Cold abscess of dental origin in a 7-year-old child

Abscess related to an infected tooth is mostly associated with pyogenic infection, but sometimes, it can be asymptomatic and indicate a chronic condition. This case report shows cold abscess with a draining sinus due to dental origin. A 7-year-old female patient complained of pain with respect to grossly decayed tooth and recurrent swelling with no response to medications. After investigations and management of the lesion, it was concluded as abscess due to chronic granulomatous infection. Cold abscess is a classical manifestation of tuberculosis with no signs of inflammation. More than 60% of cases of this pathology occur in patients below 15 years old. It needs various clinical, histopathological, and laboratory investigations. Although rare, it should be considered as a differential diagnosis when no improvement occurs postroutine therapy to prevent serious complications. Furthermore, various precautions should be taken by the clinicians to prevent cross-infection.

Study of treatment options in stricture urethra management and success rate in different types and sites of stricture

Background: A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen. As the constriction progresses, obstruction develops and leads to symptoms either directly related to the obstruction or as a secondary consequence.Methods: All the cases of stricture urethra presented to our institute between June 2017 to June 2019 (n=60) in whom treatment was required were studied in a prospective manner. All cases of obstructive voiding symptoms are evaluated by conducting uroflowmetry studies (ESPON, gravimetric type). Obstructive voiding symptoms are evaluated by using the American Urological Association questionnaire.Results: The data collected was divided into 3 groups: infective causes of stricture (n=22), traumatic causes of stricture (n=14) and idiopathic causes of stricture (n=24). The mean age of presentation was 34.4 years (range of 20 to 50 years). 18 (30.00%) patients had stricture in the bulbo-urethra, 12 (20.00%) at the external meatus, 4 patients had stricture at the bulbo-membranous region. Procedures undertaken during the study were visual internal urethrotomy in 20, anastomotic urethroplasty in 17 patients and Augmented urethroplasty in 23 patients. In our series of 60 patients, 48 patients had a Qmax of >15 ml/sec.  Average success rate was 80.1%, 12 patients had a Qmax of <15 ml/sec.Conclusions: It is unwise to make sweeping recommendations for best practice for reconstructive urethral surgery based on the literature because each patient clearly requires an individualized approach based on individual circumstances. Buccal mucosa is the most widely used graft has excellent results in all types of urethroplasty.

Role of Preoperative Rehabilitation in Hip Surgeries: A Narrative Review

Hip trauma is a significant cause of morbidity and mortalityamong elderly patients. In the United States approximately30lakhs hip fractures occur each year and this number isincreasing each year along with the increased number ofelderly population. The management of hip trauma usuallydepends on the surgical management. However evidencesuggests that even with prompt surgical interventions, thepost operative complications are common and patient face agreat difficulty in post operative rehabilitation. Recently, someof the randomized trials have suggested that preoperativerehabilitation in the form of exercise or the physiotherapyis associated with improved postoperative pain score anddecreased hospital stay in elderly frail patients and in patientswith associated co morbidities such as diabetes, cardiovascular,or respiratory complications. In this present review wewill outline the importance of preoperative rehabilitationin management of different types of hip trauma based onprevious study summaries. We will also try to evaluate theimportance of such rehabilitation therapy in final outcome ofthe patients after surgery

Peripheral Nerve Blocks in Patients with Diabetic Neuropathy and other Neuropathies: A Narrative Review.

Neuropathy, arising from different etiologies, can be a majordebilitating condition that leads to pain,reduces physicalmovement and amputation. Among all known neuropathyetiologies, diabetes mellitus is one of the significant causesthat results in peripheral and other type of neuropathies thatresult in physiological discomfort and mortality. Prolongedhyperglycemia-induced oxidative stress causes damage toneuron resulting in a range of symptoms to pain and internalorgan failure. Although treatment strategies exist to alleviatethe pain symptoms, there is no existing therapy to eliminatethe root cause of neuropathy. Presently, peripheral nerveblock by several anesthetic agents shows great promise inmanaging diabetes-induced neuropathy and neuropathiesof other etiologies. This article discusses different types ofneuropathies and their classifications with special emphasison diabetic neuropathy. The following section discusses theextent of severity of the condition in terms of its epidemiologyand associated complications. The article provides an elaborateidea on different anesthetic agents used in peripheral nerveblock in diabetic neuropathy and other neuropathic conditions.Peripheral nerve block shows a potential efficiency whensingle and combination doses of anesthetics are used. Differentadjuvants are also used in combination with anesthetics toprolong and enhance the effect of analgesia. Looking at theseverity, physiological, psychosocial and economic burden ofthe neuropathic disease, more in-depth studies and discussionshould be initiated to strengthen the use of peripheral nerveblock in the management of diabetic and other neuropathies.

The Foramen Magnum: A Morphometric Study On Ct Images Of Adults

Objective: The purpose of the present study was to assess the morphometric values of foramen magnum toevaluate sexual dimorphism as well as its clinical importance.Materials and Methods: The study was conducted on 100 (Male 56, Female 44) CT scans. Morphometric studywas conducted on foramen magnum of occipital bone. From all the CT images the foramen magnum anteroposteriordiameter and transverse diameter were measured. Area of foramen magnum was calculated automatically.Foramen magnum index was calculated by using the formula Ht/Br×100. The data was statistically analysed.Results: The mean anteroposterior diameter in males and females was 33.9± 2.78, 32.2 ± 2.24, the mean transversediameter in males and females was 27.7±2.27, 26.7± 2.68 and the area of foramen magnum in males and femaleswas 739.5 ±9.96 , 676.1 ± 8.76, index of the foramen magnum in males and females was 82.09±7.86,83.02±9.55respectivelyConclusion: This study concludes that the parameters measured were higher in males compared to femalesexcept foramen magnum index. This was noticed higher in females than males.

Differential genotypical expression of a NEDD9 in normal and tumor tissues: a possible pharmacological target

Background: Neural precursor cell expressed developmentally down regulated-9 (NEDD9) is a scaffolding metastatic marker protein in multiple cancer types. Generally, the expression occurs during the embryonic development and depletes in adults. Expression of NEDD9 in adults leads to the progression of tumor which is sufficient for the cellular invasion. Elevated behavior of the gene mediates metastatic movement which includes protease dependent neovessel formation, invasion and migration of tumor cells from the site of origin to the distant tissues.Methods: The current study involves the screening and elucidation of differential expression of NEDD9 in normal and tumor subtypes with various tissues of mice by immunohistochemistry.Results: The validating approaches in the study, low expression of NEDD9 was observed in the normal tissues and predominance in the tumor subsets.Conclusions: The experimental analysis proven that NEDD9 expression is merely associated with tumor progression and the molecular mechanism of NEDD9 is restricted in the establishment of metastatic cascade. NEDD9 association in tumor prognosis which helps in the emergence of diagnostic and therapeutic approaches.

Lignosulfonic Acid Based Hydrogel Nanocomposites for Antimicrobial Application.

Hydrogels in which poly(acryl amide)/lignosulfonic acid (AAm/LSA) crosslinked with N,N’-methylene bis acrylamide, were prepared by using a redox polymerization technique. These hydrogel networks can act as excellent nano reactors for producing and stabilizing the metal nanoparticles. The current methodology allows us to entrap metal nanoparticles throughout hydrogel networks via AAm/ LSA chains. The synthesized silver nano composite hydrogels (Ag-NCHs) were fully characterized by using UV-visible spectroscopy; Fourier transform infra-red spectroscopy (FTIR), X-ray diffraction (XRD) studies, scanning electron microscopy (SEM), dynamic light scattering (DLS) analysis and Transmission electron microscopy (TEM). The chemical structure and crosslinking in AAm/LSA hydrogels and Ag-NCHs matrix was analyzed by FTIR. SEM and TEM measurements suggested the spherical structure of the silver particles with smooth surface and size of these particles confirmed by DLS. Crystalline nature of the nanoparticles was confirmed by XRD and electron diffraction measurements. Swelling studies were performed in water with the help of an empirical equation to investigate the diffusion mechanism. The developed Ag-NCHs were evaluated for preliminary antibacterial applications against E.coli and Bacillus.

Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi

ABSTRACT Purpose To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi. Materials and Methods The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared. Results There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2. Conclusion Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.

Synthesis of Novel Hydrogels based Poly(4-Hydroxyphenylazo-3-N-(4-hydroxyphenyl)maleimide) for Specific Colon Delivery of Chemotherapeutic Agent.

In recent years azo functionalized polymeric hydrogels are very interesting; it is due to their promising applications in various fields especially in the colon drug delivery. 4-Hydroxyphenylazo-3-N-(4-hydroxyphenyl) maleimide (HPM) was synthesized and used for development of hydrogels by free radical polymerization with acrylamide (Am) and N,N-methylene bis acrylamide. Synthesized poly(Am-co-HPM) (PAH) hydrogels were used for encapsulation of 5-fluorouracil (5-FU) an anticancer drug. Structural, thermal, morphological and drug distribution of PAH hydrogels were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy and X-ray diffraction techniques, respectively. Maximum percentage of encapsulation efficiency i.e. 78.25±1.3 was observed for AZ1 PAH hydrogels. 5-FU release studies were performed by in vitro method in simulated gastro intestinal fluids (pH 1.2 & 7.4). To support the 5-FU release mechanism from PAH hydrogels, swelling and deswelling kinetics were studied in doubly distilled water.

Effect of Potassium Magnesium Citrate and Vitamin B-6 Prophylaxis for Recurrent and Multiple Calcium Oxalate and Phosphate Urolithiasis

PURPOSE: To study the effects of long-term treatment with potassium magnesium citrate and vitamin B-6 prophylaxis (Urikind-KM6; 1,100-mg potassium citrate, 375-mg magnesium citrate, and 20-mg pyridoxine hydrochloride/5 mL) every 8 hours over 3 years. MATERIALS AND METHODS: A total of 247 patients with recurrent idiopathic hypocitraturia with or without hyperuricosuria and randomized controls were studied prospectively for 3 years. The total patients were divided into three groups. Control group 1 consisted of 61 patients (24.7%) who had moderate to severe hypocitraturia with or without hyperuricosuria and were recurrent stone formers but discontinued prophylaxis because of drug intolerance within 1 month of therapy. Control group 2 constituted 53 patients (21.5%) who were first-time stone formers and who had mild hypocitraturia with or without hyperuricosuria and were not put on prophylactic therapy and were followed for 3.16+/-0.08 years. Control group 3 constituted 133 patients (54.8%) who were recurrent stone formers who had moderate to severe hypocitraturia with or without hyperuricosuria and were put on prophylaxis therapy and were followed for 3.16+/-0.08 years. All patients were followed up at 6-month intervals. RESULTS: Potassium magnesium citrate prophylaxis produced a sustained increase in 24-hour urinary citrate excretion from initially low values (221.79+/-13.39 mg/dL) to within normal to high limits (604.04+/-5.00 mg/dL) at the 6-month follow-up. Urinary pH rose significantly from 5.62+/-0.2 to 6.87+/-0.01 and was maintained at 6.87+/-0.01. The stone recurrence rate declined from 3.23+/-1.04 per patient per year to 0.35+/-0.47 per patient per year. CONCLUSIONS: Potassium magnesium citrate prophylaxis was effective in reducing the recurrence of calcium oxalate and phosphate urolithiasis.

Possible involvement of leptin in a Mas-receptor agonist, AVE-0991-induced improvement in dyslipidemia and cardiomyopathy in STZ-induced diabetic rats.

Present study was designed to investigate the possible involvement of leptin in the pharmacological activation of Mas–receptor in STZ-diabetic rats, with cardiomyopathy. A single administration of STZ (50 mg/kg, i.p.) produced diabetes which leads to cardiomyopathy after 8 weeks. Estimation of serum glucose has been used as a marker of hyperglycemia. Cardiomyopathy was assessed by measuring LV collagen content, absolute LV weight, LVW/BW ratio, LVDP, dp/dtmax and dp/dtmin. Furthermore, serum triglyceride, serum cholesterol and serum HDL levels were estimated as an index of dyslipidemia. Rat serum leptin was quantitatively estimated by using enzyme-linked immunosorbent assay (ELISA) kit. STZ-diabetic rats were associated with significant hyperglycemia, hypertriglyceridemia, decreased cardiac functions and decreased serum leptin level. Both the low and high dose AVE-0991 treatment, significantly decreased hyperglycemia and increased serum leptin level in diabetic rats. Whereas, AVE-0991 only at high dose significantly improved lipid profile and cardiac function. on the basis of above, it may be concluded that downstream activation of leptin may be responsible for the beneficial effect of AVE-0991, a Mas-receptor agonist in STZ-induced diabetic cardiomyopathy in rats.

Synthesis and Characterization of biodegradable Poly (Vinyl caprolactam) grafted on to sodium alginate and its microgels for controlled release studies of an anticancer drug.

Biodegradable sodium alginate-g-poly (vinyl caprolactam) synthesized by graft copolymerization of N-vinyl caprolactam (VCL) on to sodium alginate (NaAlg) via free radical initiation mechanism using a redox initiation system. Grafting (%), efficiency (%), and conversion (%) were all found to depend on the content of potassium persulfate (KPS), VCL reaction temperature and time. The maximum % of grafting was ascertained to be 251 at the optimum conditions of 65 oC reaction temperature, 180 min of reaction time, 1.1098X10-3 mol of KPS and 7.1844X10-3 mol of VCL. Evidence of graft copolymerization was obtained by fouriertransform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). Further, graft copolymer was used for preparation of microgels (MGs) using Ca+2 as a crosslinking agent. SEM results showed that the MGs are spherical in structure with smooth surface. The effects of pH and temperature on the swelling behaviour of MGs were studied and ascertained that they were sensitive to both pH and temperature. 5-FU drug was successfully loaded in to these MGs and encapsulation efficiency was found 84%. The release of 5-FU was systematically investigated as a function of temperature, pH, amount of crosslinker and % of drug loading concentration. The results indicate that the responsive MGs have the potential to be used as an effective pH and temperature controlled delivery of 5-FU for more than 12 h.

Unusual Penetrating Injury to the Male Genitalia / 대한배뇨장애요실금학회지

Various self-inflicted foreign bodies have been removed from the lower urinary tract and external male genitalia. In many cases foreign bodies were inserted or applied for autoerotic reasons which are frequently associated with mental health disorders. Here the author reports an unusual case of self insertion of a 6-cm long metal needle at penoscrotal junction of the erect penis for sexual pleasure. The stitching needle was inserted by a 20-year old male who was too ashamed to admit the motive at first. The caudal end of the needle was palpable at the root of the penis as it was below the urogenital diaphragm. The needle was successfully removed under fluoroscopic guidance with minor surgical exploration and with no complications.

Hypoglycemic Activity of Methanolic Extract of Talinum Triagulare Leaves in Normal and Streptozotocin Induced Diabetic Rats.

Talinum Triangulare (Family: Portulacaceae) is an herbaceous perennial plant widely grown in tropical regions as a leaf vegetable with a blood-glucose-lowering effect, but its mechanism of action are still unknown. Here we report a hypoglycemic activity of Methanolic Extract of Talinum Triangulare Leaf (METTL) in healthy, glucose loaded and Streptozotocin (STZ)-induced diabetic rats. Animals either healthy or STZ-induced diabetic show significantly lowered blood glucose levels after 2 weeks of METTL treatment (250 mg/kg), it significantly reduced blood glucose levels compared with that in diabetic control rats. Additionally, the increase in blood glucose levels after administration of glucose (1.2 g/kg) in normal rats is significantly decreased and the oral glucose tolerance (OGTT) of STZ-induced diabetic rats is largely improved by METTL treatment. However, co-administration of METTL with glipizide, an oral hypoglycemic drug, it produces synergistic effect. We conclude that METTL has a significant anti hyperglycemic effect. Continuous glucose monitoring is needed in diabetic patients.

Stems and their ashes of some herbal plants as adsorbents in the removal of chromium (VI) from waste waters.

A thorough investigation is made to explore the surface sorption abilities of powders of stems and their ashes of some herbal plants in controlling the Chromium (VI) pollution in waste waters. It is found that the powders of stems and their ashes of Achyranthes aspera, Mentha, Emblica officinalis, Hybiscus roja sinensis, Ocimum sanctum and Psidium guajava have strong affinity towards Chromate at low pH values. % of removal of Chromate is found to be pH sensitive and also depends on sorption concentration and time of equilibration. The conditions for the maximum extraction of Chromate at minimum dosage of sorbent and equilibration time have been optimized. More than 90.0% of removal of Chromate is found. Sorbent concentrations and time needed for the maximum removal of Chromate is less for the ashes of stems than with the raw stem powders. The presence of ten fold excesses of Cations : Ca2+, Mg2+ , Cu2, Zn2+ and Ni2 + and anions like NO3 - ,Chloride, Fluoride and Carbonate have marginally effected the % removal of Chromium (VI) while Sulphate and Phosphate showed some interference with some sorbents but even with them, the % of extractability never comes down to 71.0%. The adoptability of the methodologies developed in this work are tested with respect to diverse waste water samples collected from industrial effluents and in natural lakes and found to be remarkably successful.

Chitosan/guargum-g-acrylamide semi IPN microspheres for controlled release studies of 5-Fluorouracil.

Chitosan and guargum-gt-acrylamide (CH-GG-g-AAm) semi interpenetrating microspheres (semi IPNMs) were prepared by water-in-oil (w/o) emulsion cross linking method using glutaraldehyde as a crosslinker. 5-fluorouracil (5-FU) is an anticancer drug was successfully loaded in these semi IPNMs. X-ray diffraction (XRD) and differential scanning calorimetric (DSC) examined the crystalline nature of drug after encapsulation into semi IPNMs. Scanning electron microscopy (SEM) shows the formation of semi IPNMs is spherical with size around 200 􀀀m. The encapsulation efficiency of 5-FU was achieved 58%. In-vitro release studies were performed basic (pH 7.4) buffer medium. The release patterns depend on graft polymer composition, effect of cross linker and drug content in the polymer matrices. In vitro release studies indicated the release of 5- FU more than 12 hours.

Giant cystic thymoma with haemorrhage and necrosis: An unusual case.

Extreme degree of cystic, haemorrhagic and necrotic changes in a thymoma is rare. A 22-year-old male presented with cough, grade 2 dyspnoea, and occasional chest pain for the past six months. Radiological investigations revealed a large cystic lesion in the anterior mediastinum. A benign cystic tumour was suspected. Surgical resection of the tumour was done. Grossly, the almost entirely cystic and haemorrhagic dumb-bell shaped encapsulated tumour showed a subcapsular residual nodule. Histopathological examination was suggestive diagnosis of benign thymoma (World Health Organization [WHO] Type A, medullary type) associated with the rare features of cells with dendritic processes containing melanin pigment seen singly scattered throughout the tumour.

An outbreak of cutaneous anthrax in a non-endemic district--Visakhapatnam in Andhra Pradesh.

BACKGROUND: Anthrax is a disease of herbivorous animals, and humans incidentally acquire the disease by handling infected dead animals and their products. Sporadic cases of human anthrax have been reported from Southern India. METHODS: Five tribal men presented with painless ulcers with vesiculation and edema of the surrounding skin on the extremities without any constitutional symptoms. There was a history of slaughtering and consumption of a dead goat ten days prior to the development of skin lesions. Clinically cutaneous anthrax was suspected and smears, swabs and punch biopsies were taken for culture and identification by polymerase chain reaction (PCR). All the cases were treated with intravenous followed by oral antibiotics. Appropriate health authorities were alerted and proper control measures were employed. RESULTS: Smears from the cutaneous lesions of all five patients were positive for Bacillus anthracis and this was confirmed by a positive culture and PCR of the smears in four of the five cases. All the cases responded to antibiotics. CONCLUSION: We report five cases of cutaneous anthrax in a non-endemic district, Visakhapatnam, Andhra Pradesh, for the first time.

Renal functions and serum fluoride concentrations in chronic renal failure patients after sevoflurane or isoflurane anaesthesia

Sevoflurane is metabolised to hexa-fluoro-isopropanol and inorganic fluoride ions by human liver. The peak plasma fluoride level is higher after sevoflurane than after isoflurane. Although this has no effect on renal functions in normal patients and volunteers, it might be risky on those with chronic renal insufficiency. In this study, 60 patients with stable chronic renal insufficiency who required surgical intervention were randomly allocated into one of two groups each of 30 patients; sevoflurane and isoflurane groups. We compared the renal functions [serum creatinine, urea, osmolality, sodium and urine osmolality] and the serum inorganic fluoride levels afler sevoflurane to those after isoflurane anaesthesia. Peak serum inorganic fluoride concentrations were significantly higher after sevoflurane than after isoflurane anesthesia [26 +/- 3 Vs 14 +/- 2 um/L]. Laboratory measures or renal functions remained stable throughout the postoperative period in both groups. No patient suffered a permanent renal damage of preexisting renal insufficiency and non required postoperative dialysis. There is no evidence that the increased fluoride levels after sevoflurane worsened the preexisting renal impairment. We concluded that the increase in serum inorganic fluoride after sevoflurane to levels as seen in this study are of little risk to patients with chronic renal insufficiency. Further studies to evaluate the effect of compound A on the renal functions on those chronic renal impairment patients are required