Posterior surgical approach for excision of retrorectal epidermal inclusion cyst, a road less travelled by surgeon: case report

Retrorectal epidermal inclusion cysts are rare congenital cystic lesions, mostly an incidental finding usually diagnosed in middle-aged women. Surgical resection is the main stay of treatment and 3 operative approaches are commonly used: abdominal, trans-sacral/coccygeal (posterior), and combined abdomino-posterior depending on the nature and location of the lesion. We report a case of a 22-year-old male presented with complaints of on-off constipation since 4 years, perineal heaviness since 2 years. Based on digital rectal exam, trans-rectal ultrasound, computed tomography, and magnetic resonance imaging findings, a presumptive diagnosis of retrorectal cyst was made. Patient underwent excision of cystic lesion by posterior trans-coccygeal approach. Post operative histopathology confirmed diagnosis of the retrorectal epidermal inclusion cyst. On follow-up after one month, symptoms of constipation and perineal heaviness completely resolved. Posterior resection allows proximal extension for elimination of the infection and in cases of adherence of the cyst to surrounding structures or in malignancy, which require en bloc resection. Posterior approach for resection is preferred for patients with posterior retrorectal cyst or presacral cyst because it provides adequate exposure with minimum dissection.

Retrospective Analysis of Ameloblastoma: An Institutional Experience

Introduction: Neoplasms that are derived from odontogenic tissues represent an uncommon and heterogenous group of enti- ties in oral and maxillofacial region comprising about 1% of all jaw tumors. Ameloblastoma received particular attention of oral pathologists due to its local aggressive behavior. Objective: Indian studies, regarding prevalence of ameloblastoma are very few. The present study was done to analyze and compare clinical, radiographic and histopathologic features of 57 cases of ameloblastomas in India retrospectively. Materials and methods: 57 cases of histologically diagnosed ameloblastomas were retrieved from the archives over a five year period to analyze the age, sex, site, clinical presentation, radiographic features and histopathology. Results: In the present study, ameloblastoma accounted for 77% of all odontogenic tumors with a mean age of 37.5 years in males and 42 years in females. About 60% of the cases revealed mandible as most common site predominantly of posterior re- gion with common clinical presentation as painless swelling. Radiographically, multilocular radiolucency was noticed in about 54.3% of cases. Among the histological variants of solid/multicystic ameloblastomas, follicular variant was reported to be the most common (38%) and intraluminal variant (19%) to be the common subtype in unicystic ameloblastomas. Statistical analy- sis was done among the histological variants of ameloblastomas which showed no statistical significance (p<0.05). Conclusion: The findings in the present study were well in accordance with previous reported studies. However, extensive studies with larger samples need to be carried out in the Indian population to evaluate the incidence of ameloblastoma for more definitive results.

Indications and effectiveness of arthroscopic lavage and debridement in osteoarthritis knee

Background: Degenerative joint disease will afflict most of the people if they live long enough. The majority of patients with osteoarthritis present to orthopaedic surgeons seeking relief of pain and associated restoration of function. Various intraarticular and periarticular structures may be the cause of pain. Improvement in osteoarthritis by arthroscopic lavage and debridement is seen due to various mechanisms.Methods: In a prospective study from July 2016 to December 2018, 35 patients with primary osteoarthritis knee were assessed for effectiveness of arthroscopic lavage and debridement in relieving symptoms of osteoarthritis of knee and to determine the indications of arthroscopy in osteoarthritis of knee. Assessment was done using variables as age of the patient, body mass index, varus deformity, radiographic grading and arthroscopic grading.Results: A declining trend was seen on follow up over time; 91.4% excellent to good results seen at one month follow up, 76.1% at six months, 49.93% at twelve months, 37.5%, at eighteen months, 23.07% at twenty-four months and 28.5% at thirty months. Results at six month follow up when compared, were better for age less than 50 years (88.8% Vs 73.1% in >50 years age), normal weight patients with BMI 18.5 to 25(94.5% Vs 58.5% in overweight), varus angulation <100(93.1% Vs 0% in >100), radiological grade I and II (95-100% Vs 45-50% in grade III and IV) and arthroscopic grade I and II (94-100% Vs 0-77% in grade III and IV).Conclusions: Arthroscopic lavage and debridement is an effective method of treatment for osteoarthritis knee in patients with grade I and grade II osteoarthritis having symptoms of pain and locking due to loose bodies or degenerative meniscal tears.

Fingertip reconstruction: study of functional and cosmetic results of various local flaps and grafting techniques in patients attending a tertiary care center in North India

Background: Finger injuries are becoming more common with the increasing use of mechanical, industrial, and household appliances. There are six main types of repair for this injury. The replacement of skin loss in digital injuries, particularly on the volar aspects, is an important part of hand-injury management. It would be of value to know the best type of cover, especially for sensory reinnervation as well as for subjective evaluation, cosmetic appearance and freedom from complications. The objective of this study was to measure incidence of age, sex, site, pattern of injury as well as to evaluate and compare the functional and cosmetic results of the various local flap and grafting techniques in finger reconstruction distal to metacarpophalangeal joint.Methods: In a prospective study between May 2014 to October 2018 consisting of 50 patients (43 males, 7 females), aged between 2 years and 54 years, with soft tissue loss distal to metacarpophalangeal joint were treated with either free split-thickness skin grafts, palmar flaps, cross-finger flap or pedicle flaps from the abdomen. The follow-up period ranged from 10 days to 15 months from the date of surgery. Subjective and objective evaluation was done and graded as excellent, good, fair and poor.Results: In this series there were 2 good and 6 fair results for split skin grafting; 9 good and 6 fair results for v-y plasty; 5 excellent, 12 good and 4 fair results for cross finger flap; 1 good and 1 fair result for radial artery based flap; 1 excellent and 1 good for first metacarpal artery based flap and 2 good results for abdominal flap. Overall 6(12%) had excellent, 27(54%) had good and 17(34%) had fair results. None of them had poor results.Conclusions: The group of patients with cross-finger flaps had less subjective complaints and more normal objective testing results than the other groups. When an extensive tactile pad avulsion exists, the cross-finger pedicle flap offers the best long-term result with fewer secondary problems. The exclusive use of any one method cannot be advocated since each serves an useful purpose under proper conditions.

Primary Non-Hodgkin’s Lymphoma Of Epidural Space- A Case Report Of Great Mimicker And Review Of Literature

Primary Non-Hodgkin’s lymphoma of epidural space is a rare entity. Clinical presentation and imaging studies were bizarre and posed the difficulty in diagnosis. Since the management protocol of spinal lymphoma is yet to be standardized, so the prognosis is still looming. Here we are reporting a case of epidural primary Non-Hodgkin’s lymphoma in young adult female, who presented with backache and weaknes

Russel’s score and diabetes mellitus type 2 “finding the association”: a cross sectional study from one of the districts in Bihar, India

Background: Diabetes has been on the rise since last decade or so with prevalence rate changing as more research is being done. India is one of the most burdened country from diabetes specially type 2. With changing life style other diseases are also on the rise and evidence is being generated to find tangible association. One such disease is periodontitis. As evidence from the State of Bihar for association between periodontitis and diabetes mellitus is negligible this study was conducted to find the same.Methods: A cross sectional observational study in community settings was done for three months on 200 diabetic willing participants. Data was generated using a semi structured pretested questionnaire. Data analysis was done using SPSS version 22.0 and statistical measures of central tendency like mean, mode, median and standard deviation were used.  For establishing association chi square tests were used. P values<0.05 were considered to be statistically significant.Results: 61.5% of the participants were male while 65.5% were from rural area. The study population was on an average on the older side with a mean age of 52±12.15 and on the bulky size with a BMI of 28.85±4.08. Authors got the average Russel’s score to be 1.1±1.79. The mean blood sugar level for fasting was 146.40±59.99 and post prandial levels was 211.59±82.49. A Russel score category of established periodontal disease and terminal disease was present in 77.5% of participants having an altered fasting blood sugar level. Majority of the males had established periodontal disease and terminal disease. Patients with elevated postprandial blood sugar levels had more established periodontal disease and terminal disease.Conclusions: Oral health is definitely associated with diabetes mellitus type 2 and its other factors like duration, glycaemic control, blood sugar levels etc. Public awareness regarding this is minimal. More research and awareness regarding this will help in keeping the diabetic population healthy.

Infantile Achalasia Cardia.

Background:　　Achalasia is extremely rare in infants. Case characteristics:　We report three infants of age 9, 7 and 12 months, who presented with recurrent non-bilious vomiting, repeated chest infection and severe failure to thrive. Diagnosis of achalasia cardia was confirmed on contrast-swallow study. Heller’s cardiomyotomy with fundoplication led to complete symptomatic relief, and weight-gain on follow-up. Message: Achalasia cardia is often misdiagnosed as gastroesophageal reflux disease which leads to significant delay in diagnosis and increased morbidity.

Scope of photodynamic therapy in periodontics.

Periodontal disease results from inflammation of the supporting structure of the teeth and in response to chronic infection caused by various periodontopathic bacteria. The mechanical removal of this biofilm and adjunctive use of antibacterial disinfectants and antibiotics have been the conventional methods of periodontal therapy. However, the removal of plaque and the reduction in the number of infectious organisms can be impaired in sites with difficult access. Photodynamic therapy (PDT) is a powerful laser‑initiated photochemical reaction, involving the use of a photoactive dye (photosensitizer) activated by light of a specific wavelength in the presence of oxygen. Application of PDT in periodontics such as pocket debridement, gingivitis, and aggressive periodontitis continue to evolve into a mature clinical treatment modality and is considered as a promising novel approach for eradicating pathogenic bacteria in periodontitis.

Bioremediation of polyaromatic hydrocarbons (PAHs) using rhizosphere technology

The remediation of polluted sites has become a priority for society because of increase in quality of life standards and the awareness of environmental issues. Over the past few decades there has been avid interest in developing in situ strategies for remediation of environmental contaminants, because of the high economic cost of physicochemical strategies, the biological tools for remediation of these persistent pollutants is the better option. Major foci have been considered on persistent organic chemicals i.e. polyaromatic hydrocarbons (PAHs) due to their ubiquitous occurrence, recalcitrance, bioaccumulation potential and carcinogenic activity. Rhizoremediation, a specific type of phytoremediation that involves both plants and their associated rhizospheric microbes is the creative biotechnological approach that has been explored in this review. Moreover, in this review we showed the significance of rhizoremediation of PAHs from other bioremediation strategies i.e. natural attenuation, bioaugmentation and phytoremediation and also analyze certain environmental factor that may influence the rhizoremediation technique. Numerous bacterial species were reported to degrade variety of PAHs and most of them are isolated from contaminated soil, however few reports are available from non contaminated soil. Pseudomonas aeruginosa, Pseudomons fluoresens, Mycobacterium spp., Haemophilus spp., Rhodococcus spp., Paenibacillus spp. are some of the commonly studied PAH-degrading bacteria. Finally, exploring the molecular communication between plants and microbes, and exploiting this communication to achieve better results in the elimination of contaminants, is a fascinating area of research for future perspective.

Bioremediation of dyes by fungi isolated from contaminated dye effluent sites for bio-usability

Biodegradation and detoxification of dyes, Malachite green, Nigrosin and Basic fuchsin have been carried out using two fungal isolates Aspergillus niger, and Phanerochaete chrysosporium, isolated from dye effluent soil. Three methods were selected for biodegradation, viz. agar overlay and liquid media methods; stationary and shaking conditions at 25 °C. Aspergillus niger recorded maximum decolorization of the dye Basic fuchsin (81.85%) followed by Nigrosin (77.47%), Malachite green (72.77%) and dye mixture (33.08%) under shaking condition. Whereas, P. chrysosporium recorded decolorization to the maximum with the Nigrosin (90.15%) followed by Basic fuchsin (89.8%), Malachite green (83.25%) and mixture (78.4%). The selected fungal strains performed better under shaking conditions compared to stationary method; moreover the inoculation of fungus also brought the pH of the dye solutions to neutral from acidic. Seed germination bioassay study exhibited that when inoculated dye solutions were used, seed showed germination while uninoculated dyes inhibited germination even after four days of observation. Similarly, microbial growth was also inhibited by uninoculated dyes. The excellent performance of A. niger and P. chrysporium in the biodegradation of textile dyes of different chemical structures suggests and reinforces the potential of these fungi for environmental decontamination.

Attitude and knowledge of healthcare workers in critical areas towards deceased organ donation in a public sector hospital in India

Background. The attitude of healthcare workers towards organ donation can either facilitate or hinder the process of organ donation. We assessed the attitude of healthcare workers employed in intensive or emergency care units of our hospital towards organ donation, and the influence of various factors on willingness for self-organ donation after death. Methods. All doctors, paramedical workers, nursing staff and other staff members working in six distinct intensive or emergency care units in the hospital were requested to fill a completely anonymous, voluntary and self-administered questionnaire. Younger individuals, women and nurses constituted a majority of the study population. Results. The questionnaire completion rate was 99%. About 55% of the study population were agreeable to donating organs after death and 27% were undecided. The factors that positively influenced their willingness to donate organs after death were favourable attitude of the spouse, religious beliefs supporting organ donation, knowledge of hospital’s organ transplant programme, personal experience of the organ donation scenario, having ever donated blood or involvement in social activities, willingness to become an eye donor and willingness to become a living kidney donor. Conclusion. A largely favourable attitude towards organ donation was seen in our study population. However, the study reflects incomplete knowledge leading to confusion and thus, desire to know more among participants with respect to various aspects regarding organ donation. The factors identified that positively influence decisions regarding organ donation can be used as direct interventions.

Therapeutic potential of snake venom in cancer therapy：current perspectives

Many active secretions produced by animals have been employed in the development of new drugs to treat diseases such as hypertension and cancer. Snake venom toxins contributed significantly to the treatment of many medical conditions. There are many published studies describing and elucidating the anti-cancer potential of snake venom. Cancer therapy is one of the main areas for the use of protein peptides and enzymes originating from animals of different species. Some of these proteins or peptides and enzymes from snake venom when isolated and evaluated may bind specifically to cancer cell membranes, affecting the migration and proliferation of these cells. Some of substances found in the snake venom present a great potential as anti-tumor agent. In this review, we presented the main results of recent years of research involving the active compounds of snake venom that have anticancer activity.

Working Memory Deficits In Obsessive Compulsive Disorder.

Background: Cognitive deficits could be functioning as an intermediate variable between neurological abnormalities and OCD symptoms. There is lack of such data in our country. Aim : To assess the cognitive functioning of a group of patients with OCD and a group of matched normal controls using Spatial Working Memory Test (SWMT). Method : Patients of OCD were screened for selection criteria. Diagnosis of OCD was made on the basis of DSM IV TR. They were assessed using SWMT for neuro-cognitive impairments and compared the same with matched controls. Conclusions : On SWMT, OCD patients showed significant impairment.

Neuropsychological Correlates for Obsessive Slowness.

Aim : To assess the cognitive functioning of a group of patients with OCD and a group of matched normal controls. Method : Patients of OCD were screened for selection criteria. They were assessed on Wisconson Card Sorting Test (WCST) and Continuous Performance Test (CPT) for neuro-cognitive impairments and compared the same with matched controls. Conclusions : On WCST, clinical group performed poorly, which is statistically significant. On CPT, the patient groups made significantly more wrong responses, more missed responses and took more time to respond, which is statistically significant.

Pharmacognostic evaluation of Lens culinaris Medikus seeds

Objective: To present a detailed pharmacognostic study of the Lens culinaris Medikus (Fabaceae) seeds, a food grain used as Dhal in India. Methods: The macroscopy, microscopy, fluorescence analysis of powdered drug, physicochemical analysis, preliminary testing and other WHO recommended methods for standardization were investigated. Results: Seeds are greyish brown in colour. Treatment of powdered drug with various chemical reagents showed the presence of proteins, cellulose, lignins and fixed oils. Microscopy of seeds revealed the presence of starch grains in seed. The colour of seed coat changed from brown to greenish grey in day light and brown to black at 254nm when treated with acetic acid. Total ash value of the seeds was found to be 1.86% w/w whereas foreign organic matter was found to be nil. Qualitative phytochemical analysis revealed the presence of tannins and flavonoids in acetone extract. Conclusions: The present study on pharmacognostic profile of Lens culinaris Medikus seeds provides an important tool in identification and authentication of this plant to researchers in future.

A Study of Psychiatric Comorbidity in Alcohol Dependence.

Aim: To assess psychiatric comorbidity in patients of alcohol dependence. Method: All the patients of alcohol dependence attending alcohol and drug de-addiction OPD and adult psychiatry OPD on specific days were screened. Those fulfilling the selection criteria were included in the study. A detailed evaluation was done for socio-demographic variables and history of drug using semi-structured proforma especially prepared for the study. Diagnosis of alcohol dependence was made according to DSM-IV-TR criteria. The patients were seen for co-morbid psychiatric illness by applying Structured Clinical Interview for DSM-IV-TR I & II (SCID I & II). Results: Out of 37 patients 24 (64.8%) were found to have comorbid psychiatric illness. Axis I and Axis II comorbidity was found in 64.8% and 5.4% of the samples, respectively. Patients of cluster A & B personality were equally distributed in the sample. Patients with more than one comorbidity accounted for 37.8% of the sample. Conclusion: Psychiatric comorbidity in alcohol dependence is very high. Number of comorbid diagnoses in a person may as high as three.