A comparison of the quality of images of chest X-ray between handheld portable digital X-ray & routinely used digital X-ray machine

Background & objectives: Chest X-ray (CXR) is an important screening tool for pulmonary tuberculosis (TB). Accessibility to CXR facilities in difficult-to-reach and underserved populations is a challenge. This can potentially be overcome by deploying digital X-ray machines that are portable. However, these portable X-ray machines need to be validated before their deployment in the field. Here, we compare the image quality of CXR taken by a newly developed handheld X-ray machine with routinely used reference digital X-ray machine through the conduct of a feasibility study. Methods: A total of 100 participants with suspected pulmonary TB were recruited from the outpatient departments of a medical college and a community health centre in Agra. Each participant underwent CXR twice, once with each machine. Both sets of de-identified images were independently read by two radiologists, who were blinded to the type of X-ray machine used. The primary outcome was agreement between image qualities produced by these two machines. Results: The intra-observer (radiologist) agreements regarding the status of the 15 CXR parameters ranged between 74 per cent and 100 per cent, with an unweighted mean of 87.2 per cent (95% confidence interval: 71.5-100). The median Cohen’s kappa values for intra-observer agreement were 0.62 and 0.67 for radiologists 1 and 2, respectively. In addition, on comparison of the overall median score of quality of the image, the handheld machine images had a higher score for image quality. Interpretation & conclusions: The current study shows that a handheld X-ray machine, which is easy to use and can potentially be carried to any area, produces X-ray images with quality that is comparable to digital X-ray machines routinely used in health facilities.

Histopathological Spectrum of Hysterectomy Specimens

Aims:Aim of this retrospective study, was to analyze the histopathological spectrum among women who have underwent hysterectomies at our institution. StudyDesign: Allhysterectomies were included in this study. Except 7 vaginal hysterectomies, all were abdomina lhysterectomies.Clinical history and other relevant data were obtained from the records of Department of Pathology of medical college hospital. Formal in fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined and analysed for histopathological diagnosis.

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.

Radiopathological Correlation of Thyroid Masses: A Prospective Study

Background: Diseases of the thyroid continue to be a common clinical problem having a prevalence rate of 4–7% in thegeneral population. It affects patients in all age groups and the treatment modalities include either a conservative managementor a surgical excision of the gland. Fine-needle aspiration cytology (FNAC) is a minimally invasive, accurate diagnostic toolwhich can differentiate neoplastic from non-neoplastic lesions and, hence, reduces the number of unnecessary thyroidectomy.Ultrasonography (USG) is the most common and the most useful way to image the thyroid gland and its pathology. The studywas conducted with the objective of evaluating the applicability of Doppler USG in diagnosing thyroid pathologies, establishedits superiority over clinical palpation, and correlated histopathologically using FNAC. The type of thyroidectomy can be plannedbased on the type of the thyroid swelling and thereby preventing the surgical complications. Thyroid gland is afflicted by variouspathologies ranging from diffuse enlargement (goiter) to nodular lesions, thyroiditis, and malignancies.Materials and Methods: This was a prospective study done on 98 patients that came to the outpatient department of theDepartment of Radiodiagnosis of Sukh Sagar Medical College, Jabalpur, from August 2018 to May 2019. All the patients withthyroid swelling/mass/enlargement were studied under color Doppler USG and then FNAC was performed.Results: The present study had a total of 98 cases. Cytologic diagnosis was classified under benign, malignant, inconclusive,suspicious, and malignant categories. Among 98 cases, 86 cases were non-neoplastic and 12 were neoplastic. The ratio ofnon-neoplastic to neoplastic is 7.16:1. Majority of the patients were females in the age group of 41–60 years. USG was foundto be more sensitive than clinical palpation. Differences were found when the results of USG were correlated with FNAC.Conclusion: Ultrasound was found to be more reliable than palpation. The addition of color flow imaging has added valueto the prediction of thyroid, but definitive diagnosis can be reached only with FNAC/biopsy. Multinodular goiter was the mostcommon non-neoplastic lesion and papillary carcinoma was the most common neoplastic lesion. Thus, fine-needle aspirationis a very useful and indispensable test in the diagnosis of thyroid lesions.

Agents to Maintain Tooth Integrity: An Equilibrium between Remineralization and Demineralization - A Review

Changing concepts of dentistry have the aim to manage initial caries lesions with the help of remineralizing agents in an attempt to arrest or revert the disease progression by the process of depositing calcium and phosphate ions in enamel and hence, gaining net mineral loss. Concentrating mainly on prevention and early intervention of caries, minimally invasive dentistry’s first basic principle is the remineralization of early carious lesions. The purpose of this article is to review current knowledge and technologies for tooth remineralization and their applications in clinical practices.

Management of displaced transverse fractures of the patella using tension band wiring with or without circumferential cerclage wiring: A comparative study

Background: Transverse fractures of body of the patella are by far the most common fractures of this bone. Surgical fixation is the recommended treatment in displaced fractures with extensor lag. Although, tension band wiring (TBW) technique is the gold standard for these fractures, few surgeons recommend augmentation with circumferential cerclage wiring to improve the strength of the fixation. We compared the results of the internal fixation of displaced transverse fractures of the patella using TBW and circumferential cerclage wiring with those treated with TBW alone. Methods: We treated 54 displaced transverse fractures of the patella at our institution. We segregated the patients into two groups: Group 1 (n=23) included fractures treated with tension band wiring (TBW) along with augmented circumferential cerclage wiring while as Group 2 (n=31) included fractures treated by TBW alone. Outcome was studied, graded and compared on the basis of knee pain, knee stiffness, quadriceps wasting, loss of flexion and loss of extension. Results: 73.90% patients among group 1 and 70.96% among group 2 showed excellent to good results (P value < 0.1). Fixation failure and need for revision surgery among group 1 and group 2 was found to be 8.69% and 9.67%, respectively (P value < 0.6). Infections and non union occurred among 4.34% patients in group 1 whereas in group 2 it was 6.45% of the patients who encountered the same (P value < 0.6). Conclusions: The use of circumferential cerclage wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over fixation with tension band wiring alone. Keywords: Patella fracture, Tension band wiring, cerclage wiring

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.

Basal Cell Adenoma: A Rare Case Report With Immunohistochemical Analysis

Basal cell adenoma (BCA) of the salivary gland is a rare benign monomorphic adenoma accounting for approximately 1–2% of all salivary gland tumors. It is characterized by the presence of sheets/nests of monomorphic cells with a prominent basement membrane. An absence of myxoid and chondroid stroma separates it from the pleomorphic adenoma. Participation of myoepithelial cells is still a controversial issue in the histogenesis of this tumor. We are presenting a case of BCA of the parotid gland in an elderly male patient. A panel of immunohistochemical markers is used to confirm its benignity and emphasize its use to differentiate it from other common histological entities. We briefly review the literature and discuss the differential diagnosis of this rare entity.

Results of Open Vs Closed Reduction and Internal Fixation of Type III Supracondylar Fractures.

The aim of the present study was to analyze the results of fixation of supracondylar fractures by open vs. closed reduction followed by internal fixation with k wires and assessing the union radiologically, complications associated with the procedure and restoration of range of motion and function of the elbow and to evaluate the results clinically regarding pain, stiffness, range of motion. A total of 40 cases were admitted for fracture supracondylar type 3. Out of them open reduction was done in 20 and in other 20 closed reduction was done. All 40 were fixed by internal fixation with k wires. The age of the patients in this study ranged from 4 yrs to 11 yrs. Males formed 75 %of the patients. 97.5 % fractures were extension types and the rest were flexion types. Left side was involved commonly (60 %). Duration from injury to surgery was an average of 23 hours. Mean procedure duration for closed group was 20 minutes and in open group was 70 minutes. Hospital stay in pt.s treated by closed reduction was 24 hrs (1 day). In patient treated by open reduction mean hospital stay was 5 days. Overall excellent results were found in 60 % in closed group and 35% in open group.

DPPH radical scavenging activity and contents of H2O2, malondialdehyde and proline in determining salinity tolerance in chickpea seedlings.

The involvement of 1, 1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity and contents of H2O2, malondialdehyde (MDA) and proline was investigated in determining salinity tolerance among seedlings of thirty chickpea (Cicer arietinum L.) genotypes having different pedigrees. Chickpea genotypes, including cultivars and advanced lines were grown for 7 days under control and salt stress (50 mM NaCl) conditions. The genotypes showed differential response to salt stress in terms of growth, DPPH radical scavenging activity and contents of H2O2, MDA and proline in seedlings. On the basis of seedling growth, the genotypes having better performance under stress conditions had reduced levels of H2O2 and MDA contents, but increased levels of proline and DPPH radical scavenging activity. Stress tolerance index for these parameters was also determined. Agglomerative hierarchal clustering by Pearson correlation coefficient grouped the genotypes into two major clusters — MC I and MC II. MC II and A1-1 sub-cluster of MC-I comprised mainly of genotypes that showed higher stress resistance levels for the respective parameters in comparison to genotypes in other sub-clusters. Thus, it is possible to identify salt-tolerant genotypes on the basis of above parameters without a field trial.

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.

Cardiotoxicity Profile of Snake Bite.

The present study was conducted in 80 cases of snake bite to understand their possible, biochemical and electrical cardio toxic effects. All patients were subjected to routine and specific investigation (ECG, X Ray, SGOT, CPK, CPK - MB, Troponin levels). Subjects were included in three groups, haemotoxic, neurotoxic and non - envenomed group. They were subjected to investigations at the time of admission, 24 hours and 72 hours after the admission. No significant statistical change occurred in cardiac enzymes in all groups at the time of admission. Significant statistical change occurred in LDH, CPK-MB at 24 hours and 72 hours after admission in haemotoxic group. Significant statistical change occurred in Troponin levels and CPK and SGOT at 24 hours after admission but no statistical change occurred at 72 hours after admission. But there was no statistical significant change in biochemical parameters in a neurotoxic group. At admission, there was tachycardia in 29 cases (53.7%) in haemotoxic group and in 16 cases (29.7%) at 24 hours which was statistically significant. At admission there was bradycardia in 10 cases (18.5%). In neurotoxic group there was tachycardia in 6 (60%) cases at admission and in 2 cases (20%) at 24 hours. There was bradycardia in 1 case in neurotoxic group. No significant change occurred in all groups at 72 hours. The present study showed significant statistical ECG changes at admission in the non - envenomated, neurotoxic and hemotoxic groups in the form of tachycardia or bradycardia. Also significant statistical ECG changes in the form of tachycardia was observed 24 hours after admission in hemotoxic group. It could be concluded that snake bites especially haemotoxic group carry the risk of inducing cardio toxic effects but these effects are not fatal.

Antioxidant response and Lea genes expression under salt stress and combined salt plus water stress in two wheat cultivars contrasting in drought tolerance.

Two wheat cultivars, C306 and PBW343 contrasting in drought tolerance were compared for their antioxidant response and Lea genes’ expression under salt stress (SS) and combined stress (CS) of salt stress plus water stress during seedlings growth. The drought susceptible cultivar (PBW343) behaved different towards SS/CS than towards WS. It accumulated more dry masses in shoots, more ascorbate, had higher ascorbate to dehydroascorbate ratio, lesser dehydroascorbate, lesser malondialdehyde (MDA), more proline and higher antioxidant enzymes under SS than under WS. CS increased dry masses, ascorbate, ascorbate to dehydroascorbate ratio, antioxidant enzymes and decreased dehydroascorbate and MDA contents from levels under WS. The drought tolerant cultivar (C306) though showed higher levels of ascorbate, ascorbate to dehydroascorbate ratio, lower levels of dehydroascorbate, showed lesser dry biomasses in shoots, higher MDA and lesser ascorbate peroxidase and catalase activities under SS than under WS and these features were improved on combining WS with SS. All lea genes were induced under all stresses in both cultivars except Wrab17 in C306 only, was not induced under any stress. Eight Lea genes out of ten were induced higher under WS than SS in C306 but induced same in PBW343. Wdhn13 gene was higher salt-responsive than other lea genes in both cultivars.

The different treatment modalities of pyopneumothorax- Study of 50 cases.

Background: Pyopneumothorax is defined as a collection of pus and air in the pleural cavity. It may be localised (encapsulated) or it may involve the entire pleural cavity. In India, Pyopneumothorax with pre-existing disease is treated with antimicrobial multiple antituberculous drugs and Intercostal drainage tube or surgery. Aims & Objective: (1) To know the age and sex incidence. (2) To study clinical presentation and characteristics of mode of onset (3) To obtain relationship with smoking. (4) To emphasise the importance of radiological and other investigations as an aid to diagnosis and management. (5) To find out the underlying lung pathology if any. (6) To decide the response to various modes of treatment. (7) To understand the complications of Pyopneumothorax. Material and Methods: This is a progressive study of 50 Indoor patients with pyopneumothorax admitted in the civil hospital, Ahmedabad in consecutive 3 years. Traumatic pyopneumothorax patients were excluded from the Study. The response to various modes of treatment and complications were noted. Results: The age incidences indicate that it was high in 21-30 years of age. Most common complaints were cough followed by dyspnoea and chest pain. The mycobacterium tuberculosis was the most common etiological factor. The best modality of treatment was intercostal drainage by tube with antibiotic coverage. Conclusion: Tuberculosis is main etiology in country like India. Intercostal drainage with under water seal was the treatment of choice in most of the patients. The commonest complication following ICD was surgical emphysema.

Differential antioxidative response of tolerant and sensitive maize (Zea mays L.) genotypes to drought stress at reproductive stage.

The role of oxidative stress management was evaluated in two maize (Zea mays L.) genotypes — Parkash (drought-resistant) and Paras (drought-sensitive), subjected to drought stress during reproductive stage. Alterations in their antioxidant pools — glutathione (GSH) and ascorbic acid (AsA) combined with activities of enzymes glutathione reductase (GR), ascorbate peroxidase (APX), peroxidase (POX) and catalase (CAT) involved in defense against oxidative stress and stress parameters, namely chlorophyll (Chl), hydrogen peroxide (H2O2) and malondialdehyde (MDA) were investigated in flag leaves from silk emergence till maturity. The drought caused transient increase in GR, APX, POX and CAT activities in drought-tolerant genotype (Parkash) which decreased at later stages with the extended period of drought stress. However, in Paras, drought stress caused decrease in activities of GR and CAT from initial period of stress till the end of experiment, except for POX which showed slight increase in activity. A significant increase in GSH content was observed in Parkash till 35 days after silking (DAS), whereas in Paras, GSH content remained lower than irrigated till maturity. Parkash which had higher AsA and Chl contents, also showed lower H2O2 and MDA levels than Paras under drought stress conditions. However, at the later stages, decline in antioxidant enzyme activities in Parkash due to severe drought stress led to enhanced membrane damage, as revealed by the accumulation of MDA. Our data indicated that significant activation of antioxidant system in Parkash might be responsible for its drought-tolerant behavior under drought stress and helped it to cope with the stress up to a definite period. Thus, the results indicate that antioxidant status and lipid peroxidation in flag leaves can be used as indices of drought tolerance in maize plants and also as potential biochemical targets for the crop improvement programmes to develop drought-tolerant cultivars.

Drug carrier transfersomes: A novel tool for transdermal drug delivery system.

Transport of the drug through skin is best route of drug delivery because of the skin is largest organ human organ with total weight 3 kg and a surface of 1.5 -2.0 m2. Drug carries used in transdermal drug delivery such as liposomes, noisomes, or microemulsions has problem that they remains mostly confined to the skin surface and therefore do not transport drugs efficiently through the skin. By using the concept of rational membrane design we have recently devised special composite bodies, so-called Transfersomes. Transfersomes penetrate through the pores of stratum corneum which are smaller than its size and get into the underlying viable skin in intact form. This is because of its deformable nature. The system can be characterized by in vitro for vesicle shape and size, entrapment efficiency, degree of deformability, number of vesicles per cubic mm. They can act as a carrier for low as well as high molecular weight drugs e.g. analgesic, anesthetic, corticosteroids, sex hormone, anticancer, insulin, gap junction protein, and albumin.

Ethosomes: A recent vesicle of transdermal drug delivery system.

Transdermal drug delivery system was first introduced more than 30 years ago. The technology generated tremendous excitement and interest amongst major pharmaceutical companies in the 1980s and 90s. By the mid to late 1990s, the trend of transdermal drug delivery system merged into larger organizations. Ethosomes are the ethanolic phospholipid vesicles which are used mainly for transdermal delivery of drugs. Ethosomes have higher penetration rate through the skin as compared to liposomes hence these can be used widely in place of liposomes. Ethosomes have become an area of research interest, because of its enhanced skin permeation, improved drug delivery, increased drug entrapment efficiency etc. The purpose of writing this review on ethosomes drug delivery was to compile the focus on the various aspects of ethosomes including their mechanism of penetration, preparation, advantages, composition, characterization, application and marketed product of ethosomes. Characterizations of ethosomes include Particle size, Zeta potential, Differential Scanning Calorimertry, Entrapment efficiency, Surface tension activity measurement, Vesicle stability and Penetration Studies etc.