A STUDY OF IMMUNOHISTOCHEMICAL EXPRESSION OF GALECTIN-3 IN NON-NEOPLASTIC AND NEOPLASTIC LESIONS OF THYROID

Introduction: Thyroid lesions are fairly common and have a wide spectrum of diseases ranging from functional, immune mediated to neoplastic lesions. Malignancy of thyroid constitutes approximately 1% of all cancers. These malignant tumors of thyroid gland exhibit a variety of histopathologies and clinical behavior. Immune markers are gaining more and more importance in diagnostic pathology, especially in the differential diagnostics and in the grading of thyroid gland tumors. In the recent times Galectin-3 has received notable recognition for its usefulness as a diagnostic marker for thyroid cancer. To evaluate the diagnostic role of galectin-3 (Gal-3) in Aims and objectives: differentiating malignant from benign thyroid neoplasm. In this observational study, we evaluated Gal-Material and method: 3 expression in a spectrum of all non-neoplastic and neoplastic lesions including benign and malignant lesions of thyroid gland. All types of thyroidectomy specimens were xed in 10% formal saline and subjected to histopathological examination. Sections were stained with H&E stain. Gal-3 immunoperoxidase reaction was carried out in histological sections from all the cases and descriptive analysis was done. In the study of 100 cases of thyroid swelling were included and evaluated by Result: histopathological and by using Gal-3 immunoperoxidase marker. Out of 100 cases, majority of thyroid lesions were seen in females with 76 cases (76%) while only 24 cases (24%) were seen in male. Among 66 non-neoplastic cases, only 6 cases (9.1%) and among 34 neoplastic lesions, 28 cases (82.4%) were positive for galectin-3 marker. Statistical signicance of galectin-3 expression between non-neoplastic and neoplastic thyroid lesions found to be statistically signicant (P value <0000.1). The sensitivity and specicity of galectin-3 detection of malignant lesions were found to be 82.4% and 91% respectively with 82.4% positive predictive value and 90.9% negative predictive value. We suggest that Galectin-3 expression is helpful in Conclusion: enabling better diagnosis and patient care by guiding appropriate therapeutic decisions.

ON-CHIP PLANER WAVEGUIDES FOR SUPERCONTINUUM GENERATION IN THE MID-IR REGION OF ELECTROMAGNETIC SPECTRUM: A REVIEW

On-chip planer optical waveguide-based sources for supercontinuum (SC) generation have become highly attractive devices in the twenty-first century. Mid-IR SC sources in the 2-20 ?m wavelength region are advantageously used for gas sensing, high-sensitivity molecular detection, security, and industrial applications. These integrated photonic devices are cost-effective, scalable, and robust, and also offer more flexibility in tailoring the dispersion characteristics relative to other SC generation techniques. This article reviews the evolution of SC sources from fiber-based devices to optical waveguide-based devices and presents a historical as well as recent progress in various types of on-chip optical waveguides with physical mechanisms involved in generating coherent SC sources.

Functional annotation of uncharacterized proteins from Fusobacterium nucleatum: identification of virulence factors

Fusobacterium nucleatum is a gram-negative bacteria associated with diverse infections like appendicitis and colorectal cancer. It mainly attacks the epithelial cells in the oral cavity and throat of the infected individual. It has a single circular genome of 2.7 Mb. Many proteins in F. nucleatum genome are listed as “Uncharacterized.” Annotation of these proteins is crucial for obtaining new facts about the pathogen and deciphering the gene regulation, functions, and pathways along with discovery of novel target proteins. In the light of new genomic information, an armoury of bioinformatic tools were used for predicting the physicochemical parameters, domain and motif search, pattern search, and localization of the uncharacterized proteins. The programs such as receiver operating characteristics determine the efficacy of the databases that have been employed for prediction of different parameters at 83.6%. Functions were successfully assigned to 46 uncharacterized proteins which included enzymes, transporter proteins, membrane proteins, binding proteins, etc. Apart from the function prediction, the proteins were also subjected to string analysis to reveal the interacting partners. The annotated proteins were also put through homology-based structure prediction and modeling using Swiss PDB and Phyre2 servers. Two probable virulent factors were also identified which could be investigated further for potential drug-related studies. The assigning of functions to uncharacterized proteins has shown that some of these proteins are important for cell survival inside the host and can act as effective drug targets.

Assessment of optic disk by disk damage likelihood scale staging using slit-lamp biomicroscopy and optical coherence tomography in diagnosing primary open-angle glaucoma

Purpose: The current study was aimed at assessment of optic disk by disk damage likelihood scale (DDLS) staging using slit?lamp biomicroscopy and optical coherence tomography (OCT) in diagnosing primary open?angle glaucoma (POAG) patients. Methods: This was a cross?sectional observational study of 106 POAG patients, which was conducted from April 2017 to April 2018. All patients underwent slit?lamp fundoscopy with a +78 D lens and high?definition (HD)?OCT, and the vertical cup disk ratios (VCDRs) were recorded. Disk size and neuroretinal rim assessment were done, and the disk was then staged using the recent version, which stages the optic nerve head (ONH) from 1 to 10 as read from the DDLS nomogram table. DDLS scores >5 indicate glaucomatous damage. Pearson coefficient was used to correlate the DDLS staging by slit?lamp biomicroscopy with best?corrected visual acuity (BCVA), intraocular pressure (IOP), disk size, and VCDR and VCDR, mean deviation, and DDLS staging by HD?OCT. Results: The mean age of the patients was 59.54 ± 6.61 years. The male: female ratio was 2:1. The mean IOP was 16.04 ± 1.97 mmHg, and BCVA was 0.72 ± 0.13 LogMAR units. The mean VCDR on 78 D slit?lamp biomicroscopy was 0.76 ± 0.09 (standard deviation [SD]) (range 0.1–0.77), whereas on HD?OCT, the mean VCDR was 0.81 ± 0.09 (SD) (range 0.07–0.81). The mean deviation on visual field testing in decibels was ?14.43 ± 3.31 (SD). The correlation coefficient between DDLS staging by slit?lamp biomicroscopy and DDLS staging by HD?OCT parameters was r = 0.96. Conclusion: There is a positive correlation between the DDLS system of optic disk evaluation on slit?lamp biomicroscopy and most of the HD?OCT evaluation parameters

A Study on Morphometry and Related Surgical Importance of Naso Lacrimal Duct

Introduction: The Nasolacrimal duct is the terminal part of the nasolacrimal apparatus or tear apparatus. The anatomy of lateral nasal wall is Important for planning the surgeries on lacrimal duct through intranasal approach. Objective: The current study was designed to review the anatomy of nasolacrimal duct in relation to the lateral nasal wall. Material and method: Thirty sagittal sections (14 right and 16 left side) of head and neck of formalin fixed adult cadavers of known sex, gender, ethnicity present in department of anatomy GMCH, Chandigarh were studied. The following parameters were made using a digital calliper and rounded off to the nearest millimetres. 1.Length of nasolacrimal duct (NLD Length) 2. Nearest distance from the nasolacrimal duct to maxillary sinus ostium (NLD - MSO) 3. Nearest distance from the NLD to the anterior nasal spine. (NLD- ANS)4. Nearest distance of the intranasal orifice of the NLD to the nasal floor (NLD- NF) 5. Nearest distance of the intranasal orifice of the NLD to the nasal roof. (NSD- NR) 6. Nearest distance of the intranasal orifice of the NLD to the anterior attachment of the Inferior concha. (NSD- AIT). Observations: In our study the average length of the NLD was 19.8±1.57mm. The intranasal orifice of the NLD was observed to be located on an average of 24.5±2.6mm from the anterior nasal spine, ranging from 5.5-2. 9mm.The average distance from the nasal roof was found to be 32.2±1.67mm and 16.08±1.71mm from nasal floor. In addition, the average distance from the anterior attachment of inferior nasal concha was found to be 14.82±2.37mm. In our study the NLD was an average of 4.08±0.67mm anterior to MSO at the level of the anterior attachment of the MT. On Comparing right and left side The NLD Was found to be slightly longer 22.7 in comparison of 22.2 mm on left side. The distance of NLD From MSO was also found to be larger on left side. The distances of NLD-ANS, NLD NR, NLD -AIT and NLD- NF were also longer on left side. Conclusion: We found that most of the parameters were closer to a study done by Ertugel while the NLD-NF distance was more in our specimen. Running title: nasolacrimal duct: morphometry, surgical importance

Pediatric dentist attire and relationship with anxiety in children and parents during Covid-19 pandemic

Aim The study aimed to evaluate children's and parent's preferences of dentist's attire during Covid-19 pandemic and their relationship with dental anxiety. Methods A total of 139 Children(71 boys, 68 girls) aged 6-12 years were shown videos of a pediatric dentist working with different attire such as Personal Protective Equipment (PPE) and pedoscrub, and they were asked to express the way they preferred their dentist to be dressed. Children's anxiety levels with different attire of paediatric dentists were assessed in different age groups and for boys and girls separately and recorded it using the Facial image scale. A questionnaire regarding dental anxiety was created online and completed by 139 parents (76 females, 63 males) of various ages and different educational backgrounds who were asked to choose between two outfits. Results were tabulated and statistically analysed using Chi-square test. Results Children aged 10-12 years preferred PPE by 50.6%, whereas 48.1% of children aged 6-9 years least preferred PPE (<0.05). About 46 (33%) were scored as anxious children and they had a preference for pedoscrub. Also, nonanxious children 43(31%) preferred PPE. All educated parents (100%) selected PPE over pedoscrub and the result were shown to be statistically significant. (<0.05). Conclusion Ultimately, the majority of the anxious children chosen pedoscrub, whereas non - anxious children have chosen PPE. Furthermore, the data reveals that both educated parents and older children preferred PPE as their attire for paediatric dentists.

Exploring Multi-dimensional Approach for Treating and Preventing Hair Loss with Nutraceuticals

Although hair disorders are not life-threatening, there is no denying that they significantly influence social interactions and patients� psychological well-being. A sufficient and well-balanced nutritional intake is responsible for normal skin and hair function integrity. Dietary imbalance can disturb this equilibrium, whether it takes the form of an overall deficiency, a more specific shortage, or an excess of one component over another. Human skin and hair can be affected by nutritional factors, resulting in excessive hair shedding and hair loss. It is essential to separate those nutritional factors that directly affect the hair cycle and promote hair growth. One of the most emerging areas in dermatology is the role of nutraceuticals in hair loss without any side effects. However, with increasing awareness among patients, there has been a tremendous demand for natural hair care and treatment products. An effective combination of bioactive ingredients derived from natural sources is essential in hair growth stimulation and provides a therapeutic benefit in hair conditioning. When it comes to hair health, dietary supplements and nutraceuticals can be part of a plan to address a visible problem that impacts self-esteem and confidence in men and women.

All Gene Expression of Leukotriene A4 Hydroxylase (LTA4H ) Gene in Extra Pulmonary Tuberculosis Patients and Healthy Control in North Indian Population

Initial diagnosis and timely treatment of Extra Pulmonary Tuberculosis (EPTB) continues to be a challenge in all over World as well as India. First time, this analysis will discover the role of LTA4H gene and may be establishing another candidate that impacts the sensitivity to EPTB in the population of North India. This study will be the first report on LTA4H gene various diagnostic markers, expression of gene may validate as a prognostic factor in (EPTB). The diagnosis (EPTB) poses a special challenge, as it is often missed or misdiagnosed due to its atypical presentations and difficult to isolate M tuberculosis (MTB) due to the small number of organisms present at these sites. Subsequently the outcome of present study will reinforce possible use of LTA4H as biomarkers and the therapeutic utility for (EPTB). This study will be a step to decrease the analytical and therapeutic window to identify another risk factor LTA4H for EPTB. Leukotriene A4 hydroxylase (LTA4H), an enzyme which changes LTA 4 to LTB4, controls the balance amongst the anti-inflammatory lipoxins and pro-inflammatory LTB4, with directly consequences in TB-driven inflammation. In humans and will spawn new ways to protection and enhance the wellbeing status of individuals and population groups. On RT-PCR, Extra Pulmonary Patients had lower expression of LTA4H compared to the controls. Correlation of biomarkers will reveal LTA4H level correlated with age, Gender Smoking, Clinical Parameter Serum Total Protein, BMI Height and TLC, Laboratory Parameter. On ELISA kit and follow as per manufacturer protocol. CEA562Ge 96 Tests Enzyme-linked Immunosorbent Assay Kit For Leukotriene B4 (LTB4) LTB4 Protein level in Extra Pulmonary Patients, (EPTB) (2304.52pg/ml) had lower expression of gene LTB4 compared to the controls (3096.142pg/mls) (P value = 0.0012).

Morphometric Analysis of Human Fetus and Fetal Pancreas in Different Gestational Age Groups

Introduction: Fetal biometric parameters are very often utilized for calculating gestational age. The pancreas is a gland with dual functions in our body – exocrine and endocrine, with the latter component being very often discussed in the context of diabetes mellitus. Through evaluation of variations in morphometry in relation to different gestational ages, the research intends to draw attention to various associated developmental correlations that were not mentioned in previous studies. MaterialsandMethods: The current research was carried out on 30 fetuses after obtaining due approval from Institute’s Ethical Committee. Fetuses were divided into different gestational age groups and morphometric parameters such as crown‑rump length, crown heel length, head circumference, abdomen circumference, chest circumference, hand length, and Foot Length (FL) were noted by measuring with nylon thread in centimetres. Fetal pancreases were removed after stepwise dissection and pancreatic weight along with length and thickness was measured by Vernier calipers. All the parameters were then compared within different gestational age groups. Results: All the parameters and the age group of fetuses were positively correlated and showed statistical significance.Conclusion: The study would add substantial knowledge in the areas of pancreatic regeneration, surgical pancreatectomy, and treatment protocols for diabetes mellitus and pancreatic cancer. Through evaluation of variations in morphometry in relation to different gestational ages, the research intends to draw attention to various associated developmental correlations

Pterion: Morphometry and Surgical Significance

Introduction: Pterion is a H-Shaped formation of sutures and cranio-metric point on the lateral side of skull. It is marked by the junction of frontal, parietal, greater wing of sphenoid & squamous temporal bone. Objective: The study is aimed to determine prevalence of types of pterions, presence of epipteric bone. We also tried to find pterion’s relationship with anterior branch of middle meningeal artery Materials and methods: Study was done in department of Anatomy, GMCH-32, Chandigarh on 40 adult dried skulls without calvaria, of unknown age, gender and race. The skulls with broken lateral wall were excluded. Skulls were examined for 1. A. prevalence of pterion shape B. Prevalence of bilaterality of similar shape of pterion. C. Prevalence of unilateral variation of pterion on two sides of skull. 2. Epipteric bone A. Presence of epipteric bone B. relation to the suture on both sides. 3. Distance of pterion center point to frontozygomatic suture and upper border of zygomatic arch. 4. relationship of pterion on external and internal surface of skull and on inner side its relationship with anterior branch of Middle meningeal artery. Observations: In the present study 3 types of pterions i.e., Sphenoparietal, stellate, frontotemporal were observed. Sphenoparietal was found to be present bilaterally 40% on both sides. Frontotemporal & stellate were 2.5%. Sphenoparietal type of pterion was 55% on right side & 67.5% on left side. frontotemporal type of pterion was 5% on right side & 2.5% on left side, stellate type was 7.5% on right side & 2.5% on left side. epipteric bone were present in pterion on right side in 32.5% & on left side 27.5%. Pterion was lying approximately 3.5 cm above the zygomatic arch and 2.83 cm behind the posterior margin of frontozygomatic suture. Conclusion: in our study the commonest type of pterion shape was Sphenoparietal. This type was most common to be present bilaterally. Epipteric bone was found in Sphenoparietal type both unilaterally & bilaterally. The anterior branch of MMA was closest and farthest in stellate type.

Pharmaceutical co-crystals of posaconazole for improvement of physicochemical properties

Abstract Posaconazole exerts an extended spectrum of antifungal activity against various strains of clinically relevant moulds and yeasts. In recent years, antifungal triazole posaconazole has become increasingly important for the prophylaxis and treatment of systemic mycoses. After oral administration of posaconazole, absolute bioavailability has been estimated to range from 8% to 47%. Pharmaceutical co-crystallization is a promising approach for improving dissolution rate or manipulating other physical properties of API. The objective of this study is to improve the dissolution rate of posaconazole by co-crystallization. A 1:1 stoichiometric co-crystals of adipic acid were prepared by solvent assisted grinding method. The prepared co-crystals were subjected to solid-state characterization by FTIR, PXRD and DSC studies. The physicochemical properties of posaconazole and co-crystals were assessed in terms of melting point, flowability and dissolution rate. The results indicated improvement in flow property and dissolution rate. In vitro dissolution profile of co-crystals showed a significant increased dissolution of posaconazole from initial period in 0.1 N hydrochloric acid solution. The dissolution efficiency for posaconazole-adipic acid co-crystal was 61.65 % against posaconazole, 46.58 %. Thus, co-crystallization can be a promising approach to prepare posaconazole-adipic acid co-crystals with improved physicochemical properties.

Composition, Antioxidant and Anti-inflammatory activities of Hexane and Methanol extracts of Acmella uliginosa from Terai region of Uttarakhand

Abstract Acmella uliginosa, an edible herb belonging to Asteraceae family, was collected from the Terai region of Uttarakhand, India. Methanol and hexane extracts of the whole plant were prepared using soxhlet apparatus. The GC-MS analysis of plant extracts identifies 22 and 35 major compounds of methanol and hexane extracts which comprises of 74.21% and 73.20% of the total composition of extracts, respectively. The major compound in hexane was 2, 4-heptadienal (7.99%) whereas trans, trans-9, 12-octadecadienoic acid propyl ester (16.96%) was major compound in methanol extract. The extracts were evaluated for antioxidant and anti-inflammatory properties. Methanol extract showed higher free radical scavenging and reducing power activities with IC50 value 153.82±1.69 µg/mL and RP50 value of 152.28±0.41 µg/mL, respectively. The metal chelating activity was higher in hexane extract as compared to methanol extract i.e., 62.08±0.25 µg/mL. The anti-inflammatory activity assessed by its ability to inhibit denaturation was higher in methanol having IB50 value 87.33±0.15 µg/mL. The total phenolic content (TPC), total flavonoid content (TFC) and ortho-dihydric phenol content (ODP) of methanol and hexane extracts were also evaluated. TPC, TFC and ODP was higher in methanol extract having value of 122.23±0.22, 35.01±0.29 and 8±0.86 mg/mL, respectively. Acmella uliginosa, might be considered as a natural source for antioxidant and anti-inflammatory properties

Bioavailability augmentation of silymarin using natural bioenhancers: An in vivo pharmacokinetic study

Abstract Pharmacokinetic studies were carried out in male and female rats to quantify silymarin as silybin (A+B) after the oral administration of various silymarin formulations combined with three bioenhancers, namely, lysergol, piperine, and fulvic acid, and compared with plain silymarin formulation (control). A non-compartmental analysis, model independent analysis, was utilized, and various pharmacokinetic parameters (C max, T max, and AUC 0-t) were calculated individually for each treatment group, and the values were expressed as mean ± SEM (n = 6). Plasma samples obtained from the rats were analyzed for the concentration of silymarin through a validated RP-HPLC method and on the basis of data generated from the pharmacokinetic studies. Results indicated that the bioenhancers augmented pharmacokinetic parameters and bioavailability increased 2.4-14.5-fold in all the formulations compared with the control. The current work envisages the development of an industrially viable product that can be further subjected to clinical trials and scientifically supports the development of silymarin as a contemporary therapeutic agent with enhanced bioavailability and medicinal values.

Comparative evaluation of pain perception following topical application of clove oil, betel leaf extract, lignocaine gel, and ice prior to intraoral injection in children aged 6-10 years: a randomized control study

Background@#In the field of dentistry, topical anesthetics play an important role in reducing pain during needle pricks. The anesthetic property of betel leaves remain unexplored, even though they have been widely used for the treatment of various ailments. The purpose of this study was to compare and evaluate pain perception following topical application of lignocaine gel, clove gel, ice, and newly developed betel leaf extract gel during intraoral injection in children. @*Methods@#Sixty children aged 6-10 years who met the inclusion criteria were divided into four groups. Topical anesthetic agents, 2% lignocaine (Lox-2% Jelly, Neon, Mumbai, India), 4.7% clove gel (Pain Out Dental Gel, Colgate Palmolive India Ltd, Solan, India), 10% betel leaf extract gel, and ice were applied to each group for one min, followed by administration of infiltration anesthesia. Pain perception was analyzed during needle insertion.The Wong Bakers FACES pain rating scale (WBFPRS) was used for subjective assessment and the Sound, Eye, Motor (SEM) scale for objective assessment. Recorded values were tabulated and subjected to appropriate statistical analysis using SPSS software with a P value set at 0.05. @*Results@#The clove oil and betel leaf groups demonstrated the highest WBFPRS scores, followed by the ice and lignocaine groups. The clove, betel leaf extract, and ice groups showed equal and highest SEM scores, followed by the lignocaine group. The mean WBFPRS and mean SEM scores were statistically significant. @*Conclusion@#Betel leaf extract gel is effective in reducing pain and can act as an alternative topical anesthetic agent.

Comparative evaluation of pain perception following topical application of clove oil, betel leaf extract, lignocaine gel, and ice prior to intraoral injection in children aged 6-10 years: a randomized control study

Background@#In the field of dentistry, topical anesthetics play an important role in reducing pain during needle pricks. The anesthetic property of betel leaves remain unexplored, even though they have been widely used for the treatment of various ailments. The purpose of this study was to compare and evaluate pain perception following topical application of lignocaine gel, clove gel, ice, and newly developed betel leaf extract gel during intraoral injection in children. @*Methods@#Sixty children aged 6-10 years who met the inclusion criteria were divided into four groups. Topical anesthetic agents, 2% lignocaine (Lox-2% Jelly, Neon, Mumbai, India), 4.7% clove gel (Pain Out Dental Gel, Colgate Palmolive India Ltd, Solan, India), 10% betel leaf extract gel, and ice were applied to each group for one min, followed by administration of infiltration anesthesia. Pain perception was analyzed during needle insertion.The Wong Bakers FACES pain rating scale (WBFPRS) was used for subjective assessment and the Sound, Eye, Motor (SEM) scale for objective assessment. Recorded values were tabulated and subjected to appropriate statistical analysis using SPSS software with a P value set at 0.05. @*Results@#The clove oil and betel leaf groups demonstrated the highest WBFPRS scores, followed by the ice and lignocaine groups. The clove, betel leaf extract, and ice groups showed equal and highest SEM scores, followed by the lignocaine group. The mean WBFPRS and mean SEM scores were statistically significant. @*Conclusion@#Betel leaf extract gel is effective in reducing pain and can act as an alternative topical anesthetic agent.

Subdural Haematoma (SDH) Leading to Subfalcine Herniation in a Case of End Stage Renal Disease

Subdural haematoma (SDH) is characterized by bleeding into the sub dural space surrounding the brain. It is mostly associated with atraumatic brain injury. It usually results from tears in bridging veins that cross the subdural space. ESRD is a risk factor for SDH. Coagulation abnormalities, volume overload, haemodialysis and platelet dysfunction predispose to SDH in ESRD and increase the morbidity and mortality.1 We report a case of a 44-year-old female, a known case of chronic kidney disease on maintenance haemodialysis who developed SDH with resulting subfalcine herniation.

Diagnostic and Prognostic Value of N-Terminal Brain Natriuretic Peptide in Patients of Heart Failure.

Heart failure is a clinical condition in which a deviation in normal cardiac structure or function is accountable for the incapability of the heart to eject or fill with blood at a proportion proportionate to the requirements of the metabolizing tissues. The detection of heart failure is based on clinical symptoms, signs, chest x rays and reaction to the treatment. BNPs are released by the heart ventricles in reaction to volume load or pressure load physiologically and they function to counteract rennin angiotensin system, cause vasodilatation and natriuresis. The BNP evaluation has gained approval already in the recommendations of European Society of Cardiology for the detection of heart failure. We wanted to study the potential of a new unconventional assay plasma N-Terminal pro BNP in detecting cardiac failure, and correlate the levels of plasma N-Terminal pro BNP with the severity of the cardiac failure and levels of plasma N-Terminal Pro BNP with systolic and diastolic dysfunction. MethodsIt was an analytical cross-sectional study conducted among 50 patients with clinical features of cardiac failure attending medicine OPD and emergency department of the hospital for the duration of 18 months and an equal number of age and sex equivalent fit controls. In subjects with clinical features of heart failure, and in healthy controls, 2 mL of blood sample is drawn for assay of plasma N-Terminal pro BNP within half an hour of presentation. Using biomedical kit plasma N-T pro BNP concentration was measured. The entire period of the assay is 18 min. Detectability range by this method of N-T proBNP is 5 pg/mL to 35,000 pg/mL. ResultsCases comprised of 28 males and 22 females with a mean age 50.80 (13.11) years while controls comprised of 28 males and 22 females with a mean age 50.86 (12.7) years. There was a statistically noteworthy difference in Mean N-T pro BNP between case and control groups, NYHA Class, and age group. Mean N-T pro-BNP is not significantly different at discharge and on 2nd follow-up. For the rest of the diagnoses, there is a notable difference in Mean N-T pro BNP at discharge and on 2nd follow-up. ConclusionsPlasma N-Terminal pro BNP levels are useful from therapeutic point of view (aggressive therapy if needed e.g. Heart transplantation / bilateral pacemaker or invasive therapy may be planned by N-T pro BNP levels).

Analysis of intraoperative frozen section consultations and audit of accuracy: a two year experience in a tertiary care multispeciality hospital in India

Background: Diagnostic accuracy of intra-operative frozen section (FS) depends largely on quality of tissue sections backed by good clinical communication and experience of reporting pathologist. Periodic audit of this consultation in surgical pathology help in assessing the efficiency of procedure and addressing the pitfalls. In this study authors have analysed the spectrum, indications and assessed the accuracy of FS consultation in their institution.Methods: A retrospective study of 212 consequent tissue specimens submitted for FS over two years in study centre was conducted. The FS and corresponding formalin fixed paraffin embedded (FFPE) tissue section with their final histopathological examination (HPE) reports were studied and analyzed. The results were classified in concordant, discordant and deferred categories. Accuracy rates and discordant frequencies were calculated and comparison with other similar studies was done. Reasons for inaccuracies were deduced.Results: A total of 212 tissue specimens for FS were reported over two years in this study institute, six of which showed discordant results. Most common site of FS in this study centre was from central nervous system (CNS) lesions (28.77%). Indications for intra-operative consultation were mainly for establishment of tumor diagnosis (66.51%) and status of margins (29.25%). The accuracy rate was found to be 97.17% with error rate of 2.83%. On analysis of discordant cases; the reason for inaccuracy was mainly due to interpretation error (83.33%).Conclusions: The audit of FS consultation established that accuracy rates of this study institution are comparable with most international quality control statistics for FS. The discordant cases were mostly false positive hence emphasising that a variable degree of reservation is required while interpreting and communicating the FS results. The closest possible diagnosis should be communicated on FS and definitive diagnosis should be deferred to HPE in case of doubt.

Early surgical management in pancreatic ascites on a background of chronic pancreatitis

Background: Pancreatic ascites can occur as a complication of acute or chronic pancreatitis. In majority of cases, it is associated with pseudocyst or duct disruption. Management is initially conservative with paracentesis with nutritional support. Early surgery has been recently contemplated as primary management for pancreatic ascites.Methods: A prospective study was done over a duration of three years from November 2017 to October 2019 in patients of chronic pancreatitis presenting with pancreatic ascites. All patients underwent pancreatic protocol contrast enhanced computed tomography abdomen and magnetic resonance cholangiopancreatography, duct diameter and main pancreatic duct (MPD) disruption site.  pseudocyst site was identified. After optimizing patients, early surgery was planned. Surgeries included either lateral pancreatic jejunostomy, if MPD were dilated. Pancreaticogastrostomy, cystogastrostomy or cystojejunostomy, if there was pseudocyst with extraneous impression over stomach or on mesocolon, and distal pancreatectomy (and/or) splenectomy. Results: Out of 20 cases of pancreatic ascites, 6 were of acute pancreatitis and conservatively managed and 14 were subjected to early primary surgery. 8 out of 14 patients underwent LPJ. 2/14 underwent pancreaticogastrostomy. 2/14 underwent cystogastrostomy and 1/14 underwent spleen preserving distal pancreatectomy. 1/14 underwent distal pancreatectomy and splenectomy. None of the patients had postoperative recurrence of pancreatic ascites. One patient developed Postoperative intra-abdominal collection which was drained. Mortality was 2/14 (14.2%), one died immediate postoperatively and another succumb to Pulmonary embolism on post-operative day-4. Pain scores were significantly reduced post-operatively.Conclusions: Primary early surgery directed towards primary pathology, as guided by MPD status, in selected patients with chronic pancreatitis with ascites leads to faster recovery of patient.

Patient satisfaction and experience with various modes of Xylocaine administration for cervical dilatation and endometrial curettage: a randomized interventional study

Background: Patient satisfaction after a surgical procedure is an important outcome of hospital care. Many of the gynaecological menstrual problems such as abnormal uterine bleeding, postmenopausal bleeding requires endometrial evaluation which is done traditionally by dilatation and curettage. But this procedure is painful and requires appropriate pain management protocol. The aim is to evaluate the post-operative patient satisfaction following dilatation and curettage procedure.Methods: This study was conducted in a tertiary care hospital belonging to a medical college. A total of 236 patients were recruited for the study who subsequently underwent dilatation and curettage with different mode of Xylocaine anesthesia for pain relief. Of them 16 patients were excluded due to valid reasons and the remaining 220 were interviewed face to face following the procedure. The level of anxiety was assessed using Beck’s Anxiety inventory and also perception of satisfaction was documented along with complication related to the anesthesia.Results: The overall level of satisfaction was higher in the group receiving both paracervical block and intrauterine instillation of lidocaine during the procedure of dilatation and curettage. A further analysis showed that increase in level of satisfaction was due to improvement in pain scores due to combined mode of paracervical and endometrial anesthesia.Conclusions: A multimodal pain management protocol which involves pre-procedural sedation, combined cervical and endometrial anesthesia improves overall outcome with respect to reduction in anxiety scores and postoperative satisfaction levels.