A mishap in guided surgery for All-on-4� technique: A case report

A 63-year-old male patient, who had a severely resorbed edentulous maxillary arch and partially edentulous mandibular arch decided on the implant-supported fixed treatment option to replace the edentulous maxillary arch. The fully guided implant placement that utilizes the computer-generated guide is more accurate than traditional surgical guides and free-hand placements. The researchers have correlated possible implant failure risk factors with age, sex, smoking, type of edentulism, bone quality and volume, implant location, angulation, diameter, length, and various systemic factors. This case report demonstrated the failure cause of virtually planned anterior implants in All-on-4 and how to manage it by free-hand surgery without surgical guides.

Fish hook technique for nucleus management in manual small-incision cataract surgery: An Overview

Manual small-incision cataract surgery (MSICS) preserves its utility as a cost-effective and efficient strategy for mitigating cataract-associated blindness. Numerous techniques of nucleus delivery in MSICS have been described in the literature. The fish hook technique of nucleus extraction was advocated in 1997 and has been popular for high-volume surgery in limited pockets of the world. This article describes in detail the steps involved in the construction of a fish hook, tips of nucleus extraction with the help of a fish hook, and the pros and cons of fish hook-based MSICS through text, diagram, and video supplement.

Seropositivity of Anti-SARS CoV2 IgG antibodies in health care workers of an Indian tertiary care hospital during COVID-19

Purpose: Health care workers [HCW] are at a higher risk of infection SARS CoV2 infection due to frequent and close contact to patients with COVID-19. Methods: Serum samples from 500 HCW's were tested for SARS CoV2 IgG antibodies in October 2020. A questionnaire was used to collect demographic and clinical data. All these HCWs were tested for COVID-19, in 2nd week of September 2020, as a hospital policy. Results: Anti SARS CoV2 antibodies were detected in 128/ 500 [25.6%] HCWs. A total of 195/ 500 [39%] enrolled cases had already tested positive for Covid-19 at least once in last six months by RT-PCR. Sixty eight percent of HCWs with previous COVID-19 positivity by RT- PCR tested positive for Anti SARS CoV2 antibodies, whereas only 2.76% of asymptomatic HCWs tested positive. Of 121 anti SARS-CoV-2 IgG positive persons, 70 [57.85%] had CT value < 25. Low CT value and asymptomatic cases had a strong reverse statistically significant association with SARS CoV2 IgG antibody positivity. Conclusions: We report that sero-conversion rate in HCWs is similar to that in general population suggesting that preventive practices used in hospitals are satisfactory. Cases with low viral counts in respiratory sample and asymptomatic cases have lower rate of seroconversion.

Replacement of Percutaneous Endoscopic Gastrostomy Tube with Low Profile Button Percutaneous Endoscopic Gastrostomy: First Indian Experience

Background: Percutaneous endoscopic gastrostomy (PEG) is a common procedure employed for patients with swallowing disorders with a functioning gastrointestinal tract. Replacement of PEG with a conventional PEG tube by ‘pull technique’ is considered to be the standard of care. Low profile or button PEG, an alternative that obviates the need for endoscopy, is less explored in the Indian setting. Methods: Records of all the patients, who underwent PEG replacement with a low-profile PEG (MIC-KEY by Halyard, U.S.A.) for three years, were reviewed. Complications and other relevant details were recorded. Result: Twenty four low profile PEG tubes were placed in 16 patients; [male 12 (75%); median age(range) 67 (25-85) years]. The indications of PEG placement were stroke in 10 patients, other neurologic illnesses in 5 patients and laryngeal malignancy in 1 patient. Perforation peritonitis and skin induration developed in one patient each. None of the patients had any procedure-related fatal complication. Conclusion: Although PEG exchange with low profile PEG is considered safe, it has potential complications. Thus, utmost care is required to recognize and treat them early.

Outcomes of trabeculectomy in eyes with refractory acute primary angleclosure in Indian eyes

Purpose: To report the outcomes of trabeculectomy in eyes with refractory acute primary angle?closure attack. Methods: Patients with acute primary angle?closure attack and who underwent trabeculectomy for medically uncontrolled intraocular pressure within 2 months of presentation were retrospectively analyzed. Primary outcome was intraocular pressure (IOP). Secondary outcome measures were visual acuity, number of antiglaucoma medication (AGM), complications, and risk factors for failure of trabeculectomy. Results: Thirty?five eyes of 31 patients with median (interquartile range) follow?up of 3 (0.5, 9) years were included in the study. Median age at presentation was 55 (47, 60) years. Median duration of symptoms at presentation was 10 (4, 16) days and median time from presentation to surgery was 13 (6, 25) days. Median IOP reduced from 42 (36, 46) to 13 (12, 16) mmHg (P < 0.001) and median number of AGM reduced from 3 (1, 3) to 0 (0, 0) after trabeculectomy at the end of 1 year. The probability of complete and qualified success was 88% (95% confidence interval [CI]: 72%–95%) and was 97% (95% CI: 81%–99%) at 1 year, respectively. Failure was noted in six eyes. Subsequent cataract surgery was needed in 13 eyes (37%) with a median duration from trabeculectomy being 6.75 (1, 11) years. None of the preoperative, intraoperative, or postoperative factors tested were associated with failure (P > 0.10 for all associations on Cox proportional hazard regression analysis). Conclusion: In medically unresponsive cases of acute primary angle?closure attack, primary trabeculectomy seems safe and effective in Indian eyes

Orthodontic Treatment Need among Nepalese High School Students

Abstract Objective: To assess the need for orthodontic treatment among Nepalese high school students. Material and Methods: This is a quantitative, cross-sectional descriptive study. The sample comprises 938 children (537 males and 401 females) with an age group above 14 years. The subjects were selected voluntarily from seven different schools of Kathmandu valley using a multistage sampling technique. The Index of Orthodontic Treatment Need comprises two components: Dental Health Component (DHC) and Aesthetic Component (AC). Two trained and calibrated examiners performed the oral examination. Results: On analysis of the DHC component, it was found that 21% had no need, 18.1% had mild/little need, 24.3% had moderate/borderline need, 35.8% had severe need, and 0.7% had extreme treatment need. Similarly on analysis of AC component, it was found that 33% were AC-1, 30.8% were AC-2, 7.2% were AC-3, 8.2% were AC-4, 2.1% were AC-5, 3.6% were AC-6, 1.8% were AC-7, 7.4% were AC-8, 1.8% were AC-9, and 3.9% were AC-10. Conclusion: The Index of Orthodontic Treatment Need can be used as a tool for planning dental health resources and prioritizing the treatment need of different populations (AU).

Pancreatic Reconstruction With Modified Technique Using A “Double U Stitch Pancreatogastrostomy” Following A Laparoscopic Whipple’s Pancreaticoduodenectomy

Background: Pancreaticoduodenectomy is a standard procedure for periampullary tumours. Pancreatic anastomosis is the Achilles heel of the procedure with a significant leak rate and the associated high morbidity. We adopted a modified pancreatic stump drainage with pancreato-gastrostomy - pancreatic stump mobilization with invagination into the lumen of the stomach via posterior gastrotomy and fixation with two U shaped sutures to the posterior wall of the stomach traversing across the pancreatic parenchyma. Materials and Methods: We did a retrospective analysis of a prospectively maintained database of patients who underwent Laparoscopic Whipple’s pancreaticoduodenectomy (WPD) from November 2017 to March 2019 in our department, a tertiary referral centre of Northern India. A total of 34 patients underwent totally laparoscopic Whipple’s pancreatoduodenectomy with the modified Pancreatogastrostomy. Results: A total of 34 patients underwent totally laparoscopic WPD during this study period. The median age was 50 years (27 to 70 years) with 17 male and 17 female patients. Of these patients, 23 patients had their tumours arising from the ampulla, 6 from the duodenum, 3 from the pancreas, 1 SCN head of pancreas and 1 from the distal common bile duct. All patients had R0 resection with a median lymph node yield of 13 (6-19). 9 patients had stage 1 disease, 10 patients had stage 2 disease and 14 patients had stage 3 disease. 31 patients had moderately differentiated adenocarcinoma while 2 patients had well-differentiated tumour morphology. 14 patients had pancreato-biliary differentiation with the remaining 19 patients having intestinal differentiation. The overall number of significant complications according to Clavien-Dindo classification was 17.6% (Grade 3 and higher) . Conclusion: Laparoscopic WPD is a feasible procedure in the hands of a well-trained laparoscopic surgeon. Modified P-G as described, simplifies the pancreatic drainage with a low incidence of post-operative pancreatic fistula and its attendant complications.

Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis / 대한소화기학회지

Background/Aims@#Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. @*Methods@#Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. @*Results@#Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. @*Conclusions@#The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.

Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis / 대한소화기학회지

Background/Aims@#Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. @*Methods@#Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. @*Results@#Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. @*Conclusions@#The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.

Assessment of outcome and complications of ultrasonography guided pigtail catheter drainage in management of liver abscess

Background: Liver abscess (LA) is defined as an encapsulated collection of suppurative material within the liver parenchyma. Liver abscesses are most commonly due to bacterial, amoebic or mixed infections. Less commonly these may be fungal in origin. Liver abscess are associated with mortality of up to 20% and are categorized into various types based on aetiology, of which amoebic (ALA) and pyogenic (PLA) liver abscess are major types. The objective is to evaluate and assess the response of percutaneous pigtail catheter drainage in treatment of liver abscess and to document the complications of liver abscess (LA).Methods: The study was conducted on patients who were admitted from casualty and outpatient department with a diagnosis of liver abscess (LA). 100 patients of LA were included in the study. They were divided into two groups. Group 1 consists of LA patients without associated complications and Group 2 consists of LA patients with associated complications like rupture, jaundice, IVC compression, persistent or recurrent LA.Results: There were 88% males and 12% were females in the study. 30% patients had complications. Out of them, 14 (46.6%) patients of LA presented with intra-peritoneal rupture. 12 (40%) with jaundice, 2 (6.7%) with rupture into pleural cavity and 2 (6.7%) patients had IVC compression. (70%) had involvement of right lobe while minimum patients (12.9%) had bilateral lobe involvement in group 1 and (10%) had involvement of left lobe of liver in group 2.Conclusions: Pigtail insertion and percutaneous catheter drainage (PCD) of abscesses, peritoneal or pleural cavity are safe procedures. PCD is a good alternative to open surgical drainage.

Intraoperative Floppy Iris Syndrome in patients on alpha 1 blocker tamsulosin: incidence and predictability

Background: Intraoperative Floppy Iris Syndrome (IFIS) was first described by Chang and Campbell in year 2005 in male patients undergoing phacoemulsification surgery who were on Tamsulosin, an alpha 1 blocker drug for their urinary symptoms for enlarged prostate. This condition was characterized by excessive floppiness of iris, prolapse of iris tissue through phaco and sideport incisions and progressive intraoperative miosis, resulting in increased surgical time and various major surgical complications compromising visual outcome.Methods: This study of 78 patients was undertaken to know the incidence and severity of IFIS as well as to predict its occurrence by observing maximum pupil dilation achieved preoperatively.Results: It was observed that majority of patients on tamsulosin dilated poorly and severe IFIS occurred in those with pupil dilation of 5 mm or less after putting mydriatic eye drops preoperatively.Conclusions: It was concluded that if IFIS was predicted and necessary precautions taken, postoperative complications can be reduced significantly with improved visual outcome.

Role of Bacterial and Parasitic Pathogens in Occurrence of Neonatal Diarrhoea in Goat-Kids

Infectious diarrhoea in neonates of animals is one of the most common and economically important conditions encountered in the livestock industry. Faecal samples (n=210) from diarrhoeic neonatal goat-kids of different livestock sheds of ICAR-CIRG, Makhdoom, Mathura (U.P.), were aseptically collected, and immediately processed for isolation of bacterial pathogens and parasitic evaluation. A total of 178 isolates of E. coli from 210 samples were identified on the basis of cultural, morphological, biochemical and molecular characteristics. Out of 178 E. coli isolates, 3.93 % (7/178) isolates were identified as STEC by PCR amplification of stx-1 and stx-2 gene. A total of 64 isolates of E. coli were sent to National Salmonella and Escherichia Centre, Central Research Institute, Kasauli for the serotyping. The common serogroups of E. coli responsible for neonatal diarrhoea in goat-kids were identified as O36, O26, O59, O29, O43, O91, O82, O9 and O171, out of which, 46.15% were O36, O26 and O59. Cryptosporidium spp. infection was detected in 46 samples out of 148 faecal samples by ZN staining and nested PCR.Based on cultural, morphological, biochemical and molecular characteristics,16 isolates of Salmonella spp. and 5 of Klebsiella spp. were identified from 210 fecal samples. The present study concluded that E. coli followed by Cryptosporidium spp. and Salmonella spp. were the prevalent infectious agents associated with neonatal diarrhoea in goat-kids

Effect of Vitamin C Supplementation on Colonic Anastomotic Healing in the Presence of Peritonitis- An Experimental Study in Rats.

ascorbic acid plays a critical role in wound repair and healing/regeneration process as it stimulates collagen synthesis. Its effect on jejunal and colonic anastomosis is already established. We assessed its role on colonic anastomosis healing in presence of peritonitis and without peritonitis. Assessment was done by recording bursting pressure of anastomosis and histological features of healing.METHODSThis experimental study was conducted in 48 Albino Rats (mean weight of 180 g). All rats were subjected to exploratory laparotomy with colonic resection anastomosis and were divided into six groups. Group A and B control, Group C and D were supplemented with Vitamin C in low dose i.e. 100 mg/Kg body, Group E and F high dose of Vitamin C i.e. 200 mg/Kg body wt. Vitamin C was given for seven days intra muscularly. Peritonitis was created by cecal ligation and puncture (CLP) in half the number of rats (n=24), in each group. Every rat was re-explored on 7th post-operative day and anastomotic segments were harvested for bursting pressure measurement and then sent for histopathology examination.RESULTSBursting Pressure of group D (100 mg) was significantly raised (p<0.05) as compared to group B in the presence of peritonitis. Group F (200 gm vit C) showed significantly higher bursting pressure than group D (p<0.05). The findings of analysis of variance (ANOVA) showed that the mean BP of all the groups differs significantly from each other (p<0.05). High dose vitamin C supplementation gave more strength to anastomosis than low dose even in presence of peritonitis. The average histopathological examination score was 5.24 (Group E) (p<0.05). i.e., best healing among all groups. It had better effect even in presence of peritonitis - 4.62 in Group F. Healing score in this group was greater than group A, B, C, D and less than in group E.CONCLUSIONSPresence of fecal peritonitis hampers the process of healing of colonic anastomosis by impairing reparative collagen synthesis, its deposition and anastomotic strength reflected by decreasedbursting pressure and decrease HPE score. Supplementation of systemic ascorbic acid increases intestinal anastomotic healing by increasing collagen accumulation reflected by increasedbursting pressure and increase HPE score even in presence of peritonitis. High dose ascorbic acid supplementation had better effect on intestinal anastomotic healing. Importance of ascorbic acid in colonic anastomosis healing is yet to be evaluated in human beings.

A peculiar case of cancer en cuirasse in adenocarcinoma rectum

Cancer en cuirasse in a case of primary adenocarcinoma rectum is an exceedingly rare phenomenon which is scarcely seen in isolated case reports only. It is a specific morphological variant of cutaneous metastasis characterised by diffuse induration and oedema of cutis which is studded with carcinomatous lesions. Cutaneous metastases often occur in elderly individuals in their sixth decade or later. Herein we present a case of carcinoma en cuirasse arising in a young female who was operated for adenocarcinoma rectum.

Study of the Efficacy of Automated Oscillometry in Evaluating Ankle-Brachial Index for the Assessment of Peripheral Arterial Disease in Diabetes Mellitus

Peripheral arterial disease (PAD) is defined as a clinical disorder in which there is stenosis or occlusion in the aorta orarteries of the limbs. Type 2 diabetes is a strong risk factor for atherosclerotic diseases including cardiovascular aswell as peripheral arteries. The risk of development of peripheral arterial disease increases three to four folds inpatients with diabetes.Most diabetic amputations are due to peripheral arterial disease (PAD), peripheral neuropathyand infection. Ankle-brachial index is helpful in assessing the prognosis in the symptomatic as well as asymptomaticpatients in contrast to the variability of pulse assessment and the physical examination. The present study included50 patients with diabetes mellitus for more than ten years, irrespective of their symptoms. ABI was calculated bydividing the ankle systolic blood pressure by the brachial systolic blood pressure of the respective sides. The lowerof the two ABI values for the legs was used to define ankle brachial index. Of 50 patients, 20 had signs of PAD amongwhom 11 (55.0%) had abnormal ABI and 9 (45.0%) had normal ABI. Out of 30 patients with no signs of PAD, 8 (26.7%)had abnormal ABI and 22 (73.3%) had normal ABI. Automated oscillometry method for evaluating ankle-brachialindex for the assessment of peripheral arterial disease in diabetes mellitus had a sensitivity of 68.18%, a specificity of85.71%, positive predictive value (PPV) of 78.95% and negative predictive value (NPV) of 77.42%. The Accuracy ofthe test was 78.0%. Thus, our study has proved that the oscillometric method of ABI is a very useful procedure fordetecting PAD. By repeating the test the sensitivity and specificity may probably increase. The oscillometric methodof performing ABI is a simple procedure, automated, easy to perform, negligible cost of the instrument, does notrequire training and can be performed as an outpatient procedure.

Association of microvascular complications of type 2 diabetes mellitus with ABO blood group

Background: Micro vascular complications are the major outcome of Type 2 Diabetes Mellitus progression, which reduces the quality of life and increases diabetic morbidity & mortality. As the incidence of type 2 diabetes is growing day by day; our search for its aetiology and pathogenesis is also ever growing to predict its risk factors and early screening for better care and prevention of its complications. Many studies have tried to link susceptibility of type 2 diabetes with ABO blood group though results have been inconsistent. The present study aims to analyse association of micro vascular complication with different blood groups if any.Methods: A cross sectional study was conducted among patients of type 2 diabetes Mellitus in a tertiary care hospital. Determination of ABO and Rh status was done by standard slide method of agglutination. Detailed information about age, gender, BMI, duration of diabetes, age of onset of diabetes was noted with the help of a proforma. The records (clinical examination and investigations done by physician) were screened for type of micro vascular complications.Results: Out of a total of 319 patients suffering from type 2 diabetes, 209 subjects (65.15%) had one or the other complications. A statistically significant (p=0.00) difference was observed between the presence or absence of complications in different blood groups. In patients with Blood group B, 76.14% presented with complications. Though Nephropathy was the most common complication observed among different blood groups, none of the type of micro vascular complication was found to be significantly associated with different blood groups.Conclusions: The findings in our study suggest that although there was a significant association between presence or absence of complications and different blood groups, but this association was not significant for different types of complications.

Genomewide association study for C-reactive protein in Indians replicates known associations of common variants

Elevated C-reactive protein (CRP) serves as an independent biomarker for acute and chronic inflammation, and is also associated with metabolic diseases. Genomewide loci regulating CRP level in Indian population, a high-risk group for metabolic illness, is unexplored. Therefore, we aimed to discover common polymorphisms associated with plasma CRP level in 4493 Indians of Indo-European origin using genomewide association study. Genomewide strong associations of two known intronic variants in hepatocyte nuclear factor-1 α gene (HNF1A)were identified among Indian subjects. We also detected prior associations of several variants in/near metabolic and inflammatory process genes: APOC1, LEPR, CRP, HNF4A, IL6R and APOE with modest associations. This study confirms that Indians from Indo-European origin display similar core universal genetic factors for CRP levels.

Smart phones for medical undergraduates: friend or foe?

Background: Smart phones are truly a boon for us in all aspects of our life. It helps mankind to lead a faster and easier life, but the same devices used to get things done are now the gatekeepers of an infinite number of distractions and sources of instant gratification. Even though, there is an ocean full of information a click away, we fail to utilize it for something resourceful. Increased media consumption, multi screening and social media usage reduce the ability to focus on tasks and duties which have a much higher priority.Methods: A cross sectional study was conducted with a validated questionnaire among 200 undergraduate MBBS students of a deemed to be medical university.Results: Among the ninety-eight per cent of the students who own a smartphone, all have access to the internet. Seventy-seven per cent of the students use these gadgets on a very regular basis throughout the day and among them only forty-six per cent were found to be using it for academic purposes.Conclusions: Through this study, it has become more discernible that smart phones have paved its way for a reckless future, though if used wisely it would become a blessing in disguise. The ever-changing medical fraternity could really benefit from this discovery but alas, a tool made to make our lives easier is weighing us down with its addictive and time-consuming features.

​Dental Management Of Children With Special Health Care Needs

The management of children with health care needs creates hesitation and anxiety among health professionals includingdentists. There has been general agreement that disabled population has a higher prevalence of dental caries, poor oralhygiene, and compromised gingival and periodontal health than healthy population. Oral healthcare professionals requirespecialized knowledge acquired through special training and increased awareness. The purpose of this article is to describethe characteristics of some common developmental disabilities and medically compromised states and the challenges of theseissues present to the oral healthcare professionals.