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ABSTRACT Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.
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Purpose: To study the endoscopic ostium characteristics and outcome of 8 × 8 mm osteotomy in external dacryocystorhinostomy (DCR) using the microdrill system. Methods: This prospective interventional pilot study was performed on 40 eyes of 40 patients with primary acquired nasolacrimal duct obstruction (NLDO) from June 2021 to September 2021 in patients undergoing external DCR. An 8 × 8 mm osteotomy was performed using round, cutting burr attached to a microdrill system. Success was defined as patent ostium on lacrimal syringing (anatomical) and a Munk score <3 (functional) at 12 months. Postoperative endoscopic ostium evaluation was done using a modified DCR ostium (DOS) scoring system at 12 months. Results: The mean age of the study participants was 42.41 ± 11.77 years and the male?to?female ratio was 1:4. The mean duration of surgery was 34.15 ± 1.66 minutes and that for osteotomy creation was 2.5 ± 0.69 minutes. The mean intraoperative blood loss was 83.37 ± 11.89 ml. Anatomical and functional success rates were 95% and 85%, respectively. The mean modified DOS score was “excellent” in 34 patients (85%), “good” in 1 patient (2.5%), “fair” in 4 patients (10%), and “poor” in 1 patient (2.5%). Complications included nasal mucosal injury in 10% (4/40) of patients, complete cicatricial closure of ostium in 2.5% (1/40), incomplete cicatricial closure in 10% (4/40), nasal synechiae in 5% (2/40), and canalicular stenosis in 2.5% (1/40). Conclusion: An 8 × 8 mm–sized osteotomy created by powered drill and covered by lacrimal sac–nasal mucosal flap anastomosis in external DCR is an effective technique that has minimal complications and shorter surgical time
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Mucormycosis, an aggressive and opportunistic fungal infection caused by Rhizopus sp., Mucor, and Lichtheimia, poses a significant challenge in the post-COVID era. Previously considered a rare occurrence, mucormycosis has witnessed a surge in cases, particularly affecting the nose, paranasal sinuses, and cerebral tissue. These fungal pathogens exhibit a destructive behaviour, eroding small blood vessels and leading to thrombosis, ischemia, and tissue necrosis. Patients with compromised systemic health, such as diabetes mellitus, leukemia, and immunosuppressive therapy, are particularly susceptible to this infection due to impaired immunity. The various clinical manifestations of mucormycosis are categorized into rhinocerebral, pulmonary, cutaneous, gastrointestinal, and disseminated forms. Within the rhinocerebral form, subdivisions based on the affected tissues further refine the classification like rhino-orbital, rhino-sino-orbital, rhino- orbito-cerebral. Fungal culture remains a cornerstone for identifying the causative organism, while magnetic resonance imaging is the gold standard for radiological evaluation, offering detailed imaging of the affected regions. Computed tomography scans also play a crucial role in the diagnostic pathway. With dental practitioners encountering an increasing number of mucormycosis cases, Cone Beam Computed Tomography has emerged as a valuable diagnostic tool. Recent advancements have led to the development of diagnostic criteria based on CBCT findings, aiding in the accurate and timely diagnosis of mucormycosis. We report a case of mucormycosis affecting maxilla highlighting the importance of CBCT in addition to conventional diagnostic methods thereby improving its management and clinical outcome.
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Objective: To evaluate the incidence and pattern of cardiac involvement in children postCOVID (coronavirus disease) infection in a tertiary care referral hospital in India. Methods: A prospective observational study was conducted including all consecutive children with suspected MIS-C referred to the cardiology services. Results: Of the 111 children with mean (SD) age 3.5 (3.6) years, 95.4% had cardiac involvement. Abnormalities detected were coronary vasculopathy, pericardial effusion, valvular regurgitation, ventricular dysfunction, diastolic flow reversal in aorta, pulmonary hypertension, bradycardia and intracardiac thrombus. The survival rate post treatment was 99%. Early and short-term follow-up data was available in 95% and 70%, respectively. Cardiac parameters improved in the majority. Conclusion: Cardiac involvement post COVID-19 is often a silent entity and may be missed unless specifically evaluated for. Early echocardiography aids in prompt diagnosis, triaging, and treatment, and may help in favorable outcomes.
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Purpose: To evaluate the efficacy of a biosimilar ranibizumab (Razumab) on outcomes of retinopathy of prematurity (ROP) for the first time. Methods: This retrospective study included infants presenting with stage 3+ ROP either in zone 1 or zone 2 posterior or aggressive posterior ROP (APROP). All eligible infants received intravitreal razumab (0.25 mg/0.025 ml) monotherapy. Follow?up was continued monthly till complete retinal vascularization was achieved while retreatment with razumab was given when recurrent neovascularization was noted. In case of no recurrence but incomplete vascularization, laser photocoagulation was done to the residual avascular retina. Results: We included 118 eyes of 59 infants with a median gestational age of 30 weeks and median birth weight of 1250 grams. At presentation, APROP was found in 28 eyes (24%) of 14 babies while stage 3 disease was seen in zone 1 in another 28 eyes (24%) and the remaining 62 eyes (52%) had stage 3 ROP in zone 2 posterior region. Complete resolution of ROP along with complete vascularization was seen in 22 eyes (19%) at a median of 55 days (IQR = 31–56 days) and 42 eyes (35%) showed a recurrent neovascularization at a median of 51 days post razumab (IQR = 42– 55 days). The cumulative incidence of recurrence of neovascularization (21%, 95% CI = 14%–29%) peaked at seven weeks and was significantly higher in eyes with APROP (43%, 95% CI = 27%–63%) compared to eyes without APROP (13.4%, 95%CI, 8%?22%) (P < 0.001). Conclusion: Razumab appears to be safe and effective in treating ROP, with about a third requiring reinjection at seven weeks after the first dose.
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Background and Objectives@#Cochlear implantation in late implanted prelinguals necessitates a complex decision-making process for clinicians and patients due to the uncertainty of achieving adequate benefit in auditory and speech perception. This study longitudinally evaluated clinical and social outcomes of prelingually deaf children with implantation in their late childhood. @*Subjects and Methods@#A total of 113 (49 females and 64 males) participants, with an age range of 5-15 years, were assessed for the pre-implant parameters such as hearing loss etiology, aided responses, anatomical aspects, and psychological evaluation. The Category of Auditory Performance, Speech Awareness Threshold, Speech Reception Threshold, and Speech Discrimination Score were administered to assess the patient’s auditory skills. Further, the Speech Intelligibility Rating scale was administered to evaluate the patient’s speech intelligibility at 3, 6, 9, 12, 18, and 24 months post-surgery. Subjectively perceived benefits were evaluated using the satisfaction rating scale and a questionnaire. @*Results@#The statistical results showed a significant impact of cochlear implantation in all domains. Positive impact and improvement post-implantation were noted in all the spheres, including auditory, linguistic, social, and educational. @*Conclusions@#The study highlighted that the outcomes of a cochlear implant at a later age might not parallel with the implantation at a younger age. However, this still provides measurable benefits even after a longer period of auditory deprivation.
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INTRODUCTIONThe novel coronavirus also known as severe acute respiratory syndrome coronavirus-2(SARS-COV2) causes a severe respiratory disease known as covid 19 because this strain wasdiscovered in December 2019, in Wuhan, China [1,2]. It was reported first on the 31st ofDecember, 2019, by the WHO and regarded as a global pandemic on 11th march 2020[3]. Itcrossed boundaries worldwide and affected millions of people all over the world. In India, theaverage daily cases are nearly 98000 cases and the numbers are rising every day.MATERIALS AND METHODSIt is a questionnaire-based survey, taken by a total of 80 respondents, who were posted innon-patient care areas of a tertiary care hospital and the questionnaire was framed usinginformation from the world health organization (WHO), UpToDate, Indian council ofmedical research (ICMR), Centre for disease control (CDC) and National Institute of Health(NIH) website resources.RESULTOut of 80 workers, 51.25% workers were permanently employed in the setup (figure 1).Highest in the job category of store manager, tailor and chowkidar, while the highest numberof contractual workers were employed as supervisor, there were no contractual workersemployed as tailor, chowkidar and store manager in the hospital. Out of 80 workers, highestnumber of workers were employed in the category of administrators (16.25%) followed bykitchen staff (13.75%).CONCLUSIONTo conclude, the degree of awareness portrayed by the staff posted in non-patient care areasof the hospital is adequate to some extent, yet it lacks in certain dimensions like covid-19transmission and awareness regarding myths and beliefs. Based on this survey it isrecommended that all non-frontline workers posted in non-patient care areas of the hospitalshould at least be trained in order to increase their awareness and knowledge on thetransmission modes and prevention of COVID-19.
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Beauty holds a very important place in expressing the personality now-a-days. Clear and healthy skin makes a good impression. Everyone especially the young generations are most conscious and careful about the beauty of the face. Due to hurry, worry, and curry type of lifestyle and some hormonal factors in the adolescent age many people suffer through Acne. It is commonly seen in young population. Mukhadooshika, according to Ayurveda, can be correlated to acne. It is a type of Kshudraroga. It involves vitiation of Kapha and Vata along with Rakta resulting into formation of Mukhadooshika. Common sites are Mukha, Urah and Prushtha. In the management of Mukhadooshika, both Shodhan and Shaman chikitsa can be performed as per the Avastha. Vaman, Virechana, Raktamokshana, Nasya, Lepan etc. Panchakarma upakrama along with Abhyantar aushadhi chikitsa (internal medications) prove very effective in reducing the Mukhadooshika and preventing the recurrence. In this case study, a female patient with diagnosis of Mukhadooshika was treated with Virechana karma, Mukhalepa and Aushadhi chikitsa that showed marked improvement.
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Purpose: To study the risk factors, clinical presentation, management options, and outcomes in cases of culture?proven Acremonium keratitis. Methods: Medical and microbiology records of culture?proven Acremonium keratitis from Jan 2007 to Dec 2019 at a tertiary eye care center were reviewed. Details of clinical findings on each visit and operating notes were reviewed from the medical records. All cases were subjected to corneal scraping at the first visit for microbiological investigation consisting of direct smear examination and culture. Topical natamycin 5% was the mainstay of medical treatment. Surgical treatment was considered for nonresponding patients. Results: During the 13?year study period, 65 cases of culture?proven Acremonium keratitis were identified out of 1605 cases of fungal keratitis. Trauma was the most common predisposing factor in 32 cases (49.2%). The average area of the corneal stromal infiltrate was 24.8 mm2 at the initial presentation. Hypopyon at the time of presentation was evident in 28 (43.1%) cases. Staphylococcus spp. was the most common (n = 22, 33.8%) organism coexistent with Acremonium. Direct microscopy of corneal scraping was positive for fungal filaments in 57/65 (87.6%) cases. Medical management alone was given in 44 patients (67.6%). Age (>50 years) and treatment delay (>15 days) were found to be independent risk factors for the poor final visual outcome (VA <20/60). Conclusion: When treated early, Acremonium keratitis responds well to medical therapy with currently available topical antifungals. However, advanced and nonresponding cases require surgical intervention for resolution of the infection
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Physical activity and exercise for older helps improve mental and physical health, both of which will help you maintain your independence as you age. This study aimed find the type and level of physical activity and energy expenditure from physical activities done by older adults. 42 participants were approached from different residential area of Surat and IPAQ (Guajarati) was used to measure Physical activity in adults and for energy expenditure. Energy expenditure was measured by using equation EE = MET x 3.5 x Weight (kilograms)/200. For total vigorous activity PA ± EE were 7260 (MET-min/week) ± 648.75 (Kcal/week), total moderate activity PA was 72382.5 (MET-min/week) and EE was 624 (Kcal/week), total walking activity PA and EE were 31775 (MET-min/week) and 404.49 (Kcal/week) respectively, total sitting activity PA ± EE were 136800 (MET-min/week) ± 96.12 (Kcal/week) and total driving activity PA and EE were 5410 (MET-min/week) and 96.11 (Kcal/week) respectively. In older adults, sitting and walking have found most common type of PA with less EE and more EE found with less vigorous and moderate activity.
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Improvement in technology and inclusion of new parameters in automated hematology analyzers allows for better and faster detection of anemias. These parameters along with histograms provide details and clues that help to diagnose the etiology of anemia and help bridge the time lag in detection and treatment. Timely and expert interpretation of complete blood counts should not be limited to the pathologist but should also interest the clinician to allow for efficient patient care.
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Purpose: To compare the functional outcome of retropupillary iris claw lenses (RPIC?IOL) and scleral fixated intraocular lenses (SFIOL) in children with large lens subluxations. Methods: Sixty eyes of patients between 6 and 18 years of age having ?7 clock hour lens subluxation were included and equally divided into group A (RPIC?IOL implantation) and group B (Gore?Tex sutured SFIOL implantation). Cases with anterior and posterior segment abnormalities, trauma and glaucoma were excluded. Primary outcome was improvement in best?corrected visual acuity (BCVA) at 1.5 years. Secondary outcomes were assessment of intraocular lens (IOL) tilt, mean change in astigmatism at 1.5 years, and median operating time. All surgeries were performed by the same surgeon. Results: The mean improvement in BCVA in group A was 0.28 ± 0.41 logMAR and group B was 0.44 ± 0.45 logMAR (P = 0.3). Significant IOL tilt was seen in 4 eyes in group A (13.33%) and 5 eyes in group B (16.66%) (P = 0.120). Mean change in astigmatism was 4.38 ± 5.9D in group A and 4.91 ± 4.4D in group B (P = 0.299). The median operating time was 40 min in group A and 90 min in group B (P < 0.001). No significant posterior segment complications were seen in either technique. Conclusion: Both procedures had comparable visual outcomes. RPIC?IOL implantation was relatively quick and comparatively easier; it may be preferred in cases with high risk of retinal detachment.
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ABSTRACT Background: The role of ascitic and serum levels of various tumour biomarkers in the discrimination of cause of ascites is not well established. Objective: To evaluate the role of serum and ascitic levels of tumor biomarkers (CA 72-4, CA 19-9, CEA and CA 125) in discrimination of cause of ascites. Methods: A prospective study was conducted in consecutive patients presenting with ascites. Serum and ascitic levels of CA 19-9, CA 125, CA 72-4 and carcinoembryonic antigen (CEA) were determined at the presentation. The patients with cirrhotic ascites, tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC) were eventually included in analysis. Results: Of the 93 patients (58 males, mean age 47 years) included, the underlying cause was cirrhosis in 31, PC in 42 and peritoneal tuberculosis in 20. The best cutoff for discriminating benign and malignant ascites for serum CEA, CA 19-9 and CA 72-4 were 6.7 ng/mL, 108 IU/mL and 8.9 IU/mL, respectively. The best cutoff for discriminating benign and malignant ascites for ascitic CA 125, CEA, CA 19-9 and CA 72-4 were 623 IU/mL, 8.7 ng/mL, 33.2 IU/mL and 7 IU/mL, respectively. Conclusion: The performance of single biomarker for the prediction of underlying PC is low but a combination of serum CA 19-9 and CA 72-4 best predicted the presence of peritoneal carcinomatosis.
RESUMO Contexto: O papel dos níveis ascíticos e séricos de vários biomarcadores de tumores na discriminação da causa das ascites não está bem estabelecido. Objetivo: Avaliar o papel dos níveis séricos e ascíticos de biomarcadores tumorais (CA 72-4, CA 19-9, CEA e CA 125) na discriminação da causa das ascites. Métodos: Estudo prospectivo foi realizado em pacientes consecutivos que apresentaram ascite. Foram determinados níveis do soro e ascítico de CA 19-9, CA 125, CA 72-4 e antígeno carcinoembrínico (CEA). Os pacientes com ascites cirróticas, peritonite tuberculosa e carcinomatose peritoneal (CP) foram eventualmente incluídos na análise. Resultados: Dos 93 pacientes (58 homens, média de idade 47 anos) incluídos, a causa básica foi cirrose em 31, CP em 42 e tuberculose peritoneal em 20. O melhor corte para discriminação de ascites benignas e malignas para soro CEA, CA 19-9 e CA 72-4 foram 6,7 ng/mL, 108 UI/mL e 8,9 UI/mL, respectivamente. O melhor corte para discriminação de ascites benignas e malignas para CA 125 ascitico, CEA, CA 19-9 e CA 72-4 foram 623 UI/mL, 8,7 ng/mL, 33,2 UI/mL e 7 UI/mL, respectivamente. Conclusão: O desempenho do biomarcador único para a previsão do CP subjacente é baixo, mas uma combinação de soro CA 19-9 e CA 72-4 melhor previu a presença de carcinomatose peritoneal.
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As there is an increase in the rate of oral cancer, the surge for the various maxillofacial materials is increasing as well. Materials used for rehabilitation of congenital or acquired defects of patients should fulfil the requirements such as function, longevity, and aesthetics. Defects of face which may be congenital or acquired makes the condition of the affected person very disastrous mentally, physically as well as emotionally. Patient wants facial rehabilitation for a healthy happy life. To provide rehabilitation of these patients, re-evaluation of materials used in the field of maxillofacial prosthesis seems essential. Maxillofacial material should best suit the ideal selection criteria to satisfy the functionality, biocompatibility, aesthetics as well as durability. While the new materials have exhibited many desirable properties, there are also many insufficiencies involved in it. This article presents a systemic review of the evolution, current trends, and future requirements in maxillofacial materials for ensuring psychological well-being.In the recent years, a dramatic increase in the demand for prosthetic rehabilitation of patients with facial defects is seen. Increasing awareness of cancer is resulting in earlier diagnosis and treatment. Unfortunately, many of the surgical techniques are extensive and thus leave large defects that compromise not only function and aesthetics, but also psychosocial status of the patient. These problems require prompt rehabilitation with surgery or prosthetics.1 However, surgical reconstruction is often contraindicated in the presence of large defects or in high-risk patients. Prosthesis offers the advantage of quick, reversible and medically uncomplicated rehabilitation. In addition, the restoration may be readily removed to allow evaluation of the health of the underlying tissues. Historically, many types of materials have been used. Wood, wax metals, vulcanite and many types of plastics have been used as rigid materials while flexible ones like gelatin glycerine mixtures, latex and elastic plastics have also found some usefulness.2Presently, materials used for the maxillofacial prosthesis are vinyl plastics, polyurethane, silicone rubber and acrylic types.
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Life is becoming more convenient as advancement in materials has been taking place since the beginning of human history. The increased demand of aesthetics in day to day life and on the other hand disadvantages of the existing materials, clinicians are shifting their paradigms towards metal free restorations. Various researches are going on to identify the ideal restorative material with all the improved mechanical and physical qualities. Advances in the field of dental materials are providing promising results but each material is falling short of being an ideal one. One such material is biomaterials. Biomaterials are mainly used in medical sciences to replace or augment a natural function. Biomaterials are widely used in dentistry, they are divided into four categories metal, composites, polymer and resins. Biomaterials are considered as materials which replace the defects by either replacements or repair. Presently Poly-Ether Ether Ketone (PEEK) is a semi crystalline, synthetic, aromatic, thermoplastic material. Previously, it was used for industrial purposes but due to its excellent properties and biocompatibility, it has been used in medicine and dentistry. There are various applications of PEEK in dentistry such as orthodontic wires and brackets which are made from it to achieve aesthetics and strength. In endodontics PEEK posts and PEEK endocrowns are used when extensive tooth structure loss occurs, even due to its aesthetic property, it is used for anterior restorations. PEEK is a synthetic polymer and is greyish in colour which has a monomer unit of ether ether ketone. In prosthodontics, aesthetics plays an important role. Therefore, PEEK is considered as an alternative option to conventional dental materials because of its aesthetics and it being a scientifically approved material. In prosthodontics, it can be used in removable partial dentures, fixed partial dentures, dental implants and abutments, implant crowns as well as for restoring the maxillofacial defects. This review article describes the various applications of PEEK in prosthodontics in detail.
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nRBCs also referred to as normoblasts are seen in the peripheral blood films invariable numbers; both in physiological as well as pathologic states. Enumeration ofthese cells by modern day automated analysers remains a challenge. We wanted toassess the precision of the Beckman Coulter LH 755 & 780 haematology analysersTMin enumerating the nRBC count.METHODSThis is a retrospective study conducted in the Clinical Laboratory and HaematologyDivision of Kasturba Hospital, Manipal over a 3-month period on the BeckmanCoulter LH 755 & 780 haematology analysersTM (Beckman Coulter Inc., Miami, FL,USA) after obtaining requisite clearance from the Institutional Ethics Committee. Adata of 47,332 random blood samples run on the analysers was collected. Bothdescriptive and analytical statistics were performed using the SPSS softwareversion 22.0TM (Chicago, IL, USA). The sensitivity, specificity and kappa agreementwere calculated using the same.RESULTSA total of 797 cases from the 47,332 samples showed a “flag” for nRBCs. TwoTwenty of these cases were confirmed microscopically to have had nRBCs in theperipheral smear (true positives). 137 cases had nRBCs in the smear but were notdefinitively evaluated by the instrument (false negatives). A vast majority of thecases (577) did not reveal any nRBC on microscopic examination despite a flaggenerated by the machine (false positives). Additionally, a sensitivity of 27.6% andspecificity of 99.7% were also noted. The kappa agreement was 0.376 whichshowed a fair agreement between the two methods.CONCLUSIONSThe automated haematology analysers Beckman Coulter LH 755 & 780 were foundto be less sensitive in adequately enumerating the nucleated red blood cells. Thenumber of false positives can be reduced by noting the ‘cellular interference’ flag. Amanual review of such smears is necessary to confirm or refute such instrument
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Regenerative endodontics has become a revolutionizing tissue engineering concept in the treatment of immature permanent teeth for over two decades. It has been described as a ‘paradigm shift’ in the treatment of immature teeth, since it fosters continued root maturation. An immature necrotic permanent tooth is usually a result of trauma or infection due to which the tooth becomes non-vital before completing root development. In such cases, the root walls are left thin and weak with an open apex. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful regenerative endodontic procedure (REP) results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Various stem cells, growth factors, scaffolds and suitable environment form the tetrad of elements necessary to induce regeneration of dental pulp. While there has been some success in isolating dental pulp cells with in-vitroexperiments, it has been proven to be rather difficultto implement the same in a practical perspective ex vivo. Although there has been clinical success related to REP, histologically they seem to undergo guided endodontic repair rather than true regeneration of physiologic pulp tissue. This review provides an overview of components of tissue engineering, clinical protocol and predictable outcomes for REP and recent advances in regenerative dentistry.
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Filariasis is among the common parasitic infestations found in India, with Wuchereria bancrofti being the most common causative organism. Presentation ranges from clinically asymptomatic to profound elephantiasis. It is also detected incidentally in diagnostic samples such as body fluids, fine needle aspirates, peripheral blood smears, and other cytological smears. Its detection in bone marrow aspirates with an associated hematolymphoid neoplasm is rare, with only a few case reports. We report one such case of young male who presented with leukocytosis of 253 × 109/L with basophilia and massive splenomegaly. Bone marrow aspirate smears showed the presence of microfilariae along with other features of a myeloproliferative neoplasm (MPN). The present case is probably the first case of finding a microfilaria in a case of MPN