Cold spot assessment in Epithelial-Mesenchymal Transition: a histological predictor of tumor recurrence in oral cavity squamous cell carcinoma

Objectives: To investigate clinical implications of epithelial mesenchymal transition (EMT) expression in oral cavity squamous cell carcinoma (OSCC). Materials and Methods: E-cadherin and vimentin expression was studied in 50 newly diagnosed cases of OSCC who underwent surgical excision. EMT expression at non cold spot infiltrative margin and cold spot was studied and correlated with prognostic factors and disease-free survival (DFS). Results: EMT expression at the cold spot and non-cold spot infiltrative margin showed significant results with nodal status (P < 0.001, P < 0.009 respectively). On multivariate analysis, only EMT at the cold spot correlated significantly with prognostic factors (P < 0.030). The factors affecting DFS on Kaplan Meier index were EMT expression and differentiation (P < 0.002, P < 0.016 respectively) which proved significant in cox regression analysis. Conclusion: The study reveals that EMT expression at the cold spot is a significant biomarker for predicting lymph-node metastasis and tumor recurrence in OSCC.

An In Vitro Evaluation of the Remineralizing Efficacy of Two concentrations of Silica Doped Nanohydroxyapatite on Bleached Enamel

@#Introduction: Vital bleaching of teeth is associated with mineral loss and surface roughness leading to hypersensitivity. Aesthetic restorations are recommended after one week. Search is on for a suitable remineralizing material, which helps in instant adhesive bonding. Hence objective of the study is to evaluate the remineralizing efficacy of two concentrations of Silica doped Nanohydroxyapatite on bleached enamel. Methods: Enamel surfaces of 30 extracted human central incisors were divided into Part A: Unbleached enamel, Part B: Bleached enamel, Part C: Remineralized enamel. The samples were randomly divided into, Group 1: MI Paste Plus (Recaldent, USA), Group 2 and 3 for application of Dentin bonding agents (Tetric- n-bond, Ivoclar, Vivadent) mixed 0.2% and 0.8% Silica doped Nanohydroxyapatite (Sigma Aldrich, Bangalore, India). Post bleaching remineralizing agents were applied on part C. Surface roughness was evaluated with contact stylus profilometer and mineral content was evaluated with Energy dispersive X-Ray spectroscopy for three parts. Data were analysed using ANOVA and Post Hoc Tukey test with p ≤ 0.05. Results: Surface roughness values (Ra) were increased, and mineral loss (Ca:P) was observed after bleaching. After application of remineralizing agents, surface roughness was decreased with no significant value (p > 0.05) and a significant increase in mineral content of all three groups with a p < 0.05 was observed. Conclusion: Application of dentin bonding agent mixed with Silica doped Nanohydroxyapatite decreased surface roughness and improved remineralization of bleached enamel.

Remineralization efficacy of nonfluoride versus herbal-based pediatric dentifrice in demineralized primary teeth

Background: Dental caries is one of the most prevalent posteruptive bacterial infections worldwide, characterized by a progressive demineralization process that affects the mineralized dental tissues. Although the decline of dental caries prevalence can be attributed to the widespread use of dentifrices that contain fluoride, yet there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Yet, there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Aim: The aim of this study was to evaluate and compare the remineralizing effect of nonfluoride-based and herbal-based pediatric dentifrice in demineralized primary teeth with an ideal in vitro method of pH cycling and evaluating the values under Polarized Light Microscope (Olympus BX43) using image analysis software (ProgRes, Speed XT core3). Materials and Methods: A total of 30 tooth samples were collected and placed in the demineralizing solution for 96 h to produce a demineralized lesion of approximately 100 ?m, and then cut longitudinally into 60 sections that were randomly assigned to two groups with 27 samples each, Group A – nonfluoride-based dentifrice (Mee Mee®), Group B – herbal-based dentifrice (Mamaearth™), after which they were subjected to pH cycling for 7 days along with dentifrice slurry preparation. The sections were evaluated under the polarizing light microscopy for remineralizing efficacy. The lesion depth was measured and tabulated to be sent for statistical analysis. Results: The mean demineralization value for nonfluoride and herbal-based dentifrice groups were 7.8730 ?m and 28.3174 ?m, respectively. Hence, it can be inferred that since lesion depth measured was lesser in nonfluoride than herbal-based dentifrice, remineralization has occurred in the nonfluoride-based dentifrice group. Conclusion: Nonfluoride-based dentifrice showed significant results in remineralizing the demineralized lesion, while herbal-based dentifrice showed poor efficiency in remineralizing the demineralized lesion.

Comparison between Conventional Gastric Adenocarcinoma and EBV Associated Gastric Carcinoma

Epstein Barr Virus (EBV or Human herpesvirus 4) belongs to the genus Lymphocryptoviridae, the gamma 1 subtype of the Subfamily Gamma herpes viridae and is one of the most common viruses in humans. It is present in all populations, infecting more than 95% of all individuals within the first four decades of life. In developing countries, infections occur very early in life with no specific characteristics other than the general symptoms of acute viremia. In developed countries however, the infection is usually delayed until adolescence or early childhood years where it causes infectious mononucleosis, a benign self-limiting lymphoproliferative disorder.Though the infection with EBV is benign in the acute stages and latent in the chronic phase in the vast majority of people, the virus has been demonstrated to be involved in the development of many malignancies with the list of such malignancies progressively increasing. The first association was with the endemic Burkitt’s lymphoma. Subsequently, other lymphomas (subtypes of Hodgkin’s and non-hodgkin’s lymphomas) are also known to be associated with EBV infection. Epithelial malignancies such as lymphoepitheliomas of nasopharynx and stomach are included in the list of EBV associated tumors. Tumors arise as a result of genetic and epigenetic alterations produced by the virus, which transforms the normal cell into an immortalized proliferating cell. Since Burke et al first detected EBV in undifferentiated lymphoepithelioma like gastric cancer in 1990, many researches are undertaken to prove the same. EBV expresses latent membrane protein which can be detected immune histochemically.Our study is aimed at detecting the EBV expression in gastric carcinoma cells

A Study on Mode of Injury, Types of Fractures and Associated Trauma in Unstable Pelvic Fractures

Aim:The present study was aimed to analyze the mode of injury, different type of fractures and associated injuries in patients with unstable pelvic fractures who are later managed by surgical interventions. Materials and Methods:The study involved 21 cases of unstable pelvic injuries (Tile type B and C) managed surgically patients. Results:The result showed that out of 21 patients, 6 patients (28.6%) had associated skeletal and/or soft tissue injuries. Of which 9.4% (n=2) patients had nerve injury. Despite aggressive resuscitation including application of external fixators, the mortality of 10-20% remain unchanged. Conclusion:Anatomic reduction and internal fixation of unstable pelvic injuries gives excellent stability, allows for early mobility with good functional outcome

A retrospective study of clinical profile and outcome of patients with rodenticide poisoning in tertiary care teaching hospital, Mandya, Karnataka, India

Background: Poisoning is the major health problem in developing countries like India. Rodenticides are one of the commonest substances used for poisoning in India. Rodenticides are the substances used to kill rats. They differs from chemical composition and toxicity profile. Prognosis mainly depends on chemical content of poison.Methods: This retrospective record-based study was conducted between October 2018 to September 2019 at MIMS tertiary care teaching hospital, Mandya, Karnataka, India. Data regarding age, sex, marital status, occupation, socioeconomic status, type of poison, route of exposure, clinical presentation, complications and outcome of poisoning and associated comorbid conditions were collected from the hospital records and documented in the pre-structured proforma. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: Out of 126 study subjects, 77 (61.11%) were female, 49 (38.89%) were male. Most common age group was 21 to 30 years (45.23%), followed by 31 to 40 years (26.19%) group. Most common poison was zinc phosphide (52.39%), followed by yellow phosphorous (30.16%). Mode of poisoning was suicidal (94.4%) followed by accidental (5.6%).Most common symptom at presentation was nausea, vomiting (62.6%) followed by pain abdomen (52.4%).Most common complication was hepatitis 34 (26.98%) patients, followed by hepatic encephalopathy in 6 (4.76%) and cardiogenic shock in 6 (4.76%) patients. Total mortality was 8 (6.3%).Conclusions: Among rodenticides zinc phosphide was most common consumed poison in present study. Yellow phosphorous was most toxic poison and Aluminium phosphide was most lethal poison. Even though there is no specific antidote, early symptomatic treatment is the key in reducing the mortality.

Effect of in-house training of health care personnel on biomedical waste management in a tertiary care hospital, Warangal, Telangana, India

Background: Every day, relatively large amount of potentially infectious and hazardous wastes is generated in the health-care hospitals and facilities around the world. Indiscriminate disposal and improper management of waste generated in health care facilities causes serious threat to environment and to human health that requires specific treatment and management prior to its final disposal.Methods: Cross-sectional study was conducted among 241 health care personnel working at Mahatma Gandhi Memorial hospital, Warangal. Data was collected and pre and post analysis was done using a pre-validated self-administered questionnaire. Data was entered in MS Excel and analysed using SPSS 17 software.Results: Among 241 respondents, 33.2% were sanitary staff, 35.3% are nursing staff and 31.5% are nursing students. Only 35.7% of participants has knowledge regarding the colour of the bag into which expired antibiotics are discarded and 45.2% of participants were aware of the colour of the bag in which IV bottles, gloves were discarded. Scoring for 10 was done in both pre and post-test and post test scores were found to be higher and there is significant increase in level of knowledge of biomedical waste management rules in study population in post-test analysis (p<0.001).Conclusions: Training program on the waste management in the health sector has significant effect in increasing knowledge of the healthcare personnel

Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication

ustification: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However,these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required whenrecommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and mayhave co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National ConsensusMeeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of MedicalSciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA.Objectives: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heartdiseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases.Recommendations: Evidence based recommendations are provided for indications and timing of intervention in common congenitalheart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductusarteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heartdiseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebsteinanomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.

A study on work characteristics and morbidity pattern of coal mine workers in South India

Background: Globally, coal mining is one of the dangerous occupations which leads to hazardous effects to coal mine workers due to production and dispersion of coal dust. These workers face more survival and working pressure than normal workers. Hypertension, diabetes and chronic respiratory symptoms are more prevalent in coal miners than normal population. This study was conducted with the objective to know the working pattern of coal mine workers and to know their habits and morbidity pattern.Methods: A descriptive study was conducted in one of the coal mines during October 2016 to December 2017. 846 coal mine workers were included in the study.Results: 480 (56.74%) workers belong to the age group of 50-60 yrs. Present study includes 696 underground mine workers and 150 surface workers. 222 (26.23%) workers had a habit of smoking, alcohol consumption is seen in 96 (11.35%) of surface workers and 480 (56.73%) of underground workers. In present study prevalence of hypertension is 19.15%, prevalence of diabetes is 16.31% and the prevalence of symptoms of chronic respiratory disease is 28.38%.Conclusions: The current study has shown a higher prevalence of diabetes than national prevalence and showed a lesser prevalence of hypertension than national prevalence which may be probably due to other causes rather than occupational stress alone. Morbidity is more than the normal population hence health education is done among workers regarding chronic diseases and their risk factors.

A comparative study on efficacy of metoprolol and ivabradine in acute ST elevation myocardial infarction patients

Background: The ST-elevation myocardial infarction (STEMI), a fatal disease, is rapidly extending in patients, worldwide. Therefore, proper and timely diagnosis followed by appropriate management becomes necessary. The study aimed to compare the effectiveness of metoprolol and ivabradine in acute STEMI patients.Methods: This was an observational, comparative, in-hospital study carried out in patients admitted in the in-patient cardiac department, intensive cardiac care unit of a tertiary care centre in India. Total 60 patients diagnosed with acute ST-elevation MI were included in the study and were equally divided into two groups. Group 1 involved patients who were given metoprolol for treatment and group 2 involved patients who were given ivabradine. The patients were assessed in terms of heart rate, NYHA class, and ejection fraction. Follow-up of 30 days was taken in all patients.Results: Ivabradine reduced mean heart rate from 85.57 bpm at baseline to 78.23 bpm. Heart rate in the metoprolol group was reduced from 81.93 bpm to 76.47 bpm over the same time period. Metoprolol and ivabradine showed significant improvement in the ejection fraction volume during the in-hospitalization stay. Ivabradine showed a better improvement in ejection fraction when compared to metoprolol but the difference was not found to be statistically significant. Higher mortality was assessed in ivabradine group compared to metoprolol.Conclusions: The study gives the gold standard efficacy and mortality benefit of metoprolol, although ivabradine on the other hand gave better responses in heart rate reduction and improvements in ejection fraction.

Estimation of Blood Urea Nitrogen as an Indicator of Severity in Acute Pancreatitis

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable involvement of the pancreas, regional tissues around the pancreas, or remote organ systems. The aim of study was to evaluate Blood urea nitrogen (BUN) as an indicator of severity and single prognostic indicator in acute pancreatitis and to Compare BUN with Ranson’s and BISAP criteria in prediction of SAP and mortality. Methods: A prospective observational study, total 72 patients participated in this study. All Patients presenting to the Emergency and Outpatient Departments of Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from October 2015 to September 2016 with suspicion of acute pancreatitis. Results: In the study, of these 66 (91.7%) were male and 6 (8.3%) were female. Mean age of the study subjects was 38.47 + 11.01. Mean age of patients with SAP was slightly higher than with non severe pancreatitis (41.89 vs. 37.33) but not statistically significant (p=0.55). 75% of the Pancreatitis was due to alcohol (54 out of 72), followed by gallstones in 13.88% (10/72). Conclusion: BISAP score within the first 24 hours of admission stratifies patients according to their risk of mortality and onset of organ failure.

Quadricuspid aortic valve: A rare intraoperative diagnosis by transesophageal echocardiography

Quadricuspid aortic valve (QAV) is a rare congenital anomaly frequently associated with other anomalies particularly coronary anomalies. It may be detected on transthoracic or transesophageal echocardiography. We present here a case report of a 27-year-old male patient with a QAV, the valve being regurgitant and requiring aortic valve replacement. It has been reported as isolated case reports in the literature and various theories exist to the development of QAV. The diagnosis requires a high degree of suspicion and a detailed assessment, and if asymptomatic, then patients need to be carefully followed up for the development of aortic regurgitation.

Aortic valve homograft for revision surgery ‑ transesophageal echocardiography considerations.

Aortic root surgical anatomy and knowledge of the various homograft implantation techniques is of paramount importance to the attending anesthesiologist for echocardiographic correlation, estimation and accurately predicting aortic annular dimensions for the valve replacement in a case of diseased homograft.

Clinico-pathological Evaluation and Management of Gastrointestinal Hollow Viscous Perforation.

Background: Gastrointestinal hollow viscous perforations constitute one of the important causes of acute pain abdomen in adults and if not treated properly may lead to significant morbidity and sometimes mortality. Successful treatment requires a thorough understanding of anatomy, microbiology, pathophysiology of the disease process and in-depth knowledge of the therapy, including resuscitation, antibiotics, source control, and physiologic support. Aim: To evaluate the etiopathology, clinical signs and symptoms, investigations in the management of gastrointestinal hollow viscous perforations. Materials and Methods: This was a prospective study conducted on patients presenting with gastrointestinal hollow viscous perforations to the Department of General Surgery, Rajarajeswari Medical College and Hospital over a period of 2-year from July 2013 to June 2015. A total of 110 patients were included in the study. A written, informed consent was taken from all patients before enrolling into the study. The Institutional Ethical Committee clearance was taken before starting the study. A pre-formed questionnaire was used to collect the clinical information from the patients. Results: The majority of the patients involved were males (81%) and in the age group of 30-50 years. 80% of the perforations were noted in the Gastroduodenal region, and the remaining was seen in the small bowel (13%) and appendix (7%). Pain abdomen was the presenting complaint in all patients (100%) while vomiting was seen in 50% and abdominal distension was seen in 80% of the patients. 91% of the patients had gas under the diaphragm. Wound infection (9%) lead the list of post-operative complications with a residual abscess (6%) following behind burst abdomen (4%) and fecal fistula (1%). 2% (2 patients) of patients died due to varied reasons. Conclusion: Even after the introduction of proton pump inhibitors, the incidence of perforations resulting from acid peptic disease is still high. Early recognition of perforation, prompt surgical intervention, good post-operative care, recognition of co-morbid conditions and early recognition, and management of complications would reduce morbidity and mortality.

A study of Obstructive Uropathy among Children.

Background: Where in the infection occur repeatedly leaving residual inflammatory changes. It is more common in the presence of structural or functional anomalies of the urinary tract, which interfere with drainage of urine. Common organisms are E. coli in early infancy, while the later resistant organism like proteus and klebsiella predominate. Objective: To study, obstructive uropathy among children. Methods: A hospital-based study was carried out among children of 6 months to 5 years of age who satisfied inclusion and exclusion criteria. Complete detailed history, examination and investigations like urine for culture and sensitivity, and radiological investigations were carried out. Results: Out of total no. of 60 cases sent for urine culture, 44 cases were culture positive. E. coli is isolated in 32 cases (53.3%). Klebsiella in 7 cases (11.6%) and pseudomonas in only 3 cases (5%) and proteus in 2 cases (3.3%). Out of total no of cases, 60 cases, 15 cases were presented with predisposing factors like vesical stones in 8 cases (13.3) noted on plain X-ray of abdomen, where as hydronephrotic changes were seen in 7 cases (11.6%). Conclusion: Organism isolated in present study E. coli (53.3%) was commonest organism isolated, then followed, by Klebsiella, Pseudomonas and Proteus.

A Comparative Study of Lipid Profile in Apparently Healthy Smokers and Non-Smokers.

Background: Smoking is considered as the single most important risk factor for coronary heart disease and cerebrovascular disease, mainly through its effect on accelerating atherosclerosis. It has also been observed that smoking causes increased serum cholesterol, triglyceride and beta lipoprotein levels and alpha lipoproteins. Objective: To compare the lipid profile among smokers and nonsmokers. Method: In this study the lipid profiles of apparently healthy non-smokers in the age group 20-55 was compared with that of smokers with relation to dose response and duration response relationship. Result: It was observed that the mean value of all lipids were significantly higher in smokers as compared to nonsmokers. Analysis of the data with regards to the duration of smoking also showed statistically significant increase in the mean levels of serum lipids with increase in the duration of smoking. There was also significant fall in the mean values of serum HDL in all groups of smokers in a dose response sequence when compared to that in non- smokers. However the fall was not clinically significant. Mean HDL in heavy smokers 31.40± 6.67 as compared to 48.47 ±6. 88 in nonsmokers. P value was <0.001. When the same characteristics were analyzed with regards to the duration of smoking again a statistically significant rise in LDL, VLDL cholesterol & a statistically significant fall in HDL cholesterol were observed when compared to that of non-smokers. Conclusion: The smokers are definitely exposed to the risk of high lipid levels and hence to the risk of cardiovascular diseases,

In vitro antioxidant and antitubercular activity of Leucas marrubioides Desf. root extracts.

Modern civilization is facing hundreds of disorders associated with free radicals. The natural antioxidants from non-edible plants are gaining importance to fight against these disorders. The intention of this study is to evaluate the petroleum ether, chloroform and methanol extracts of roots of Leucas marrubioides Desf. (Lamiaceae) for antioxidant and antitubercular activities. The antioxidant activity of the extracts has been evaluated using DPPH radical scavenging, reducing power and nitric oxide scavenging methods. The results of the study indicated that, methanol extract posses promising DPPH radical scavenging, reducing power and nitric oxide scavenging activity. The petroleum ether and chloroform extracts showed moderate antioxidant activity in all the three models. The antitubercular activity of all the extracts of L. marrubioides have been evaluated against Mycobacterium tuberculosis H73Rv strain using Microplate Alamar Blue Assay (MABA). The activity was documented within MIC range of 0.2 to 100μg/ml. The results of MABA showed that petroleum ether extract exhibited excellent antitubercular activity. The chloroform extract is moderately active, whereas methanol extract is less active against M. tuberculosis. The present investigation suggests that L. marrubioides posses remarkable antioxidant and antitubercular activity.

Compliance to Anti-rabies Vaccination in Post-exposure Prophylaxis.

Complete post-exposure prophylaxis is necessary to prevent rabies among all animal bite victims. It is essential for the bite victims to complete the full course of vaccination as recommended for complete protection. The present study was conducted to determine the compliance rate for anti-rabies vaccination by both intramuscular route and intradermal route and to determine the major constraints. The study was done at two municipal corporation hospitals in Bangalore, India. The compliance rate for intramuscular rabies vaccination was 60.0% and for intradermal rabies vaccination 77.0%. The major constraints were loss of wages, forgotten dates, cost incurred and distance from the hospital. Hence, the present study showed that the compliance to anti-rabies vaccination for post-exposure prophylaxis is low and is a cause of concern, as animal bite victims who do not complete the full course of vaccination are still at risk of developing rabies.