A bolt from the blue in a testicular mass - continuous Splenogonadal fusion with maturation arrest

ABSTRACT Splenogonadal fusion is an infrequent cause of testicular or scrotal swelling with less than 250 cases reported. We report the case of a 27-year-old male who presented with painless scrotal swelling. The sonography showed a homogeneous, well-encapsulated left extratesticular mass, which was surgically removed. The gross examination revealed a grey-brown tissue below the left testis. The microscopy of the grey-brown mass revealed splenic tissue, and the testis showed maturation arrest, resulting in the diagnosis of splenogonadal fusion. These can be easily mistaken for a tumor, especially in this age group. Reporting such an entity increases awareness among clinicians, radiologists and pathologists, which will aid in preventing an orchiectomy for these patients.

Special Features in the Reproductive Anatomy, Physiology, and Behavior of Male Camels (Camelus dromedarius)

The peculiarities of anatomic and physiologic features of dromedary camels are elucidated in this review and compared with Bactrian, camels, and other species. Both dromedary and Bactrian camel scrotum varies in length from 10-20 cm and the testes are in the perineal region behind the thighs (like dogs) and weigh from 80-90 gm and length varies from 10-14 cm. Compared to ram and buck, camel epididymis has a higher weight (20-46 g) and has a unique structure called the intra-epithelial glands. Both dromedaries and Bactrian camels do not have seminal vesicles. Male camels have specialized secretory glands behind the ears known as poll glands that are bigger in the Bactrian camels compared to dromedary camels and similar glands are not seen in any of the other domestic species. Camels have a special reproductive behavior during the breeding season known as rut and include extrusion of the soft palate, copious froth from the mouth, gurgling sounds, splashing of urine, increased secretion from the poll glands and loss of appetite with considerable reduction in body weight. Such behaviors are not evidenced by any other domestic species including buffalo. Serum testosterone rises substantially in male camels during rut (2-42 ng/mL) compared to the non-rutting season (0.6-8 ng/mL) and the resultant increase in the size of the testes, number, and functionality of Leydig cells and secretion of poll glands. The serum thyroidal hormones also increase significantly during the rut season. It is concluded that male camels have some special anatomic and physiologic features of reproduction not observed in other domestic species.

Study of Correlation of CD4, CD8 Count with Tuberculous Pneumonia and Non Tuberculous Bacterial Pneumonia in Type_x0002_2 Diabetes Mellitu

Aim: Type-2 DM patients are susceptible for various types of infections. Long standing Type2 DM patients have strong predilection for tuberculosis as seen in various studies. Here, we aimed to study susceptibility of tuberculosis as compared to other non tuberculous pneumonia in type-2 DM on the basis of CD markers. Material and Methods: A case control study on 150 subjects was conducted in S.P. Medical College and Associated Group of P.B.M. Hospitals, Bikaner. Subjects were divided into 3 groups each of 50 type-2 diabetic patients having tuberculous pneumonia, of 50 type-2 diabetic patients having non tuberculous pneumonia and 50 patients of type 2 diabetes as a control group attending Medical Outdoor and those Admitted in Hospital IPD Wards. All participants were subjected to detailed clinical examination and relevant investigations. Flow cytometry was used for CD4 and CD8 count. Results: Diabetic patients with tuberculous pneumonia have significantly (p-value <0.05) elevated numbers of CD4 and CD8 cell count in comparison of both controls and nontuberculous pneumonia. Diabetic patients with non tuberculous pneumonia have significantly (p-value <0.05) lower CD4 and CD8 cell count in comparison of diabetic controls and diabetic patients with tuberculous pneumonia. Conclusion: DM is associated with an alteration in the immune response to tuberculosis, leading to a induction of CD4 and CD8 mediated cellular responses and likely contributing to increased immune pathology in M. tuberculosis infection.Our study also provides an impetus to perform longitudinal studies examining the role of immunological biomarkers in the development of tuberculosis in diabetic patients.

Brush up: an innovative technological aid for parents to keep a check of their childrens oral hygiene behaviour / Brush up: uma ajuda tecnológica inovadora para os pais controlarem o comportamento de higiene bucal de seus filhos

ABSTRACT Objective: To investigate the impact of "Brush Up" - a mobile application, on oral hygiene behaviours of 4-6-year-old children in Bangalore city. Methods: In this experimental study, 247 children aged 4-6, were randomly divided into three groups. Considering "Brush Up" is a mobile application, parents of the children in Group 1 (n=82) downloaded the application on their smartphones. Children in Group 2 (n=83) and Group 3 (n=82) received tooth brushing instructions by an educative video and manual demonstration, respectively. Effectiveness of tooth brushing was assessed with plaque scores, which were recorded for all the groups at baseline and one month using Visible Biofilm Index. Results: Wilcoxon signed rank test showed a significant improvement in the tooth brushing behaviour for the Brush Up group, which was indicated by a lower plaque score after a follow-up of one month. Kruskal-Wallis test followed by post-hoc test showed that the mean ranks of plaque scores of Brush Up group are consistently lower than those of video demonstration group and manual demonstration group. Conclusions: The lower plaque score in subsequent follow-up in Brush Up group suggests that using a smart system can enhance learning a correct tooth brushing method in young children and can also help in implementing the required reinforcement and motivation to brush and aid in better plaque control.

RESUMO Objetivo: Investigar o impacto do "Brush Up", um aplicativo móvel, sobre comportamentos de higiene bucal de crianças de 4 a 6 anos na cidade de Bangalore, na Índia. Métodos: Neste estudo experimental, 247 crianças de 4 a 6 anos foram divididas aleatoriamente em 3 grupos. Como "Brush Up" é um aplicativo móvel, os pais das crianças do Grupo 1 (n=82) baixaram o aplicativo em seus smartphones. As crianças do grupo 2 (n=83) e do grupo 3 (n=82) receberam instruções sobre escovação por meio de vídeo educativo e demonstração manual, respectivamente. A efetividade da escovação foi avaliada por meio de escores de placa bacteriana, registrados para todos os grupos antes da intervenção e um mês depois. Resultados: O teste de Wilcoxon sinalizou uma melhora significativa na escovação para o grupo "Brush Up", com uma pontuação mais baixa na placa bacteriana após um mês de acompanhamento. O teste de Kruskal-Wallis, seguido do teste post hoc, mostrou que as classificações médias das pontuações do grupo "Brush Up" foram consistentemente mais baixas do que as do grupo com demonstração em vídeo e demonstração manual. Conclusões: Os resultados obtidos no grupo "Brush Up" sugerem que o uso de um sistema inteligente pode melhorar o aprendizado de um método correto de escovação em crianças pequenas e ajudar na implementação do reforço e motivação necessários para escovar e controlar melhor a placa bacteriana.

A Cross Sectional Study of Tubotympanic Chronic Suppurative Otitis Media with Reference to Sinonasal Pathology

In tubotympanic Chronic Suppurative Otitis Media (CSOM) the persistent inflammation of mucosa leads to irreversible changes in the middle ear and mastoid cavity. The Eustachian tube has several functions that facilitate the communication of the middle ear cavity with the nasopharynx, nasal cavity, nasal mucosa, and indirectly also with the paranasal sinuses and plays an important role in the disorders of middle ear. The Eustachian tube dysfunction and non-ventilation of middle ear cleft leads to vacuuming once the entrapped air gets absorbed by the mucosal capillaries leading to CSOM. A disease of the nose and paranasal sinuses influences causes dysfunction of the Eustachian tube leading to a middle ear infection. We wanted to study the correlation between nasal and paranasal sinus pathologies and their role in the management safe CSOM. MethodsIn this observational study, a total of one hundred cases of CSOM in the age group of 20 - 60 years was included in the study as per set criteria over a period of 6 to 7 months. All cases with persistent ear discharge were treated medically before undergoing functional endoscopic sinus surgery and septoplasty simultaneously whenever indicated after routine investigations, diagnostic nasal endoscopy (DNE), computed tomography of paranasal sinuses (CT - PNS) and otoendoscopy. A lesion causing dysfunction of ET in nasopharynx such as anatomical variants like medialised uncinate process, enlarged bulla ethmoidalis, enlarged middle turbinate, accessory ostium and deviated nasal septum (DNS) were searched and noted during DNE, FESS, and in CT - PNS. Postoperatively all cases were followed for 3 months using a nasal endoscope and otoendoscope to assess overall improvement. ResultsThere were 55 males and 45 females, with the male : female ratio of 1.22 : 1. Majority of cases were from the age group of 31 - 50 years (59 %). Among the 100 cases of CSOM, deviated nasal septum (62 %) was the most common sinonasal pathology and the majority of the cases (56 %) had ipsilateral mucopurulent discharge in the middle meatus. Confirmatory finding of DNS was 62 % with CT (p < 0.003). There was a significant association between the successful treatment of sinonasal pathology and improvement in the status of CSOM (P < 0.003). ConclusionsIn this study, DNS is the commonest aetiopathological factor for the development of CSOM apart from medialised uncinate process and hypertrophy of middle turbinate. Documentary evidence of CT scan for confirmation of DNS in the management of active safe CSOM having sinonasal pathology was important.

Management of acute bacterial skin and skin structure infections in India: are we equipped to meet the challenges of the growing menace of methicillin-resistant Staphylococcus aureus?

Staphylococcus aureus (S. aureus) is a Gram-positive facultative anaerobic bacterium that colonizes the skin and nasal passages of humans. The incidence of invasive S. aureus infections has increased over the past decades and is associated with poor outcomes and high mortality rates. S. aureus is responsible for almost one-third of acute bacterial skin and skin structure infections with methicillin-resistant Staphylococcus aureus (MRSA) accounting for a large proportion of these. The S. aureus strains prevalent inIndia are more aggressive and there are recent reports of the emergence of the more virulent multidrug resistant lineages ST2371 and ST8. Management of these infections is complicated by the fact that antimicrobial stewardship is non-existent, the choice of treatment is often empirical and available treatment options are limited due to a high prevalence of resistance strains. Currently available anti-MRSA agents include vancomycin, teicoplanin, linezolid, daptomycin, tigecycline, and clindamycin. However, the emergence of resistant strains and several undesirable features related to the safety and tolerability of these agents have limited the options available for the management of MRSA infections. A newer, safe and efficacious antibiotic is thus an unmet need for the management of MRSA in patients with acute bacterial skin and skin structure infections. In this review we explore the current and future trends in the management of acute bacterial skin and skin structure infections highlighting the challenges in their management in India, and current progress in the development of some novel drugs for the management of MRSA infections.

Management of Wounds of Peripheral Arterial Disease Using Platelet Rich Plasma.

Arterial ulcers are caused by inadequate perfusion of skin and subcutaneous tissues. The key treatment is correcting the underlying medical problem and re-perfusion of the affected tissue. Interventional procedures like angiography, transluminal angioplasty, and stenting have hazards like bleeding, hematoma formation, false aneurysm formation etc. This study was conducted to investigate the effect of platelet-rich plasma (PRP) on the rate of healing of peripheral arterial wounds. MethodsA randomized controlled trial was conducted with 80 participants admitted with peripheral arterial disease in Acharya Vinoba Bhave Rural Hospital, Wardha district, Maharashtra, from September 2017 - August 2019. Data was entered into MS Excel and was analysed for descriptive statistics. 40 patients each were allotted randomly to control group and treatment group. In the control group, conventional dressings was done with hydrogen peroxide and betadine. Wounds were treated with PRP infiltration in the treatment group. Outcome was compared between both groups. ResultsMean surface area of wound in control group reduced from baseline 2262.5 mm2 to 1758.4 mm2 (29.89% reduction) in ulcer surface area, and 2298.9 mm2 to 1158.1 mm2 (66.22% reduction) in treatment group (p= 0 at the end of study) at the end of two months. Standard deviation of the same (Control: 1739.2 mm2 to 1566.3 mm2 vs Treatment: 1906.5 mm2 to 1402.4 mm2). Rate of epithelization was faster in treatment group (8.92 mm2/day vs 17.27 mm2/day, p=0 at the end of study). PRP resulted in early healing of ulcers with earlier reduction in wound surface area. ConclusionsPRP is an effective method for healing of wounds resulting from peripheral arterial disease.

Evaluation of demographic, radiological and intraoperative factors for assessment of postoperative pain and complications in surgical removal of impacted mandibular third molar: a prospective study / Evaluación de factores demográficos, radiológicos e intraoperatorios para la evaluación del dolor postoperatorio y las complicaciones en la extracción quirúrgica del tercer molar mandibular impactado: un estudio prospectivo

Third molars usually erupt within the age of 17 ­ 21years. Usually, due to the evolution of human jaws, the size is decreasing leading to the impacted tooth. An impacted tooth may lead to external resorption of the adjacent tooth, trismus, infection, etc. Many studies have been reported in the literature for evaluating the surgical difficulty and postoperative complications secondary to impacted third molars. This study includes a sample of 100 subjects evaluated for the surgical difficulty and postoperative complications. Various demographic, radiological, and intraoperative factors were evaluated which may lead to postoperative complications. Factors responsible for postoperative sequelae were also evaluated with complications. Postoperative pain after 4 hours and 7 days was assessed to mark the factors commonly responsible. Pain at 7th postoperative day was significant involving factors like fully impacted, horizontal impaction, level C, no/very little retromolar space, and root contact. Postoperative complications were not reported in this study.

Los terceros molares suelen erupcionar entre los 17 y los 21 años de edad. Por lo general, debido a la evolución de las mandíbulas humanas, el tamaño disminuye, lo que conduce al diente impactado. Un diente impactado puede conducir a la reabsorción externa del diente adyacente, trismo, infección, etc. Se han reportado muchos estudios en la literatura para evaluar la dificultad quirúrgica y las complicaciones postoperatorias secundarias a terceros molares impactados. Este estudio incluye una muestra de 100 sujetos evaluados por la dificultad quirúrgica y las complicaciones postoperatorias. Se evaluaron diversos factores demográficos, radiológicos e intraoperatorios que pueden conducir a complicaciones postoperatorias. También se evaluaron los factores responsables de las secuelas postoperatorias con las complicaciones. Se evaluó el dolor postoperatorio después de 4 horas y 7 días para marcar los factores comúnmente responsables. El dolor al séptimo día postoperatorio fue significativo e involucró factores como impacto total, impactación horizontal, nivel C, espacio retromolar nulo o muy pequeño y contacto con la raíz. En este estudio no se informaron complicaciones posoperatorias.

Screening of Painful Hip Joint with Radiography and MRI

The basic tool for hip joint study is radiography. Pelvic radiograph helps in deciding whether the hip joint is normal and also includes opposite hip joint for comparison. It also helps in identification of signs of degenerative and inflammatory changes, avascular necrosis, soft tissue calcification and bone tumours. The investigation of choice to assess the bone marrow, acetabular labrum, articular cartilage, peri-articular muscles, tendons, ligaments and bursae is MRI. Pain at hip joint has different aetiologies divided into intra-articular, peri-articular and extra-articular conditions in adults and children. This study is being done to evaluate painful hip joint with radiography and MRI.METHODS50 cases of painful hip joint referred to the Radiology Department, Bharati Hospital were evaluated with radiography and MRI over a period of 24 months.RESULTSOut of 50 patients 20 were diagnosed as AVN, 10 cases showed changes of osteoarthritis, 7 cases had joint effusion, 5 cases were of fracture of neck of femur, 4 cases had sacroiliitis and 4 cases revealed metastatic disease of hip joint. Of the 50 cases that presented with pain in hip joint, 26 cases showed radiographic findings. The rest 24 radiographs were normal.CONCLUSIONSRadiography is easily available and economical for imaging the hip joint. Radiography is the initial investigation for evaluation of joint pain. MRI is non-invasive. There is no radiation exposure. It is a valuable tool in diagnosing hip pain when radiography shows subtle or no findings. MR imaging is the most sensitive imaging modality for bone pain.

A study of knowledge, attitude and practice on use of antibiotics and its resistance among the doctors and interns at urban tertiary care hospital: an interventional study

Background: Infections due to resistant micro-organisms considerably increase the mortality rate, treatment cost, disease spread and duration of illness. The development of antibiotic resistance (AMR) is increasing steadily increasing over the last 10-15 years, which is a real threat to disease management. Many studies states that about 20-50% of antibiotic use unnecessary so decreasing the use of antibiotics is the first step to curb the AMR.Methods: A questionnaire based prospective interventional study among the doctors. Systemic random sampling was applied. The pre tested structured questionnaire was used. Data抯 were summarised in the excel sheet, analysed by proportions, percentages and other statistical methods like Student t test, Fisher test and Chi square test were used to check the association. The p>0.05 was considered as significant.Results: Out of 200 doctors, preliminary screening of 170 was included in the study and finally 156 participants were actively selected for analysis of results. Out of 156 participants, 55.1% were MBBS Intern and 44.9% were doctors. High significance (p=0.0001) were found between pre and post knowledge, attitude and practice of doctors.Conclusions: Further modes of studies have to perform to identify the determinants of attitude behaviour and motivation that lead people to use and misuse antibiotics. For effective outcome many more qualitative and quantitative studies are required. In addition, health care system should follow proper regulation and prescription policy as well as controls for prescription of antibiotic drugs.

Toxinotyping of Clostridium perfringens in Poultry from Necrotic Enteritis Cases

Clostridium perfringens is well known causative agent of necrotic enteritis in poultry and is mainly caused by Type A toxin. NetB toxin is found to be one of the newly emerging virulent toxin gene which is also responsible for necrotic enteritis. The present study was carried out to characterize and to type the different toxins associated with C. perfringens in NE cases of poultry. For the present study total 125 samples were collected from poultry birds, out of which 50 samples were of intestinal content from diseased birds, 50 cloacal swabs and 25 intestinal content from healthy birds. These samples were further processed for isolation, identification, and toxinotyping of Clostridium perfringens isolates. Onisolation of C. perfringens on blood agar total 43 isolates were found positive showing a pattern of double hemolysis on blood agar. The positive isolates of C. perfringens were further confirmed by using 16S rRNA species specific PCR. After confirmation isolates were processed for toxinotyping mainly targeting cpa, cpb and cpb2 toxins by using multiplex PCR. On toxinotyping it was found that NE in poultry birds were mainly caused by C. perfringens type A. On virulent gene detection of netB toxin, total 4 isolates were found positive for netB toxin. This study pointed out that C. perfringens type A is responsible for development of NE in poultry along with net B toxin which is a new key virulent factor. Further studies of netB toxoid and C. perfringens type A for vaccine production could minimize the clostridial problems in broiler farms

Pathology and Molecular Diagnosis of Mycoplasma gallisepticum and Mycoplasma synoviae Infections in Broiler Chickens from Western Maharashtra, India

Mycoplasma gallisepticum and Mycoplasma synoviae are worldwide in distribution including India and causes heavy economic losses to the poultry industry. The present study confirms the incidence of M. gallisepticum and M. synoviae infections by gross and microscopic pathology and PCR in broiler chickens. Incidence of pathogenic Mycoplasma spp. in broiler chickens with respiratory lesions was found to be 26.66%. Out of total 60 flocks, 6 flocks (10%) were found positive for M. gallisepticum and 12 (20%) were positive for M. synoviae. The incidence of M. synoviae was found to be higher than M. gallisepticum. Catarrhal tracheitis, focal pneumonic consolidation of lungs and airsacculitis were consistent lesions in M. gallisepticum and M. synoviae positive broiler chickens. However, synovitis/arthritis was not observed in any of the flock positive for M. synoviae. Incidence of E. coli amongst broiler chickens with respiratory lesions was found to be 40% by PCR targeting 16S rRNA gene and was higher than Mycoplasma spp. Mixed infection of M. gallisepticum and E. coli was detected in 3(9.09%) flocks, M. synoviae and E. coli in 4 (12.13%), M. gallisepticum and M. synoviae in 1(3.03%) and M. gallisepticum, M. synoviae and E. coli combined infection was detected in 1 (3.03%) flock. Mixed infection of M. gallisepticum and E. coli, M. synoviae and E. coli and M. gallisepticum, M. synoviae and E. coli revealed moderate to severe lesions of chronic complicated respiratory disease

CRB modification to retromandibular approach for management of subcondylar fractures

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular sub-condylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was ca-rried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was re-corded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of re-tromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome

Analysis of surgical outcome and review of literature of schwannomas arising from the extremities

Background: Schwannoma is a benign peripheral nerve sheath tumour derived from Schwann cells. Also known as Neurilemoma, it can affect any nerve in the body. They usually present as a painless swelling or paresthesia over the sensory distribution of the affected nerve. Although it is classically described that schwannomas are well encapsulated and can be completely enucleated during excision, many of them have fascicular involvement and could not be completely shelled out. The aim of this work is to present our experience in operative management of schwannomas located in extremities.Methods: Authors conducted a retrospective review for 18 adult patients with schwannoma, from June 2012 to June 2018.  There were 10 men and 8 women, ranging from 20 to 68 years of age, with a mean age of 46 years old. All patients had excision done for the tumour and histopathological examination confirmed schwannoma. All patients were preoperatively evaluated both clinically and radiologically. FNAC was also done to confirm the origin of the swelling.Results: The mean follow up period has been 2 years. Complete excision with preservation of nerve was done in all cases except for one case in which nerve graft was used.Conclusions: Use of preoperative MRI, magnification and good surgical technique will help to enucleate the tumour completely without any collateral damage or recurrence. The possibility and option of nerve graft should be discussed with patients prior to schwannoma excision, so that nerve grafting could be directly proceeded with patient consent in case there is fascicular involvement of tumour found intraoperatively.

A comparative study on health seeking behaviour of parents towards their child’s illness in rural and urban field practice area of a medical college

Background: The attitude of parents towards their children’s health and illness is an important factor with regards to child’s overall development. In most developing countries, the health of the children is strongly dependent on parental healthcare behavior. This current study mainly looks into these aspects.Methods: A community based cross sectional study involving urban and rural area field practice areas of a medical college in the study period of November 2016-January 2017 with a sample size of 100 families each having children in urban and rural areas have been fixed purposively. House to house survey done by simple random method using pretested semi structured interview schedules.Results: Around 55% of rural parents took treatment from RMP (quacks) with 55% of urban counterparts opting for wait and watch method. Only 8% of respondents from both areas too their children to a pediatrician. About 12% of urban area went to government hospital and none from rural utilized government hospital facilities.Conclusions: Large proportions of respondents did not seek appropriate medical care for childhood illnesses.

Cytotoxicity based screening for radioprotective properties of methanolic extract of Tragia involucrata L. on cultured human peripheral lymphocytes exposed to gamma radiation

Radioprotective drugs of plant origin with bioactives are a boon against ionizing radiation injuries. Tragia involucrata L. (Indian stinging nettle), has medicinal properties and is traditionally used to treat various ailments. Here, we evaluated the radioprotective efficacy of the methanolic whole plant extract of T. involucrata against the damaging effects of gamma radiation. Cultured lymphocytes were treated with methanolic extract for one hour and irradiated with (1-4 Gy) gamma radiation. This pretreatment of lymphocytes with methanolic extract significantly increased the cell viability at 10 μg/mL and reduced the damage to the treated cells compared to the radiation control. In addition, a significant decrease in comet parameters (Comet length and percent DNA in tail and olive moment) and formation of micronuclei (P <0.001) were observed. It also decreased the levels of malondialdehyde, while regulating the status of the total antioxidant capacity, superoxide dismutase, catalase, reduced glutathione, and glutathione transferase (P <0.05) when compared to the radiation control. Similarly, a decrease in caspase 3 cellular activity compared to the radiation control was observed. The results indicated the methanolic extract to be an effective radioprotector up to 4 Gy, by enhancing the antioxidant enzyme levels, scavenging the production of reactive oxygen species, reducing the damaging effects of radiation by increasing the DNA repair mechanism, and by inhibiting the mitochondrial apoptotic pathway. Therefore, methanolic extract of the Indian stinging nettle, Tragia involucrata L. has been proposed as a candidate with a radioprotective property, and further study on animal models would strengthen this claim

Assessment of intraoperative risk factors for surgical difficulty in surgical extraction of impacted mandibular third molar: a prospective study

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, espe-cially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complica-tions in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon's experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for 'right side' was higher with 49.20 ± 17.94 minutes (p=0.691). Total surgical time intervention for 'gagging reflex present' was 50.21 ± 17.812 (p=0.674). Multiple linear regression shows that surgeon's experience was the only predictor (p<0.001). The surgical difficulty of impacted mandibular third molar are likely to depend on the intraoperative factors like Surgeon's time, surgeon's experience, check flexibility, and inter incisal mouth opening.

Assessment of endothelial dysfunction in young healthy first-degree relatives with family history of premature coronary artery disease using vascular doppler ultrasonography

Background: Endothelial dysfunction in young healthy first-degree relatives with family history of premature coronary artery disease was assessed in the present study using vascular doppler ultrasonography.Methods: Thirty young (10-40 years) first degree relatives of 17 patients with premature CAD without risk factors were selected for the study. Age and gender matched healthy subjects were enrolled as controls. Non- invasive assessment of endothelial dysfunction was done by vascular doppler study of brachial artery. Brachial artery diameter, velocity and blood flow were estimated in every study subject and control at rest, after stress and again at rest and after glyceryl-trinitrate (GTN) by vascular Doppler ultrasonography.Results: The percent rise in lumen diameter of brachial artery after stress i.e. reactive hyperaemia, labelled as percent rise in flow mediated dilatation (FMD), was significantly lower in family history group than in controls (8.42±3.47% vs 12.22±4.31%, p<0.05). The statistically significant difference in percent rise in FMD was observed to be consistent across different ages/genders (p<0.05). The mean percent rise in FMD among family history group with positive maternal history (8.06±3.65) was lower as compared to those with positive paternal history (8.57±3.12), but the difference was not statistically significant (p>0.05).Conclusions: Apparently healthy young subjects with family history of premature CAD have impaired endothelium dependent FMD in systemic circulation. Simple, non-invasive, cost-effective vascular doppler ultrasonography is recommended as a potential screening tool to detect subclinical atherosclerosis.

Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects

Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved.

A cross sectional study on self-medication practices among a selected rural community of Hooghly district, West Bengal

Background: Medicines are often used incorrectly; around 50% of all medicines are prescribed, dispensed or sold inappropriately, while 50% of patients fail to take their medicines appropriately (WHO 2002). Self-medication is an important concern worldwide and WHO has laid emphasis on correctly investigating and controlling it. Self-medication practices have dramatically increased in the last few decades, especially in developing countries like India. Therefore, the present study was planned to assess the prevalence of self-medication for during acute illness episodes and factors associated among a rural community.Methods: The cross sectional study was conducted from February to March, 2017 in Anandnagar village, Singur block. All the 900 households in village were included in the study. Data regarding pattern of self-medication were collected by using pretested structured schedule from head of the family or next available adult member. Data were analysed by using Microsoft Excel 2016.Results: Amongst 900 household’s data could be collected from 864 households. Majority respondents were housewives in age group 40-60 years and primary educated. 50.7% respondents reported having acute illness among family members in past 3 months, 48.5% amongst them reported using self-medication. Cough (56.6%), fever (20.3%) and pain (11.2%) were the conditions for which self-medication was used. Nearby medicine shop was the source of self-medication among 59.3% respondents. 2.3% reported using old prescriptions.Conclusions:Half of the communities having acute illness were using self-medication. Uncontrolled use of medicines needs to be addressed as it brings potential health hazards, drug resistance and misuse.