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Background@#High blood glucose levels in diabetes lead to vascular inflammation which accelerates atherosclerosis. Herein, Morin was orally administered in male Wistar rats, at the dose of 40 mg/kg for 28 days, and on the 27th and 28th day, ISO was administered to designate groups at the dose of 85 mg/kg s.c., to induce myocardial infarction. @*Results@#Free radical generation, including ROS, in diabetes following ISO administration, leads to the activation of both intrinsic and extrinsic pathways of apoptosis. Morin significantly (p ≤ 0.05) reduced oxidative stress (GSH, MDA, SOD), cardiac injury markers (CK-MB, LDH), inflammation (TNF, IL-6), and apoptosis (Bax, BCl 2 , Caspase-3). In addition, it also reduced insulin and blood glucose levels. Akt/eNOS, Nrf2/HO-1, MAPK signaling pathways, and Insulin signal transduction pathways were positively modulated by morin pre-treatment. @*Conclusions@#Morin attenuated oxidative stress and inflammation and also modified the activity of various molecular pathways to mitigate cardiomyocyte damage during ISO-induced MI in diabetic rats.
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We present an 8-year-old boy who presented with predominant abdominal symptoms initially to the referring hospital and the initial Chest radiograph being reported as normal. Inflammatory markers being sky high with abdominal symptoms and minimal Chest signs, he was referred to as an atypical case of Perforated Appendicitis. By the time patient was seen in the Tertiary University Teaching Hospital, he had developed classic clinical features of Left Basilar Pneumonia which was clearly evident on good quality repeat Chest radiograph and Ultrasound confirmed it and ruled out any abdominal pathology. The patient responded well to intravenous antibiotics followed by oral one with excellent recovery. Our case is a usual reminder of the fact that a patient is more likely to have a rare presentation of a common disease, than a common presentation of a rare one. Take a careful history and examine the child; consult the appropriate specialist resources and then, if necessary, extend your history and examination with review of available investigations especially being good at reading plain radiographs.
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Context: Fracture of endodontically treated teeth is a grave sequela that a clinician should seriously ponder. Suitable selection of restorative materials is a requisite for long?term clinical success. Aims: To compare the fracture resistance of endodontically treated teeth restored with three different posts luted using two different cements under all ceramic crowns. Settings and Design: This in vitro study was conducted in the Department of Prosthodontics, Government Dental College, Kottayam, Kerala, India. Methods and Material: Thirty endodontically treated single?rooted mandibular premolars in which post spaces were prepared and divided into three different groups. Group 1 (n = 10): zirconia post group. Group 2 (n = 10): quartz fibre post group. Group 3 (n = 10): glass fibre post group. Each group is sub?divided into two based on the luting system: resin?modified glass ionomer cement (RMGIC) or dual?cure resin cement (DCRC). The fracture resistance testing was performed in a universal testing machine with a crosshead speed of 0.5 mm/min. Statistical Analysis Used: The mean fracture resistance were analysed using independent sample Student t?test and one?way ANOVA. Results: Within the zirconia post group, the mean fracture resistance was higher in DCRC sub?group compared to the RMGIC sub?group and the difference was statistically significant (p = 0.017). The difference in fracture resistance between three different post systems was not found to be statistically significant with respect to both the luting systems. Conclusions: It was observed that when zirconia post is used, the mean fracture resistance was higher in dual?cure resin group compared to the resin?modified GIC group.
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Objectives@#The aim of the study was to quantify and compare craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders (TMDs). @*Materials and Methods@#A total of 126 adult subjects were categorized into two groups (63 with a TMDs and 63 without a TMDs), based on detection of symptoms using the Temporomandibular Joint Disorder-Diagnostic Index (TMD-DI) questionnaire. Posteroanterior cephalograms of each subject were traced manually and 17 linear and angular measurements were analyzed. Craniofacial asymmetry was quantified by calculating the asymmetry index (AI) of bilateral parameters for both groups. @*Results@#Intra- and intergroup comparisons were analyzed using independent t-test and Mann–Whitney U test, respectively, with a P<0.05 considered statistically significant. An AI for each linear and angular bilateral parameter was calculated; higher asymmetry was found in TMD-positive patients compared with TMD-negative patients. An intergroup comparison of AIs found highly significant differences for the parameters of antegonial notch to horizontal plane distance, jugular point to horizontal plane distance, antegonial notch to menton distance, antegonial notch to vertical plane distance, condylion to vertical plane distance, and angle formed by vertical plane, O point and antegonial notch. Significant deviation of the menton distance from the facial midline was also evident. @*Conclusion@#Greater facial asymmetry was seen in the TMD-positive group compared with the TMD-negative group. The mandibular region was characterized by asymmetries of greater magnitude compared with the maxilla. Patients with facial asymmetry often require management of temporomandibular joint (TMJ) pathology to achieve a stable, functional, and esthetic result. Ignoring the TMJ during treatment or failing to provide proper management of the TMJ and performing only orthognathic surgery may result in worsening of TMJ-associated symptoms (jaw dysfunction and pain) and re-occurrence of asymmetry and malocclusion. Assessments of facial asymmetry should take into account TMJ disorders to improve diagnostic accuracy and treatment outcomes.
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We report the case of a 52-year-old patient with type 2 diabetes mellitus diagnosed with adenocarcinoma rectum, presenting with the complaint of breathlessness to the emergency department. Chest radiograph done showed a left-sided hydropneumothorax with mediastinal shift to the right side. Tube thoracostomy was done. Pleural fluid was exudative; there was no evidence of malignancy. The patient developed a right-sided pleural effusion; anaerobic bacteria were grown on pleural fluid culture. Computed tomography (CT) of the chest was done in view of the new onset empyema on the right side. The CT showed pneumomediastinum and periesophageal air pockets. Orally administered methylene blue had appeared in the pleural drain confirming the diagnosis. The patient was taken up for feeding jejunostomy and repair of tear was planned for a later date. He succumbed to sepsis due to empyema.
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Biotinidase defciency (BD) is an autosomal recessive disorder caused by bi-allelic mutation in the BTD gene. Clinical manifestations in BD mainly depends on residual biotinidase enzyme activity, although there are some exceptions. Broadly BD disorders are classifed as profound BD and partial BD. Further profound BD can be early onset, late onset, and sometimes may be asymptomatic. Clinically late-onset profound BD can present with spectrum of manifestations ranging from single organ to multiple organ involvement, typically afecting function of brain, eye, ear, and skin. Here, a frst-born child to consanguineous parents with late-onset profound BD presenting with hyperventilation secondary to lactic acidosis, hypotonia, evolving spasticity, and abnormal neuroimaging fndings caused by novel homozygous variant, c.466-3T>G in the BTD gene is reported.
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Purpose: To study the use of teleophthalmology as a tool to manage patients with uveitis and to describe the experience of teleconsultation for uveitis at a tertiary eye care hospital in India during the two waves of the COVID?19 pandemic. Methods: A prospective observational case series of uveitis patients seeking teleconsultations during the first (March 25–May 2020) and second lockdown (April 27 to June 21, 2021) in a tertiary eye care center were analyzed. Results: There were 79 teleconsultations in the first and 89 teleconsultations in the second lockdown. A majority of the patients presented in the age group of 41– 60 years in both the lockdowns. There were both new or primary consultations and follow?up patients (6% vs. 94%) in the first lockdown, and similarly in the second lockdown (8% new vs. 92% follow?up). The majority of patients resided in Bengaluru city (78% in the first and 76% in the second lockdown). After evaluation through video consultation, only 15% required a hospital referral in the first lockdown, whereas in the second lockdown, 21.3% were referred to the hospital. During the second lockdown, 20% presented with COVID?19 infection?related ailments. Conclusion: Based on our preliminary experience using a customized smartphone?based application for teleconsultation, we found it to be an alternative option to provide continuation of ophthalmic care to uveitis patients. Given the current COVID?19 situation, it can help avoid physical visits of uveitis patients to the hospital
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Purpose: We aimed to study the success of prism in regard to diplopia resolution score and associated factors in patients presenting with symptomatic diplopia arising from various etiologies. Methods: In this descriptive, retrospective study diplopia resolution among 31 patients who were prescribed prism were analyzed. Results: Fifty?four patients were evaluated for diplopia and 31 were included for the study done over 3 years. The mean follow?up was 15 months. Esotropia, exotropia, and hypertropia were seen in 39%, 51%, and 19.4% of patients, respectively. Furthermore, 71% received Fresnel prism and 29% were given ground glass prism. The mean prism power prescribed was 13.3 PD. 87% had complete resolution of diplopia; 96.8% continued usage of prism. High success rates were seen among patients with decompensated strabismus, sixth and fourth nerve palsy. Horizontal prism and oblique prism in the form of Fresnel prism yielded complete resolution of diplopia (P = 0.028). There was no association between the success of prism and etiology (P 0.058), history of trauma (P = 0.212), and type of deviation (P = 0.387). The study showed that oblique Fresnel prism can be considered for combined deviation. Conclusion: Our study showed prism to be effective in alleviating diplopia over a varied range of etiologies
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Purpose@#Intensity-modulated radiotherapy (IMRT) provides higher dose to target volumes and limits the dose to normal tissues. IMRT may be applied using either simultaneous integrated boost (SIB-IMRT) or sequential boost (SEQ-IMRT) technique. The objectives of this study were to compare acute toxicity and objective response rates between SIB-IMRT and SEQ-IMRT in patients with locally advanced head and neck cancer. @*Materials and Methods@#Total 110 patients with locally advanced carcinoma of oropharynx, hypopharynx, and larynx were randomized equally into the two arms (SIB-IMRT vs. SEQ-IMRT). Patients in SIB-IMRT arm received dose of 66 Gy in 30 fractions, 5 days a week, over 6 weeks. SEQ-IMRT arm’s patients received 70 Gy in 35 fractions over 7 weeks. Weekly concurrent cisplatin chemotherapy was given in both arms. Patients were assessed for acute toxicities during the treatment and for objective response at 3 months after the radiotherapy. @*Results@#Grade 3 dysphagia was significantly more with SIB-IMRT compared to SEQ-IMRT (72% vs. 41.2%; p = 0.006) but other toxicities including mucositis, dermatitis, xerostomia, weight-loss, incidence of nasogastric tube intubation and hospitalization for supportive management were similar in both the arms. Patients in SIB-IMRT arm showed better treatment-compliance and had significantly less treatment-interruption compared to SEQ-IMRT arm (p = 0.028). Objective response rates were similar in both the arms (p = 0.783). @*Conclusion@#Concurrent chemoradiation with SIB-IMRT for locally advanced head and neck cancer is well-tolerated and results in better treatment-compliance, similar objective response rates, comparable incidence of mucositis and higher incidence of grade 3 dysphagia compared to SEQ-IMRT.
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Purpose@#Intensity-modulated radiotherapy (IMRT) provides higher dose to target volumes and limits the dose to normal tissues. IMRT may be applied using either simultaneous integrated boost (SIB-IMRT) or sequential boost (SEQ-IMRT) technique. The objectives of this study were to compare acute toxicity and objective response rates between SIB-IMRT and SEQ-IMRT in patients with locally advanced head and neck cancer. @*Materials and Methods@#Total 110 patients with locally advanced carcinoma of oropharynx, hypopharynx, and larynx were randomized equally into the two arms (SIB-IMRT vs. SEQ-IMRT). Patients in SIB-IMRT arm received dose of 66 Gy in 30 fractions, 5 days a week, over 6 weeks. SEQ-IMRT arm’s patients received 70 Gy in 35 fractions over 7 weeks. Weekly concurrent cisplatin chemotherapy was given in both arms. Patients were assessed for acute toxicities during the treatment and for objective response at 3 months after the radiotherapy. @*Results@#Grade 3 dysphagia was significantly more with SIB-IMRT compared to SEQ-IMRT (72% vs. 41.2%; p = 0.006) but other toxicities including mucositis, dermatitis, xerostomia, weight-loss, incidence of nasogastric tube intubation and hospitalization for supportive management were similar in both the arms. Patients in SIB-IMRT arm showed better treatment-compliance and had significantly less treatment-interruption compared to SEQ-IMRT arm (p = 0.028). Objective response rates were similar in both the arms (p = 0.783). @*Conclusion@#Concurrent chemoradiation with SIB-IMRT for locally advanced head and neck cancer is well-tolerated and results in better treatment-compliance, similar objective response rates, comparable incidence of mucositis and higher incidence of grade 3 dysphagia compared to SEQ-IMRT.
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Background: The repair of inguinal hernias has seen an evolution over the past few decades and more research on the same is still underway. Though laparoscopy has gained widespread acceptance in today’s era of surgery, there is still a debate between laparoscopic and open hernia mesh repair. Methods: A randomized prospective study was conducted at a tertiary care teaching hospital to compare laparoscopic hernioplasty and Lichtenstein’s open mesh repair. The study consisted of 70 subjects with unilateral or bilateral inguinal hernia and they were randomly allocated into either group. Various parameters like duration of surgery, intra and post-operative complications, post-operative pain, recurrence, stay in the hospital and resumption of daily activities were compared.Results: Out of the 70 patients, 35 underwent laparoscopic hernioplasty and 35 underwent open hernia repair. The mean operative time for laparoscopic hernioplasty (unilateral 63.44mins, bilateral 123.80mins) was greater than open hernioplasty (unilateral 47.35mins, bilateral 90.42 mins). Post-operative complications, like wound infection, seroma formation and urinary retention were noted more in the open hernioplasty group. The mean pain score for laparoscopic hernia repair was lower than open hernia repair on postoperative day 3 and 7. The average duration of hospital stay was 3.5 days in laparoscopy group and 6 days in open group. The mean duration for resumption of daily activities was 4.8 days following laparoscopic hernioplasty and 8.1 days following open hernioplasty.Conclusions: Laparoscopic hernioplasty is more beneficial than Lichtenstein’s open hernia mesh repair as it is safer, with faster recovery, lesser post-operative complications and reduced morbidity.
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Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.
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Background: Alcohol use and traumatic brain injury (TBI) are closely linked public health problems. Alcohol intoxication is one of the major risk factor for TBI, and is a main determinant of prognosis in terms of mortality and functional outcome. The aim of the study is to find out the impact of alcoholism in the neurobehavioral outcome following TBI.Methods: A total of 150 head injury patients were divided into two groups: alcoholics and non-alcoholics, and evaluated between six weeks to one year after injury using the revised neurobehavioral rating scale by Levin et al (NRS-R) for the evaluation of neurobehavioral sequelae and the outcome was compared between groups.Results: The study showed significant difference between the groups indicating that the neurobehavioral sequelae were more in the chronic alcoholics group. In the comparison of individual factors, all except factors III (negative symptoms) and IV (mood and affect) were found to be significantly different. The factors I (executive), II (positive symptoms), V (oral and motor), and VI (not loading on any of the factors) were significant at 0.01 level.Conclusions: Chronic alcoholism significantly increases the risk of developing neurobehavioral sequelae after traumatic brain injury.
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Background: Uroflowmetry is a simple non-invasive technique in evaluating patients presenting with Lower urinary tract symptoms (LUTS), to assess voiding patterns, maximum urinary flow (Qmax), average urinary flow (Qave) and voided urine volume. Uroflowmetry is considered mandatory prior to surgical intervention in diagnosis and assessment of men with LUTS. Correlating the International prostrate symptom score (IPSS) with that of uroflowmetry results will allow a better diagnosis and help in determining more appropriate modality of treatment. Therefore, the purpose of our study is to correlate IPSS and the findings of uroflowmetry in evaluation of Benign prostrate hypertrophy (BPH).Methods: This was a prospective study of 50 patients presenting with LUTS diagnosed with BPH. Patient’s symptoms were initially evaluated by administering a pre-treatment IPSS/Quality of Life Score (QoL) and uroflowmetry. All patients underwent Transurethral resection of the prostate (TURP). A post TURP IPSS/QoL score assessment and uroflowmetry was done. Pre-operative IPSS and uroflowmetry results were correlated using spearman’s correlation coefficient. Outcome of IPSS and uroflowmetry following TURP was assessed in terms of percentage improvement.Results: Statistically significant correlation (p<0.05) was seen between IPSS and uroflowmetry results. No correlation was found between prostate volume and IPSS. Significant improvement in symptom severity (IPSS score) and uroflowmetry results was observed in post TURP patients.Conclusion: IPSS is a valuable tool in the evaluation and grading of LUTS. Correlating both IPSS and uroflowmetry results will help in better diagnosis and management of patients. It can also be concluded that IPSS and uroflowmetry can be used for evaluation and monitoring patients following prostate surgery.
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Background: This study investigated the epidemiological pattern of traumatic brain injury (TBI) in our hospital, so as to juxtapose with available statistics and formulate recommendations for patient betterment.Methods: The Government Medical College, Thiruvananthapuram was the setting of this cross-sectional longitudinal study and included all patients admitted with clinical/radiological evidence of TBI over a period of three months (October 2019 to December 2019). Details regarding mechanism of injury and the socioeconomic background of the subjects were collected during the stay in hospital, by means of a semi structured questionnaire. SPSS software was used to analyze the data collected.Results: Out of 658 patients included in the study, majority of the subjects belonged to the age group 30-60 years. About 80% of subjects were males. 63% were manual laborers. Majority of the patients had about 10-15 days’ stay in the hospital. Road traffic accidents were the most common mechanism of injury and involved two wheelers mainly. Lack of helmet and restraining seat belt was noted in a sizeable percent of the subjects. Loss of consciousness was the most common complaint and GCS in the majority of subjects ranged from 9-13. Subdural hematomas and hemorrhagic contusions were the most common CT findings. 39.7% of the patients had associated spinal injury. About 48% of the subjects were operated. There was 7% mortality.Conclusions: Road traffic accidents accounted for the majority of traumatic brain injury incidents and a sizeable portion of patients required expert neurosurgical care.
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Background: Cervical spine injuries, according to severity can leave victims with long standing neck pain or varying degrees of weaknesses. The purpose of this study is to determine the epidemiological pattern of cervical spine injury in our hospital so that comparison may be made with other institutions and guidance regarding management may be formulated for the betterment of patients.Methods: This cross-sectional longitudinal study was conducted in Government Medical College, Thiruvananthapuram and included all patients admitted with clinical or radiological evidence of cervical spine injury, over a period of three months. Semi-structured questionnaire was used to collect socio demographic data and details regarding mechanism of injury. Data was analyzed using SPSS.Results: Out of 452 patients enrolled, 69.7% were males and 30.3% were females. Patients were the most commonly between 30-60 years of age (52.4%). Majority (56.1%) had hospital stays lasting less than 10 days. Most common mechanism of injury was road traffic accidents (46.6%). Neck pain was the most common symptom and cervical spine straightening was the most common radiological abnormality. The severity of injuries was more severe in patients who were not restrained by seat belt or using a helmet.Conclusion: Road traffic accidents are the most common cause for cervical spine injuries and majority of patients required only symptomatic care.
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Background: Iodine deficiency disorders are recognized as major public health problem in India and the simplest, most effective and inexpensive preventive method is the consumption of Iodized salt. The objective of this study is to estimate the prevalence of goitre among children aged 6 to 12 years in rural areas of Koppal district, to determine various factors associated with goiter among children, to estimate the level of urinary iodine excretion among urine samples collected from children and to estimate the level of iodine content among salt samples collected in the study setting.Methods: A cross sectional study was conducted for a duration of 6 months from June 2018 to November 2018 in rural areas of Koppal district among 3047 school children aged 6 to 12 years selected by cluster sampling technique. Goiter was detected and graded using standard techniques and the collected salt and urine samples were sent to MRHRU, Sirwar, Raichur for analysis. Data was collected using pretested and semistructured questionnaire and was analyzed using WHO Epi info software version 3.5.4.Results: The prevalence of goitre among school children in Koppal district was 442 (14.5%) and it was found to be significantly associated with age and source of drinking water. Majority i.e., 65.96% of urine samples had iodine content less than 100 µg/l and majority i.e., 79.15% of salt samples had iodine content less than 15 PPM.Conclusions: Goiter is mild public health problem in Koppal district with majority of urine samples excreting iodine below optimum levels and majority of salt samples being inadequately iodized.
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Background: Surgical site infection (SSI) is defined as those infections presenting up to 30 days after a surgical procedure if no prosthetic is placed and up to 1 year if prosthesis is implanted in the patient. SSI contributes to increasing morbidity, mortality and cost related to surgeries and continues to be a major problem even in tertiary care modern hospitals following standard protocols of peri operative preparation and antibiotics prophylaxis. Objective of this study was to study and analyse the pattern of pathogen causing SSI in abdominal surgeries in a tertiary care hospital.Methods: Descriptive study on patients undergoing abdominal surgery in the department of surgery. Patients satisfying inclusion criteria will be assessed on 2nd postoperative day and then daily for surgical site pain, redness, warmth, discharge and swelling of surgical site till the patient gets discharged and followed up after discharge every 7 days up to 1 month. If SSI is detected, swab will be taken and sent for culture and sensitivity.Results: At the end of the study, after analysing the pattern of pathogens and antibiotic susceptibility, we intend to conclude the safe usage of empirical antibiotic prophylaxis to prevent the incidence of SSI’s in our hospital.Conclusions: Appropriate prophylactic therapy for any open abdomen surgeries reduces incidence of surgical site infection thereby reducing morbidity, mortality and cost burden in patients undergoing abdominal surgeries.
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Background@#Aplastic anemia (AA), an unusual hematological disease, is characterized by hypoplasia of the bone marrow and failure to form blood cells of all three lineages resulting in pancytopenia. This study aimed to investigate TNF-α-308 and IFN-γ-874 gene polymorphisms and their respective plasma protein levels in patients with AA and healthy controls. @*Methods@#Two hundred and forty individuals were included in this study; the case group comprised 120 AA patients, while 120 healthy individuals served as controls. Genotyping was performed using the PCR-restriction length fragment polymorphism method and TNF-α-308 and IFN-γ-874 plasma levels were evaluated using an ELISA kit. @*Results@#There was a significantly higher prevalence of the IFN-γ-874 genotype in patients with AA than in healthy controls, while the TNF-α-308 genotype was associated with lower risk of developing AA. Furthermore, the levels of both TNF-α-308 and IFN-γ-874 were higher in the plasma of AA patients. @*Conclusion@#Our findings suggest that the IFN-γ-874 genotype may be a greater risk factor in the causation of AA, whereas the TNF-α-308 genotype has a protective role in the North Indian population.