Anterior Wall Myocardial Infarction With Conduction Defect And It's Outcome During Hospital Stay

Background: Qrbb myocardial infarction has high mortality and morbidity. So we want to study in hospital outcome of qrbbb myocardial infarction Methods: It is a prospective study. We studied qrbbb mi patients admitted in our hospital from December 2016 to June 2017 Results: About 90% of patients had heart failure. And 80% of patients required ventilatory support in the form of non–invasive positive pressure ventilation (NIPPV) or invasive ventilation. About 37% of patients had ventricular arrhythmias. Thrombolysis with streptokinase was done in 64% of patients and with tenecteplase for 20% of the patients. Percutaneous transluminal coronary angioplasty (PTCA) was done in 47% patients. Two patients had pharmacoinvasive PTCA. 16% of patients were conservatively treated due to late presentation. 24% patients died during hospital stay while 76% got discharged. 14% of patients had reversal of rbbb wave. 14% had stent thrombosis. 100% of patients had left anterior descending artery (LAD) disease. While 10% had left main coronary artery disease and 14% had triple vessel disease (TVD), 10% were sent for coronary artery bypass grafting (CABG). Conclusions: qRBBB AWMI carries high mortality of 24% with 90% of patients going in to heart failure. Ejection fraction is a good predictor of death and diabetes is a covariate of predictor of death.

A randomized placebo-controlled trial to assess the efficacy and safety of bilateral superficial cervical plexus block in patients undergoing thyroid surgery

Background: Efficient analgesia and achieving hemodynamic stability is vital in patients undergoing thyroid surgery. Bilateral superficial cervical plexus block (BSCPB) is one of the commonly performed regional anaesthesia technique, but studies documenting the superiority of various local anaesthetic medication, as compared to placebo are scarce. To compare the efficacy of analgesia, intra and post-operative hemodynamic status between bilateral superficial cervical plexus block with 0.5% bupivacaine and a control group (normal saline) in thyroid surgeries. Materials and methods: The current study was a randomized double-blinded controlled trial conducted with prior ethical approval. The study population included, people undergoing thyroid surgery under general anaesthesia, randomized to either 0.5% Bupivacaine or normal saline groups. The post-operative pain was assessed by Visual Analogue Scale (VAS). The intra and postoperative hemodynamic parameters were compared. Unpaired t-test, Mann-Whitney U test was used appropriately. Results: A total of 58 patients included in the final analysis, with 29 subjects in each group. Both the study groups were comparable, with respect to various baseline parameters. The highest difference in the mean visual analogue score was observed in the immediate post-operative period (mean difference 4.03, 95 CI 3.4 to 4.66, p value < 0.001). This difference even though was variable and lower compared to the immediate post-operative value, was sustained throughout the post-operative R. Vasanthageethan, G. Sivakumar, R. Arunachalam. A randomized placebo-controlled trial to assess the efficacy and safety of bilateral superficial cervical plexus block in patients undergoing thyroid surgery. IAIM, 2018; 5(8): 64-71. Page 65 period. At 24 hours, post-operative period the mean difference in visual analogue score was 1.55 (95% CI 0.93 to 2.16, p value < 0.001). All these differences in the mean visual analogue scores were statistically significant at p value < 0.05. No major hemodynamic fluctuations were observed in either of the study groups and no statistically significant difference was observed with respect to various hemodynamic parameters. Conclusions: The data and statistical analysis suggest that Bilateral Superficial Cervical Plexus Block with bupivacaine did not alter the intraoperative hemodynamic parameters and was effective in reducing the pain during the postoperative period. No significant adverse effects were noted both during surgery and postoperative period.

Prophylactic combined supplementation of choline and docosahexaenoic acid attenuates vascular cognitive impairment and preserves hippocampal cell viability in rat model of chronic cerebral hypoperfusion ischemic brain injury.

Background: Stroke is the second cause of mortality in the world and third leading cause of disability in surviving victims. Cerebral ischemic cascade involves multiple pathways that can result in motor and cognitive deficits. The current treatment strategy focuses mainly on motor recovery, and the management of post-stroke cognitive impairment is largely neglected. Similarly, very few studies have explored the prophylactic combined synergetic treatment strategies that have the potential to target multiple pathways in the ischemic cascade to alleviate vascular cognitive impairment (VCI) in the event of an ischemic stroke. Choline and docosahexaenoic acid (Cho-DHA) are both essential neuronal membrane phospholipid precursors, known to be important in enhancing cognitive functions. The objective of present study was to explore the prophylactic efficacy of combined Cho-DHA supplementation (Cho-DHA suppl.) in attenuating VCI in a rodent model of ischemic brain injury. Methods: An 10-months-old male Wistar rats were subdivided into four groups (n=8/group); normal control (NC), bilateral common carotid artery occlusion (BCCAO) induced ischemic brain injury group, sham BCCAO (S-BCCAO) group, and prophylactic combined Cho-DHA suppl. BCCAO group. Subsequently, all groups of rats were tested for cognition and neuro-morphological changes in the hippocampus. Results: BCCAO rats showed significant learning and memory deficits (p<0.05) and neuronal injury compared to S-BCCAO and NC rats. These cognitive deficits and neuronal injury were significantly (p<0.01) attenuated in Cho-DHA suppl. BCCAO rats. Conclusion: Prophylactic combined Cho-DHA suppl. may be envisaged as an effective preventive strategy to attenuate VCI and neuronal injury in high-risk individuals susceptible for a future event of an ischemic stroke.

Acute effects of deep breathing for a short duration (2-10 minutes) on pulmonary functions in healthy young volunteers.

Breathing is the most vital function for maintenance of life. Slow and deep breathing is an integral part of Pranayama and it reduces dead space ventilation and renews air throughout the lungs. The reported beneficial effects of deep breathing as a part of either long term or short term practice of pranayama are well documented. However our knowledge about the effects of a few minutes’ of deep breathing on human ventilatory parameters is poor. In the present study, we examined the relationship between exposure to short duration of deep breathing and performance on Pulmonary Function Tests before and after the deep breathing. The study was conducted in a homogenous group of 12 volunteers containing 4 females and 8 males who were well trained in pulmonary function testing (PFT) before the start of the study. The volunteers performed deep breathing (DB) exercise for 2, 5 and 10 minutes at the rate of 6 breaths per minute under guidance, and the duration of DB exercise for that day was randomly selected for each group. PFT was done before and after the DB exercise. There was a significant (P<0.05) increase in vital capacity (VC) after 2 and 5 minutes’ DB exercise and a consistent improvement in tidal volume (TV) and minute ventilation (MV) after the DB exercise in all the three groups, though it wasn’t statistically significant. There was a significant (P<0.05) increase in forced vital capacity (FVC) after 2 minutes’ of DB exercise and a consistent increase in all the three groups in forced inspiratory vital capacity (FIVC) and peak inspiratory flow rate (PIFR), though this increase was not statistically significant. This shows that deep breathing exercise, even for a few minutes’ duration is beneficial for the lung functions.

Odontogenic myxoma of maxilla.

Odontogenic myxoma (OM) is a rare and locally invasive benign neoplasm found exclusively in the jaws. OM commonly occurs in the second and third decade, and the mandible is involved more commonly than the maxilla. The lesion often grows without symptoms and presents as a painless swelling. The radiographic features are variable, and the diagnosis is therefore not easy. A case of OM of the maxilla with unusual radiographic and histologic features is described in a 30-year-old male. A panoramic radiograph revealed a well-demarcated, multilocular radiolucent lesion with 'tennis racket' appearance involving maxillary antrum. The histopathology showed loosely arranged spindle-shaped stellate cells and few areas of inactive odontogenic epithelium in a mucoid intercellular substance.

Oral manifestations and analysis of salivary and blood urea levels of patients under going haemo dialysis and kidney transplant.

AIM AND OBJECTIVES: To evaluate oral manifestations in patients with renal diseases and to correlate blood and salivary urea levels in patients undergoing haemodialysis and kidney transplant. MATERIAL AND METHODS: Study group subjects were selected from patients undergoing hemodialysis and patients who had underwent kidney transplant. Adequate history was recorded. All the groups were examined extra orally and intra orally and findings were recorded. SAMPLE COLLECTION: Venous blood was collected from the antecubital fossa in control group. In patients with renal disease undergoing dialysis, blood was collectedjust prior to the dialysis. Renal transplant patients' blood samples were collected during review visit. Unstimulated saliva was collected and submitted to the laboratory immediately for urea examination by an automated analyzer. RESULTS: Extra oral manifestations like swollen face, pale skin, pedal edema, and bruises on the skin, nausea and vomiting in nearly 50% of the patiens, and oral manifestations like uraemic odour, dry mouth, and altered taste sensation were noted. There was a correlation between blood urea and salivary urea concentration in patients under going hemodialysis and kidney transplant. CONCLUSION: Saliva can be used as a non-invasive diagnostic tool.

Ameloblastic fibro odontoma.

Ameloblastic fibro odontoma is relatively a rare mixed odontogenic tumor comprising of ameloblastic fibroma and ameloblastic odontoma. This group of lesions represent neoplastic and hamartomatous changes. Data regarding age, sex, and site of occurrence of these lesions have been uniquely described. A case of ameloblastic fibro odontoma in a 17-year-old male involving the left body of the mandible, and its radiographic, clinical symptoms and histological features is described herewith. A conservative surgical approach, including enucleation and mechanical curettage of the surrounding bone was done.

Primary de novo intraosseous carcinoma of the mandible--report of a case and review of literature.

Primary intraosseous carcinoma (PIOC) is a rare malignant odontogenic neoplasm defined as squamous cell carcinoma arising within thejaws, having no initial connection with the oral mucosa and presumably developing from the residues of the odontogenic eptihelium. A 37yr old male patient reported with the complaint of pain and swelling in the right mandible and inability to open his mouth for the past six months. Examination revealed an expansile mass that involved the right mandible and extended from the 1st premolar region to the right angle of the mandible. The alveolar ridge was markedly expanded and was covered with intact, normal appearing mucosa. Radiographic examination revealed an ill-defined radiolucent area in the right body of the mandible, which extended to the lower border. Histopathologic examination revealed a well differentiated keratinizing squamous cell carcinoma. PIOC has no specific histopathologic features and can be definitively diagnosed only upon fulfillment of various criteria. These criteria were followed in our case and reported here for its rarity.

Malignant melanoma of the oral cavity--case reports and review of literature.

Melanoma is a malignant tumor of melanocytes or their precursor cells. It is the third most common skin cancer and is one of the most biologically unpredictable neoplasms. Sunlight is an important etiological factor in cutaneous melanoma. Oral melanoma is relatively uncommon, exhibiting a definite predilection for palate and maxillary gingiva, and is twice as common in males as in females. We herewith report three cases of oral melanoma out of which two occurred on the palate and one in the maxillary gingiva. Their clinical presentations, histopathology and management are discussed.

Lip prints (cheiloscopy).

External surface of the lip has many elevations and depressions forming a characteristic pattern called lip prints, examination of which is referred to as cheiloscopy. This is unique for individuals like the finger prints. The biological phenomenon of systems of furrows on the red part of the human lips was first noted and described by anthropologist R.S. Fischer, in 1902. However until 1930, anthropology merely mentioned the existence of furrows without suggesting a practical use for the phenomenon. Since 1950, the Japanese have carried out extensive research in this matter. In the period 1968 to 1971, Y.T Suchhihashi and T.Suzuki examined 1364 persons at the department of forensic odontology at Tokyo university and established that the arrangement of lines on the red part of the human lips is individual and unique for each human being. Lip print recording is helpful in forensic investigation that deals with identification of humans, based on lip traces. A lip print may be revealed as a surface with visible elements of lines representing the furrows. This characteristic pattern helps to identify the individuals since it is unique for individuals. When the lines are not clear (Only the shape of lines is printed), individual identification of human being based on this trace is extremely difficult, unless the trace contains more individual characteristics like scars, clefts etc, and often identification ends with group identification.

Predicting the composition of gallstones by infrared spectroscopy.

AIM: To determine the composition of gallstones in South India by comparing visual assessment with graphic interpretation of infrared spectra. METHODS: Infrared spectroscopy (IRS) was used in qualitative analysis of 168 gallstones from Tamilnadu, Kerala and Karnataka and compared with visual interpretation. The spectrum of cholesterol, calcium bilirubinate and calcium carbonate for each stone was correlated with visual inspection. RESULTS: Fifty four percent of gallstones were of pigment variety, 43% were of mixed and the remaining 3% were cholesterol gallstones as categorised by visual interpretation. Based on infrared spectrocopic interpretation the percentages were 58%, 39% and 2% respectively. There was a good agreement between the visual inspection and IRS in classification of gallstones (Kappa value 85%; 95% CI 77-93%). CONCLUSION: Visual inspection of gallstones can predict the composition of gallstone with good accuracy and was comparable to infrared spectroscopic interpretation.