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Oral signs are an early indicator for a variety of systemic diseases. Gingival enlargement can be due to local factors, certain medications, hormonal changes, and malignant diseases. Leukemia is a malignancy characterized by the proliferation of abnormal white blood cells within the bone marrow; oral changes may be the first and only presenting feature in these patients, making it imperative for dental surgeons to make accurate diagnosis and timely referral to prevent a fatal situation. This article aims to discuss a case of acute myeloid leukemia (AML) that came with the chief complaint of swollen gums for 2-month duration. The case was provisionally diagnosed as a leukemic gingival enlargement on the basis of oral manifestation and lymph node examination. Accurate diagnosis and early initiation of chemotherapy for leukemic gingival enlargement can improve the prognosis of the patient and also helps in avoiding complications. Around 50–80% of patients with AML achieve complete remission, more often in children and patients under the age of 60. This paper aims at emphasizing the importance of thorough oral examination and careful investigations to identify the underlying life-threatening condition.
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Introduction The C-MAC D-blade was designed for difficult airway intubation scenarios. To facilítate easier and faster endotracheal intubation in the laryngoscopy paradox, an introducer is preferred. Hence, we decided to conduct a study to compare the 60° angled C-MAC stylet and the gum elastic bougie as aids to intubation while using the C-MAC D-blade laryngoscope in a simulated difficult airway setting. Objective To compare the ease of oral intubation with the use of the C-MAC stylet (60° angled stylet) versus intubation performed over a bougie inserted using the C-MAC D-blade guidance in patients with simulated restricted cervical mobility. Method Prospective, randomized controlled single-center study. Intubation using the C-MAC D-blade laryngoscope was performed in 48 surgical patients randomly assigned to 2 groups of 24 each: Stylet group, Group S (using 60° angled stylet) and Bougie group, Group B (using bougie) after providing manual in-line stabilization to restrict cervical mobility. The Mann-Whitney U test and the Chi square test were used as applicable. Results The use of stylet resulted in easier (Group S 75% vs. Group B 16.7%) and faster (Group S 26.83 ± 8.61s vs. Group B 47.18 ± 16.46s) intubation with fewer attempts compared to group B. Both groups experienced a similar hemodynamic stress response to intubation. Conclusions The 60° angled C-MAC Stylet is a more effective and time-saving intubation aid with C-MAC D-blade compared to bougie.
Introducción: El videolaringoscopio C-MAC D-blade se diseñó para los casos de intubación de la vía aérea difícil. Para facilitar una intubación más rápida y sencilla en la paradoja de la laringoscopía se prefiere un introductor. Por tanto, decidimos realizar un estudio para comparar el estilete de 60° C-MAC y el bougie elástico de goma como ayudas para la intubación utilizando el laringoscopio C-MAC D-blade en una situación simulada de vía aérea difícil. Objetivo: Comparar la facilidad de intubación oral mediante el uso del estilete del C-MAC (estilete angulado de 60°) con la intubación realizada sobre un bougie insertado con la guía del C-MAC D0-blade en pacientes con restricción simulada de la movilidad cervical. Métodos: Estudio prospectivo, aleatorizado y controlado realizado en un solo centro. Se realizó intubación utilizando el laringoscopio C-MAC D-blade D en 48 pacientes quirúrgicos asignados aleatoriamente a 2 grupos de 24 cada uno: grupo de estilete, grupo S (con el estilete angulado de 60°) y el grupo de bougie o grupo B (con bougie) después de establecer una estabilización manual del eje para restringir la movilidad cervical. Se aplicaron las pruebas U de Mann-Whitney U y de Chi cuadrado según correspondiera. Resultados: Con el estilete fue más fácil (Grupo S 75% vs. Grupo B 16.7%) y más rápida (Grupo S 26.83 ± 8.61s vs. Grupo B 47.18 ± 16.46s) la intubación, requiriéndose un menor número de intentos en comparación con el Grupo B. Los dos grupos experimentaron un estrés hemodinámico similar en respuesta a la intubación. Conclusiones: El estilete angulado de 60° C-MAC es una ayuda más efectiva y ahorra más tiempo con el C-MAC D-blade en comparación con el bougie.
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Background: Patient satisfaction is crucial for research, administration, and planning. Since it reveals the ef-fectiveness of the provider, customer happiness is of utmost importance as a gauge of the quality of service.Inpatient satisfaction is an essential tool to identify the level of patient satisfaction and it is one of the im-portant goals of any healthcare system. The objective of the study is to validate the questionnaire developed and to assess the inpatient satisfaction level among patients admitted to OBG ward in a tertiary care hospital. Methods: A cross-sectional study was done among 160 women inpatients admitted in the OBG ward in a ter-tiary care hospital, Chengalpattu. Patient satisfaction was measured by a validated questionnaire with seven domains, the data were collected by face-to-face interview method. Results: Themean age of the respondent were 28 years. 60% of respondents were highly satisfied with the effectiveness of the treatment. Only 33.8% of respondents were highly satisfied with the diet food served and 56.3% were highly satisfied with the cleanliness of wards, and restrooms. Conclusions: The results obtained from the present study can serve as a baseline to compare the future sur-vey and helps to provide healthcare services that fulfil patient desires and expectations.
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Introduction: In spite of the various advances in the Tuberculosis (TB) management system in our country, we are still struggling to achieve the End TB strategy. Addressing the health provider difficulties in TB care will definitely be potential tool to control TB. Objective: To assess the competency, challenges and solutions of Indian medical graduates to provide effective Tuberculosis care. Method: It is a mixed methodological study conducted among the Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates practising in various parts of Chennai, Tamil Nadu, India. The competency of the Indian medical graduates in delivering TB care was assessed using a content validated e-survey questionnaire disseminated through social media affinity groups and free listing;pile sorting and in-depth interview was done in the qualitative part. Results:The proportion of participants having good, fair and poor competency in providing effective TB care was 35%,19% and 46%, respectively. Various challenges in attaining good competency were enlisted by the participants through free listing, a smaller number of TB patients in private medical college has attained the highest Smith S value followed by other eleven challenges. Based on the pile sorting and in- depth interview various solutions have been suggested, with most of them emphasizing on compulsory TB chest clinic posting followed by others measures. Conclusion: The major reason identified in difficulties in delivering TB care was inadequate exposure in managing TB patients, incomplete knowledge on notification,referral and followup system. These lacunae can be overturned by compulsory posting in TB clinics during internship period, provision of required personal protective equipment (PPE) for doctors and patients in TB wards and outpatient department, mandatory teaching on updates of TB management
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Talon cusp is an uncommon developmental anomaly resulting in an extra cusp or cuspal projection on an anterior tooth consisting of normal enamel, dentin, and varying degrees of pulp tissue. Talon cusp shows varied presentations of which the palatal talon cusp has been the most common of all. The management requires an extensive understanding of this clinical entity and the complications associated with its occurrence. In this case series, we are reporting double talon cusps which is a rarity itself, involving the palatal aspect of maxillary central incisors
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Aromatase inhibitors (AI) are drugs that are widely used in treating estrogen receptor (ER)–positive breast cancer patients. Drug resistance is a major obstacle to aromatase inhibition therapy. There are diverse reasons behind acquired AI resistance. This study aims at identifying the plausible cause of acquired AI resistance in patients administered with non-steroidal AIs (anastrozole and letrozole). We used genomic, transcriptomic, epigenetic, and mutation data of breast invasive carcinoma from The Cancer Genomic Atlas database. The data was then separated into sensitive and resistant sets based on patients’ responsiveness to the non-steroidal AIs. A sensitive set of 150 patients and a resistant set of 172 patients were included for the study. These data were collectively analyzed to probe into the factors that might be responsible for AI resistance. We identified 17 differentially regulated genes (DEGs) among the two groups. Then, methylation, mutation, miRNA, copy number variation, and pathway analyses were performed for these DEGs. The top mutated genes (FGFR3, CDKN2A, RNF208, MAPK4, MAPK15, HSD3B1, CRYBB2, CDC20B, TP53TG5, and MAPK8IP3) were predicted. We also identified a key miRNA - hsa-mir-1264 regulating the expression of CDC20B. Pathway analysis revealed HSD3B1 to be involved in estrogen biosynthesis. This study reveals the involvement of key genes that might be associated with the development of AI resistance in ER-positive breast cancers and hence may act as a potential prognostic and diagnostic biomarker for these patients.
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COVID-19 pandemic caused by SARS-CoV-2 virus has been around for 2 years causing significant health-care catastrophes in most parts of the world. The understanding of COVID-19 continues to expand, with multiple newer developments such as the presence of asymptomatic cases, feco-oral transmission, and endothelial dysfunction. The existing classification was developed before this current understanding. With the availability of recent literature evidences, we have attempted a classification encompassing pathogenesis and clinical features for better understanding of the disease process. The pathogenesis of COVID-19 continues to evolve. The spiked protein of the SARS-CoV-2 virus binds to ACE2 receptors causes direct cytopathic damage and hyperinflammatory injury. In addition to alveolar cells, ACE2 is also distributed in gastrointestinal tract and vascular endothelium. ACE2–SARS-CoV-2 interaction engulfs the receptors leading to depletion. Accumulation of Ang2 via AT1 receptor (AT1R) binding causes upregulation of macrophage activity leading to pro-inflammatory cytokine release. Interleukin-6 (IL-6) has been attributed to cause hyperinflammatory syndrome in COVID-19. In addition, it also causes severe widespread endothelial injury through soluble IL-6 receptors. Thrombotic complications occur following the cleavage and activation of von Willebrand factor. Based on the above understanding, clinical features, organ involvement, risk stratification, and disease severity, we have classified COVID-19 patients into asymptomatic, pulmonary, GI, and systemic COVID-19 (S-COVID-19). Studies show that the infectivity and prognosis are different and distinct amongst these groups. Systemic-COVID-19 patients are more likely to be critically ill with multi-organ dysfunction and thrombo-embolic complications.
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A typical case of Axenfeld-Rieger syndrome (ARS), a rare autosomal dominant condition manifesting with ocular, craniofacial, and dental abnormalities, is presented. The patient showed dental features such as oligodontia, microdontia, abnormally shaped teeth, hyperplastic maxillary labial frenum, and maxillary retrognathism. Early diagnosis of the syndrome from its dentofacial manifestations and a multidisciplinary approach is required for the management of patients with ARS.
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Secukinumab, a fully human monoclonal antibody, is a biological agent that targets interleukin-17A. Secukinumab is used in the management of the common dermatological entity - plaque-type psoriasis and its various types, namely psoriatic arthritis, hypertrophic palmoplantar psoriasis and generalized pustular psoriasis. Other less common indications of this popular interleukin -17A inhibitor, secukinumab include ankylosing spondylitis, rheumatoid arthritis, systemic lupus erythematosus, Familial Mediterranean fever, and tumor necrosis factor receptor-associated periodic syndrome (TRAPS). This review article was written by referring to various review articles, original articles, and some books related to highly regarded databases, such as the Web of Science, PubMed, and Scopus. The keywords explored during review of literature consisted of combinations of the following words: human monoclonal antibody, IL-17A, and biologicals. The authors with this in-depth review hope to explore the working of this versatile biological, Secukinumab, especially as a silver lining in dermatology
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Introduction: A good understanding of biostatistics can improve clinical thinking, decision-making, evaluations, and medical research. Undoubtedly, medical professionals are becoming aware of the importance of learning and applying biostatistical methods in their research. This study was done to assess the knowledge and attitude among medical graduates regarding the role and application of biostatistics in medical science. Method: The study was a cross-sectional study conducted in a tertiary care teaching hospital among 120 medical students pursuing MBBS third and final year. Systematic random sampling was used to select the study participants. A pretested validated semi-structured questionnaire was used for data collection. Results: Majority of the study participants, strongly agree that the subject helps in interpretation (75.8%), and is important in medical practice (61.7%). However, 85% of the study participants feel that software is difficult to use. 90% of the study participants find the subject hard to understand. The mean score of subject content, understanding, the current impact was significantly higher among the fourth-year students than the third-year students. There was no significant difference between the genders. Conclusion: Introduction of data collection sessions and appraisal of excerpts in published articles can provide practical knowledge and accentuate the role of bio statistics in health care.
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Background: Essential health services including immunization were significantly impacted due to COVID-19 with devastating outcomes in low- and middle-income countries (LMIC). The disruption in immunization services due to global pandemic and measures undertaken at regional levels to overcome need to be studied as pandemic preparedness strategy. Objective: To document the contextual narratives related to immunization services during the Covid-19 disease outbreakby interviewing qualified paediatricians in the field practice area of private tertiary care teaching medical college Methodology: In-depth phone-based interviews were conducted with paediatricians in diverse settings during November 2020 to March 2021. Reflexive thematic analysis was performed, major themes identi-fied, and case studies documented. Results: Paediatricians shared rich experiences related to immunization services impacted due to COVID-19 especially during the earlier months due to imposition of lockdowns leading to discontinua-tion, disruption of services, decrease in volume of immunizations, modest transition to telehealth ser-vice delivery, facility-level changes brought in to ensure immunization services and capacity building measures for upskilling. Conclusions: Contextual narratives revealed in this study provide rich narrative about the disruption of immunization services due to COVID-19. These findings need to be understood and leveraged to be fu-ture ready and prevent further disruptions by identifying and scaling up key solutions piloted in this study.
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Purpose: To compare the efficacy of Kane formula with Sanders Retzlaff Kraff/Theoretical (SRK/T) and Barrett Universal II in predicting intraocular lens (IOL) power in Indian eyes. Methods: This retrospective study conducted in a tertiary care eye hospital. Data from patients having uneventful cataract surgery with Tecnis ZCB00 IOL implantation were obtained from Lenstar and electronic medical records. Eyes were divided into subgroups based on axial length (AL) as short (<22.0 mm), medium (22� mm), and long (>24 mm). The predicted refractive outcome for each patient was calculated after optimizing the lens constant. Prediction error was calculated by subtracting the predicted spherical equivalent from achieved spherical equivalent 1 week post?surgery. The mean absolute error (MAE) and median absolute error (MedAE) and percentage of eyes within 0.25, 0.5, 1, and 2 D were calculated for each formula. Friedman test, Cochrane Q test were used for statistical analysis. Results: Out of the 350 eyes included in the study, we found that without lens constant optimization, Barrett formula performed better than SRK/T and Kane (P < 0.0001). Over the entire range of axial lengths, Kane formula performed slightly inferior compared to Barrett and SRK?T, both of which performed equally well (P = 0.006). On subgroup analysis, Kane formula performed inferiorly for medium eyes as compared to the other two. No significant differences were noted between the formulae for short and long eyes. Conclusion: Kane formula did not outperform Barrett Universal II and SRK/T in Indian eyes
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Background:Tobacco harm reduction when advocated by care providers as continuum of care towards the goal of tobacco cessation might result in long-term abstinence than it is currently seen. This study aimed to qualitatively explore the healthcare professionals approach and self-reported practices related to tobacco harm reduction and smoking cessation. Methods: A purposive sample (N=36) of multi-specialty healthcare professionals providing tobacco related cessation services at six private medical teaching institutes were engaged in semi-structured qualitative interviews between July 2020 and October 2020 in Chennai. Results: The results indicated that majority of the healthcare professional抯 lack conceptual understanding about tobacco harm reduction. Harm reduction was practised and nicotine replacement therapy was prescribed by psychiatrists in this study. Majority of the healthcare professionals were found to have misconceptions that promoting harm reducing practices instead of cessation might result in continued addiction to nicotine products among the clientele. Conclusions: The findings reveal that tobacco harm reduction remains an under-utilized clinical practise in Indian setting due to knowledge and awareness gaps among multi-specialty healthcare professionals. Improved sensitization through continuous medical education updates is needed to inform effective clinician-affirmative tobacco harm reduction practices.
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Background: In 2019, a novel virus belonging to the coronavirus (CoV) family, SARS-CoV-2, emerged in Wuhan,China’s Hubei province. This was first reported to the WHO Country Office in China at the end of that year and isnow known as COVID -19.Although this is a new strain, related coronaviruses can cause illnesses ranging fromthe common cold to more severe diseases such as SARS and MERS as per the literature.The clinical presentationis generally that of a respiratory infection with a symptom severity ranging from a mild common cold-like illness,to a severe viral pneumonia leading to acute respiratory distress syndrome that is potentially fatal.Aim and Objective of the study: Unprecedented measures have been espoused to control the rapid spread of theenduring COVID-19 epidemic in Andhra Pradesh. Health science students and primary health care physician’sadherence to control measures is prejudiced by their knowledge, attitudes, and practices (KAP) towards COVID19.The battle against COVID-19 is continuing in India. To guarantee the final success, public adherence to thesecontrol measures are vital, which is mostly pretentious by their knowledge, Awareness, and practices (KAP)towards COVID-19 in accordance with KAP theory.Materials and Methods: A cross sectional study is designed to include health sciences students and primary healthcare physicians in Andhra Pradesh state. An interview questionnaire has been designed to assessKnowledge,Awareness and Practices of health sciences students and primary health care physicians, regardingCOVID -19.Results and Discussion: All the registered study participants after giving their consent,completed the questionnaireperfectly. Regarding the Sociodemographic characteristics, out of 243,Male 79 (32.5), Female 164 (67.5) in Gender.Majority of the study participants 128(52.7%) were from Allied Health Science background, 95 (39.1% ) medicinebackground 10(4.1%) and others 10(4.1%). Knowledge variables,Type of Locality and Educational qualificationsvariables, *Awareness variable and *Practices variables i.e.,Occupation variable unvarying with demographicsusing Multiple linear regression endured significant.Educational qualifications variables and Monthly incomewise most of the study participants are students 208.
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Alkaptonuria, is a rare metabolic autosomal recessive disorder, which affects 1:1,000,000 people. It is also called endogenous ochronosis. Though it is mainly seen in children, in adults it usually presents after the age of 30.1 It arises from decreased activity of liver homogentisate 1,2-dioxygenase which leads to accumulation of homogentisic acid (HGA) and production of a melanin-like polymer which is deposited mainly in cartilaginous tissue, mucous, skin, bone surface, internal cardiac structures, as well as excreted in urine.2 The main presentation of alkaptonuria is valvular calcifications and osteoarthritis of spine, along with dark pigmentation of skin, cartilage, sclera and other connective tissues. It is diagnosed by a combination of clinical history, histopathological examination, and estimating the levels of homogentisic acid in urine.3
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A 26 year old male presented to the emergency department with alleged history of RTA and sustained run over injury to right lower limb. On examination his vitals were HR-132/min. BP-70/42 mmHg SpO2 – 97% with room air. He was papery pale, drowsy and arousable to calls. A provisional diagnosis of severe hypovolemic shock was made. 16G Venflon was secured and resuscitation initiated with crystalloids and colloids. Blood samples sent for routine investigations (CBC, RFT) and blood grouping, typing and coagulation parameters. Meanwhile during resuscitation patient had cardiac arrest with asystole for which CPR initiated and ROSC achieved in 5 minutes. His haemoglobin levels were 5 g% with ABG showing mild metabolic and lactic acidosis. He was then stabilised with 3 units of PRBC in ER and shifted to CT scans. OF CASE
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Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.
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Introduction: Delayed gastric emptying (DGE) is one of the most troublesome post-operative complications following pancreatic resection. Not only does it contribute considerably to prolonged hospitalization but it is also associated with an increased cost of treatment, necessitates the use of additional investigations and procedures, and can cause life-threatening complications. Aim: This study aims to study the feasibility of implementing chewing gum protocol in pancreaticoduodenectomy (PD) with pancreaticogastrostomy, using historical control for comparison. Materials and Methods: Patients having pancreatic, periampullary cancer and other diseases who were planned for elective PD procedures were included in the study. Patients were divided into two groups, control group: Traditional protocol and intervention group: Chewing gum intervention. The primary endpoint for this study was fixed as the occurrence of DGE following PD. Results: Statistical analysis showed significant differences in the occurrence of DGE and its related parameters such as time for the removal of nasogastric tube (NGT) and time to start an oral solid diet. It also showed a significant difference in secondary parameters such as time to first flatus, time to stools, and post-operative hospital stay. Multivariate analysis also showed a significant beneficial effect of chewing gum. Conclusion: In patients undergoing PD, implementing gum chewing in the early post-operative period is easy, inexpensive, and without any adverse events. Gum chewing has significantly reduced the incidence of DGE and its parameters such as time to the removal of NGT, resumption of solid diet, time to the passage of first flatus, time to the passage of first stool, and thereby reduced the post-operative hospital stay significantly.
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@#In Malaysia, COVID-19 pandemic recorded considerable number of cases. Many hospitals have been converted into COVID-19 centres to manage these cases. The Penang General Hospital was designated as a hybrid hospital to manage both COVID-19 and non-COVID-19 cases. Consequently, services across specialties, including urology have been affected. Triage of referrals was necessary to ensure optimum patient care, thus we designed a triage system to address this situation. A record screening system of patients was also implemented to limit outpatient appointments. We share this early experience in managing urology patients during this pandemic.