Minimal clinically important difference of mouth opening in oral submucous fibrosis patients: a retrospective study

Objectives@#The purpose of this study was to estimate the minimal clinically important difference (MCID) of mouth opening (MO) and patient satisfaction in surgically treated oral submucous fibrosis (OSMF) patients. @*Materials and Methods@#The status of MO was collected preoperatively (T0), postoperatively at 3 months (T1), and at a minimum of 6 months postoperatively (T2). MCID was determined through the anchor-based approach with the change difference method, mean change method, and receiver operator characteristic curve (ROC) method. @*Results@#In this study, 35 patients enrolled and completed postoperative follow-up (T2) averaging a duration of 18.1 months. At T1, using the change difference method, MO was 14.89 mm and the ROC curve exhibited a 11.5 gain in MO (sensitivity 81.8% and specificity 100%, area under the curve [AUC] of 0.902) and was classified as MCID as reported by patients. At T2, MCID of MO was 9.75 mm using the change difference method and 11.75 mm by the mean change method. The ROC curve revealed that the MCID of MO at T2 was 10.5 mm with 73.9% sensitivity and 83.3% specificity (AUC of 0.873). The kappa value was 0.91, confirming reliability of the data. @*Conclusion@#This study demonstrated MCID values that indicate the clinical relevance of surgical treatment of OSMF if the minimum possible gain in MO is approximately 10 mm.

Prevention of epidural catheter migration: a comparative evaluation of two tunneling techniques / 대한마취과학회지

Background@#Epidural analgesia failure episodes can be reduced by catheter fixation techniques with a lower incidence of catheter migration. In this clinical study, we compared the roles of two epidural catheter tunneling techniques for the prevention of epidural catheter migration. @*Methods@#Patients undergoing major abdominal surgery were randomized into three groups of 50 patients each based on the method used to secure the epidural catheter. In the control group (CG), the epidural catheter was secured without tunneling. Tunneling groups 1 and 2 (TG1 and TG2) were defined as tunneling with and without a catheter loop, respectively. The primary outcome measure was the migration of the epidural catheter, while the secondary outcome measures were the adequacy of analgesia and signs of inflammation. All patients were followed up by the acute pain service team twice daily in the postoperative period until the epidural catheter was removed. The results were analyzed by the one-way analysis of variance (ANOVA), chi-square test, and Fisher’s exact test. P values 0.050). @*Conclusions@#Catheter migration was significantly reduced by tunneling without a catheter loop in TG2 as compared to the other two groups. Therefore, we suggest routine use of tunneling without a catheter loop technique in anesthesia practice and look forward to future studies with larger sample sizes.

Phenolic and Mineral Characteristics of Seed Coats and Kernels from 24 Species from Raipur Area, India

Aims: The objective of the present work is the investigation of the physicochemical characteristics of seed coats and kernels from 24 species with medicinal and food applications. Methodology: Seeds from 24 species (2 herbs, 11 vines and 11 trees), belonging to 13 families, were sampled in Raipur (India) in 2017. The collected seeds were dried and weighed, after which seed coats were manually peeled and separately weighed. Phenolic and mineral contents in the seed coats and kernels were analyzed by spectrophotometric and X-ray fluorescence (XRF) techniques, respectively. Results: The seed coat fraction represented from 12% to 95% of the seed mass, depending on the species. The concentrations of total polyphenols, flavonoids and minerals in the seed coats varied from 1800 to 32300 mg/kg, from 1200 to 26900 mg/kg, and from 5876 to 36499 mg/kg, respectively. In the seed kernels, TPh, Fla and minerals ranged from 780 to 31760 mg/kg, from 300 to 12020 mg/kg, and from 12595 to 40810 mg/kg, respectively. P, S, K, Mg, Ca and Fe were found to be the main macro- and micro-elements. Seed coats from Loganiaceae, Phyllanthaceae, Lauraceae and Rutaceae families featured the highest total polyphenol contents, and those from Lauraceae and Rutaceae families showed the highest flavonoid concentrations. The highest total mineral contents corresponded to seed coats from Lauraceae, Rutaceae and Euphorbiaceae families. Conclusion: Indian-laurel and curry tree stand out as promising phytochemical and nutrient sources.

Nutritional, Spectral and Thermal Characteristic of Lamiaceae Seeds

Aims: Species of the family Lamiaceae possess a rich tradition of use for flavoring and medicinal purposes. This paper focusses on the nutritional and thermal characteristics of the seeds from eight species belonging to this family: Gmelina arborea Roxb. ex Sm., Hyptis suaveolens (L.) Poit., Leonotis nepetifolia (L.) R.Br., Ocimum americanum L., Ocimum sanctum L. (Rama Tulsi), Ocimum tenuiflorum L. (Krishna Tulsi), Origanum vulgare L. and Tectona grandis L.f. Methodology: The oil, starch, total polyphenol, flavonoid and mineral contents for aforementioned seeds were determined. Fourier-transform infrared (FTIR) spectroscopy was used to assess the phytoconstituents. Thermogravimetric/derivative thermogravimetric analyses (TG/DTG) and differential scanning calorimetry (DSC) analyses were performed to analyze the decomposition patterns. Results: The concentrations of oil, starch, total polyphenol, flavonoids and minerals for the seeds from the eight plants under study ranged from 11.8 to 50.4%, from 0.22 to 1.84%, from 295 to 5842 mg/kg, from 1660 to 12680 mg/kg and from 11756 to 33927 mg/kg, respectively. Unsaturated oils, polyphenols and lignin were recognized by vibrational spectroscopy. The sequence of thermal effects in the seed pyrolysis process above 100°C have been put in relation to seed protein crystallization (endotherm at 200°C), oxidation reactions and degradation of hemicellulose and other fiber components (at around 300°C), and decomposition of polyunsaturated (at 357°C) and mono-unsaturated (at 391°C) triglycerides. Conclusion: Lamiaceae seeds are potential food alternatives to cereals.

Incidence and predictors of forearm hematoma during the transradial approach for percutaneous coronary interventions

Background The transradial approach for percutaneous coronary intervention (TRA-PCI) reduces vascular complications compared with the transfemoral approach (TFA). Although hematoma formation is less frequent with the TRA than TFA, it is not uncommon, and its presentation ranges from mild hematoma to compartment syndrome. Incidence and predictors of hematoma have not been well studied. Methods and results The present study was conducted to prospectively evaluate the incidence and predictors of forearm hematoma after TRA-PCI. The study population consisted of consecutive patients undergoing TRA-PCI. Baseline and procedural characteristics and clinical outcomes were prospectively collected. All patients were observed for forearm/arm hematoma immediately after procedure, after band removal, before discharge, and whenever the patient complained of pain/swelling in the limb. Logistic regression analysis was performed to determine the predictors for hematoma formation. A total of 520 patients who had successfully completed TRA-PCI were included in the final analysis. The mean age was 55.2 ± 9.5 years, and 24% patients were women. Hematoma occurred in 53 (10.2%) patients. Hematomas were of grade I, II, III, and IV in 22 (4.2%), 9 (1.7%), 18 (3.5%), and 4 (0.8%) patients, respectively. On multivariate logistic regression analysis, age, body mass index, multiple puncture attempt, glycoprotein IIb/IIIa receptor blocker use, nonclopidogrel agent use for dual antiplatelet therapy, and multiple catheter exchanges emerged as independent predictors for hematoma formation. Conclusions Forearm hematoma following TRA-PCI occurs in about 10% patients. Most hematomas occur near the puncture area. The independent predictors for hematoma formation are age, body mass index, multiple puncture attempts, intensive antiplatelet therapy, and multiple catheter exchanges.

An epidemiological study on the prevalence of temporomandibular disorder and associated history and problems in Nepalese subjects

BACKGROUND: Temporomandibular disorder (TMD) represents a subgroup of painful orofacial disorders involving pain in the temporomandibular joint (TMJ) region, fatigue of the cranio-cervico-facial muscles (especially masticatory muscles), limitation of mandible movement, and the presence of a clicking sound in the TMJ. TMD is associated with multiple factors and systemic diseases. This study aimed to assess the prevalence of TMD in Nepalese subjects for the first time. METHODS: A total of 500 medical and dental students (127 men and 373 women) participated in this study from May 2016 to September 2016. The Fonseca questionnaire was used as a tool to evaluate the prevalence of TMD, and Fonseca's Anamnestic Index (FAI) was used to classify the severity of TMD. RESULTS: The majority of the participants with TMD had a history of head trauma, psychological stress, and dental treatment or dental problems. The prevalence of TMD in Nepalese students was mild to moderate. CONCLUSIONS: The prevalence of TMD in Nepalese subjects was mild to moderate. The majority of the study subjects had eyesight problems, history of head trauma, psychological stress, and drinking alcohol and had received dental treatments.

Early detection of multidrug resistant (MDR) Mycobacterium tuberculosis in a single tube with in-house designed fluorescence resonance energy transfer (FRET) probes using real-time PCR.

Rapid and correct diagnosis is crucial for the management of multidrug resistance (MDR) in Mycobacterium tuberculosis (MTB). The present study aims at rapid diagnosis for identification of multidrug resistance tuberculosis (MDR-TB) using real-time PCR. FRET hybridization probes targeting most prominent four selected codons for rpoB526 and 531 and for katG314 and 315 genes were designed and evaluated on 143 clinical MTB isolates and paired sputa for rapid detection of MDR-TB. The results of real-time PCR were compared with gold standard L-J proportion method and further validated by DNA sequencing. Of the 143 MTB positive cultures, 85 and 58 isolates were found to be ‘MDR’ and ‘pan susceptible’, respectively by proportion L-J method. The sensitivity of real-time PCR for the detection of rifampicin (RIF) and isoniazid (INH) were 85.88 and 94.11%, respectively, and the specificity of method was found to be 98.27%. DNA sequencing of 31 MTB isolates having distinct melting temperature (Tm) as compared to the standard drug susceptible H37Rv strain showed 100% concordance with real-time PCR results. DNA sequencing revealed the mutations at Ser531Leu, His526Asp of rpoB gene and Ser315Thr, Thr314Pro of katG gene in RIF and INH resistance cases. This real-time PCR assay that targets limited number of loci in a selected range ensures direct and rapid detection of MDR-TB in Indian settings. However, future studies for revalidation as well as refinement are required to break the limitations of MDR-TB detection.

Evaluation of goat based ‘Indigenous vaccine’ against Bovine Johne’s Disease in endemically infected native cattle herds.

‘Indigenous vaccine’ prepared from ‘Indian Bison Type’ a native bio-type of Mycobacterium avium subspecies paratuberculosis strain ‘S5’ of goat origin (goat based) was evaluated in indigenous cattle herds located in gaushalas (cow shelters), endemic for Bovine Johne’s disease. Cows (893) were randomly divided into vaccinated (702 = 626 adults + 76 calves) and control (191 = 173 adults + 18 calves) groups. Response to vaccination was evaluated on the basis of health (mortality, morbidity), productivity (growth rate, reproductive performance, total milk yield), immunological parameters (LTT, ELISA titer), survivability of animals naturally infected with MAP, bacterimia (by specific blood PCR), sero-conversion (by indigenous ELISA) and status of shedding of MAP in feces (by microscopy) in the two groups before and after vaccination. Reduction in MAP shedding [to the extent of 100% in Herd A; and from 82.1% (0 DPV) to 10.7% (270 DPV) in Herd C] was the major finding in vaccinated cows. Whereas, the control group cows have shown no improvement. As the first indicator of vaccine efficacy, MAP bacilli disappeared from the blood circulation as early as 15 days post vaccination, however, peak titers were achieved around 90 DPV. Peak titers initially declined slightly but were maintained later throughout the study period. Control animals did not show any pattern in antibody titers. Mortality was low in vaccinated as compared to the control groups. Vaccination of endemically infected native cattle herds with inactivated whole-cell bacterin of novel ‘Indian Bison Type’ bio-type of goat origin strain ‘S5’ effectively restored health and productivity and reduced clinical BJD. Application of goat based ‘indigenous vaccine’ for therapeutic management of BJD in native cattle herds (gaushalas) is the first of its kind.

Application of IS1311 locus 2 PCR-REA assay for the specific detection of ‘Bison type’ Mycobacterium avium subspecies paratuberculosis isolates of Indian origin.

Background & objectives: Of the three major genotypes of Mycobacterium avium subspecies paratuberculosis (MAP), ‘Bison type’ is most prevalent genotype in the domestic livestock species of the country, and has also been recovered from patients suffering from Crohn’s disease. Recently, a new assay based on IS1311 locus 2 PCR- restriction endonuclease analysis (REA) was designed to distinguish between ‘Indian Bison type’ and non-Indian genotypes. The present study investigated discriminatory potential of this new assay while screening of a panel of MAP isolates of diverse genotypes and from different geographical regions. Methods: A total of 53 mycobacterial isolates (41 MAP and 12 mycobacterium other than MAP), three MAP genomic DNA and 36 MAP positive faecal DNA samples from different livestock species (cattle, buffaloes, goat, sheep and bison) and geographical regions (India, Canada, USA, Spain and Portugal) were included in the study. The extracted DNA samples (n=92) were analyzed for the presence of MAP specific sequences (IS900, ISMav 2 and HspX) using PCR. DNA samples were further subjected to genotype differentiation using IS1311 PCR-REA and IS1311 L2 PCR-REA methods. Results: All the DNA samples (except DNA from non-MAP mycobacterial isolates) were positive for all the three MAP specific sequences based PCRs. IS1311 PCR-REA showed that MAP DNA samples of Indian origin belonged to ‘Bison type’. Whereas, of the total 19 non-Indian MAP DNA samples, 2, 15 and 2 were genotyped as ‘Bison type’, ‘Cattle type’ and ‘Sheep type’, respectively. IS1311 L2 PCR-REA method showed different restriction profiles of ‘Bison type’ genotype as compared to non-Indian DNA samples. Interpretation & conclusions: IS1311 L2 PCR-REA method successfully discriminated ‘Indian Bison type’ from other non-Indian genotypes and showed potential to be future epidemiological tool and for genotyping of MAP isolates.

Evaluation of the Efficacy of Methylprednisolone, Etoricoxib and a Combination of the Two Substances to Attenuate Postoperative Pain and PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Placebo-controlled Trial

BACKGROUND: Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. METHODS: One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher's exact test. P values of less than 0.05 were considered to be significant. RESULTS: Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P<0.05). CONCLUSIONS: A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.

Lipoprotein [a] levels in relation to severity of coronary artery disease in north Indian patients

Lipoprotein [a] [Lp [a]] is an established risk marker of coronary artery disease which is independent from other risk factors. The aim was to address the association between Lp [a] and CAD risk in North Indians. To evaluate whether high levels of lipoprotein [a] [Lp [a]] is a predictor of risk and is related to the severity of CAD. This was a cross-sectional study done on 360 patients presenting with chest pain. Coronary angiography revealed CAD in 270 patients and 90 patients without CAD. Lipoprotein [a] level, lipid profile, fasting blood glucose, anthropometric and clinical parameters were analyzed. Lipoprotein [a] 21.0 mg/dL is associated with the presence of coronary lesions [P = 0.0001]. A highly significant difference in Lp [a] levels was observed between normal coronaries vs. single-vessel disease, double-and triple-vessel disease [P < 0.0001]. Body mass index [BMI] was significantly raised in CAD group compared to normal coronary. Multivariate analysis found that Lp [a] was considered an independent predictor for severity of CAD and Lp [a] levels 21.0 mg/dL are associated with severe patterns of coronary atherosclerosis

A study of ventricular asynchrony in patients with varying QRS duration and its correlation with left ventricular function.

BACKGROUND: Biventricular pacing (cardiac resynchronization therapy) has been shown to improve patients of dilated cardiomyopathy (DCMP), which include largely those with broad QRS complex (LBBB) and a few with normal QRS duration having associated interventricular and/or intraventricular delay. The true prevalence of ventricular asynchrony in a broad subset of patients of DCMP however has not been studied at large and it is unclear if there is association of asynchrony with the LV function. The present study was therefore conducted to assess the prevalence of ventricular asynchrony in a broad set of patients of dilated cardiomyopathy with varying QRS duration and also trying to correlate the same with the LV function. METHOD AND RESULTS: Ninety three consecutive patients of DCMP (EF < 40%) with varying QRS duration and twenty patients with broad QRS complexes (LBBB morphology) with normal LV function (LVEF > 40%) were studied. The patients were then grouped as Group-I, including patients of DCMP with broad QRS (>120 msec, LBBB morphology) (n = 40), Group-II, including patients of DCMP with narrow QRS, (QRS width < or = 120 msec) (n = 53) and Group-III, including patients of LBBB with normal LV function (n = 20). Ventricular asynchrony was diagnosed using standard echocardiography criteria on 2-D, M-mode and pulse wave Doppler including, 1) Interventricular delay:- diagnosed when the difference between aortic (Q-AV) and pulmonary ejection delays (Q-PV) was 340 msec and 2) Intraventricular delay:- diagnosed when posterior left ventricular activation occurred later than onset of diastolic mitral inflow or septal to post wall motion delay of > or = 130 msec. Ventricular asynchrony was present in 97.5% (39/40) in Group-I, 50.9% (27/53) in Group-II and 90% (18/20) in Group-III. Amongst this however interventricular conduction delay was present in 97.5% (39/40) of group-I, 20.7% (11/53) of group-II and 90% )18/20) of group-III, while intraventricular delay was present in 62.5% (25/40) of Group-I, 43.3% (23/53) of Group-II and none of Group-III. Analyzing the contribution of LV dysfunction independent of QRS duration to the occurrence of LV dyssynchrony, patients were further divided in three groups, viz. DCM with LVEF < 20% (group A) (mean LVEF = 16.53 +/- 2.28%), DCM with LVEF > or = 20% (group-B) (mean LVEF = 27.15 +/- 4.29%) and LBBB with normal LV function (group C) (mean LVEF = 53.45 +/- 4.83%). The mean QRS durations were not different between groups A and B (114.3 +/- 32.2 msec vs. 109.1 +/- 13.9 msec, respectively, p = 0.16). However group A had a significantly higher number of patients with ventricular asynchrony compared to group B [37/45 (82.2%) vs. 29/48 (60.4%), p = 0.001)]. CONCLUSION: We conclude that there is a wide prevalence of, but heterogeneity in occurrence of ventricular asynchrony among patients of dilated cardiomyopathy. The asynchrony possibly relates more to left ventricular function in addition rather than to the QRS duration alone. Criteria for biventricular pacing probably need to relate to ventricular asynchrony than to the QRS duration alone.

Budd-Chiari syndrome--a case report.

A 21year old male presented with abdominal pain for 2 months and abdominal distension and swelling of lower limbs for 1 month. Ultrasonography of abdomen showing coarse echotexture of liver and intraluminal filling defect of inferior vena cava (IVC) and CT scan confirming the USG finding and showing enlarged caudate lobe of liver and thrombus in proximal IVC suggested the possibility of Budd-Chiari syndrome. Confirmation of diagnosis was done by inferior venacavography. The patient had nephrotic syndrome as the risk factor for thrombosis. The patient was portally decompressed by portocaval shunt with significant symptomatic relief.