Clinical Outcomes of Del Nido Cardioplegia and St Thomas Blood Cardioplegia in Neonatal congenital Heart Surgery

Objectives:Cardioplegia is essential for adequate myocardial protection. There continues to remain ambiguity regarding the ideal cardioplegia for adequate myocardial protection in congenital heart surgery. This study compares clinical outcomes using St Thomas II solution and Del Nido cardioplegia in neonates undergoing cardiac surgery. Methods: All neonates (<30 days) from 2011 to 2017 who underwent surgery requiring cardioplegic arrest were analyzed retrospectively. We divided the cohort into two groups depending on cardioplegia received, as group A (Blood cardioplegia with St Thomas II solution, n = 56) and group B (Del Nido cardioplegia, n = 48). Various demographic, intraoperative, early postoperative, and discharge variables were analyzed. Results: Two groups were similar in age, gender, pre?operative diagnosis, and risk category. Cardiopulmonary bypass (CPB) time (P = 0.002), aortic cross?clamp (ACC) time (P = 0.018), and the number of doses of cardioplegia (P < 0.001) were significantly lower with Del Nido group. Though vasoactive inotropic score (VIS) (P = 0.036) was high during the first 24 h in the immediate postoperative period in group A, there was no difference in early mortality among both groups (P = 0.749). Both groups did not show significant differences related to various postoperative and discharge variables. Conclusion: When compared to St. Thomas solution, the use of Del Nido cardioplegia solution in neonates is associated with a significant decrease in CPB and ACC times and VIS in the first 24 h after surgery. The choice of cardioplegia (St Thomas/Del Nido) in neonates does not affect early mortality and early postoperative clinical outcomes.

Emerging intervention of antidepressant with DMARD in non-cancerous nociceptive persistent pain associated depression in FCA induced rheumatoid arthritic rats

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that causes pain, systemic complications and premature mortality. Depression has also been identified as a problem for persons with RA. This association remaining significant even after the degree of disease activity is controlled. In the present study, the efficacy of combination therapeutic effect of antidepressant (amitriptyline) with Disease Modifying Anti rheumatoid drug (leflunomide) was determined in rheumatoid arthritis pain associated depression in Freund's complete adjuvant (FCA) induced arthritic rats. Drug treatment was started 9 days after induction of FCA induced arthritis in rats. The antiarthritic activity was assessed by measuring paw volume, weight-bearing, hematological, biochemical, serological parameters, Radiographic analysis and Histopathology of tibiotarsal joints. The antidepressant activity was assessed by Forced swimming test, Rota-rod test and confirmed by estimation of brain neuro transmitters (serotonin and norepinephrine) level. Results of this study revealed that leflunomide and amitriptyline combination showed more significant (p<0.001) antiarthritic and antidepressant action and leflunomide alone treatment showed significant (p<0.001) antiarthritic activity only as compared to arthritic control. The leflunomide and low dose amitriptyline combination found to be more effective in pain associated depression in rheumatoid arthritic rats

Prospective evaluation of the diagnostic potential of LipL32 based latex agglutination test for Bovine leptospirosis

@#The Livestock Sector of India plays an important role in livelihood security and socioeconomic development of rural households. Leptospirosis is an important zoonotic disease responsible for septicaemia, interstitial nephritis, jaundice, abortion, reproductive problem in most of the animal species. Reproductive disturbances in bovine population is most often restricted to investigation of brucellosis, however apart from brucellosis, there are many undiagnosed diseases like leptospirosis that takes a toll in the reproductive anomalies of cattle and buffalo. Hence, the present study was elucidated to screen the seroprevalence of Leptospira in cattle and buffalo in various hamlets of North India using a user friendly screening test i.e. LipL32 latex agglutination test. The overall seropositivity was found to be 26.01% (230/884) in case of bovine in this study and the LipL32 LAT showed a profound sensitivity and specificity with level of 94.97% and 99.53% respectively.

Dynamic Slow Motion Video Endoscopy as an Adjunct to Impedance Audiometry in the Assessment of Eustachian Tube Function

Abstract Introduction Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment. Objective To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases. Methods Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive ofmiddle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology. Results A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar's chi-squared (χ2) test, showed a significant association between the 2 tests (p = 0.017). Conclusion There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.

Calcifying Cystic Odontogenic Tumor: A Case Report and Review.

Calcifying cystic odontogenic tumor (CCOT) are uncommon benign slow-growing cysts of developmental origin partly exhibiting characteristics of a neoplasm. Until date, the exact behavior of CCOT had been enigmatic and still the lesion portrays a platform to be debatable. The lesion has been reviewed and readdressed from the date first reported about its diverse clinical and histopathological features. The name of the lesion itself has undergone extensive review for the same reason. We report a case of calcifying odontogenic cyst in the mandible with a review of the literature. This paper also highlights the update on nomenclature and classification.

Risk Factors for Hypertension and its Complications – A Hospital Based Case Control Study.

Hypertension is one of the major public health problems and it is prevalent all over the world. It is a ‘silent killer’ as it is asymptomatic until its effects like Stroke, Myocardial Infarction, Renal dysfunction or visual problems are observed. So, the assessment on the risk factors which contribute more to development of blood pressure and the efforts at an early stage to control them will prevent the health hazards of Hypertension. The aim of the study was to identify the risk factors for Hypertension among patients attending Medicine OPD of Sree Mookambika Institute of Medical Sciences (SMIMS). This study also evaluated the complications associated with hypertension.This hospital based case control study was conducted in the Medicine OPD of SMIMS during March 2012. 100 consecutive Known hypertensive patients aged ≥40yrs were taken as cases. Another 100 age and sex matched non-hypertensive patients from the same OPD were taken as controls. Pretested questionnaire was applied to get the socio-demographic details and life style. Height, weight, BP and Hip Circumference were measured. Complications were assessed from the history and medical records. The analysis shows that family history of hypertension (OR=2.614, p-value=0.002) and Obesity (OR=1.833, p-value=0.040) are the major risk factors for hypertension. Among the complications, Coronary artery disease (OR=1.949, p-value=0.048) and Retinopathy (OR=2.111, p-value=0.015) are most commonly associated with hypertension. Diabetes, Stroke, Peripheral vascular disease, Neuropathy are also more with hypertension than controls but statistically not significant. The positive family history and Obesity are the significant risk factors for hypertension. Coronary Artery Disease and Retinopathy are the most common complications of hypertension. Health education is to be given to the patients on the risk factors for hypertension and its prevention. Prompt control of hypertension should be imparted to avoid complications.

Seroprevalence of leptospirosis among suspected cattle in eastern part of India: a comparative study between rLipL32ELISA and MAT

Leptospirosis in cattle is a worldwide problem associated with abortion, agalactia, still birth and infertility resulting in major economic losses to dairy industry. There is lack of data regarding seroprevalence of bovine leptospirosis in eastern India. So, with the aim to investigate the prevalence of the disease in OdishaandWest Bengal state of eastern India, a total of 350 cattle serum samples were collected with distinct geographical attributes having history of infertility, abortion, and haemogalactia. Serum samples were tested by microscopic agglutination test [MAT] using a battery of twelve Leptospira serovars as live antigen to detect the serovars present in the studied area. Further a recombinant protein [LipL32] based ELISA was carried out for comparative study. Overall seropositivity using MAT and rLipL32ELISA were found to be 50.85% and 56%, respectively. The sensitivity and specificity of rLipL32ELISA relative to MAT was calculated and found to be 100% and 89.53%, respectively. In the current study among the serovars, icterohaemorrhagiae was the most predominant serovar reported in this study. So to conclude, this study warrants further investigations in this area to establish the risk factors involved in disease transmission cycle. Key words: Cattle, Leptospirosis, MAT, rELISA, India

Plasma cell granuloma of lip.

Plasma cells are medium-sized round-to-oval cells with eccentrically placed nuclei, usually found in the red pulp of the spleen, tonsils, medulla of the lymph nodes, nasal mucosa, upper airway, lamina propria of the gastrointestinal tract, and sites of inflammation. Plasma cell granuloma is a rare reactive tumor-like proliferation composed chiefly of plasmacytic infiltrate. Here, we present a case of plasma cell granuloma of lip in a female patient.

Evaluation of oral submucous fibrosis using ultrasonographic technique: A new diagnostic tool.

Aim: The aim of this study is to evaluate oral submucous fibrosis (OSMF) by clinical and histopathological examination, and compare the results with those from ultrasonographic technique. Materials and Methods: 30 clinically diagnosed OSMF patients were subjected to both ultrasonographic and histopathological evaluation before treatment. Later, only ultrasonographical examination was done during 4 th and 8 th week of treatment. Prognosis of the lesion for the treatment was evaluated. Peak systolic velocity (PSV) of blood in the lesional area was statistically analyzed. 10 normal individuals without any mucosal lesions were considered as the control group. Results: In normal individuals, ultrasonography delineates normal mucosa with uniform fine mottled appearance with interspersed hypoechoic areas. Color Doppler and spectral Doppler depicts uniform distribution of blood vessels and normal peak systolic velocity of blood respectively. All OSMF patients were diagnosed upon clinical and histopathological examination. Clinical examination revealed 14 individuals with unilateral palpable fibrotic bands and 16 individuals with bilateral fibrotic bands whereas, ultrasonographic evaluation revealed 6 individuals with unilateral fibrotic bands and 24 individuals were with bilateral fibrotic bands, which was statistically significant. Ultrasonography demonstrated number, length and thickness of the fibrotic bands. Color Doppler and spectral Doppler showed decreased vascularity and PSV in lesional area. Prognosis evaluation revealed 25 cases of good prognosis and 5 cases were showed poor prognosis. Wilcoxon Signed Ranks Test revealed no significant difference of PSV was seen in poor prognosis patients. Conclusion: Ultrasonography is a non-invasive diagnostic tool for OSMF. It could be a better diagnostic tool compared to clinical and histopathological examination.

Immunohistochemical evaluation of mast cells and vascular endothelial proliferation in oral submucous fibrosis.

Introduction: Oral submucous fibrosis (OSMF) is a chronic, progressive, scarring disease that predominantly affects the people of south-east Asian origin. Aim: The present study is aimed at comparing and correlating the mast cell density (MCD) and micro vascular density (MVD) in normal mucosa and different grades of OSMF and to analyze their role in the disease progression. Materials and Methods: MCD was assessed immunohistochemically using anti mast cell tryptase and MVD was assessed using anti-factor VIII related von Willebrand factor. Results: The one way comparison of MVD and MCD in normal mucosa and among different grades of OSMF showed a significant increase in MCD and MVD among OSMF cases. Correlation analysis using Pearson correlation coefficient, showed positive correlation between MCD and MVD i.e. as MCD increases there is an exponential increase in MVD. Conclusion: The increase in MVD and MCD reveals their role in the pathogenesis of OSMF, a lesion characterized by progressive fibrosis in early stages and failure of degradation or remodeling in the advanced stages.