Point-of-Care Ultrasound in Neonatology in India: The Way Forward

The clinician-performed point-of-care ultrasound (POCUS) is a useful tool, and its scope includes bedside assessment of pulmonary (e.g., pneumothorax, pleural effusion), cardiac (e.g., pulmonary hypertension, ductus arteriosus), gastrointestinal (e.g., necrotising enterocolitis), and intracranial (e.g., intraventricular hemorrhage, cerebral blood flow velocities) pathologies, procedural guidance and rapid assessment of etiologies of acute clinical deterioration (e.g., pneumothorax, poor cardiac contractility, intraventricular hemorrhage). Despite its potential to improve patient care, a curriculum and a structured program for POCUS training is lacking in India. Homogenous approach to training and ongoing quality assurance is essential to optimize benefits of POCUS as an effective tool in clinical practice. The training needs, the legal and infrastructural barriers to successful implementation of POCUS, and strategies to implement the program at the national level are discussed.

Analysing the Effect of Incorporating Images While Framing MCQs For Online Clinical Anatomy Assessment Among First Year Medical Students

The disruptions caused by COVID-19 pandemic has significantly affected the assessment component of the undergraduate medical curriculum. The lack of physical ascertainment of the learning outcomes has forced the medical educators across the world to adopt online modes of assessment. Though multiple options like true / false, short answers and viva were available, the most common tool for many was multiple choice questions as they could be arranged according to the cognitive hierarchy of Miller’s pyramid. The present study was undertaken to analyze the effect of incorporating images while framing MCQs for online anatomy assessment among first year medical students. The study was planned in a quasi-controlled design where a batch of 150 students were subjected to a set of 40 multiple choice questions (20 text based and 20 image based MCQs). The questions were designed following Ebel and Frisbie guidelines of MCQs and validated by three investigators independently. Three cycles of assessments were conducted, and the scores were analyzed. At the end of 3 cycles of assessment feedback was taken from the students regarding this method of assessment. The performance of students was better in image based MCQs compared to traditional MCQs in all regions. Upon documenting the percipience, students had felt that image based MCQs were interesting, improved their clinical reasoning skills, lateral thinking abilities and quest for learning applied anatomy. Thus, we postulate that image based MCQs could be considered as better assessment tool in the era of online learning

Amniotic fluid embolism: lessons for rapid recognition and intervention

Amniotic fluid embolism is a rare, often fatal complication of labor and delivery. The classic presentation is the sudden onset of a triad of clinical manifestations: hypoxia, hypotension and coagulopathy. Understanding of the syndrome as an immunologically mediated, complicated and often catastrophic maternal response to fetal or placental antigens is coming into focus. New treatments such as extracorporeal membrane oxygenation (ECMO) and better use of old treatments such as transfusion offer hope, but the condition is often rapidly fatal, so saving the maternal and fetal lives depends on rapid recognition of the syndrome. This series of three cases illustrates the clinical features enabling the rapid recognition needed for successful treatment of amniotic fluid embolism syndrome.

Systemic Effects and Medicolegal Aspects of Formic Acid Poisoning - An Autopsy Study.

Formic acid is easily available in open market, because of its wide use in the rubber industry for processing of latex. Because of the easy availability, case of accidental and suicidal poisoning by formic acid are on the rise and most of them end fatally. On reviewing the literature, only a few were found to be reported and studied in detail. MethodsThis study was carried out on seventy-five medicolegal cases, brought with history of formic acid poisoning which were brought for autopsy during the period February 2012 - July 2013. Bits of tissues from upper part of oesophagus, lesser curvature of stomach, lungs, liver, kidney and pancreas were collected. The tissues were processed, and slides were prepared. Microscopic study of each slide was done. ResultsMales (57.3%) outnumbered females and maximum number of cases was of age group 41-70 yrs. (72%). Most of the victims were taken to hospital for treatment and died after admission (85.3%). Laboratory investigations revealed that most of the cases (85.3%) showed impairment in renal function tests, evidence of haemolysis, and metabolic acidosis, corrosion of the upper part of alimentary tract, glottic oedema and brownish fluid in peritoneal cavity. ConclusionsIn Kerala the incidence of formic acid poisoning is on the rise, probably because of the easy availability of the acid to people engaged in rubber industry which is widely prevalent in this state. Ingestion of formic acid leads to a serious systemic and metabolic damage

Infusing the axioms of clinical reasoning while designing clinical anatomy case vignettes teaching for novice medical students: a randomised cross over study / 대한해부학회지

The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The ‘ideal’ blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning (‘serial cue’ approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student’s t-test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions (P<0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.

Infusing the axioms of clinical reasoning while designing clinical anatomy case vignettes teaching for novice medical students: a randomised cross over study / 대한해부학회지

The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The ‘ideal’ blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning (‘serial cue’ approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student’s t-test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions (P<0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.

Prevalence of bacterial vaginosis among reproductive age group women in a tertiary care centre

Background: Vaginal discharge in reproductive age poses a serious problem in the developing countries. Bacterial vaginosis also known as non-specific vaginitis is the most common cause of vaginal infections, detecting the organism at an early stage and initiating a proper treatment is very difficult in our country due to lack of awareness and proper follow-up. The disease manifests in the form of vaginal discharge with or without itching. It has a strong association with preterm labor, preterm premature rupture of membranes and low birth weight in pregnancy. The objective of this study was to find out the prevalence of bacterial vaginosis among the reproductive age group women, in a tertiary care centre.Methods: A cross sectional study was conducted among 150 women of the reproductive age group in the department of obstetrics and gynaecology Sree Mookambika Institute of Medical Sciences over a period of one month October 2018 the diagnosis was made with history and nugents scoring system.Results: Out of the total 150 women enrolled in the study 74 had positive results, 50% of them were of the age group 26-30.Conclusions: The study shows us the high prevalence of bacterial vaginosis.

Association between decreased expression of estrogen receptor alpha, androgen receptor and phosphatase and tensin homolog immunoexpression in the canine prostate / Associação entre diminuição da expressão dos receptores de estrógeno alfa e andrógeno, e imunoexpressão de fosfatase e tensina homóloga na próstata canina

Canine prostate gland is a hormonal dependent organ and its imbalance of estrogen and androgen receptor expressions are directly associated with the development of different diseases. Due to the lack of information regarding the behavior of the aforementioned receptors in canine prostate cancer (PC), this study aimed to identify estrogen receptor alpha (ERα), androgen receptor (AR), Ki67 and phosphatase and tensin homolog (PTEN) protein expressions in canine PC by immunohistochemistry. We found nuclear expression of ERα and AR in the epithelial cells of normal canine samples and a loss of protein expression in PC samples. Normal samples showed Ki67 expression in a few basal cells and the PC samples showed the highest mean of positive cells (253.1). Canine prostate cancer showed a high proliferative index, which was associated with independence of hormonal actuation. PTEN showed positive nuclear and cytoplasmic expression in normal canine samples and a loss in PC. Loss of ERα, AR and PTEN indicated that canine PC exhibits the same immunohistochemical phenotype as in human patients with PC resistant to hormonal therapy. Therefore, canine PC should be considered as a model to study human PC resistant to hormonal therapy.(AU)

A glândula prostática canina é um órgão dependente de hormônio, e o desequilíbrio na expressão dos receptores de estrógeno e andrógeno estão diretamente associados com o desenvolvimento de diferentes doenças. Devido à falta de informação sobre o comportamento desses receptores no câncer prostático canino (PC), este estudo tem por objetivo identificar a expressão proteica através da técnica de imuno-histoquímica do receptor de estrógeno alfa (REα), receptor de andrógeno (RA), Ki67 e fosfatase e tensina homóloga (PTEN). Foi encontrado nas células epiteliais prostáticas normais caninas a expressão nuclear de REα e RA, e perda de expressão proteica nas amostras de PC. As amostras normais apresentaram expressão de Ki67 em poucas células basais e as amostras de PC apresentaram a maior média de células positivas (253,1). O câncer de próstata canino apresentou uma taxa alta de proliferação, o qual foi associado com a atuação independente de hormônio. As amostras de próstatas caninas normais revelaram marcação nuclear e citoplasmática da proteína PTEN e perda nas amostras de PC. A perda de REα, RA e PTEN indicam que as amostras de PC exibem o mesmo fenótipo imuno-histoquímico de pacientes humanos com câncer prostático resistente a terapia hormonal. Sendo assim, o PC canino deve ser considerado um modelo para estudos de câncer prostático humano resistente a terapia hormonal.(AU)

Potential of phloroglucinol to improve erectile dysfunction associated with streptozotocin-induced diabetes in rats / 中西医结合学报

OBJECTIVE@#Diabetes is a common metabolic disease with several complications in its patients. Often, people living with diabetes develop erectile dysfunction (ED). The primary aim of this work was to investigate the effect of phloroglucinol in diabetes-induced ED in rats.@*METHODS@#Male Wistar rats were given 52 mg/kg of streptozotocin, by intraperitoneal injection, to induce diabetes and ED. Subsequently, animals were grouped into three groups: group 1, diabetic control; group 2, low-dose phloroglucinol (150 mg/kg body weight); and group 3, high-dose phloroglucinol (250 mg/kg body weight). A group of six normal rats served as a normal control. The rats were treated with phloroglucinol for six weeks and then were assessed for treatment effects. Sexual behavior, glycosylated hemoglobin A1c (HbA1c) values, serum testosterone, serum nitric oxide (NO), blood pressure and sperm count were measured after the end of treatment.@*RESULTS@#After a 6-week treatment period, the high dose of phloroglucinol significantly decreased HbA1c values in diabetic rats. Rats treated with phloroglucinol had increased serum testosterone, NO and sperm count. Animals treated with 250 mg/kg phloroglucinol performed similar to normal rats in the sexual behavioral study, suggesting the reversal of complications of ED. Conversely, a decrease in the blood pressure in treated groups was observed.@*CONCLUSION@#The results highlight the protective effect of phloroglucinol in diabetes-induced ED in rats warranting further studies.

Free Style Libre Pro (FSLP) Flash Glucose Monitor (FGM) – A Novel Monitoring Tool for Children with Type 1 Diabetes Mellitus

Flash glucose monitoring using Free Style Libre Pro (FSLP) wasundertaken among fifteen diabetic children. Data revealed highglycaemic variability, Time in Target Range (TIR) to be 27% and12% of time in hypoglycaemia. Sensor insertion and retentionwere problematic in 33%. Though user friendly, sensors mayneed an additional adhesive plaster for retention.

Absent superior vena cava in tetralogy of fallot

Absent superior vena cava (SVC) is an asymptomatic congenital systemic venous anomaly which is rarely detected and compatible with normal life. Undiagnosed absent SVC may cause problems during cardiac catheterization or cardiac surgery. We present our surgical experience in a patient with tetralogy of Fallot who had undiagnosed absent SVC.

Surgical sponge associated with platelets rich plasma in skin mesh grafts and layer in rabbits (Oryctolagus cuniculus) / Esponja cirúrgica associada com plasma rico em plaquetas em enxertos cutâneos em malha e camada em coelhos (Oryctolagus cuniculus)

The aim of this study was to evaluate of the efficacy of PRP employment associated with surgical sponges to improve the integration of the graft in the recipient bed. It was held at the Veterinary Hospital UNESP, Campus of Jaboticabal - SP, a study of 64 rabbits, divided into eight groups with eight animals. The groups were divided in control with saline solution 0,9%, control with PRP both without the sponge, surgical sponge with PRP, surgical sponge without PRP, and were used mesh and layer grafts in the respective groups. The data were submitted to statistical analysis (paired t-test, Kruskal-Wallis test, with subsequent use of the multiple comparison tests of Dunn, analysis of variance (F) test, Tukey test, P< 0.05). Edema and exudate with 3 and 3 and 7 days (P= 0,03 e P= 0,0049); coloring on the 14th day (P= 0,0001); cosmetic appearance on the 7th and 14th day (P= 0,0026 and P= 0,0001); mononuclear cells (P= 0,01) and polymorphonuclear (P= 0,01); fibroblast proliferation (P= 0,01); collagenous (P= 0,05); hemorrhage (P-007); necrosis and re-epithelialization (P= 0,2928 and P= 0,1). We concluded that the use of Platelet Rich Plasma Gel on skin grafts associated with a sponge as a compressive dressing promote the skin graft survival without a previous granulation tissue.(AU)

O objetivo deste estudo foi avaliar a eficácia do PRP associado com esponjas cirúrgicas na integração do enxerto ao leito receptor. Realizou-se, no Hospital Veterinário da Unesp, Jaboticabal, SP, um estudo com 64 coelhos, separados em oito grupos, com oito animais. Os grupos foram: Gprpc (PRP, sem esponja cirúrgica, enxerto camada), Gprpce (PRP, esponja cirúrgica, enxerto camada), Gcc (solução fisiológica 0,9%, sem esponja cirúrgica, enxerto camada), Gcce (solução fisiológica 0,9%, esponjas cirúrgicas, enxerto camada), Gprpm (PRP, sem esponja cirúrgica, enxerto malha), Gprpme (PRP, esponja cirúrgica, enxerto malha), Gcm (solução fisiológica 0,9%, sem esponja cirúrgica, enxerto malha) e Gcce (solução fisiológica 0,9%, esponjas cirúrgicas, malha). Os dados foram analisados pelo teste t emparelhado, Kruskal-Wallis, análise de variância, e teste de Tukey (P<0,05). Edema e exsudato presente com três e sete dias (P=0,03 e P=0,0049); coloração cianótica no 14º dia (P=0,0001); aspecto cosmético bom no sétimo e no 14º dia (P=0,00026 e P=0,0001); presença de células mononucleares (P=0,01) e polimorfonucleares (P=0,01); proliferação de fibroblastos discreta (P=0,01); colagenização intensa (P=0,05); hemorragia discreta (P=0,007); ausência de diferença significativa em necrose e reepitelização (P=0,2928 e P=0,1). Conclui-se que o emprego do PRP gel em enxertos cutâneos associando esponjas cirúrgicas como curativo compressivo favorece sua integração ao leito receptor sem a presença prévia de tecido de granulação.(AU)

Osteoporosis: a common health problem in senior adult population of arar city, saudi arabia

Background: Osteoporosis is characterized by compromised bone strength predisposing to an increased risk of fracture, which has significant effects on human health, quality of life

Objective: To determine the prevalence and determinant factors of osteoporosis among elderly in Arar, KSA

Methods: The present cross sectional community based study was conducted in Arar city, the capital of Northern Borders Governorate on 229 adult people aged 60 years and more. Data were collected through personal interviews with the sampled population and filling the questionnaire which guided us to the data of socio-demographic status, smoking, chronic diseases, already previously diagnosed osteoporosis, after ensuring the diagnosis by reviewing the accompanied health reports and/or prescriptions and asking the accompanied caregivers about the case

Results: The mean age of the participants [+/-SD] was 70.5 [+/- 9.4] years. Males were 48% and females were 52%. The overall prevalence rate of osteoporosis found in this study was 24.5%. There was significant relationship between osteoporosis and sex, presence of thyroid disease [P<0.05]. While there was an insignificant relationship between osteoporosis and age group, BMI group, presence of diabetes mellitus and presence of hypertension [P>0.05]

Conclusion: In conclusion, osteoporosis is a common health problem [24.5%] in the elderly population in Arar city, KSA. Conclusion: Osteoporosis is significantly higher in elderly females. Health education and preventive programs are highly recommended to protect and treat that vulnerable group

Histochemical and immunohistochemical evaluation of angiogenesis in rabbits (Oryctolagus cuniculus) submitted to skin grafts associated with platelet-rich plasma / Histoquímica e imunohistoquíca na avaliação da angiogênese em coelhos submetidos ao emprego de enxertos cutâneos associado com plasma rico em plaquetas

Histochemical staining consists of a set of specific chemical reactions of structures or tissue-endogenous substances. Immunohistochemistry allows verification of proteins in tissues related to biological and pathological factors. The standardization of methods to assess angiogenesis resulting from formation of new blood vessels in procedures with stimulants is important to facilitate the implementation of research as well as to assist interpretation of data. In rabbits some markers of angiogenesis antibodies in the skin are not standardized because of cross-reactions that may occur because the antibodies are made from such animals.The aim of this study was to analyze the immunohistochemical methods through dyes and immunohistochemical markers angiogenesis in rabbits (Oryctolagus cuniculus) having undergone reconstructive surgery with skin grafts associated with plasma angiogenesis stimulator rich in platelets, in order to evaluate which method would be better to visualize the vessels, as well as to evaluate which antibody would promote better immunostaining, and find the differences between the methods and to standardize the methodology to be applied in experiments using rabbits. Sixteen rabbits were used, split into two groups of eight animals: Gprp (plasma rich in platelets) and Gc (control, saline solution, 9%). The same technique of reconstructive surgery using graft mesh was performed on each rabbit. The groups differed only in the application of platelet-rich plasma before the surgical wound synthesis. Samples for evaluation of angiogenesis were collected 15 days after the surgical procedure. The dyes Hematoxylin & Eosin and Masson's Trichrome were used in the histochemical study to evaluate vascular proliferation. Markers CD31, CD34 and Caveolin-1 was used for the immunohistochemical study. The evaluation between the groups (Gprp and Gc) in regard to the categorical variable (vascular proliferation intensity) used the Kruskal-Wallis test with p values equal to or less than 0.05 being considered significant. The immunohistochemistry was subjected to analysis of variance for a completely randomized design, with two groups and five repetitions (medium) and 5% significance level. Multiple comparison of groups resulted in the Tukey test (p=0.05) used. The amount of vascular proliferation assessed by histochemical method HE and Masson's Trichrome was found to be a significant variable in Gprp when compared with group Gc. When evaluating the methods used, there was no significant difference. There was no difference in the three markers which were used for correlating microvessels; however, there was more intense staining of vessels when Caveolin-1 Antibody was used. This caused intense marking of the capillaries and small vessels, as well as of larger vessels. When using CD31 and CD34, the same was observed, but it was not as intense as with Caveolin-1; though some cases showed sincere and discreet marking. The results of this study demonstrated that the histochemical methods performed are effective for semi-quantitative assessment of angiogenesis. The immunohistochemical comparison of Caveolin-1, CD31, and CD34 as markers of angiogenesis in rabbits showed that both antibodies could immunostain the newly formed vessels; but the Caveolin-1 showed better immunostaining in small and medium-sized vessels, as well as a minor presence in the background. Although not specific markers for angiogenesis, they can be used as immunohistochemical markers of vascular endothelium in rabbits.(AU)

Colorações histoquímicas consistem de um conjunto de reações químicas específicas das estruturas ou substâncias endógenas do tecido. Logo a Imunohistoquímica permite observar proteínas presentes nos tecidos relacionadas com fatores determinantes do comportamento biológico e patológico. A padronização dos métodos que avaliam a angiogênese decorrente de procedimentos que utilizam substâncias estimulantes à formação de novos vasos são importantes, a fim de facilitar a execução das pesquisas, bem como auxiliar na interpretação dos dados, visto que em coelhos alguns anticorpos marcadores de angiogênese na pele ainda não são padronizadas em virtude das reações cruzadas que podem ocorrer devido aos anticorpos serem confeccionados a partir de tais animais. Objetivou-se analisar os métodos histoquímicos por meio das colorações e imunohistoquímicas com marcadores de angiogênese em coelhos (Oryctolagus cuniculus) submetidos ao emprego de enxertos cutâneos associado com estimulador de angiogênese plasma rico em plaquetas, a fim de avaliar qual método seria melhor para visualização dos vasos, bem como avaliar qual anticorpo promoveria melhor imunomarcação, buscando-se assim encontrar a diferenças entre os métodos e padronizar a metodologia a ser aplicada em experimentos que utilizem coelhos. Utilizou-se 16 coelhos, separados em dois grupos com oito animais, compreendendo os grupos Gprp (plasma rico em plaquetas) e Gc (controle, solução fisiológica 0,9%). Em todos os animais foi realizada a mesma técnica de cirurgia reconstrutiva de enxertia do tipo malha, os grupos diferiram apenas a aplicação do plasma rico em plaquetas antes da síntese da ferida cirúrgica. As amostras para avaliação da angiogênese foram coletadas após 15 dias do procedimento cirúrgico. Utilizou-se no estudo histoquímico as colorações Hematoxilina & Eosina e Tricrômico de Masson para avaliação da proliferação vascular, e os anticorpos CD31 e CD34 e Caveolina - 1 para avaliação imunohistoquímica. A comparação entre os grupos (Gprp e Gc) em relação à variável categórica (intensidade de proliferação vascular) foi utilizado o teste de Kruskal-Wallis, com valores de p iguais ou inferiores a 0,05 foram considerados significativos. Os dados imuno-histoquímico foram submetidos à análise de variância para um delineamento inteiramente ao acaso, com 2 grupos e 5 repetições (médias) e nível de significância de 5%. Nas comparações múltiplas das médias dos grupos, utilizou-se o teste de Tukey (α = 0,05). A intensidade de proliferação vascular avaliada pelo método histoquímico HE e Tricômico de Masson encontrou-se que tal variável foi significativa no Gprp, quando comparado com o Gc. Avaliando os métodos utilizados não houve diferença significativa. A contagem microvascular (MVC) realizada com os diferentes marcadores (Caveolina-1, CD31 e CD34) foi significativa no Gprp. Correlacionando a contagem microvascular dos três marcadores utilizados não houve diferença significativa, no entanto observou-se marcação mais intensa dos vasos utilizando o anticorpo Caveolina-1, sendo intensa a marcação dos capilares, vasos de pequeno calibre, bem como em vasos maiores. Nas avaliações de CD31 e CD34 observou que houve imunomarcação dos vasos, porém não foi intensa como a Caveolina-1, alguns casos apresentaram fundo, bem como marcação discreta. Os resultados encontrados neste estudo evidenciaram os métodos histoquímicos são eficazes para avaliação semiquantitativa da angiogênese. A comparação imunohistoquímicas da Caveolina-1, CD31 e CD34 como marcadores de angiogênese em coelhos evidenciaram que ambos os anticorpos são capazes de imunomarcar os vasos neoformados, porém a Caveolina-1 apresentou melhor imunomarcação de vasos de pequeno e médio calibre, bem como menor presença de fundo, embora não seja um marcador específico para angiogênese pode ser utilizada como marcador imunohistoquímico de endotélio vascular em coelhos.(AU)

Sexual dysfunction in females with depression: a cross-sectional study / Disfunção sexual em mulheres com depressão: um estudo transversal

Abstract Introduction Female sexual dysfunction (FSD) in depression albeit common is strikingly understudied. The condition, if addressed properly, can be readily cured, improving the quality of life of the patient. Methods A consecutive sample of drug-naïve married female patients with depression was assessed. Depression was diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D), and sexual dysfunction, the Female Sexual Function Index (FSFI). Results Sexual dysfunction was found in 90% of the patients in our study. Patients with medical comorbidities showed a significant decrease in the desire subset of the FSFI (Mann-Whitney U=11.0, p=0.009), however there was no significant association with other subsets. Patients who expressed passive death wishes had higher scores on all indicators of sexual function and a significantly higher score in the orgasm subset of the FSFI (Mann-Whitney U=11.0, p=0.009). Conclusion The study showed a high prevalence of FSD in depressed females regardless of type and severity of depression. Depression with medical comorbidities was associated with a significant decrease in desire. Patients who expressed passive death wishes showed improved sexual function and significantly better orgasm.

Resumo Introdução Disfunção sexual feminina (DSF) na depressão, apesar de comum, é pouco estudada. Se tratada adequadamente, a condição pode ser prontamente curada, aumentando a qualidade de vida da paciente. Métodos Foi avaliada uma amostra consecutiva de mulheres casadas, virgens de tratamento, com depressão. A depressão foi diagnosticada utilizando a Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). A gravidade da depressão foi avaliada utilizando a Escala de Avaliação de Depressão de Hamilton (HAM-D), e a disfunção sexual, com o Índice da Função Sexual Feminina (Female Sexual Function Index, FSFI). Resultados Foi observada disfunção sexual em 90% das pacientes do estudo. As pacientes com comorbidades médicas mostraram uma diminuição significativa no subdomínio desejo da FSFI (Mann-Whitney U=11,0, p=0,009), porém não houve associação significativa com os outros subdomínios. Pacientes que expressaram desejos passivos de morte apresentaram escores mais altos em todos os indicadores de função sexual e um escore significativamente mais alto no subdomínio orgasmo da FSFI (Mann-Whitney U=11,0, p=0,009). Conclusão O estudo revelou uma alta prevalência de DSF em mulheres deprimidas, independentemente do tipo e da severidade da depressão. A depressão com comorbidades médicas foi associada a uma diminuição significativa do desejo. Pacientes que expressaram desejos passivos de morte mostraram função sexual melhor e orgasmo significativamente melhor.

Dermoid Cyst of the Floor of Mouth in a Pediatric Patient: A Case Report.

Dermoid cysts are rare benign cystic lesions encountered in the head and neck region. Only 7% of dermoid cysts occur in the head and neck area of which only 1.6% appears in the oral cavity. Still rarer is the presentation of the dermoid cyst in the maxillofacial region in a pediatric patient, which is about 0.29%. Herein, we report a pediatric case of a female patient of 13 years old who came with the chief complaint of swelling below the chin since 8 years. Th e purpose of this case report is to emphasis on the rarity of the condition and how important it is to be considered in the differential diagnosis of lesions seen in relation to floor of mouth.

Acromegaly: Oral Diagnostician’s Role in Diagnosis: A Case Report.

Acromegaly is an acquired disorder related to overproduction of growth hormone (GH). The condition, though described more than 120 years ago, was only later found to be due to pituitary over secretion and adenomas. It is a rare condition with a tendency toward overgrowth of the mandible, maxillary widening, tooth separation, and skeletal malocclusion which makes its diagnosis important for us dentists. The majority of the cases in the past have been diagnosed by physicians and endocrinologists. Here, we present a case of a 38-year-old male patient who presented with the complaint of increase in the size of lips and forward movement of the jaws since 1 year. Clinical features, radiographic features, and arrival at the diagnosis of Acromegaly with the subsequent referral and treatment are discussed.

Sexual Dimorphism Using Canine Width and Inter-Canine Distance in South Indian Population: A Cross Sectional Study.

Background: Teeth provide excellent materials for forensic investigations intended for sex identification as they are the hardest and chemically most stable tissues in the body. The aim of this study was to evaluate the existence of sexual dimorphism in maxillary and mandibular permanent canines and also to estimate the level of accuracy with which they could be used for sex determination. Methods: The study sample consisted of 300 healthy adult patients aged between 20-30 years. Using sliding vernier calliper and divider, the maxillary and mandibular inter-canine distances and mesio-distal widths (MD) of left and right permanent maxillary and mandibular canines were recorded. The data was then subjected to Student’s t-test. Results: Mandibular canine width (MnCW) in males was significantly higher as compared to females. The mesiodistal widths of all the canines (MxRC, MxLC, MnLC, MnRC) were significantly higher in males than in females. Both maxillary right as well as left canine index (MxRCI, MxLCI) was significantly higher in males than the females. Statistically significant difference between male and females subjects was not observed pertaining to Maxillary canine width (MxCW) and mandibular canine index (MnRCI, MnLCI). Sexual dimorphism was exhibited by two teeth: maxillary right canine (8.34%) and maxillary left canine (13.04%). Conclusion: We evaluated a simple and inexpensive linear method as canine measurement for sexual dimorphism. Maxillary canines (particularly, maxillary left canine) showed a greater percentage of sexual dimorphism. Thus, maxillary canines can be used as an adjunct along with other accepted procedures for sex determination.

Clinical characteristics and treatment outcomes of primary autoimmune hemolytic anemia: a single center study from South India

BACKGROUND: Autoimmune hemolytic anemia (AIHA) is a less recognized, potentially fatal condition. There is a scarcity of data on clinicoserological characteristics and response to therapy concerning this disease from South India. METHODS: Data for 33 patients with primary AIHA recorded from July 2009 to June 2015 were retrospectively analyzed for clinical presentation, response to frontline therapy, durability of response, time to next treatment (TTNT), and response to second-line agents. RESULTS: The median follow-up period was 50 months. Among 33 patients, 48% of the cases were warm autoimmune hemolytic anemia (WAIHA), 46% were cold agglutinin disease (CAD), and 6% were atypical. Three-fourth of patients had severe anemia (<8 g/dL hemoglobin [Hb]) at onset; younger patients (age <40 yr) had more severe anemia. All of the patients who required treatment received oral prednisolone at 1.5 mg/kg/d as a frontline therapy, and the response rate was 90% (62% complete response [CR] and 28% partial response [PR]). The overall response to corticosteroids in WAIHA and CAD was 87% and 92%, respectively. The median corticosteroid duration was 14 months, and 50% of the patients required second-line agents. Fourteen patients received azathioprine as a second-line agent, and 11 of these patients responded well, with half of them not requiring a third agent. Four patients developed severe infections (pneumonia, sepsis, and soft tissue abscess) and two had life-threatening venous thrombosis. One case of death was recorded. CONCLUSION: AIHA is a heterogeneous disease that requires care by physicians experienced in treating these patients.

Efeitos da terapia combinada com ácido zoledrônico e propranolol na resistência mecânica em um modelo de rato com osteoporose por desuso / Effect of combined treatment with zoledronic acid and propranolol on mechanical strength in an rat model of disuse osteoporosis

Resumo Objetivos: Investigar os efeitos aditivos do agente antirreabsorção ácido zoledrônico (ZOL), isolado e em combinação ao propranolol (PRO), em um modelo de rato com osteoporose por desuso. Métodos: Usou-se um modelo de pata traseira direita de rato privada de descarga de peso para estudar as consequências da falta de descarga de peso sobre o esqueleto durante várias condições, como missões espaciais e repouso prolongado no leito em idosos. Ratos Wistar machos de três meses de idade foram submetidos à imobilização da pata traseira direita (IPTD) por 10 semanas para induzir à osteopenia; em seguida, foram divididos aleatoriamente em quatro grupos: 1 – IPTD para controle positivo; 2 – IPTD mais ZOL (50 μg/kg, dose única intravenosa); 3 – IPTD mais PRO (0,1 mg/kg, via subcutânea, cinco dias na semana); 4 – IPTD mais PRO (0,1 mg/kg, via subcutânea, cinco dias na semana) mais ZOL (50 μg/kg, dose única intravenosa) por outras 10 semanas. Um grupo de ratos não imobilizados foi usado como controle negativo. No fim do tratamento, os fêmures foram removidos e testaram-se a porosidade do osso e suas propriedades mecânicas, além do peso seco e das cinzas do osso. Resultados: No que diz respeito à melhoria da resistência mecânica da diáfise femoral média, a terapia combinada com ZOL mais PRO foi mais eficaz do que a monoterapia com ZOL ou PRO. Além disso, a terapia combinada com ZOL mais PRO foi mais eficaz na melhoria do peso seco do osso e preservou melhor a porosidade do osso cortical do que a monoterapia com ZOL ou PRO em ratos submetidos à imobilização da pata traseira direita. Conclusões: Esses dados sugerem que a terapia combinada com ZOL mais PRO deve ser recomendada para o tratamento da osteoporose por desuso.

Abstract Objectives: A model that uses right hind-limb unloading of rats is used to study the consequences of skeletal unloading during various conditions like space flights and prolonged bed rest in elderly. This study was aimed to investigate the additive effects of antiresorptive agent zoledronic acid (ZOL), alone and in combination with propranolol (PRO) in a rat model of disuse osteoporosis. Methods: In the present study, 3-month-old male Wistar rats had their right hind-limb immobilized (RHLI) for 10 weeks to induce osteopenia, then were randomized into four groups: (1) RHLI positive control, (2) RHLI plus ZOL (50 μg/kg, i.v. single dose), (3) RHLI plus PRO (0.1 mg/kg, s.c. 5 days per week), (4) RHLI plus PRO (0.1 mg/kg, s.c. 5 days per week) plus ZOL (50 μg/kg, i.v. single dose) for another 10 weeks. One group of non-immobilized rats was used as negative control. At the end of treatment, the femurs were removed and tested for bone porosity, bone mechanical properties, and bone dry and ash weight. Results: With respect to improvement in the mechanical strength of the femoral mid-shaft, the combination treatment with ZOL plus PRO was more effective than ZOL or PRO monotherapy. Moreover, combination therapy using ZOL plus PRO was more effective in improving dry bone weight and preserved the cortical bone porosity better than monotherapy using ZOL or PRO in RHLI rats. Conclusions: These data suggest that this combined treatment with ZOL plus PRO should be recommended for the treatment of disuse osteoporosis.