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Posterior maxillary region is often limited for standard implant placement because of reduced residual vertical bone height. An elevation of the maxillary sinus floor is one option in solving this problem. This article describes the various surgical techniques that can be used to enter the sinus cavity, elevating the sinus membrane and placing the bone grafts for placement of dental implants in the resorbed posterior maxillary region.
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Reconstruction plates with or without bone grafts are used to restore mandibular continuity, form and function following segmental resection of mandible. Fracture of reconstruction plate is observed in 2.9 % to 10% of cases reported in the literature excluding other complications. In this case, we report the fracture of stainless steel reconstruction plate used without bone graft and its management using locking reconstruction plate with non vascularised iliac crest graft following removal of the fractured plate. Review of literature describing incidence, pattern and causes of reconstruction plate fracture and its management is discussed.
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Introduction: Poor insight is a common feature of bipolar depression and unipolar depression with and without psychotic symptoms (PS) which may lead to poor clinical outcome. Studies on insight in these populations are relatively limited and the majority of studies were published over the previous decade. Methods: This was a cross-sectional, observation study conducted in Psychiatry O.P.D. of tertiary care hospital. The sample consisted cohort of 20 outpatients each with unipolar depression, unipolar depression with psychotic symptoms and bipolar disorder current episode depression with psychotic symptoms. The depression was assessed by HAM-D and insight by Item G12 of the General Psychopathology section of PANSS. Results: Significant difference in insight is seen in all three groups. Bipolar patients with PS had the poorest insight, patients with unipolar depression had best. Statistically significant correlation is present with older age and lack of insight among patients of unipolar depression with PS (rho =.599, P =.005) and bipolar depression with PS (rho =.686 P=.001). Conclusion: Insight in depressive illness is affected by multiple factors; this study shows that age, bipolarity and presence of psychotic symptoms are associated with poor insight. Management of the patients of depressive spectrum should incorporate strategies to improve insight
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Background & objectives: The COVID-19 pandemic has caused significant global morbidity and mortality. As the vaccination was rolled out with prioritization on healthcare workers (HCWs), it was desirable to generate evidence on effectiveness of vaccine in prevailing real-life situation for policy planning. The objective of the study was to evaluate the safety, effectiveness and immunogenicity of COVID-19 vaccination among HCWs in a tertiary care hospital. Methods: This prospective observational study was undertaken on the safety, immunogenicity and effectiveness of the ChAdOx1 nCoV- 19 coronavirus vaccine (Recombinant) during the national vaccine roll out in January-March 2021, in a tertiary care hospital, New Delhi, India. Results: The vaccine was found to be safe, with local pain, fever and headache as the most common adverse events of milder nature which generally lasted for two days. The adverse events following vaccination were lower in the second dose as compared to the first dose. The vaccine was immunogenic, with seropositivity, which was 51 per cent before vaccination, increasing to 77 per cent after single dose and 98 per cent after two doses. Subgroup analysis indicated that those with the past history of COVID-19 attained seropositivity of 98 per cent even with single dose. The incidence of reverse transcription (RT)-PCR positive COVID-19 was significantly lower among vaccinated (11.7%) as compared to unvaccinated (22.2%). Seven cases of moderate COVID-19 needing hospitalization were seen in the unvaccinated and only one such in the vaccinated group. The difference was significant between the fully vaccinated (10.8%) and the partially vaccinated (12.7%). The hazard of COVID-19 infection was higher among male, age >50 yr and clinical role in the hospital. After adjustment for these factors, the hazard of COVID-19 infection among unvaccinated was 2.09 as compared to fully vaccinated. Vaccine effectiveness was 52.2 per cent in HCWs. Interpretation & conclusions: ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) was safe, immunogenic as well as showed effectiveness against the COVID-19 disease (CTRI/2021/01/030582).
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Introduction: Continuing advancements in quality of health care has led to increased life expectancy over time. This in turn has resulted in increased prevalence of noncommunicable diseases (NCDs), especially among the elderly. An appropriate portrayal of its epidemiology is essential to adequately understand the health-care needs of the population. The evidence generated from the study will give us an incentive to address the rising burden of polymorbidities. We did the study to assess the prevalence and pattern of NCDs in the elderly above 60 years of age and to determine age- and sex-wise distribution of single and multiple NCDs. Materials and Methods: A community-based cross-sectional study was conducted among 350 elderly participants over 60 years of age in Mehrauli area of Delhi. Data were collected using a semi-structured questionnaire. Detailed general and systemic examination was also done. Results: A total of 87.4% of the study population were suffering from at least one NCD. The number of NCDs per person is 2.41. Overall, 80 out of the total 350 study participants(22.9%) had a single NCD, whereas 226 (64.6%) had two or more NCDs. Hypertension was the most prevalent NCD, followed by cataract, osteoarthritis, diabetes mellitus, and obesity. Conclusion: The prevalence of NCDs was quite high among the elderly. Multimorbidity was more common among the oldest-old age group and elderly women. This calls for increased focus on timely and comprehensive screening for NCDs in adults and asserts the need to approach the screening and management of NCDs in a more holistic way and not as isolated health events.
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Introduction: Tuberculosis (TB) is an age-old disease killing significant number of humans over history and one of the major cause of morbidity and mortality, especially in developing and underdeveloped countries. It killed 1.4 million people annually worldwide in the year 2019. India had 2.69 million cases in 2019, according to TB report 2020. Despite the presence of the programme for it's control, TB continues to threaten the population due to emergence of more and more resistance cases challenging it's elimination. This study reflects the annual burden of tuberculosis in an area served by a Primary Health Centre in Urban Delhi and the treatment outcomes. The records of the patients attendingMethods: the DOTS centre was obtained from the treatment register at Primary Health Centre, Palam, Delhi. The records of patients visiting between April 2020 to March 2021 were included. Data analysis was done on Statistical Package for the Social Sciences (SPSS) version 22 and appropriate statistical tests were applied. The total number ofResults & Conclusion: tuberculosis patients registered from April 2020 to March 2021 were 260. Out of these 260 patients, 155 (59.6%) were pulmonary and 105 (40.4%) were extra-pulmonary. A total of 175 (67.3%) were microscopically confirmed and 85 (32.7%) were clinically/radiologically diagnosed.
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Intubation of a patient with temporomandibular joint ankylosis is a challenge for every anaesthesiologist. Dependable anaesthetic technique is most desired by all anaesthesiologists. The purpose of the present article is to have a brief overview of temporomandibular joint ankylosis, its clinical features, management and to review literature demonstrating various intubation techniques available to an anaesthesiologist while managing patients with temporomandibular joint ankylosis.
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Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.
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Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is an aggressive subtype of inflammatory myofibroblastic tumor (IMT) harboring anaplastic lymphoma kinase (ALK) gene fusions and is associated with high risk of local recurrence and poor prognosis. Herein, we present a young, non-smoking male who presented with complaints of cough and dyspnoea and was found to harbor a large right lower lobe lung mass. Biopsy showed a high-grade epithelioid to rhabdoid tumor with ALK and desmin protein expression. The patient initially received 5 cycles of crizotinib and remained stable for 1 year; however, he then developed multiple bony metastases, for which complete surgical resection was performed. Histopathology confirmed the diagnosis of EIMS, with ALK gene rearrangement demonstrated by fluorescence in situ hybridization. Postoperatively, the patient is asymptomatic with stable metastatic disease on crizotinib and has been started on palliative radiotherapy. EIMS is a very rare subtype of IMT that needs to be included in the differential diagnosis of ALKexpressing lung malignancies in young adults.
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Background/Aims@#The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19). @*Methods@#This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages. @*Results@#A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period. @*Conclusions@#The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
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Background/Aims@#The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19). @*Methods@#This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages. @*Results@#A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period. @*Conclusions@#The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
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Background/Aims@#The management of patients with walled-off necrosis (WON) has undergone a paradigm shift from surgical to nonsurgical modalities. Real-world data on the management of symptomatic WON are scarce. @*Methods@#Prospectively collected data of symptomatic WON cases were retrospectively evaluated. The treatment modalities used were medical management alone, percutaneous catheter drainage (PCD) or endoscopic drainage, or a combination of PCD and endoscopic drainage. We compared technical success, clinical success, mortality, readmissions, complications, and length of hospital stay among these modalities. @*Results@#A total of 264 patients were evaluated (predominantly men: n=195, 74%). The mean age was 37.66 (±14.41) years. The etiology of acute pancreatitis was excessive alcohol consumption in 115 (44%) and biliary (gall stone, microlithiasis) in 89 (34%). The most common indications for drainage were pain (n=253, 96%) and fever (n=140, 53%). Of the patients, 74 (28%) were treated with medical therapy alone, 81 (31%) with endoscopic drainage, 98 (37%) with PCD, and 10 (4%) with a combined approach. Technical success and clinical success were achieved in 78 (93%) and 74 (91%) patients in the endoscopic arm and in 88 (90%) and 79 (81%) patients in the PCD arm, respectively (p=0.0004 for clinical success). Lower rates of complications (7% vs. 22%, p=0.005), readmission (20% vs. 34%, p=0.04), and mortality (4% vs. 19%, p=0.0012), and shorter hospital stay (13 days vs. 19 days, p=0.0018) were observed in the endoscopic group than in the PCD group. @*Conclusions@#Endoscopic drainage of WON is better than PCD and is associated with lower mortality, fewer complications, and shorter hospitalization.
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Myelodysplastic syndromes (MDSs) are characteristically defined by the presence of specific karyotypic abnormalities, based on which they have been prognosticated. Translocation t(9;22)(q34;q11.2) (Philadelphia positive [Ph +ve]) and corresponding BCR-ABL fusion transcript is the defining parameter of chronic myeloid leukemia. It is also seen in a fair proportion of adult acute lymphoblastic leukemia. Occurrence of a Ph +ve MDS is very uncommon, and that too is seen mostly on progression to higher stage/acute leukemia. Even rarer is the de novo presence of Ph positivity in an MDS. A literature search through PubMed has shown only about forty cases of Ph +ve MDS among which less than half had shown Ph positivity at the time of initial diagnosis. Due to its rarity, this entity has not yet found its space in current WHO 2008 classification and is still under “yet to be validated phase” in current practice of hematological malignancies. The benefit of using a tyrosine kinase inhibitor in such a situation is also debatable. We report here two such cases of de novo Ph +ve MDS, diagnosed in last 1½ year at our institute along with brief literature review
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Introduction: Microorganism present in blood whethercontinuously or intermittently are threat to every organ in thebody. The surveillance of etiological agents in these infectionsis essential for their prevention and treatment. Awarenessof the baseline microbial resistance specific to a hospitalprevents irrational use of antibiotics in that hospital. Thushelps progress a step forward in the prevention of spread ofantibiotic resistance.Material and methods: A retrospective study was conductedin the department of Microbiology. During the study period,blood samples collected from all age group OPD, IPD andICU patients suspected of bacteremia and septicemia wereanalyzed. All Gram-negative bacilli, Gram-positive cocci andYeast were investigated while anaerobic bacteria and cultureswith mixed growth were excluded.Results: During the study period of Jan 2017-Dec2017, 1885blood cultures were analyzed. 305 (16.1%) were found tobe positive, out of which 236 were from ICU, 58 were fromIPD and 11 from OPD. Among Gram positive cocci, CoNSis commonest followed by Staphylococcus aureus whereas inGram negative bacilli, Klebsiella pneumoniae was commonestorganism followed by Pseudomonas aeruginosa. In our study,90% of Enterobacteraceae were ESBL producers. MRSA wereisolated in 50% and MRCoNS in 71%.Gram-positive isolate were least sensitive to penicillin(10%) while it was most sensitive to tigecycline in 100%followed by vancomycin in 95%. Gram negative isolates ofEnterobacteriaceae were least sensitive to Aztreonam (11%)and while it was most sensitive to Colistin in 87% of cases.Candida species were isolated in 54 (18%) of which NICUaccounted for majority of cases. Candida albicans was leastsensitive to Fluconazole (82%) and Non albicans candida toAmphotericin B (70%) while they were sensitive to all otherantifungals.Conclusion: The retrospective study conducted showed bothgram positive and gram negative bacteria were responsiblefor blood stream infections. Most of the strains were multidrug resistant. Rapid isolation and identification of pathogensby automated blood culture system and antibiogram withminimum inhibitory concentration (MIC) value provides earlyand appropriate treatment to the seriously ill patients leadingto reduce mortality and reduce duration of hospitals.Resistance flagging of the bacterial isolates guides us toperform barrier nursing and isolate the patient to preventspread of infection. The daily analysis of resistance flaggingand MIC values give important information for choosingselective antibiotics leading to good antibiotic stewardshipwhich in turn reduces patient morbidity and mortality.
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The current study was carried out to examine in-vitro antimicrobial, antioxidant and antibiofilm efficacy of Peppermint essential oil (PEO) for its potential application in meat products. Antimicrobial activity was measured by using zone inhibition assay (ZOI) and Minimum Inhibitory Concentration (MIC) against ten food borne pathogens including four Gram-positive viz. Listeria monocytogenes, Enterococcus faecalis, Bacillus cereus and Staphylococcus aureus and six Gram-negative viz. Proteus mirabilis, Salmonella enterica serovar Typhi, Klebsiella pneumonia, Shigella flexneri, Escherichia coli and Pseudomonas aeruginosa whereas antioxidant assay was measured using 1,1 diphenyl-2 picrylhydrazyl (DPPH) and 2-2- azinobis-3 ethylbenthiazoline-6-sulphonic acid (ABTS) radical scavenging activity. Maximum zone size was observed for Proteus mirabilis whereas, MIC values ranged from 5000-20000 ppm for all tested organisms. The oil was found to be more effective against Pseudomonas aeruginosa and Salmonella enterica serovar Typhi. Antibiofilm activity (%) was also performed against pure cultures of two pathogens i.e. Listeria monocytogenes and Proteus mirabilis as positive control. The results exhibited that with application of PEO, biofilm formation of both Listeria monocytogenes and Proteus mirabilis was inhibited by 45.80% and 73.01%, respectively in contrast to their respective controls. ABTS and DPPH radical scavenging activity of PEO was measured at five different concentrations and values were ranging from 17.24-49.07% for ABTS whereas 35.16 – 60.70% for DPPH under investigation. It can be concluded that peppermint essential oil possesses potent antimicrobial, antioxidant and antibiofilm activity and can be further used as a natural alternative for preservation in meat industry
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Introduction: The commonest day to day ailment of humanbeings is the gastrointestinal diseases. Apart from traditionaluses, there are several reports on important pharmacologicalactions of musa sapientum. Study aimed to compare acidsecretion and ulcer healing effect of methanolic extract ofbanana, ranitidine, and omeprazole.Material and methods: The present study was carried out on30 albino rats for a period of 7 days. The animals were dividedrandomly into 5 groups of 6 animals each. Group I or controlgroup received 3% gum acacia suspension orally for 7 days.Group II, III, IV and V received 100mg/kg of aspirin orally asa single dose the 7th day. Group III was pretreated with 100mg/kg of MSE orally for 7 days. Group IV was pretreated with 20mg/kg omeprazole and Group V was pretreated with 150mg/kg of ranitidine orally for 7 days. After the administration ofthe drugs on the 7th Day, the albino rats were fasted for 24 hrsand then sacrificed after 4 hrs of pyloric ligation.Results: In the control group (n=6) the values of ulcer index(µmol tyrosin/ml), free acidity (mEq/l), total acidity (mEq/l),and volume of gastric juice (ml/4 hrs) were 0.22±0.01,53.25±2.59, 72.24±4.19 and 5.1±0.32 respectively. Whencompared to aspirin treated group, the MSE pretreated group(100 mg/kg) single dose orally on 7th day showed significantreduction (p<0.01, n=6) of ulcer index, free and total acidity(mEq/l), and volume of gastric juice (ml/4 hrs), whosevalues were 5.3±0.46, 71.31±4.15, 72.24±4.19 and 65.4±2.9respectively.Conclusion: The present study suggests that themethanolic extract of musa sapientum possesses significantulceroprotective effect, which is comparable to omeprazoleand ranitidine, except for gastric juice, where the effect ofomeprazole was more. The observations of the present studyputs forward omeprazole as a promising ulceroprotectiveagent, but further studies with more refined extracts andtechniques on animal and human subjects are requiredto establish the true potential in terms of therapeutic andeconomic viability of this herbal plant.
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Objective: The present study was designed to evaluate the impact of Education (Edu) vaccine in National Program forPrevention and Eradication of Heart Attack (NPPEHA).Methods: This pretest–posttest designed study was held in the SAAOL Heart Center in different cities (Delhi,Kolkata, Bangalore, and Mumbai) of India from Nov 2016 to Dec 2017. Total 6,225 community people were enrolled.An educational counseling intervention (Edu vaccine) comprising: knowledge of heart, heart disease awareness,risk factor awareness, preventive measure awareness and diagnostic, and regular medical checkups were given tocommunity people with expert doctors through face-to-face interactions and video counseling. The effect of lifestylebased counseling was assessed through pre- and post-designed Edu vaccine questionnaire.Results: The results of this study showed a significant improvement in knowledge of heart (79.6%), heart diseaseawareness (87.8%), risk factor awareness (74.9%), preventive measure awareness (89.8%), diagnostic, and regularmedical checkups (84.7%), respectively.Conclusion: The results of this study showed a significant improvement in knowledge of heart (79.6%), heart diseaseawareness (87.8%), risk factor awareness (74.9%), preventive measure awareness (89.8%), diagnostic, and regularmedical checkups (84.7%), respectively. The first phase study of NPPEHA results conclude that lifestyle-based Eduvaccine is effective, and this tool is very easy to follow and heart attack prevention methods. The next phase ofNPPEHA program is ongoing and results are awaited.
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Background: Cancer of uterine cervix is one of the commoncarcinoma among females. The global incidence of cervicalcancer varies (5 lakhs new cases/year), highest in developingcountries with >50% dying. In India, cervical cancer contributesto approximately 6–29% of all cancers in women. Prevention ofcervical cancer, whether primary or secondary requires activeparticipation of the community. This study is to assess thePrevalence, Pap screening, knowledge, attitude practice andprevention regarding cervical cancer. Identification of riskfactors is necessary to curb the disease.Methods: A cross-sectional study was conducted in differentCHC, PHC and MGM Medical college Jamshedpur area ofKolhan region of Jharkhand. A sample of 499 women aged 15-70 years was taken from January 2017- August 2019 and wasselected and subjected to Pap smear test of cervix andabnormal smears, Histopathological report of HSIL/invasivecarcinoma, Factors like menarche, coitarche, age at marriage,parity, contraception, smoking habit and socio-economic statuswere noted.Results: In our study, HSIL was 0.2% and invasive cancer was2.8%. Out of the 499 respondents most of them belonged tothe 15-39 years age group. About 81.96% were Hindu, morethan all the other religion respondents 79.75% of the womenwere educated in primary level. Around 85.17% of therespondents were housewives by occupation. Majority of thembelonged to the lower socio-economic strata. The awarenessabout Pap smear where p>0.05 not significant.Conclusions: Early menarche, early coitarche, early marriage,high parity, use of contraception other than barrier, lowsocioeconomic status, poor habitat and HPV infection, carrieda high risk of developing cervical cancer. HPV infection wasthe most important risk factor. Improvement of socioeconomicstatus, education and cervical cancer screening of the high-riskgroup can reduce cervical cancer mortality and morbiditysignificantly.
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Snakebite is a severe medical, economic, and social problem across the world, mostly in the tropical and subtropical area. These regions of the globe have typical of the world's venomous snakes present where access to prompt treatment is limited or not available. Snake venom is a complex mixture of toxin proteins like neurotoxin and cardiotoxin, and other enzymes like phospholipase A2 (PLA2 ), haemorrhaging, transaminase, hyaluronidase, phosphodiesterase, acetylcholinesterase, cytolytic and necrotic toxins. Snake venom shows a wide range of biological effects like anticoagulation or platelet aggregation, hemolysis, hypotension and edema.Phospholipase A2 is the principal constituent of snake venom; it catalyzes the hydrolysis of the sn-2 position of membrane glycerophospholipids to liberate arachidonic acid, which is the precursor of eicosanoids including prostaglandins and leukotrienes. The information regarding the structure and function of the phospholipase A2enzyme may help in treating the snakebite victims. This review article constitutes a brief description of the structure, types, mechanism occurrence, and tests of phospholipase A 2 and role of components of medicinal plants used to inhibit phospholipase A2 .
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Snakebite is a severe medical, economic, and social problem across the world, mostly in the tropical and subtropical area. These regions of the globe have typical of the world's venomous snakes present where access to prompt treatment is limited or not available. Snake venom is a complex mixture of toxin proteins like neurotoxin and cardiotoxin, and other enzymes like phospholipase A2 (PLA2 ), haemorrhaging, transaminase, hyaluronidase, phosphodiesterase, acetylcholinesterase, cytolytic and necrotic toxins. Snake venom shows a wide range of biological effects like anticoagulation or platelet aggregation, hemolysis, hypotension and edema.Phospholipase A2 is the principal constituent of snake venom; it catalyzes the hydrolysis of the sn-2 position of membrane glycerophospholipids to liberate arachidonic acid, which is the precursor of eicosanoids including prostaglandins and leukotrienes. The information regarding the structure and function of the phospholipase A2enzyme may help in treating the snakebite victims. This review article constitutes a brief description of the structure, types, mechanism occurrence, and tests of phospholipase A 2 and role of components of medicinal plants used to inhibit phospholipase A2 .