Doppler Indices of the Fetal Middle Cerebral and the Umbilical Arteries in Pregnancies at High Risk Followed Up for Suspected Fetal Growth Restriction

Background: Fetal growth restriction is related to compromised perinatal outcomes. The screening and prevention tools for fetal growth restriction like Doppler indices in high-risk groups compared with general antenatal populations. An evaluation of the correlation between Doppler indices and placental weight and birth weight of the neonate at term pregnancy in high-risk pregnancies is essential. For the early detection of fetal growth limitations in high-risk pregnancies, sensitive screening techniques are few. Objectives: To determine the most accurate indicator for predicting a poor perinatal outcome or intrauterine growth restriction by comparing and correlating the modifications in Doppler ultrasound studies of fetal circulation in general pregnant women with those of high-risk patients both with and without intrauterine growth retardation. Study design: A cross-sectional research including 81 healthy pregnancies and 19 high-risk patients at 31–40 weeks of gestation was conducted. The pulsatility index (PI) of the middle cerebral artery (MCA), the umbilical artery (UA), and the MCA PI to UA PI ratio were all analyzed. We compared the Doppler indices’ mean values. Then these values were correlated with placental weight and birth weight of the offspring. Results: A significantly low birth weight and less fetoplacental ratio and placental coefficient ratio were found in high-risk cases than in normal pregnant women (P <0.05). A strong positive relationship was observed between the middle cerebral artery pulsatility index and placental weight, while negative relationship between the pulsatility index of the middle cerebral artery and the Feto-placental ratio (P < 0.05). In addition, a positive association was found between the pulsatility index of the middle cerebral artery and placental coefficient, whereas a negative correlation was observed between the Cerebro-placental ratio and Feto-placental ratio in high-risk cases (P <0.05). Conclusion: Low birth weight can be predicted using Doppler indices since there is a definite correlation between it and unfavorable perinatal outcomes.

Retinal nerve fiber layer thickness in amblyopia

Purpose: To report retinal nerve fiber layer thickness (RNFLT) in eyes with amblyopia compared with contralateral healthy eyes. Methods: In this cross-sectional study, we included patients with anisometropic amblyopia, strabismic amblyopia, and mixed amblyopia. All subjects underwent complete ophthalmic examination, including RNFLT measurement with time-domain OCT (Stratus OCT) and scanning laser polarimeter (GDX VCC). A paired “t” test was used to compare average and quadrant-wise RNFL thickness between the amblyopic and contralateral normal eyes. In addition, an analysis of variance test was used to compare various RNFL thickness parameters between the three groups. Results: A total of 33 eyes of 33 subjects with anisometropic amblyopia, 20 eyes of 20 subjects with strabismic amblyopia, and 38 eyes of 38 subjects with mixed amblyopia were included. In the anisometropic amblyopia group, the average RNFLT in the amblyopic eye was 98.2 ?m and 99.8 ?m in the fellow normal eye (P = 0.5), the total foveal thickness was 152.82 ?m (26.78) in the anisometropic eye and 150.42 ?m (23.84) in the fellow eye (P = 0.38). The difference between amblyopic and contralateral normal eye for RNFL and macular parameters was statistically insignificant in all three groups. The RNFL thickness in four quadrants was similar in the amblyopic and non-amblyopic eye between all three groups and statistically non-significant. Conclusion: Our study showed that RNFL thickness was similar in amblyopic and non-amblyopic eyes between all three amblyopia groups

Morphometry and Sexual Dimorphism of the Human Clavicle in South Indian Population

Background: In forensic anthropology, determining an individual’s sex is the fundamental criteria of identification, but this is a tough task that gets considerably more difficult when only a single bone, such as the clavicle, is available. In physical anthropology, determining the sex of a deceased individual is a fundamental prerequisite. Physical anthropologists have gotten more concerned about the difficulties of human identity in recent years. Traditional techniques of sexing bone are subjective and ineffective when absolute sexing precision is desired, hence this study. Methods: Measurement of clavicular length and circumference using an Osteometric board or sliding and Vernier Callipers product from 1128 dry clavicles of unknown sex and age procured from various medical institutions and departments of anthropology in south India. Length, inner angle, outer angle, the sum of angles, inner segment, middle segment, outside segment, width at the inner end at an inner angle, least width at conoid tubercle, at the outer end, and mid circumference have all been measured. Results and Discussion: The male mid-shaft circumference is 38.0±0.5mm on the right side and 36.5±0.5mm on the left side, whereas the female mid-shaft circumference is 31.4±0.3mm on the right side and 31.4±0.6mm on the left side. The length of the left clavicle is greater than the length of the right collarbone. The curvature of the right collarbone is higher than that of the left, resulting in a shorter right bone than the left. The clavicle of males has a higher mean across all parameters than females. Male clavicle length is more than female clavicle length, midshaft circumference is less in females than males, and breadth at an inner angle is shorter in females than men, all of which are statistically significant. The Mid-shaft Circumference as a sex-determination metric is statistically significant in differentiating the clavicle’s sex. This delivers a better result than clavicle weight since clavicle weight fluctuates with age and the health state of the individual. Male clavicles have a larger Midshaft Circumference than female clavicles.

Adverse events following pediatric immunization in an Indian city

Purpose@#Adverse effects are noticeable immediately after vaccination, especially when vaccinated to healthy people at the time of vaccination. The vaccine may cause adverse events which are very rare but adverse event following immunization surveillance becomes correspondingly more important in a less studied population like India. Hence, there is a need for carrying out a study pertaining to vaccine safety in the pediatric population of age 0–12 years and assessing the events occurring post-vaccination. @*Materials and Methods@#A prospective observational study was conducted in three primary healthcare centers and two tertiary care hospitals for 6 months from April 2016 to September 2016 with a total of 826 children enrolled. Detected adverse events for suspected vaccines were analyzed for causality by the World Health Organization causality assessment instrument. Sex-specific differences in incidences of adverse events were assessed. @*Results@#The cumulative adverse events were found highest in pentavalent vaccines (510 incidences, 62.04%) followed by the bacillus Calmette-Guérin vaccine (189 incidences, 22.99%). The study didn’t reveal any significant association in incidences of adverse events following immunization and sex of the children. @*Conclusion@#Vaccine safety surveillance studies are need of the hour in developing countries to maintain public trust in vaccines, the ultimate objective being to have vaccines with the most favorable benefit-risk profile. The present study discussed the various adverse events following immunization and suggested the absence of any sex-specific difference in incidences of adverse events in children.

A study of effect of topical anaesthetics on injection pain during immunization in infants

Background: Immunization is a necessary aspect of health care of children and injections are there for unavoidable. Many factors affect injection pain during immunization in infants. This study aims to see the effect of use of local anesthetics delivered by various modes for attenuation of vaccine related injection pain in infants and to compare them.Methods: An Open Label Four-Arm Randomized Control Trial of 300 healthy infants of age group 6 weeks to 6 months reported to immunization clinic for immunization with DPT-HiB-Hepatitis B combination vaccine were taken for study. The enrolled subjects were allocated into control group and intervention group (who were applied some form of local anesthesia).Results: Among the four groups of the patients studied we observed a statistical difference in the mean pain scores of the patients recorded at 15 second, 60 second and 5 min after vaccine injection (p value 0.0024 - 0.000). Group A (Infants with topical occlusive LA cream) showed minimum pain scores values at 15 second, 60 second and 5 min after vaccine injection, followed by Group C (Infants with topical LA spray with vapocoolant) whereas Control group (Infants not received any local anaesthesia) and Group B (Infants with topical LA spray without vapocoolant) exhibited the maximum pain scores.Conclusions: Topical occlusive local anesthetic cream and topical LA spray with vapocoolent, were found to be better than topical LA spray without vapocoolant or no topical anesthetic. Use of topical occlusive LA cream led to a lowest pain score. There was no significant difference in the profile of side effects following injection in the four group.

Study Of Wormian Bones In Adult Dry Skulls Of Human Cadaver

Introduction: Wormian bones are islands of small bones found at the sutures and fontanelles of the skull.Commonly appears in the lambdoid suture. This study reporting the incidence, location and morphology ofWormian bones as it may give the false impression as fractures and lead to confusion to the radiologists,surgeons and traumatologists to deal during surgeries.Materials and Methods: The study comprises the 100 human adult skulls. Measuring tape, Sliding calipers,sutural thread and scale were used for measuring the length of the suture, incidence, types, morphology andtopography of sutural bones were observed and compared with the studies done by previous authors. The boneswere obtained from the Department of Anatomy, sri venkata sai medical college Mahbubnagar, Telangana, India.Results: Wormian bones were found in Lambdoid suture (28%), Lambda (12%), Parietomastoid suture (0%),Coronal Suture (0%), Asterion (8%), Sagittal suture (12%), Occipitomastoid suture (0%), Parietosquamous (0%)and Pterion (8%). Three different shapes of WBs was witnessed; Quadrangular (4%), Irregular (36%), Triangular(8%).Discussion: the knowledge of wormian bones is important to radiologists, orthopedicians and traumatologistsas it can imitate fractures and lead to confusion and eventually differential diagnosis.

Study of profile of cardiac dysfunction in HIV infected children

Background: There are very few published studies of heart disease in HIV infected children. The incidence of cardiovascular disease reported among HIV infected children ranges from 72% to 90%. Cardiac disease was primary cause of death in 25% of HIV Positive patients. Studies carried out in Indian subcontinent have demonstrated the presence of systolic and diastolic dysfunction on 2D Echo in HIV infected patients. Objectives: To determine the prevalence, and describe the type of heart disease among children with HIV attending an ART centre in Gandhi hospital and centre of excellence Niloufer hospital in collaboration Department of Cardiology, Gandhi Hospital. Materials and methods: 100 HIV infected children in age group of 1-18 years attending an ART centre in Gandhi hospital and centre of excellence Niloufer hospital from December 2011 to August 2013 were evaluated clinically, and investigated by chest X-ray, electrocardiography and 2D-echo. Results: Heart abnormalities were detected in 48 children (43 by 2D-echo, 4 by ECG, 1 by chest Xray). The abnormalities included left ventricular systolic dysfunction (16%), left ventricular dilation (8%), left ventricular hypertrophy (11%), Pulmonary artery hypertension (11%), tricuspid regurgitation (14%) pulmonary regurgitation (4%), mitral regurgitation (4%), sinus tachycardia (4%), cardiomegaly on chest X-ray 1 of total 100 children taken for study. Conclusions: Heart abnormalities were common especially in HIV infected children. Clinical examination, chest radiograph and ECG may pick up manifest cardiac disease. Sub-clinical manifestations such as left ventricular dilatation hypertrophy and decrease systolic dysfunction can be detected only by echo cardiography. Annual echography and ECG examination is recommended to evaluate the progression of cardiac disease and treat the same before it become irreversible in HIV infected children.

Giant fibroadenoma or juvenile fibroadenoma of breast: Conservative surgery.

A 10 years prepubertal age girl presented with huge 17 X 14 cm painless breast lump of four months duration. Based on the cytological, imaging and clinical findings a preliminary diagnosis of benign proliferative breast lesion closest to giant fibroadenoma was offered. Giant fibroadenomas are rare in young girls and are difficult to differentiate from low grade phylloides tumor by cytology/ imaging. Giant fibroadenomas have to be differentiated from phylloides tumor by the lack of leaf-like structures and stromal cell atypia and from the breast hamartoma and asymmetric breast hypertrophy in girls by the lack of mammary lobules. Giant fibroadenoma should take its due place in the diagnostic algorithm of the breast tumors. Marginal excision with nipple areola sparing and close follow up should be the standard of treatment in young girls.

Zip injuries: A simple solution.

Entrapment of penile foreskin between zipper teeth and zip slider is a common injury in children. It is seen in boys of age group 5-12 years who usually do not wear underpants. About 80% of these injuries occur accidentally while zipping up. Here, We have described a technique which is simple, quick, pain less and require no special instruments.

Feasibility of two staged newborn hearing screening and identification of risk factors for hearing loss other than those included in high risk registry (HRR) given by joint committee on infant hearing (JCIH).

Background: Hearing impairment in neonates is a hidden disability, which is usually detected around 2 years of age. Crucial speech and language development begins during first six months of life. Undetected hearing loss present from an early age can impede acquisition of speech language, communication, cognitive and social-emotional development of a child. Across the globe, there is an evolving consensus that all infants should be screened for hearing impairment and appropriate interventions should be instituted in those found to have the problem by six months of age. Most developed countries have introduced mandatory screening and interventional programme with strategies appropriate for their public health concerns. Unfortunately, in developing countries, due to the paucity of resources, infant hearing screening programme has not been introduced as national programme. There have been very few large scale hearing screening studies done in India, to know the feasibility of universal hearing screening or high risk neonate hearing screening. The present study is taken to fill in the lacune in this aspect. Aims & Objective: To study the feasibility of using two staged Transient Evoked Otoacoustic Emissions (TEOAE) followed by confirmation with Auditory Brainstem Response (ABR) in hearing screening of newborns along with an attempt to identify additional risk factors, other than those included in “High Risk Registry (HRR)” given by Joint Committee on Infant Hearing (JCIH) in 2007. Material and Methods: A prospective observational study of hearing impairment screening was conducted on 800 newborns, who were screened with two staged Transient Evoked Otoacoustic Emissions TEOAE, using handheld TEOAE device, followed by confirmation with Auditory Brainstem Response (ABR). The study was done in Command Hospital Air Force, Bangalore, during Jan 2010 to May 2011, where in all new born, born during the study period were screened, which included 757 healthy neonates and remaining 43 high risk neonates as per HRR of JCIH 2007. Additional risk factors that could affect the hearing in the normal neonates was also studied. Results: At the end of the two TEOAE tests, 15 (1.8%) neonates of the 800 cohort screened were suspected of hearing impairment and referred for ABR test. Sensorineural hearing loss was confirmed by ABR in 5 (0.6%) of those 15 referred, with a 1.2% false positive rate at the end of 2nd TEOAE. 2 of the hearing impaired infants belonged to “at risk group” neonates with remaining 3 not having any risk factor as per “High Risk Registry (HRR)” of Joint Committee on Infant Hearing (JCIH). This study showed the presence of medical conditions like maternal Urinary Tract Infection (UTI), Gestational Diabetes Mellitus (GDM) or maternal Diabetes Mellitus (DM) and Pregnancy Induced Hypertension (PIH) along with the well-known risk factors of HRR in the infants with hearing loss. But a strong association between these maternal conditions and hearing impairment could not be established due to small sample size, warranting a detailed study of these other possible risk factor. Conclusion: This study has shown that two–stage hearing screening with TEOAE & ABR is a feasible method that can be successfully implemented for newborn hearing screening, for early detection of hearing impaired, on a large scale, in hospital, to achieve the high quality standard of screening programs. 3 of the 5 hearing impaired detected in the study had no known risk factor for hearing loss, advocating universal hearing screening and an extensive efforts are required to find additional risk factors that can be included in the HRR of JCIH so as to make high risk screening more effective.

Quantitative determination of Cimetidine in both bulk and formulations using neutralization titrations.

Cimetidine is the selective H2 receptor antagonist and inhibits the secretion of hydrochloric acid in the stomach. In the present study, simple titrimetric method was developed. Respective quantities of Cimetidine were taken in aqueous methanol and acetic acid titrated against 0.1N hydrochloric acid and 0.1N perchloric acid using methyl orange and crystal violet as indicators for neutralization and non-aqueous titrations. All the titrations are carried out by running simultaneous blank determinations. The final titer values are subtracted from blank to get actual amount of acid consumed was determined. These methods were found to be sensitive and inexpensive, do not require any sample processing steps and can be utilized for estimation of cimetidine in bulk and formulations.

Formulation of colchicine ointment for the treatment of acute gout

<p><b>INTRODUCTION</b>In spite of being the fastest acting drug available for the control of an acute gout attack, colchicine is generally considered a last alternative in gout therapy. This is mainly due to the severe adverse effects associated with its administration through the enteral and parenteral routes, as well as its high risk/benefit ratio. The preparation of dosage forms of colchicine that can be administered by alternative routes is therefore a beneficial exercise. Among the formulable substitute dosage forms of colchicine, its ointment seems to be the best option available due to its ability to deliver the drug transdermally as well as its ease of preparation and evaluation. In this study, we prepared and tested 0.2% and 0.5% colchicine ointments for their effectiveness in delivering colchicine transdermally.</p><p><b>METHODS</b>Colchicine ointment was prepared using a self-formulated water-in-oil type of emulsion ointment base, with the colchicine dissolved in the water portion of the ointment base. In vitro drug release studies were carried out using the Franz diffusion test apparatus and an ultraviolet (UV)-visible spectrophotometer was used to quantify the drug in the samples. Rabbits were used as test animals for in vivo studies and the blood samples were analysed using the UV-visible spectrophotometer.</p><p><b>RESULTS</b>Colchicine was found to be well-absorbed transdermally, although absorption was not 100%. No side effects were associated with its 0.2% formulation.</p><p><b>CONCLUSION</b>Ointments containing colchicine in low concentrations may be a feasible and effective treatment option for the prevention and treatment of acute gout attacks.</p>

Cancer stem cell markers as potential targets for epithelial cancers.

In recent years, the role of tumor-initiating cells (popularly known as cancer stem cells) in tumor development and availability of novel cancer stem cell/tumor initiating cell markers promises a new arena in understanding their role in developing novel targeted molecules. It is important to identify and understand the relevance of cancer stem cells (CSC)/tumor initiating cells (TIC) in tumor development and to design appropriate strategies for CSCs and TICs elimination, which is crucial to future cancer prevention and treatment. In this review, we attempt to define various potential markers of cancer stem cells and potential exploration as therapeutic targets for epithelial cancer prevention and treatment.

Complications of exodontia: A retrospective study.

Purpose: The purpose of this study was to analyze the incidence of various complications following routine exodontia performed using fixed protocols. Materials and Methods: A total of 22,330 extractions carried out in 14,975 patients, aged between 14 and 82 years, who reported to the Department of Oral and Maxillofacial Surgery at Padmashree Dr. D. Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, were evaluated for various complications. Results: The most common complications encountered were tooth fracture, trismus, fracture of cortical plates and dry socket. Wound dehiscence, postoperative pain and hemorrhage were encountered less frequently. Luxation of adjacent teeth, fracture of maxillary tuberosity, and displacement of tooth into adjacent tissue spaces were rare complications. Conclusion: The practice of exodontia inevitably results in complications from time to time. It is imperative for the clinician to recognize impending complications and manage them accordingly.

Formulation and evaluation of bi-layer floating tablets of ziprasidone HCl and trihexyphenidyl HCl / Formulação e avaliação de bi-camada comprimidos flutuantes de ziprasidona HCl e HCl triexifenidila

The purpose of this research study was to establish ziprasidone HCl NR 40 mg and trihexyphenidyl HCl SR 4mg in the form of bi-layer sustained release floating tablets. The tablets were prepared using sodium HPMC K4M / HPMC K15M as bio-adhesive polymers and sodium bicarbonate acting as a floating layer. Tablets were evaluated based on different parameters such as thickness, hardness, friability, weight variation, in vitro dissolution studies, content of active ingredient and IR studies. The physico-chemical properties of the finished product complied with the specifications. In vitro release from the formulation was studied as per the USP XXIII dissolution procedure. The formulations gave a normal release effect followed by sustained release for 12 h which indicates bimodal release of ziprasidone HCl from the matrix tablets. The data obtained was fitted to Peppas models. Analysis of n values of the Korsmeyer equation indicated that the drug release involved non-diffusional mechanisms. By the present study, it can be concluded that bi-layer tablets of ziprasidone HCl and trihexyphenidyl HCl will be a useful strategy for extending the metabolism and improving the bioavailability of Ziprasidone HCl and Trihexyphenidyl HCl.

O propósito deste trabalho foi preparar ziprasidona. HCl NR 40 mg e triexifenidila.HCl SR 4 mg na forma de comprimidos efervescentes bicamada de liberação controlada. Os comprimidos foram preparados utilizando HPMC K4M / HPMC K15M sódico como polímero bioadesivo e bicarbonato como camada efervescente. Os comprimidos foram avaliados quanto a diferentes parâmetros, como espessura, dureza, friabilidade, variação de peso, dissolução in vitro, conteúdo do ingrediente ativo e estudos de IV. As propriedades físico-químicas dos produtos finais cumprem as especificações. A liberação in vitro da formulação foi estudada de acordo com o procedimento de dissolução da USP XXIII. As formulações resultaram em liberação normal, seguida por liberação controlada por 12 h, o que indica a liberação bimodal de cloridrato de ziprasidona dos comprimidos matriz. Os dados obtidos se adequaram aos modelos de Peppas. A análise de valores de n da equação de Korsmeyer indicou que a liberação do fármaco envolveu mecanismos não difusionais. Por este estudo, pode-se concluir que os comprimidos bicamada de ziprasidona.HCl e de triexifenidila.HCl serão um bom caminho para estender o metabolismo e para melhorar a biodisponibilidade de ziprasidona.HCl e de triexifenidila.HCl.

Early intervention of cross bite during mixed dentition with quad helix appliance.

'Posterior crossbite' occurs when the maxillary posterior teeth bite lingual to mandibular posteriors by obstructing the growth of dento facial complex. Early orthodontic intervention helps in disability limitation and reestablishment of form and function by both banded and bonded appliances. Quad Helix indicated its use in bilateral as well unilateral cross-bites involving primary and transitional dentitions1. The Concern over excessive force generation during rapid maxillary expansion led to its development and use in growing children6. Correction of cross bite with quad helix appliance in two patients is presented here along with discussion.