Trends of humoral immune responses to heterologous antigenic exposure due to vaccination & omicron SARS-CoV-2 infection: Implications for boosting

Background & objectives: Vaccination and natural infection can both augment the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but how omicron infection has affected the vaccine-induced and hybrid immunity is not well studied in Indian population. The present study was aimed to assess the durability and change in responses of humoral immunity with age, prior natural infection, vaccine type and duration with a minimum gap of six months post-two doses with either ChAdOx1 nCov-19 or BBV152 prior- and post-emergence of the omicron variant. Methods: A total of 1300 participants were included in this observational study between November 2021 and May 2022. Participants had completed at least six months after vaccination (2 doses) with either ChAdOx1 nCoV-19 or an inactivated whole virus vaccine BBV152. They were grouped according to their age (? or ?60 yr) and prior exposure of SARS-CoV-2 infection. Five hundred and sixteen of these participants were followed up after emergence of the Omicron variant. The main outcome was durability and augmentation of the humoral immune response as determined by anti-receptor-binding domain (RBD) immunoglobulin G (IgG) concentrations, anti-nucleocapsid antibodies and anti-omicron RBD antibodies. Live virus neutralization assay was conducted for neutralizing antibodies against four variants – ancestral, delta and omicron and omicron sublineage BA.5. Results: Before the omicron surge, serum anti-RBD IgG antibodies were detected in 87 per cent participants after a median gap of eight months from the second vaccine dose, with a median titre of 114 [interquartile range (IQR) 32, 302] BAU/ml. The levels increased to 594 (252, 1230) BAU/ml post- omicron surge (P<0.001) with 97 per cent participants having detectable antibodies, although only 40 had symptomatic infection during the omicron surge irrespective of vaccine type and previous history of infection. Those with prior natural infection and vaccination had higher anti-RBD IgG titre at baseline, which increased further [352 (IQR 131, 869) to 816 (IQR 383, 2001) BAU/ml] (P<0.001). The antibody levels remained elevated after a mean time gap of 10 months, although there was a decline of 41 per cent. The geometric mean titre was 452.54, 172.80, 83.1 and 76.99 against the ancestral, delta, omicron and omicron BA.5 variants in the live virus neutralization assay. Interpretation & conclusions: Anti-RBD IgG antibodies were detected in 85 per cent of participants after a median gap of eight months following the second vaccine dose. Omicron infection probably resulted in a substantial proportion of asymptomatic infection in the first four months in our study population and boosted the vaccine-induced humoral immune response, which declined but still remained durable over 10 months

Clinical and surgical outcomes of glaucoma drainage device tube in ciliary sulcus versus anterior chamber in North Indian glaucoma patients

Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.

Quality of life in glaucoma patients: Comparison of medical therapy, trabeculectomy, and glaucoma drainage device surgery

Purpose: To compare the quality of life (QoL) in patients with glaucoma on medical therapy and after trabeculectomy and glaucoma drainage device (GDD) using vision, glaucoma, and surgery?specific questionnaires. Methods: This cross?sectional study enrolled 30 patients of moderate to severe glaucoma, each in medical, trabeculectomy, and GDD groups. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ?25), Glaucoma Quality of Life (GQL?15), and Surgery Specific Questionnaire (SSQ) were administered, and cumulative scores were compared. Results: The mean age of the participants was 58.95 ± 13.6 years with a male preponderance (73.3%, n = 66). The mean scores (SD) in the medical, trabeculectomy, and GDD groups using NEIVFQ?25 were 68.97 (6.98), 72.83 (7.81), and 75.20 (8.77), respectively, those using GQL?15 were 20.63 (6.00), 26.23 (9.12), and 28.43 (7.74), respectively, and for the SSQ, they were 74.33 (8.75) and 72.10 (5.92) in trabeculectomy and GDD groups, respectively. NEIVFQ?25 showed a better QoL in the GDD group compared to the medical group, whereas GQL?15 showed a better QoL in the medical group and comparable QoL in trabeculectomy and GDD. Both these QoL scores correlated to the LogMAR visual acuity. SSQ scores did not show a significant difference in the QoL across both surgical groups. Conclusion: NEIVFQ?25 questionnaire scores provided a holistic measure of QoL. GQL?15 assessed the activity limitation and visual disability of the patients but did not take into account the general health and psychological factors influencing the QoL. We did not find a significant difference between trabeculectomy and GDD using the SSQ. For QoL assessment in medically or surgically treated glaucoma, vision?specific and disease?specific questionnaires should always be used in conjunction

Normative database for Spaeth Richman contrast sensitivity test for Indian eyes

Purpose: To ascertain normative database of contrast sensitivity (CS) using Spaeth/Richman CS test (SPARCS) in the Indian population. Methods: This cross?sectional study enrolled 200 healthy individuals, and CS was tested in both eyes of each participant using SPARCS. A detailed ocular examination was done before enrollment to rule out pathologies that may affect CS. A practice test was performed in the right eye (OD), followed by uniocular testing in each eye and a final binocular test. Results: Data of 400 eyes of 200 subjects who fulfilled the inclusion criteria was evaluated. The average age of subjects was 46.57 ± 16.77 years (range 21–79 years), with a slight female preponderance (53%, n = 106). A statistically significant decline in average SPARCS scores was noted with increasing age (P < 0.05), ranging from 86.68 (20–29 years age group) to 67.44 (70–79 years age group). Higher scores were noted in binocular testing than uniocular testing (Interclass correlation coefficient [ICC] = 0.83; P < 0.001). Females achieved statistically significant higher total scores in uniocular SPARCS testing (both OD and OS), but there was no significant difference noted between the two genders in binocular testing. Correlation between practice and main tests was statistically Significant with an interclass correlation coefficient of 0.54 (P < 0.001). Conclusion: Normative database for SPARCS was established for Indian eyes, with a decreasing trend noted in peripheral as well as central CS scores with increasing age.

Clinical perspectives on the management of common psychiatric disorders in India

Psychiatric disorders are common health problems in patients of all age groups, under-diagnosis and under-treatment of these disorders can result in disability and serious complications. With an objective of creating a comprehensive evidence-based consensus on common mental health disorders and their management in the Indian setting, 10 expert groups meetings involving 98 psychiatrists across India were conducted in the month of May 2020. Clinical insights related to burden, signs and symptoms, diagnosis and management were summarized based on the discussions during these meetings. Experts agreed that depressive disorders and anxiety disorders represent two important psychiatric disorders in India. Selective serotonin reuptake inhibitors (SSRIs) are commonlyused for the treatment of depression. Benzodiazepines are effective for the treatment of comorbid anxiety in patients with depression, but their long-term use causes adverse events such as dependence and withdrawal reaction. Obsessive compulsive disorder (OCD), bipolar disorder, substance use especially alcohol withdrawal syndrome, and sleep disorders are other common psychiatric disorders found among Indian patients. Lithium and valproate represent the commonly used and effective pharmacological treatments for bipolar disorder. SSRIs are preferred drugs in the treatment of OCD,whereas benzodiazepines such as chlordiazepoxide and diazepam represent important pharmacological treatment optionsfor alcohol withdrawal. Early identification and timely and effective treatment of psychiatric disorders is important for prevention of complications. Treatment should be individualized based on efficacy, tolerability profile of the medicine, risk of drug interactions, and cost. This consensus may be useful to psychiatrists and general practitioners treating common psychiatric conditions in Indian patients.

Ocular sequelae in severe COVID-19 recovered patients of second wave

Purpose: To evaluate the retinal microvascular changes in patients, recovered from severe COVID?19 during the second wave of the pandemic in North India. Methods: In this observational cross?sectional study, 70 eyes of 35 patients who recovered from severe COVID?19 during the second wave underwent detailed ophthalmic evaluation 4–6 weeks after discharge. Twelve controls were also enrolled, and the difference in the findings between the case and control groups on optical coherence tomography (OCTA) were studied. Result: The ages of study participants ranged from 27 to 60 years with the male:female ratio being 1.05:1. The fundus changes suggestive of ischemia in the form of cotton wool spots and vascular tortuosity were seen in 25 eyes (35.71%). Increased venous tortuosity was the most common finding seen in 23 eyes (32.85%), of which 10 eyes (28.57%) had concurrent hypertensive retinopathy (HTR) changes. There was a significant reduction in the mean vascular density (VD) and perfusion density (PD) for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at inner, outer ring, and whole (P < 0.05). Foveal avascular zone was significantly enlarged in both the SCP (P = 0.01) and the DCP (P = 0.03). The mean ganglion cell?inner plexiform layer (GC?IPL) was significantly reduced in comparison to controls (P < 0.001). Conclusion: Severe COVID?19 can result in microvascular changes at the macula in the form of reduction in vascular and perfusion density, which can be evaluated using OCTA. As structural changes precede functional changes, a close watch is recommended in patients showing compromise in retinal microvasculature

Impact of moderate and severe primary open-angle glaucoma on quality of life due to activity limitation

Purpose: To study the impact of moderate and severe primary open?angle glaucoma (POAG) on the quality of life (QoL) due to activity limitation using glaucoma?specific questionnaires. Methods: This cross?sectional study enrolled 122 participants, 50% (n = 61) being controls and 50% were diagnosed cases of moderate/ severe POAG. Three orally administered glaucoma?specific QoL instruments were used: Glaucoma Activity Limitation (GAL?9), Glaucoma Quality of Life (GQL?15), and Viswanathan questionnaires. The questions related to activity limitation were identified and analyzed for each questionnaire separately. Results: The mean age of the participants was 61.04 ± 9.88 years and a majority were males (64.8%, n = 79). The mean scores in controls, moderate glaucoma, and severe POAG patients for GAL?9 questionnaire were 9.77 ± 1.36 (P = 0.44), 13.75 ± 4.76 (P < 0.001), and 23.45 ± 5.62 (P < 0.001), for GQL?15, these were 16.39 ± 2.18 (P = 0.5), 22.75 ± 7.89 (P < 0.001), and 39.34 ± 9.42 (P < 0.001), respectively, while for the Viswanathan questionnaire, they were 9.49 ± 0.94 (P = 0.38), 7.91 ± 1.59 (P < 0.001), and 4.41 ± 2.20 (P < 0.001), respectively. The GQL?15 and GAL?9 questionnaires concluded that activity limitation pertaining to dark adaptation?related tasks affected the QoL the most in moderate as well as severe POAG (P < 0.001). Using the Viswanathan questionnaire, it was observed that the peripheral vision?related activity limitation was most significant for the decrease in QoL in moderate POAG while near vision?related activity limitation affected the QoL the most in severe POAG (P < 0.001). Conclusion: All three questionnaires concluded that the activity limitation due to moderate and severe glaucoma has a negative impact on the QoL. The limitation of the tasks involving dark adaptation/glare and peripheral vision has the most significant impact on the QoL in moderate glaucoma. As the disease progresses to a severe category, the limitation of activities requiring central and near vision causes the most significant worsening in QoL.

Management of pseudo tumour in haemophilia patients

A hemophilic pseudotumor is one of the rare complications of hemophilia that results from repetitive bleeding, forming an expanding destructive encapsulated hematoma and necrosed tissue. It has a considerable amount of morbidity. These have become rare over the years with better treatment modalities like factor replacement. Presently, excision is the preferred treatment by many authors. There are instances where surgical excision is not feasible. In such situations, radiotherapy and arterial embolization should be considered either alone or as an adjunct to surgery. A 32 years old male patient, with severe hemophilia A diagnosed with an abdominal tumour 7 years ago during routine screening, that progressively grew to encompass the lower abdominal area. A 44 years old male patient with hemophilia A presented with slow growing swelling over the left gluteal region since, 10 years associated with ulceration and bleeding since, 3 days. The management of a patient with a haemophilic pseudo tumour is complex, with a high rate of potential complications. Surgical excision is the treatment of choice but can only be carried out by a multidisciplinary surgical team. The main postoperative complications are rebleed, infection, fistula and pathological fractures. Pelvic pseudo tumours can even become complicated by fistula formation to the large bowel and by obstruction of the ureters. Untreated pseudo tumours will ultimately destroy soft tissues, erode bone, and may produce neurovascular complications. The hemophilic pseudo tumour is a rare entity which is slow growing painless tumour, with few reports worldwide in the management of this rare complication.

Prevalence and clinical manifestations of vitamin K deficiency in complicated severe acute malnutrition

Background: In Severe Acute Malnutrition (SAM) clinical and biochemical abnormalities are commonly observed. In this institute author observed that many children of complicated SAM had bleeding manifestations but there is no defined prevalence of vitamin K deficiency in SAM that's why author have planned this study.Methods: This was the hospital based prospective study conducted in 150 complicated SAM children. All children were treated according to WHO protocol for SAM management. Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) along with routine investigations were done on admission. All the collected data was managed and analyzed with standard software Biostatics (SPSS Version 20).Results: Total 150 complicated SAM children were studied for prevalence and clinical manifestations of vitamin K deficiency. Mean age of children was 17.03'11.0 months, 52.0% were male and 48.0% were female children. Average weight was 5.92'1.57 kg. Average height/length was 70.66'8.38 cm and mean MUAC was 10.47'1.31 cm. Out of 150, 42(28%) children had abnormal INR and 28(18.7%) had abnormal aPTT with abnormal INR. The mean INR was 2.11'1.1 and mean aPTT was 45.30'9.59 in children those had abnormal INR. Twelve out of 42(28.6%) had various bleeding manifestations and majority (66.6%) had gastrointestinal bleeding.Conclusions: More than one fourth children (28%) of complicated SAM children are having vitamin K deficiency and majority of children present with gastrointestinal bleeding.

Neurotransmitters and neuromodulators involved in learning and memory

Learning and memory being highly specialized process of human brain involves complex interaction between neurotransmitters and cellular events. Over the years, the understandings of these processes have been evolving from psychological, neurophysiological, and pharmacological perspectives. The most widely appraised model of learning and memory involves attention, acquisition, storage and retrieval. Each of these events involve interplay of neurotransmitters such as dopamine, acetylcholine, norepinephrine, N-methyl-d-aspartic acid, gamma-aminobutyric acid, though preponderance of specific neurotransmitter have been documented. The formation of long-term memory involves cellular events with neuroplasticity. Further, dopamine is documented to play crucial role in the process of forgetting. Understanding of the processes of learning and memory not only facilitates drug discovery, but also helps to understand actions of several existing drugs. In addition, it would also help to enhance psychological interventions in children with learning disabilities. Thus, the review intends to summarize role of neurotransmitters and neuromodulators during different phases of learning and memory.

Development of EST-SSR markers in Cenchrus ciliaris and their applicability in studying the genetic diversity and cross-species transferability

Most of the grasses of the genus Cenchrus (20–25 species) and Pennisetum (80–140 species) are distributed throughout the tropical and subtropical regions of the world and reproduce both by sexual and apomictic modes. However, the relationships among the Cenchrus–Pennisetum species are not very clear yet. Molecular markers like expressed sequence tag-simple sequence repeats (EST-SSRs) have been reported to be a better choice for resolving the phylogenetic relationships and to estimate the genetic diversity. The present study describes the identification of EST-SSR markers based on the transcriptome data of Cenchrus ciliaris inflorescence and illustrates the genetic diversity and phylogenetic relationships among these species. Of the 378 primer pairs used across 33 accessions of 21 Cenchrus, Pennisetum, and related grass (Bothriochloa, Dichanthium and Panicum) species, 116 EST-SSR markers were found to be polymorphic with an average polymorphism information content (PIC) of 0.49. Fifty-one EST-SSR loci and 520 alleles showed that where the PIC value is >0.5 there the GAG repeat motif was highly polymorphic. Two EST-SSR markers, CcSSR_80 and CcSSR_102, are polymorphic among the Cenchrus species, while they are absent in Pennisetum and the allied species. Five SSR markers (CcSSR_75, CcSSR_85, CcSSR_87, CcSSR_88 and CcSSR_114) showed 100% cross-transferability among the 21 Cenchrus–Pennisetum species. Species-specific alleles could also be detected for seven species of Cenchrus, Pennisetum and Panicum across 10 SSR markers. Assay of polymorphism across these agamic complexes showed that the three SSR markers (CcSSR_26, CcSSR_97 and CcSSR_109) were associated with Cenchrus–Pennisetum complex, and one (CcSSR_47) with Bothriochloa–Dichanthium complex. Markers with high discriminating power, namely CcSSR_4, CcSSR_38, CcSSR_48, CcSSR_66, CcSSR_67 and CcSSR_70, can be used to estimate the allelic sequence divergence across the sexual and apomictic lineages. Genetic diversity analysis using neighbour-joining (NJ) and principal co-ordinate analysis (PCoA) based approaches showed six and five clusters for the 33 accessions, respectively, having congruence in the pattern of clustering. These accessions were grouped according to their mode of reproduction. Cenchrus and Pennisetum species were grouped separately within the same clade, implying monophyletic group within a ‘bristle clade’. Thus, this study showed high discrimination power of microsatellite (EST-SSR) markers to resolve the phylogenetic relationships.

Association of Serum Vitamin D, IL-4 Levels and Vitamin D Receptor Gene Polymorphism in Coronary Artery Disease with and Without Type 2 Diabetes Mellitus

The aim of this study was to investigate the association of serum vitamin D, IL-4 levels and vitamin D receptor gene polymorphism in coronary artery disease with and without type 2 diabetes mellitus. Methods: The study was conducted in Department of Medicine and Department of Biochemistry, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi. It involved two groups of patients suffering from CAD with type 2 diabetes mellitus (n =40) and CAD without type 2 diabetes mellitus (n =40). Blood sample was collected from all subjects using all aseptic precautions. The levels of serum 25-hydroxy Vitamin D were measured by Electrochemiluminescence Immunoassay. Expected normal serum values considered was 14-80ng/ml. Serum IL-4 had been measured by using commercially available ELISA kit provided by GEN- PROBE Diaclone, France. Expected normal serum value considered was < 98pg/ml. Results: The mean age of patients in different study groups were CAD with DM, 59.15± 9.31 years and CAD without DM, 58.1±9.51 years. Mean vitamin D levels were 18.6±8.3 ng/ml in CAD with DM and 23.4±9 ng/ml in CAD without DM. Mean IL-4 levels were 1.31±0.27pg/ml in CAD with DM group, 1.21±0.29pg/ml in CAD without DM group. The FF genotype of vitamin D receptor gene was present in 47.5 % of CAD with DM patients and 35 % of CAD without DM patients. The Ff genotype was present in 37.5 % of CAD with DM patients and 52.5 % of CAD without DM patients. The ff genotype was reported in 15 % of CAD with DM patients and 12.5 % of CAD without DM patients. Allele F of Vitamin D receptor gene constituted 66 % of total gene pool in CAD with DM patients and 61 % in CAD without DM patients. No significant association was observed with respect to the VDR FokI genotypes and cardiovascular outcomes. Conclusion: Serum Vitamin D levels were decreased in both groups of patients, more significantly decreased in the presence of DM in CAD patients. Serum IL-4 levels were significantly higher in CAD with DM group as compared to CAD without DM group. No associations could be found between Vitamin D receptor gene FokI polymorphism and risk of CAD in diabetic and non-diabetic individuals. No significant correlation was found between vitamin D and IL-4 levels in the patients of both groups. The association between VDR FokI polymorphism, vitamin D and inflammatory markers needs to be further explored in diabetic CAD patients.

Hashimoto‘S Encephalopathy Case Reports Of Hashimoto‘S Encephalopathy In Tertiary Care Hospital

Hashimoto's encephalopathy (HE) is an uncommon syndrome and rare disease, associated with Hashimoto thyroiditis. It is characterized by a acute to chronic loss of cognitive dysfunction ,subacute onset of confusion with altered level of consciousness, stroke like episodes , neuropsychiatric manifestations ,seizures, and myoclonus. HE is believed to be an immune-mediated disorder rather than representing the direct effect of an altered thyroid state on the central nervous system. Hashimoto encephalopathy or Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) and a more general term, nonvasculitic autoimmune meningoencephalitis, are also used to describe this condition. Here we are reporting 3 cases of hashimoto encephalopathy in the tertiary care centre who presented with acute to chronic memory loss , neuropsychiatric disturbances, complex parital seizures visual hallucinations and myoclonus and responded to steroids. A negative microbiological screen of the CSF and serum along with raised CSF protein, elevated serum antithyroid antibodies, characteristic EEG and neuroimaging findings yielded the diagnosis

​Clinical Profile and Outcome of Ludwig’s Angina in Tertiary Care Hospital in Tamil Nadu

Background: Ludwig’s angina is a lethal infectious cellulitis of the submandibular space, which always makes a difficult situationfor treating surgeons.Objectives: The objective of this study was to study about the presentation, management, and clinical outcome of Ludwig’sangina.Materials and Methods: A study made in the Department of ENT - Head and Neck Surgery, Tirunelveli Medical College,Tirunelveli, for a period of 1 year from July 2016 to July 2017, a total of 41 patients - 33 males and 8 females were includedin the study.Results: Majority of the patients were having a dental infection before the episode - 85%. Pseudomonas aeruginosa is the mostcommon among the isolated pathogens. Six patients presented with stridor and needed tracheostomy. With early incision anddrainage, proper antibiotics and supportive measures, 37 patients survived without any morbidities. Despite all of our greatestefforts, four patients expired. Although comorbidities such as diabetes and chronic kidney disease are seen in few, majoritywere not having any other systemic illness.Conclusion: Prompt diagnosis and surgical drainage with broad-spectrum antibiotics and if needed tracheostomy often givemuch better results in the treatment of Ludwig’s angina. An early intervention of dental infection in early stages may be helpfulin avoiding progression into Ludwig’s angina.

A study on the glycemic, lipid and blood pressure control among the type 2 diabetes patients of north Kerala, India

Aim The aim of the study was to detect the level of comprehensive diabetes control among the diabetic patients of Kerala, India. Methods Patients (1200) were randomly selected from a diabetes care center. Their blood sugar, biochemical and anthropometric measurements were done and statistically analyzed. Results Only 28.3% had their HbA1c at or below 7% and 45% above 9%. One-third of the female and one-fifth of the male patients had coronary artery disease. The prevalence of hypertension was almost equal in both sexes. However, there was a statistically significant higher systolic blood pressure (mean 162.12 mmHg vs 147.49 mmHg, p = 0.01044) among females. The total cholesterol was above 200 mg/dl in 42.1% of males and 45.61% of females. The triglyceride was >150 mg/dl in 38.6% males and 50.88% females. Low high density lipoprotein (HDL) cholesterol levels were found in 20.07% of males and 41.12% of females (p = 0.0445). The mean low density lipoprotein (LDL) was 121.75 (± 32.29) Conclusion The mean blood sugar values are found to be high, which will lead to a predictable increase in vascular disease, which in turn will affect the quality of health and productivity of the individual and the economic growth of the society as a whole. Studies suggest that therapeutic interventions to improve glycemic control may reduce the risk of cardiovascular disease and microvascular disease. This study shows that the level of diabetes control in Kerala is unsatisfactory. We need more medications, better strategies and more emphasis on glycemic management than we are currently able to apply.

Comparison of Anesthetic Efficacy of IANB - Classical and Gow-Gates Technique during Surgical Removal of Impacted Mandibular Third Molar

Background: The most frequently used mandibular injection technique is inferior alveolar nerve (IANB) block for achieving local anesthesia for dental treatment. The IANB block does not always give success. The interruption of sensory transmission to its best, by depositing anesthetic solution at lingula has not been proved. Aim: To compare the degree of patient acceptability and clinical efficacy of IANB and GG techniques in patients undergoing surgical removal of impacted mandibular third molar under local anesthesia. Methods: The split-mouth design was conducted on 20 healthy and ambulatory individuals (10 male and 10 female) aged between 40 and 50 years undergoing surgical removal of bilateral symmetrical impacted mandibular third molar reporting. Results: VAS of IANB was 4.60±1.82 and GG was 1.95±1.64 with GG more comfortable and no difference in case of aspiration. Onset of Anesthesia was better in IANB than GG with no difference in duration of anesthesia in both groups. Conclusion: To conclude GG is considered better than IANB in Mandibular block anesthesia

Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis / 世界急诊医学杂志（英文）

BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia (VAP) and whether the location of intubation posed a risk in trauma patients. METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for > 48 hours, admitted between 2010 and 2013. Patients' demographics, clinical presentations and outcomes were compared according to intubation location (prehospital intubation [PHI] vs. trauma room [TRI]) and presence vs. absence of VAP. Multivariate regression analysis was performed to identify predictors of VAP. RESULTS:Of 471 intubated patients, 332 patients met the inclusion criteria (124 had PHI and 208 had TRI) with a mean age of 30.7±14.8 years. PHI group had lower GCS (P=0.001), respiratory rate (P=0.001), and higher frequency of head (P=0.02) and chest injuries (P=0.04). The rate of VAP in PHI group was comparable to the TRI group (P=0.60). Patients who developed VAP were 6 years older, had significantly lower GCS and higher ISS, head AIS, and higher rates of polytrauma. The overall mortality was 7.5％, and was not associated with intubation location or pneumonia rates. In the early-VAP group, gram-positive pathogens were more common, while gram-negative microorganisms were more frequently encountered in the late VAP group. Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models. CONCLUSION:In trauma, the risk of developing VAP is multifactorial. However, the location of intubation and presence of chest injury could play an important role.

Anticancer potential of Alternanthera sessilis extract on HT-29 human colon cancer cells

Objective: To identify the bioactive extracts from Alternanthera sessilis and investigate its cytotoxicity potential against colon cancer cells, HT-29. Methods: This study examined the effects of three parts (aerial, leaf, stem) of whole plant on HT-29 colon cancer cell lines. Three different extracts from the plant parts were prepared by maceration technique using 80％ ethanol. The anticancer activities were determined using MTT, clonogenic, cell motility and AOPI assay. The chemical composition profiling was analyzed by GC-MS. Results: Among three plant part extracts, leaf extract greatly suppressed the growth of colon cancer cells in time and dosage-dependent manner, followed by aerial and stem. The cytotoxicity results were rationalized with clonogenic, cell motility and AO/PI assay, where extract showed the most active activity compared to aerial and stem extracts. GC-MS analysis of leaf extract showed there were various recognized anti-cancer, anti-oxidant and anti-inflammatory compounds. Conclusions: Amid the screened extracts, the leaf extract exhibits the credible cytotoxic, anti-proliferative and apoptotic activity and hence, our findings call for additional research to conclude the active compounds and their mechanisms determining the apoptotic activity.

Neuropharmacological investigations on Actaea acuminata Wall. ex Royle roots.

Actaea acuminata Wall. ex Royle, synonym of Actaea spicata var. acuminata (Wall. ex Royle) H.Hara, commonly called the Himalayan Baneberry ( Ranunculaceae) has been investigated for various pharmacological activities, based on its traditional claims. Properly identified A. acuminata roots were defatted by extracting with petroleum ether. The marc was then extracted in a Soxhlet apparatus with methanol. Various pharmacological activities such as antianxiety (Elevated plus maze, Hole board and Light/Dark tests), anticonvulsant (Maximum electroshock test), antidepressant (Despair swim test), sedative (Actophotometer), antistress (Cold swim test), analgesic (Tail immersion test) and anti-inflammatory (Carrageenin-induced paw edema model) were evaluated after administration of 50, 100 or 200 mg/kg, p.o., doses of methanol extract. The methanol extract exhibited significant antianxiety, anticonvulsant, antidepressant and antistress activities, and mild sedative activity at a dose of 200 mg/kg. It was found to be devoid of analgesic and anti-inflammatory activities. Preliminary phytochemical screening of methanol extract showed the presence of alkaloids and polyphenols. Thus, CNS activities of the plant may be attributed to these groups of phytoconstituents.

A rare case of Enterococcus faecalis-induced orbital cellulitis and myositis.

Orbital cellulitis is an infection of soft tissue behind the orbital septum. Common pathogens isolated include Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae. It is a straightforward diagnosis and usually responds to empirical treatment without any sequela. We report a case of orbital cellulitis caused by Enterococcus faecalis, which was complicated by myositis of levator palpebrae superioris. To the best of our knowledge, only one case report exists dating way back to 1986.