THE ‘FEEDING BRONCHUS SIGN‘ IN CAVITARY LUNG LESIONS, ITS EVALUATION WITH COMPUTED TOMOGRAPHY AND A GUARDED OPINION REGARDING PHYSIOTHERAPY

BACKGROUND Bronchiectasis and cavitation are key features of acute and chronic pulmonary infections. Cavitary lesions may carry unfavourable prognosis with regard to complete restoration of pulmonary function in few patients. OBJECTIVES To evaluate type and site of bronchiectasis, its relation with cavity formation on computed tomography and providing an insight to sorting out subjects suited for physiotherapy. A radiological sign-“Feeding bronchus sign” has been discussed with reference to bronchiectasis, its origin, natural course and a suggestion of guarded future management and rehabilitation. METHODS Total 150 chest CT scans with presence of cavity and bronchiectasis were retrospectively reviewed and followed up for type, site of bronchiectasis, signs of active infection, site of cavity and presence of “feeding bronchus sign”. Final diagnosis was confirmed by sputum sample, acid-fast bacillus test or culture or polymerase chain reaction. RESULTS Out of 150 cases, 70 (46%) had chronic and 80 (53%) had active infection. 33 (22%) had solitary and 117 (78%) had multiple cavities. 37 (34.6 %) patients had cylindrical, 11 (7.3 %) had varicose, 27 (18%) had cystic bronchiectasis, 23 (15.3%) had cylindrical and varicose, 19 (12.6%) had cylindrical and cystic and 33 (22%) had all three types. “Feeding bronchus sign” was observed in 102 (68%) patients. Radiological evidence of disease progression was seen in 21 patients, improvement in 19 and no change in 17 on follow-up CT. CONCLUSION Patients with positive “Feeding bronchus sign” are at risk for increased disease transmission and secondary opportunistic infections. Improvement and maintenance of quality of life is ultimate goal of management. Apart from antibiotics, pulmonary rehabilitation also plays an important role in cavitary lung disease

Predicting recurrence in oral cavity cancers: a review of 116 patients with buccal mucosa carcinoma in northwestern India

Background@#Oral cavity cancers, the second most common type in India, are responsible for 10% of the overall cancer burden. With a recurrence rate of 30% to 40% and a 5-year survival rate of 50%, these malignancies account for substantial morbidity and mortality. Despite advances in treatment modalities, survival rates following treatment completion have not improved significantly. The present study aimed to establish specific epidemiological and pathological factors responsible for recurrence after treatment completion in buccal mucosa cancers. @*Methods@#A retrospective analysis of the data of 116 patients treated for biopsy-proven cancers of the buccal mucosa was undertaken 1 year after treatment completion. Factors such as age, sex, education, lymphovascular invasion, extranodal extension (ENE), perineural invasion, depth of invasion, and pathological margin status were compared between patients who presented with recurrence and those who did not. Statistical significance was set at p 10 mm did not show statistically significant associations. @*Conclusion@#Neck node metastasis, ENE, and margins of resection < 5 mm were the histopathological factors associated with recurrence in cancers of the buccal mucosa.

A rare case of malakoplakia of the urinary bladder

Malakoplakia (from Greek Malako “soft” + Plako “plaque”) is a rare inflammatory condition that presents as a papule, plaque, or ulceration that usually affects the genitourinary tract. The most frequently affected organ is the urinary bladder. This condition has features of granulomatous inflammation. The pathogenesis of the disease is not completely understood. It is often misdiagnosed as malignancy. In this case report, we present a case of urinary bladder malakoplakia which presented with obstructive uropathy and acute kidney injury (AKI)

A giant parathyroid adenoma mimicking a thyroid swelling: A case report

Giant parathyroid adenomas are uncommon. Its clinical management is challenging. Our study抯 goal is to share our experience with pre-operative localization of parathyroid adenomas while emphasizing the importance of intraoperative parathyroid hormone (IOPTH) assays in such situations. Here, we present the case of a 46-year-old woman who was diagnosed with parathyroid adenoma. The clinical aspects, pre-operative management, and surgical procedure have all been examined. Parathyroid hormone levels were reduced by 90% following surgical removal of the tumor and an IOPTH assay. IOPTH significantly improves surgical success rates in patients with only one positive imaging test result and adds significant value to surgical decision-making.

Diagnostic Lacunae and Implications of an Automated Implantable Cardioverter Defibrillator Implantation in a Child with Type 3 Long QT (LQT3) Syndrome

A diagnosis of congenital long QT interval syndrome based on history and electrocardiogram was made in a child in the absence of readily available genetic testing. A genotype 3 (LQT3) was suspected after exclusion of other variants as the child was non?responsive to beta?blocker and sodium channel blocker medication. As the child continues to show episodic bradycardia, polymorphic ventricular ectopy, and T?wave alternans, a single?chamber automated implantable cardioverter?defibrillator implantation was done successfully. This report highlights how the diagnosis of LQT3 was arrived at as well as the anesthetic challenges in the management of patients with LQTS.

ATOM technique: Anatomic reduction using screw-wire Traction for Open reduction and internal fixation of Mandibular fractures

Various techniques are well documented to obtain anatomic reduction, such as reduction forceps, manual reduction, or a combination of these methods. However, these techniques have inherent drawbacks. We propose a new intra-operative technique for anatomic reduction using screw-wire traction for open reduction and internal fixation of mandibular fractures.

Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial / Efeitos da expansão maxilar na função auditiva e vocal em pacientes sem fissura labiopalatina e com fissura labiopalatina e deficiência maxilar transversa: um estudo controlado multicêntrico e randomizado

Abstract Introduction The association between the treatment of transverse maxillary deficiency and the recovery of hearing and voice functions has gained attention in recent years. Objective This prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency Methods 53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1 ± 1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups. Results Rapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0-T1, T1-T2, T0-T2, and T0-T3 observation periods (p < 0.05). The significant increase was observed in right middle ear volumes during the T0-T1, T0-T2 and T0-T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p < 0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods. Conclusion Correction of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.

Resumo Introdução A associação entre o tratamento da deficiência maxilar transversa e a recuperação das funções auditivas e vocais ganhou atenção nos últimos anos. Objetivo Avaliar os efeitos da expansão rápida da maxila na função auditiva e vocal em crianças sem fissura labiopalatina e com fissura labiopalatina bilateral com deficiência maxilar transversa. Método Foram recrutados para este estudo 53 pacientes (26 sem fissura e 27 com fissura labiopalatina bilateral; média de 11,1 ± 1,8 anos) que necessitam de expansão rápida da maxila para correção de arcos maxilares estreitos. Oito subgrupos foram estabelecidos com base no grau de perda auditiva. Registros audiométricos e timpanométricos de tons puros foram obtidos para cada indivíduo em quatro períodos. Os primeiros registros foram obtidos antes da expansão rápida da maxila (T0), o segundo após a expansão (T1) (média de 0,8 meses), o terceiro após três meses (T2) (média de 3 meses) e o quarto no fim do período de retenção (T3) (média de 6 meses). Anova e o teste post-hoc de Tukey HSD foram usados para análise dos dados. Além disso, a análise da voz foi feita com um programa PRAAT atualizado em um laboratório de fala computadorizadaem T0 e T2. Foi usado um teste t de amostras pareadas para comparação dos valores médios dos parâmetros de voz em T0 e T2 nos dois grupos. Resultados O tratamento com expansão rápida da maxila produziu um aumento significativo nos níveis auditivos e nos volumes da orelha média de todos os pacientes sem fissura e pacientes com fissura labiopalatina bilateral e níveis auditivos normais e com perda auditiva condutiva leve, durante os períodos de observação T0-T1, T1-T2, T0-T2 e T0-T3 (p < 0,05). Aumento significativo foi observado nos volumes da orelha média direita durante os períodos T0-T1, T0-T2 e T0-T3 em pacientes sem fissura e com perda auditiva moderada. Para a análise de voz, diferenças significantes foram observadas apenas entre a frequência fundamental média T0 e T2 (F0) e a porcentagem de jitter (p < 0,05) no grupo sem fissura. No grupo com fissura, não foram observadas diferenças significantes para nenhum parâmetro de voz entre os períodos T0 e T2. Conclusão A correção da anatomia palatal pela expansão rápida da maxila tem um efeito benéfico tanto na melhoria da audição quanto na função normal da orelha média em pacientes sem fissura e com fissura labiopalatina bilateral. Da mesma forma, a expansão rápida da maxila influencia significativamente a qualidade da voz em pacientes sem fissura, sem efeito significativo em pacientes com fissura labiopalatina bilateral.

Winged nance palatal arch An adjunct to tooth movement

Anchorage control during the correction of severely crowded dentitions has always been a source of concern during orthodontic therapy. The Nance palatal arch (NPA) has, in the past, been widely used for reinforcing anchorage in such cases. Modifications of the NPA have been reported for use as a fixed functional appliance or for molar distalization. Herein, a simple, effective modification of the conventional NPA is introduced incorporating two power arms, which can be used for unravelling of anterior crowding at the same time effectively augmenting molar anchorage.

Simultaneous enantioseparation and simulation studies of atenolol,metoprolol and propranolol on Chiralpak(R) IG column using supercritical fluid chromatography / 药物分析学报

Enantioseparation of three β-blockers,i.e.,atenolol,metoprolol and propranolol,was studied on amylose tris(3-chloro-5-methylphenylcarbamate) immobilized chiral stationary phase using supercritical fluid chromatography (SFC).The effect of organic modifiers (methanol,isopropanol and their mixture),col-umn temperature and back pressure on chiral separation of β-blockers was evaluated.Optimum chro-matographic separation with respect to resolution,retention,and analysis time was achieved using a mixture of CO2 and 0.1％ isopropyl amine in isopropanol:methanol (50:50,V/V),in 75:25 (V/V) ratio.Under the optimized conditions,the resolution factors (Rs) and separation factors (α) were greater than 3.0 and 1.5,respectively.Further,with increase in temperature (25-45 ℃) and pressure (100-150 bars)there was corresponding decrease in retention factors (k),α and Rs.However,a reverse trend (α and Rs)was observed for atenolol with increase in temperature.The thermodynamic data from van't Hoff plots revealed that the enantioseparation was enthalpy driven for metoprolol and propranolol while entropy driven for atenolol.To understand the mechanism of chiral recognition and the elution behavior of the enantiomers,molecular docking studies were performed.The binding energies obtained from simulation studies were in good agreement with the elution order found experimentally and also with the free energy values.The method was validated in the concentration range of 0.5-10 μg/mL for all the enan-tiomers.The limit of detection and limit of quantitation ranged from 0.126 to 0.137 μg/mL and 0.376-0.414 μg/mL,respectively.The method was used successfully to analyze these drugs in pharmaceutical preparations.

Efficacy and safety of ivermectin for COVID-19: A systematic review and meta-analysis

Objective: To critically evaluate the trials that have assessed the efficacy and safety of ivermectin COVID-19 and to validate the rationality of using this drug in the management of COVID-19 either as a prophylactic or therapeutic agent. Methods: The authors conducted a systematic search through various databases, i.e., Cochrane library, PubMed, clincialtrials.gov, and preprint servers, for publications from 2020 to May 2021. The keywords used for the search were: "COVID-19 and ivermectin"(with filter set for "trials"). All the trials assessing efficacy in prophylaxis and treatment of COVID-19 were included for analysis. The primary outcome was the proportion of patients showing disease progression. Secondary outcomes were mean duration of hospitalization and resolution of symptoms, the proportion of patients testing positive on day 5-7, the mortality rate in severe cases, incidence of serious adverse events, and contacts of COVID-19 positive patients who turned RT-PCR positive after prophylaxis treatment. Results: A total of 17 clinical trials were included for the evaluation. Ivermectin proved to be a beneficial add-on therapy, as it reduced the risk of disease progression (OR 0.47, 95% CI 0.30-0.74, P =0.001), led to early resolution of symptoms (MD -1.16, 95% CI-1.52 - 0.81, P <0.001), and had less duration of hospitalization (MD -2.21, 95% CI -3.23 - 1.19, P <0.001). In addition, ivermectin was better in providing effective prophylaxis (OR 0.13, 95% CI 0.05-0.30, P <0.001). The incidence of serious adverse events was low. Conclusions: As an adjunct to standard care, ivermectin has shown its efficacy and safety in treating and prophylaxis in COVID-19 disease. These results should be interpreted cautiously as these trials had significant shortcomings.

Uncontrolled per rectal bleeding in chronic myeloid leukaemia: a mere coincidence or a dangerous sign report of an unusual case

Bleeding haemorrhoids present commonly to surgical outpatient departments (OPDs) and sometimes in emergency. Most often conservative management suffices but infrequently the patients can land up in emergency operation theatre for uncontrolled bleeding. Some haematological disorders can also present with rectal bleeding and amongst them Chronic myeloid leukaemia (CML), a haematological malignancy, presenting as bleeding per rectum has been not been reported so far, though instances of CML with gingival bleed, epistaxis have been reported. CML per se is known to be asymptomatic (40% cases) and bleeding is rarely seen. Here we present an interesting case of an emergency hemorrhoidal bleed that was subsequently diagnosed as CML. The patient after failed conservative management for bleeding haemorrhoids was taken up for emergency haemorrhoidectomy and again a relook under general anaesthesia in the post-operative period as he continued to ooze. The total leucocyte counts which were initially high continued to rise further and the bone marrow examination was reported as chronic myeloproliferative neoplasm and the excised mass was consistent with haemorrhoids. Rectal bleeding associated with CML is so far unreported even though bleeding is seen due to platelet dysfunction from gums and nose in chronic phases of the disease. A high index of suspicion is needed particularly with deranged haematological parameters for considering a diagnosis of these rare presentations. and anaesthesia.

Experience of management of abdominal cysts

Benign intra-abdominal cystic masses in children are rare and they have diverse etiopathogenesis, clinical presentation. The present study highlights the experience in the management of benign intra-abdominal cysts pertaining to the diverse etiologies associated with these lesions. The medical records of our hospital between November 2016 to November 2019 were retrospectively reviewed. Patients with cystic abdominal masses were studied with respect to less different clinical presentations, localization of masses, diagnostic tests, surgical aapproaches, histopathological examinations and outcome. Out of the 55 cases, most common lesion was a choledochal cyst. Miscellaneous diagnosis includes an omental cyst, urachal cyst and a pedunculated bile duct cyst. All the cystic lesions of the abdomen need to be considered as close differentials in clinical practice due to the common presentations and similar symptoms produced by these lesions. All the lesions were managed by exploratory laparotomy except two ovarian cysts which were managed with laparoscopic approach.

A comparative study of open preperitoneal versus laparoscopic mesh hernioplasty in cases of incisional hernia repair

Background: Incisional hernias repair being done in large numbers there is still not a consensus about the best repair. Very few studies have been done on comparison open and laparoscopic incisional hernia repair.Methods: A prospective, cross-sectional study was undertaken in Department of Surgery of Civil Hospital. The study included total 50 patients, out of which 25 patients underwent open approach and rest of 25 patients, underwent laparoscopic approach. Patients were assigned to both the groups randomly.Results: Pain, duration of post-operative stay, and return to routine work is earlier in patients with laparoscopic repair mainly due to decreased pain, fewer complications, early mobility and faster return of bowel movements. Laparoscopic repair is more expensive and operative time is more as compared to open method.Conclusions: Keeping in view the advantages and limitations of laparoscopic repair, the choice among two surgical modalities should be made on a case to case basis depending on patient preference and characteristics.

Cyto-histological correlation in diagnosis of gastrointestinal lesions- a prospective study in a tertiary care institute

Background: Gastrointestinal tract is involved by a large number of inflammatory, infectious and neoplastic diseases. There is a worldwide rising incidence of GIT lesions especially neoplasms.Methods: This study was planned to correlate endoscopic and colonoscopic brush cytology with histopathology of gastrointestinal lesions and to determine the spectrum of gastrointestinal lesions in patients subjected to endoscopic brushings and biopsy.Results: Sensitivity of upper GI brush cytology was 95.15% and specificity 90.41%. Sensitivity of colonoscopic brush cytology was 100% and specificity 86.79%. The accuracy of brush cytology came out to be 92.45% in upper GIT and 92.22% in lower GIT.Conclusions: Brush cytology is a non-invasive and cost-effective method to retrieve epithelial cells from a much larger surface area of the mucosa, thus allowing thorough sampling and increasing the diagnostic yield.

Comparison of the efficacy, safety, acceptability and fetomaternal outcomes of combination of mifepristone and foley’s catheter with foley’s catheter alone in induction of labour in term pregnancies with previous lower segment caesarean section

Background: Objective of the study was to compare the efficacy, safety, acceptability, fetomaternal outcomes of combination of mifepristone and Foley’s catheter with Foley’s catheter alone in induction of labor in term pregnancies with previous Lower segment caesarean section (LSCS).Methods: This was a prospective study of 36 women induced with mifepristone and foley’s catheter and 36 women induced with foley’s catheter alone at 37 weeks to 41+6 weeks with previous LSCS.Results: Mean bishop score on admission in combined group (2.44) was comparable with that of foley’s alone group (2.91, p=0.888). Mean Bishop score (BS) after foley’s expulsion in group A and group B was 7.46 and 6.33 respectively, which was statistically significant (p<0.001). In group A 69.5% of women delivered vaginally compared to 52.2% in group B which was comparable (p=0.230). Mean induction to delivery interval was significantly short in combination group (15.5±1.3 hours versus 20.8±1.07 hours, p=0.003). 50% women in group A required oxytocin for induction/ augmentation of labour as compared to 77.8% in group B (p=0.02). Failed induction was statistically higher in group B (p<0.05). No difference was found with regards scar dehiscence, scar rupture, Postpartum hemorrhage (PPH), wound infection, puerperal pyrexia, Meconium stained liquor (MSL), fetal distress, mean birth weight, 1 and 5 minutes Appearance, pulse, grimace, activity, and respiration (APGAR) score, neonatal outcome, hospital stay.Conclusions: Priming with mifepristone before insertion of foley’s catheter results in significant change in BS signifying that combination promotes early cervical ripening as compared to foley’s catheter alone. Mifepristone plays significant role in cervical ripening, reduces induction to delivery interval, oxytocin requirement and failed induction.

Prevalence of Helicobacter pylori infection in dyspeptic patients undergoing upper gastrointestinal endoscopy in a tertiary-care teaching hospital

Background: Helicobacter pylori infection is widely prevalent in the world especially in the developing countries. The common clinical presentation of this disease includes peptic and duodenal ulcer. A major post-infection complication of this disease is gastric carcinoma. The scope of this study was to determine the prevalence of active H. pylori infection in the local population by retrospective review of patient records, which can give a better picture of the current situation and estimate the at-risk population of gastric carcinoma. Objective of the study was to determine the prevalence of H. pylori infection in biopsy specimens obtained from upper gastrointestinal endoscopy performed in dyspeptic patients in a tertiary-care hospital.Methods: The study was performed as a retrospective review of biopsy reports of 262 dyspeptic patients with previously unknown H. pylori status who underwent upper gastrointestinal endoscopy during the months of January 2018 to May 2018. Biopsy obtained from stomach was evaluated for the presence of H. pylori infection by Rapid Urease Test (RUT) or histopathological examination.Results: The prevalence of H. pylori infection in dyspeptic patients obtained from the above study was 44.7% and was found to be more common in males compared to females.Conclusions: H. pylori is a risk factor for gastric carcinoma. Determining the prevalence with early identification of active infections results in better treatment and post infection monitoring for malignancy.

Serum albumin and total protein level as plausible marker for diagnosis of protein energy malnutrition in children under age 5 years

Background: The circulating concentration of transport protein, traditionally albumin, has been used to define protein deficiency. However, few studies have been conducted to see if there is any correlation between serum total protein and albumin levels in children with PEM. Hence the study was planned to estimate serum total protein, serum albumin levels in children with PEM and healthy controls.Methods: All the children were divided in two groups. Case Group A consist of 250 children with protein energy malnutrition and control Group B consist of healthy 250 children. Venous blood of amount 3 ml was collected with full aseptic precautions. The blood was collected in the EDTA vacutainer and test tube. Serum total protein was estimated by Biuret method, serum albumin was estimated by Bromocresol green dye method (BCG dye).Results: When the mean serum levels of albumin levels and the total protein levels were measured in the controls as well as case groups, there was decrease in levels in case group as compared to control group. This difference of decrease when evaluated statistically it was found to be statistically significant. When the albumin/globulin ratio was calculated in both the groups, it was found to be statistically lower in case group as compared to control group. PEM children have low serum total protein and albumin levels as compared to healthy controls (p<0.001), this is probably due to decreased intake of proteins and reduced biosynthesis. PEM children have lower hemoglobin levels as compared to healthy controls; this is probably due to deficiency of iron and other micronutrients, which is often found in a child with malnutrition.Conclusions: Early diagnosis and prompt management of PEM and its complications can prevent development of permanent physical and mental retardation.

Accidental aspiration of endodontic file: a dreaded but a preventable complication

Accidental ingestion of dental objects has been reported previously in literature. Accidental aspiration of a dental object is however uncommon. The affected patient may exhibit varying range of symptoms depending on location, type, shape and size of the foreign body swallowed/aspirated. We report a case about successful retrieval of an aspirated endodontic file with special focus on risk factors, prevention and management of these iatrogenic complications.

A Comparison of Ondansetron, Palonosetron and Granisetron for Prevention of Post-Operative Nausea and Vomiting after Laparoscopic Surgeries.

Post-Operative Nausea and Vomiting (PONV) “the little big problem” after surgery/anaesthesia is a common side-effect which compromises the quality of care, delays discharge and thereby delays resumption of activities of daily living. A number of pharmacological agents (antihistamines, butyrophenones, dopamine receptor antagonists) have been used, and the 5‑hydroxytryptamine type 3 receptor antagonists have been found to be effective in prevention and treatment of PONV. Thus, we compared the prophylactic effects of intravenously administered ondansetron, palonosetron, and granisetron in prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery under general anaesthesia. METHODSThis prospective, double blind study, comprising of 135 patients of ASA physical status I and II of either gender, was carried out after approval was obtained from the Institutional Ethical and Scientific Committee. Patients were randomized into three equal groups. Group P received inj. palonosetron (0.075 mg), group O received inj. ondansetron (8 mg), and group G received inj. granisetron (2.5 mg) intravenously five minutes before induction of anaesthesia. The episodes of postoperative nausea and vomiting, severity of nausea, need for rescue antiemetic, side effects and patient satisfaction were observed in the study groups for 24 hours in the post-operative period. At the end of study, results were compiled, and statistical analysis was done using ANOVA, chi‑square test, and Kruskal Wallis Test. Value of p < 0.05 was considered significant.RESULTSThe incidence of PONV was significantly less in the palonosetron group (95.6%) as compared to the ondansetron group (80%) and granisetron group (73.3%), with a lesser need for rescue antiemetic in the palonosetron group. All the three study groups did not have significant adverse effects reflecting that all the three drugs were well-tolerated. Patient satisfaction score was also more with palonosetron