimedto determine the adverse drug reaction (ADR) pattern in the pediatric population over a period of 6 months. A total of200 patients were enrolled in the study, 15 patients were suspected with ADRs and were confirmed by the physiciansattending the pediatric department. Out of 15 cases, eight were male patients (53.33%) and seven were female patients.46.66% of ADRs were affected in the skin and subcutaneous tissue, followed by the gastrointestinal system (40%).Most common group of showing ADRs were found to be antibiotics (66.65%), followed by anticonvulsants (19.99%).Type B reactions were the most commonly observed ADRs, of which subtype 1 was of the common type. 73.33% ofthe events were in the probable category, 20% of the events were in the possible category, and 6.66% events were inthe definite category and also most of the ADRs were of mild varieties (60%), followed by moderate (40%). 73.33% ofADRs were cured and 26.66% were getting better with further therapeutical management. The study indicated the needfor a rigid ADR monitoring among pediatric patients to ensure the safety of drug therapy. Various pharmacovigilanceawareness programs should be conducted to increase the spontaneous reporting of ADRs.

A Metric Scrutiny Of The Orbital Margins

Background: The anatomical boundaries of the orbit are defined and the contribution of various bones in makingup the orbital margins is determined .Associated with this, orbital dimensions like length, breadth and theorbital index are determined along with the associated dimorphic and bilateral variations. The findings of theseterritorial specimens are analyzed and compared with similar findings from other vernacular territories. Thebilateral craniofacial structures are studied and they are dimensionally classified and characterized.Comprehensive documentation thus promulgated functions to prove vital in the conquest of dexterity in the fieldof surgery and forensic anthropometry alike. The evaluated parameters also serve as an empirical guide indiscerning tenuous sites that are susceptible to impaction and in defining the safe limits of orbital explorationResults: The study has returned an average value of 81.47 as the orbital index of the scrutinized dry skullspecimens thus placing them under the category of microseme. The average values of orbital length and breadthwere found to be 31.26mm and 38.37mm respectively. The superior margin formed exclusively by the frontalbone measured 32.7mm on average with the supraorbital notch/foramen being displaced 5.92mm from themedial limit of the superior margin. For 25.88mm, which was the average length of medial margin, maxilla stoodthe dominant contributor (13.81mm) with the frontal bone chipping in to contribute to the rest. The inferiormargin paints a contrary picture of maxilla being the secondary contributor (16.13mm) whilst here it is thezygoma which makes a greater contribution (17.29mm).Conclusion: This study hereby establishes Microseme to be the predominant orbital index of the scrutinized skullspecimens in addition to quantifying the contributions of various bones towards making up the margins.Comparative analysis with confluent such studies from other provinces of the Indian subcontinent has confirmedthe latitude variation associated with orbital index. The results thus established will be unerringly essential inthe field of surgery and forensic anthropometry

CD56 expression in benign and malignant thyroid lesions

@#Introduction: Thyroid cancer is the most common endocrine malignancy with more than 95% originating from follicular epithelial cells. Diagnostic dilemma may arise in occasional cases such as when an encapsulated nodule with a follicular growth pattern exhibits clear nuclei with grooves making it difficult to distinguish a follicular adenoma from encapsulated follicular variant papillary thyroid carcinoma. This study aimed to evaluate the diagnostic utility of an immunohistochemical marker, CD56, to distinguish between benign and malignant thyroid lesions. Materials and Methods: We retrospectively studied CD56 expression in 54 benign and 54 malignant thyroid lesions using archival formalin fixed paraffin-embedded tissue blocks for the study period from January 2010 to December 2015, diagnosed in a tertiary hospital. Results: CD56 was expressed in 52/54 (96.3%) of benign specimens and only 24/54 (44.4%) of malignant ones. The malignant specimens comprised 31 (57.4%) papillary thyroid carcinomas (PTC), 11 (20.3%) follicular carcinomas (FC), seven (13%) medullary thyroid carcinomas (MC), one (1.9%) poorly differentiated carcinoma (PC) and four (7.4%) anaplastic carcinomas (AC). CD56 was not expressed in 28/31 (90.3%) of the PTCs, 1/11 (9.1%) FCs, 1/4 (25%) of ACs while all MCs and the PD were positive. The benign group comprised nodular hyperplasias (29/54), lymphocytic thyroiditis (10/54), follicular adenomas (FA) (14/54) and one hyalinising trabecular tumour. CD56 was expressed in all the benign cases except one FA and one nodular hyperplasia. Thirteen of the 14 FAs were CD56 positive. The difference in expression between benign and malignant tumours was statistically significant as the p value was <0.01. Conclusion: CD56 is a potentially good immunohistochemical marker for differentiating papillary thyroid carcinoma from other benign follicular lesions of the thyroid especially in differentiating follicular variant PTC from FA in equivocal cases.

A cross sectional study to assess clinical profile of acne vulgaris presenting to a tertiary care teaching hospital

Background: Acne is one of the most commonly prevalent skin conditions. It commonly affects the adolescents and young adult age groups. The lesions start as microcomedones and progress to nodular or inflammatory acne with post inflammatory hyperpigmentation. Although acne is not life threatening it has multiple impacts in the affected individual’s quality of life and psychological morale. Hence this study was undertaken to analyze the clinical profile of patients having acne vulgaris to facilitate better management. Materials and methods: A cross sectional observational study was conducted among patients attending the dermatological outpatient department in a tertiary care hospital. A pre-tested semistructured questionnaire was administered to the individuals after obtaining informed written consent. Data on demographical variables, menstrual history and clinical features of acne were collected and presented. Results: A major proportion of the population was comprised of adolescents and young adults similar to previous studies. Around 13% of them had a positive family history of acne. Associated factors such as menstrual flare, increased consumption of dairy products and high glycemic index foods were also present. Almost 88% of the participants had mild acne. Half of them had post inflammatory hyperpigmentation. Conclusions: Most patients of acne vulgaris are either adolescents or young adults. This group is more prone to endocrine co-morbidities such as polycystic ovarian syndrome and impairment in quality of life. Hence considering the above factors, early diagnosis and management of acne vulgaris B.M. Monisha, G. Kannan, Muthusamy. A cross sectional study to assess clinical profile of acne vulgaris presenting to a tertiary care teaching hospital. IAIM, 2018; 5(5): 111-116. Page 112 is essential. This is expected to yield better results in the long term in improving the quality of life in the affected persons

Self-Healing in Dentistry by Stem Cells

Mesenchymal stem cell-mediated tissue regeneration is a promising approach for regenerative medicine for a wide range of applications. The days are not far that human beings by the help of stem cell technologists and medical experts shall regenerate their organs and tissues. There are reported cases of success of regenerating craniofacial structures. This article discusses the use of Stem Cells in Apical Papilla (SCAP) to regrow a human tooth. Also, the article highlights the preference of SCAP over other stem cells of dental origin.

The role and utility of cholangioscopy for diagnosing indeterminate biliary strictures

Biliary strictures are considered indeterminate when evaluation with imaging and standard tissue sampling during endoscopic retrograde cholangiopancreatography (ERCP) are non-diagnostic. Standard tissue sampling techniques include cytologic brushings, with or without fluorescence in situ hybridization (FISH), and endoscopic intraductal biopsies. These strictures are often clinically suspicious for malignancy. The management of these patients can vary substantially and relies on an accurate diagnosis of the lesion. Unfortunately, despite numerous modalities, the sensitivity of existing tissue sampling techniques remains low and can lead to delays in diagnosis and the need for additional procedures. Cholangioscopy has emerged as a means to visually inspect and obtain image-guided biopsies of the lesion in question, with improved sensitivity as well as a high specificity and accuracy for diagnosing the etiology of indeterminate biliary strictures. The types of cholangioscopy systems and a summary of the pertinent literature are discussed in this review.