An Ancient Drug for a Modern Era: Minocycline for the Treatment of Multi-Drug-Resistant Acinetobacter baumannii.

INTRODUCTION: Infections caused by Acinetobacter baumannii are a major cause of health concerns in the hospital setting. Moreover, the presence of extreme drug resistance in A. baumannii has made the scenario more challenging due to limited treatment options thereby encouraging the researchers to explore the existing antimicrobial agents to combat the infections caused by them. This study focuses on the susceptibility of multi-drug-resistant A. baumannii (MDR-AB) strains to minocycline and also to colistin. METHODOLOGY: A cross-sectional study was conducted from June 2022 to June 2023. One hundred isolates of​​​​​​ A. baumannii â€‹â€‹â€‹obtained from various clinical samples were sent to Central Laboratory, Department of Microbiology, Sree Balaji Medical College and Hospital, Chrompet, Chennai, India. The antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, 2022. For the standard antibiotics, the disc diffusion method was performed. For minocycline and colistin, the minimum inhibitory concentration (MIC) was determined using an epsilometer strip (E-strip) test. RESULTS: In this study, 100 isolates of A. baumannii were obtained, and 83% of the isolates were multi-drug-resistant. Among the MDR-AB, 50 (60%) were susceptible to minocycline and 40 (48%) were susceptible to colistin. Out of the 40 colistin-susceptible A. baumannii strains, 29 (73%) were susceptible to minocycline with a statistically significant P-value of <0.05. Among the 43 colistin-resistant A. baumannii strains, 21 (53%) were susceptible to minocycline with a statistically significant P-value of <0.05. CONCLUSIONS: When taking into account the expense of treating carbapenemase-producing Gram-negative bacteria, colistin and minocycline can be used as an alternative drug as they have fewer side effects and are more affordable. Minocycline can be used as an alternative to colistin because it is feasible to convert from an injectable to an oral formulation.

Increased vascular risk factors, atherosclerosis, and psychological distress among Indian adults with refractory epilepsy in comparison to well-controlled epilepsy.

OBJECTIVE: Comparison of cardiovascular risk factors, atherosclerosis, and psychological distress among adults with refractory versus well-controlled epilepsy. METHODS: The cross-sectional study consisted of two groups of 40 people each: Group I - People with well-controlled epilepsy, Group II - People with refractory epilepsy. Age- and gender-matched people of 20-50 years were recruited. People who were diabetic, smokers, hypertensive, alcoholic, pregnant, with infections, and lactating women were excluded from the study. Biochemical parameters, fasting glucose, lipid profile, fasting insulin, leptin, adiponectin, Lp[a], hsCRP, TyG INDEX, HOMA1-%S, HOMA1-IR, HOMA1-%B, QUICKI, FIRI, AIP, AC, CLTI, MLTI, CRI-I, CRI-II, and CIMT were estimated. Stress levels [PSS-10, GAD-7 & PHQ-9] were assessed based on the scoring system from the questionnaires. RESULTS: The existence of metabolic syndrome, levels of triglycerides, TyG index, MDA, OSI, CIMT, AIP, and stress scores [PSS-10, GAD-7 & PHQ-9] were significantly higher in the refractory-epilepsy group in comparison to the well-controlled group. There were associations between LDL -C and CIMT as well as between GAD-7 and CIMT among all the study subjects. There were no significant differences in the levels of glucose homeostasis parameters, hsCRP, leptin, adiponectin, and Lp[a] between the two groups. Based on the ROC analysis, MDA [AUC = 0.853] and GAD-7 [AUC = 0.900] are useful in the differential diagnosis of the study groups. CONCLUSION: People with refractory epilepsy had increased levels of vascular risk factors, atherosclerosis, and stress levels compared to people with well-controlled epilepsy. Suitable disease management and therapeutic approaches to address cardiovascular and psychological distress could be planned out among people with refractory epilepsy to improve their quality of life.

Cog - A Radiological Indicator in Identifying Dysventilation Syndrome.

Background: Anterior epitympanic recess (AER) is a small anatomical space in the epitympanum anterior to level of the head of malleus. This space has received lot of attention because of its role in cholesteatoma. Dysventilation of AER can lead to retraction pockets and cholesteatomas. Due to the advent of endoscopic middle ear surgeries the visualization of the mucosal folds and spaces have been possible for the past 2 decades. Mucosal folds and spaces play an important role in middle ear ventilation and pathologies obstructing these ventilation pathways can lead to dysventilation resulting in retraction pockets / cholesteatoma. In our study we have analysed the importance of cog with respect to dysventilation syndrome. Materials and methods: This prospective radiological study was conducted at Apollo Hospitals, BG road, Bangalore for a study period of 1 year (January 2021-January 2022). All patients who underwent high resolution CT scan (HRCT) of temporal bone were included in this study. They were divided into 2 groups (Group I & II). For group I HRCT temporal bone of 200 normal scans were included and scans with chronic otitis media, congenital anomaly, temporal bone fractures and tumors were excluded from the study. 50 HRCT temporal bone scans of chronic otitis media with squamous disease were included in group II. Results: 200 HRCT scans were included in the normative data analysis of the temporal bone. Out of 200, 133 had complete cog, 54 had incomplete cog and 13 had absent cog (Table 2). We also calculated the mean diameters of the AER, AP diameter- 4.24 ± 1.3, TD - 3.36 ± 1.05 and VD - 5.3 ± 1.94 (Table 3). Similarly, we analyzed 50 HRCT temporal bone with squamous disease 32 out of 50 had absent cog (Table 4). We also calculated the dimension of AER in diseased temporal bones (Table 5). A paired T test was conducted in order to analyze these values. Conclusion: In our study we performed a radiological evaluation of AER and cog and found that incidence of absent cog is more among individuals with squamous disease than normal individuals. Hence we advocate that absent cog can lead to horizontally oriented tensor tympani that in turn results in dysventilation. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03507-9.

Effect of Trunk Targeted Interventions on Functional Outcomes in Children with Cerebral Palsy- A Systematic Review.

Objective of this review was to collate information on the effectiveness of trunk targeted intervention on children with cerebral palsy (CP) on three functional outcomes that are gross motor function, trunk control and balance. A comprehensive search was conducted on online databases from inception to August 2021, using relevant keywords. A total of 15 randomized controlled trials which enrolled children with cerebral palsy under 18 years met the inclusion criteria. A significant improvement was seen in the trunk targeted training groups on applying trunk targeted interventions. Trunk targeted interventions improve gross motor function, trunk control as well as balance, hence should be incorporated in the conventional physical therapy program delivered to children with CP and would help in greater functional recovery.

3,3'-Diselenodipropionic acid immobilised gelatin gel: a biomimic catalytic nitric oxide generating material for topical wound healing application.

Nitric oxide (NO) plays a pivotal role in the wound healing process and promotes the generation of healthy endothelium. In this work, a simple method has been developed for fabricating a diselenide grafted gelatin gel, which reduces NO donors such as S-nitroso-N-acetylpenicillamine (SNAP) by glutathione peroxidase-like mechanism to produce NO. Briefly, the process involved covalently conjugating 3,3'-diselenodipropionic acid (DSePA) with gelatin via carbodiimide coupling. The resulting gelatin-DSePA conjugate (G-Se-Se-G) demonstrated NO production upon incubation with SNAP and glutathione (GSH) with the flux of 4.8 ± 0.6 nmol cm-2 min-1 and 1.6 ± 0.1 nmol cm-2 min-1 at 10 min and 40 min, respectively. The G-Se-Se-G recovered even after 5 days of incubation with the reaction mixture retaining catalytic activity up to 74%. Subsequently, G-Se-Se-G was suspended (5% w/v) in water with lecithin (6% w/w of gelatin) and F127 (3% w/w of gelatin) to prepare gel through temperature dependant gelation method. The fabricated G-Se-Se-G gel exhibited desirable rheological characteristics and excellent mechanical stability under storage conditions and did not cause any significant toxicity in normal human keratinocytes (HaCaT) and fibroblast cells (WI38) up to 50 µg ml-1 of selenium equivalent. Finally, mice studies confirmed that topically applied G-Se-Se-G gel and SNAP promoted faster epithelization and collagen deposition at the wound site. In conclusion, the development of a biomimetic NO generating gel with sustained activity and biocompatibility was achieved.

Solvated electron-induced synthesis of cyclodextrin-coated Pd nanoparticles: mechanistic, catalytic, and anticancer studies.

Herein, using in situ generated solvated electrons in the reaction media, a highly time-efficient, one-pot green approach has been employed to synthesize palladium (Pd) nanoparticles (NPs) coated with a molecular assembly of α-cyclodextrin (α-CD). The appearance of a shoulder peak at 280 nm in the UV-Vis absorption spectra indicated the formation of Pd NPs, which was further confirmed from their cubic phase XRD pattern. The nanomorphology varied considerably as a function of the dose rate, wherein sphere-shaped NPs (average size ∼ 7.6 nm) were formed in the case of high dose rate electron-beam assisted synthesis, while nanoflakes self-assembled to form nanoflower-shaped morphologies in a γ-ray mediated approach involving a low dose rate. The formation kinetics of NPs was investigated by pulse radiolysis which revealed the formation of Pd-based transients by the solvated electron-induced reaction. Importantly, no interference of α-CD was observed in the kinetics of the transient species, rather it played the role of a morphology directing agent in addition to a biocompatible stabilizing agent. The catalytic studies revealed that the morphology of the NPs has a significant effect on the reduction efficiency of 4-nitrophenol to 4-aminophenol. Another important highlight of this work is the demonstration of the morphology-dependent anticancer efficacy of Pd NPs against lung and brain cancer cells. Notably, flower-shaped Pd NPs exhibited significantly higher cancer cell killing as compared to spherical NPs, while being less toxic towards normal lung fibroblasts. Nonetheless, these findings show the promising potential of Pd NPs in anticancer treatment.

The long-term outcomes of the Anderson-Kestenbaum procedure.

Introduction: Nystagmus is an involuntary, conjugated, rhythmic movement of the eye that can be idiopathic or secondary to ocular or neurologic pathologies. Patients with nystagmus often have a position of gaze in which their symptoms are dampened or absent, referred to as the "null zone." The Anderson-Kestenbaum procedure is a bilateral recess-resect procedure of the four horizontal rectus muscles which aims to bring the null position into the primary gaze. This study aims to further elucidate long-term outcomes and factors associated with optimal postoperative outcomes. Methods: Patients with a diagnosis of nystagmus and a surgical code for strabismus between June 1990 and August 2017 were considered for inclusion in the study. Patients were included if they had undergone the Anderson-Kestenbaum procedure and had follow-up lasting at least 24 months post-operatively. Data collected included demographic information, characteristics of the nystagmus, underlying etiology of nystagmus, and pre-and post-operative measurements. Results: 25 patients were included. At their last recorded follow-up, 44% of patients achieved an optimal surgical outcome -an abnormal head position of 10 degrees or less. 88% of patients showed an overall improvement in their head posture at the last follow-up. The absence of an abnormal head position at the visit closest to 24 months post-operatively was found to be significantly associated with the lack of a significant head position at the last follow-up visit. Optimal surgical outcomes were not significantly associated with the underlying diagnosis, the direction of the abnormal head position, or the type of nystagmus. Discussion: The relatively long follow-up of this cohort allows this study to further elucidate the long-term outcomes of the Anderson-Kestenbaum procedure. Overall, our results suggest that although improvement in head position post-operatively is likely, it is still expected that many patients will have a residual abnormal head position after the procedure. The results of this study are helpful in counseling patients, especially knowing that if they do not have a significant head position at 24 months follow-up, they are unlikely to develop one. However, due to the small sample size, larger cohorts and more standardized follow-up may provide further insight into the procedure's outcomes.

Cameron Lesions With Severe Anemia: A Case Report.

This case presentation involves an elderly patient presenting with signs of severe anemia. Investigations lead to the detection of Cameron lesions within a large paraesophageal hiatus hernia (HH). These lesions have been described in the literature as being an incidental finding within the herniated stomach during endoscopy in patients with large HH who presented with microcytic hypochromic anemia. Progressive information regarding the relationship of this occurrence in patients with this specific type of anemia associated with HH has heightened physician awareness to rule out these lesions as a primary cause of chronic bleeding. There has been sporadic publication in literature stating Cameron lesions to be an unusual cause of chronic blood loss resulting in microcytic hypochromic anemia. Perhaps due to the lack of adequate emphasis on this frequent finding in elderly with HH in literature, textbooks are yet to include this condition as a differential diagnosis as one of the causes of upper GI bleeding (UGIB). This case study makes us ponder if this etiology is not rare after all and emphasizes the importance of considering Cameron lesions to be one of the established causes of chronic blood loss of upper GI origin in elderly with a large HH. Screening methods such as chest X-rays (CXR) could be used for early detection of the condition, and an esophagogastroduodenoscopy (EGD) for confirmation before requiring additional invasive investigations.

Modified CT Scan Scoring System for Evaluating Symptom Severity of Chronic Rhinosinusitis.

There are various subjective as well as objective tools to evaluate the severity of chronic rhinosinusitis (CRS). SNOT-22 is the most commonly used subjective scoring system to determine the severity of CRS. Lund-Mackay (LM) CT scan scoring is widely used as an objective tool in CRS. However LM scores does not correlate well with the subjective tools. We evaluated the modified CT scan scoring system (SN score) for its efficacy in determining the severity of CRS in both subjective as well as objective manner. To correlate the severity of symptoms and CT scan findings in adult patients with chronic rhinosinusitis by estimating the strength of correlation of severity of symptoms of CRS assessed by SNOT-22 scorings with CT scan findings by Lund Mackay scoring system and SN CT scan scoring system. A prospective, observational study was conducted in the tertiary care center from June 2019 to August 2020. The study included 150 adult patients diagnosed with Chronic Rhino Sinusitis resistant to primary medical therapy, who were subjected to CT scan imaging. The symptom severity of CRS was assessed by the SNOT 22 scores. CT scan was done and Lund Mackay scores and SN CT scan scores by the senior author were calculated. The correlation of SNOT 22 score with LM score and Modified CT score were assessed. The correlation of LM score with SNOT 22 score was assessed by plotting Scattered plot diagram, which showed a moderate positive, statistically significant correlation (Person correlation co-efficient: 0.466; p value: 0.032). The correlation of SN CT score with SNOT 22 was assessed by Chi Square test which showed a highly significant, positive correlation (p value of 0.000793). Our study shows a positive correlation of symptoms assessed by SNOT 22 system with radiological findings analyzed by both LM system as well as SN CT scan scoring system. However, SN CT scan scoring system showed a highly significant positive correlation over LM system as it correlates well with symptoms and also provides a grading of disease severity. SN CT scan scoring system can be considered as a tool for assessing the disease severity both in subjective and objective manner. It can be used in place of subjective tools like SNOT 22 for assessing the severity of symptoms in CRS where subjective analysis of the disease is difficult.

Endoscopic Ear Surgery: Our Experience.

Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality replacing the microscopes. We performed primary endoscopic ear surgery at a tertiary care center to evaluate the scope of endoscopic ear surgeries and to evaluate the anatomical, functional and quality of life outcomes. We evaluated 103 cases of which included patients with chronic otitis media mucosal disease (64), chronic otitis media squamous disease (29), otosclerosis (6), and benign ear tumors (4). In our study, the structural and functional outcomes of endoscopic ear surgeries were comparable to microscopic techniques however it conferred superior patient related outcomes of cosmesis, post-operative pain and early return to daily routine. Thus endoscopic ear surgery is a minimally invasive alternative option to microscopic techniques in the field of otology.

Outcomes of Totally Endoscopic Versus Microscopic Techniques in Middle Ear Cholesteatoma: A Systematic Review and Meta-Analysis.

Endoscopes have revolutionized the field of otology for the past two decades due to its minimally invasive technique and improved visualization. The advantage of endoscope during surgery for middle ear cholesteatoma both for diagnosing and aiding in removal of residual disease from the hidden areas and the resulting lower recurrence rates have been proven in the past by many authors. But the feasibility of totally endoscopic ear surgery and its surgical and patient related outcomes are yet to be explored in detail. We conducted this systematic review and meta-analysis to compare the surgical and patient related outcomes between totally endoscopic and microscopic technique in cases of acquired middle ear cholesteatoma. This meta-analysis has been conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Search engines used to identify the eligible articles were Pubmed, Web of Science, Cochrane Library, Virtual Health Library databases. The studies that compared the outcomes of microscopic and endoscopic techniques in case of acquired middle ear cholesteatoma and with more than 10 patients were included. Outcomes like recurrence, residual disease, graft uptake rate, audiological outcome, conversion rate, pain score, surgery duration, complications and quality of life outcomes were compared.The quality of the included studies was assessed by Methodological Index for Non-randomized studies criteria in case of non-randomized studies and by means of Cochrane Risk of Bias Tool in case of randomized controlled studies. A random effects model was used to calculate pooled estimates. The ODDS ratio and 95% confidence interval were calculated. The heterogeneity among the studies was represented by the Q statistic and Higgins I2 statistic. The test for overall effect was calculated by Z test and a p value of < 0.05 was considered as statistically significant. 11 studies were included in this meta-analysis. Out of 11 included studies, 4 were prospectively designed and 7 were retrospective studies. The overall effect showed recurrence rate (Z:2.69, P:0.007) was lower among endoscopic technique. Post-operative pain was less among the endoscopic technique and there was no difference between the groups with respect to surgical duration. Although endoscopic technique showed lower residual rate and post-operative vertigo with better graft success rate among the individual studies, the overall analysis showed that the difference was not statistically significant. Endoscope has been an invaluable tool in the cholesteatoma surgery over the past 20 years due to its excellent optics and minimally invasive technique. Evaluation of the present data available in the literature reveals that both the techniques have similar outcomes except for a definite advantage of endoscopic technique in reducing the recurrence and post-operative discomfort.

Mini-Incision Parotidectomy-Our Technique.

Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to improve the aesthetic outcome and at the same time for complete disease clearance with reduced complications. In this study, we evaluated the feasibility of our mini-incision parotidectomy technique along with the surgical and quality of life (QOL) outcomes. This prospective case series was conducted at Apollo Hospitals, Bangalore over a period of 2 years (June 2018-August 2020) and includes 20 patients. The surgical outcomes were assessed in terms of feasibility of mini-incision technique with respect to levels of parotid involved and functional outcomes in terms of presence or absence of complications like facial palsy (temporary or permanent), seroma and Frey's syndrome. Patient related quality of life (QOL) outcomes were assessed in terms of post-operative pain score, patient comfort score and cosmetic score by using numerical rating scale-11 (NRS-11). The mini-incision parotidectomy technique is feasible for lesions in all the parotid levels and conversion or lengthening of incision was not needed in any of the cases. 2(10%) patients had temporary facial palsy (House-Brackman grade III) which was recovered within 3 weeks after surgery. One patient (5%) with adenoid cystic carcinoma had permanent facial palsy. Out of 20 patients 2(10%) had seroma and 1(5%) patient presented with Frey's syndrome. Mean post-operative pain score at 0, 6 and 24 h were 4.8, 3.4 and 1.8 out of 10 respectively. Mean comfort score was 9 out of 10 and mean cosmetic score was 9.5 out of 10. Mini-incision parotidectomy technique can render improved functional as well as aesthetic outcomes after parotidectomy without compromising the surgical clearance of the disease process.

Surgical Landmarks for Parapharyngeal Internal Carotid Artery During Extended Endoscopic Surgery of Nasopharynx: A Cadaveric and Radiological Study.

Nasopharynx is a complex region situated at the center of skull surrounded by various vital neurovascular structures. Surgical access to the nasopharyngeal space poses significant challenges due to the position of the internal carotid artery (ICA). Open approaches to nasopharynx utilize the lateral to medial anatomy but the endoscopic endo-nasal approach warrants knowledge about the medial to lateral anatomy. In this study we attempted to find the consistent surgical landmarks for parapharyngeal portion of internal carotid artery at the level of nasopharynx by means of cadaveric and radiological study. Eight fresh frozen cadavers (16 sides) and 30 CT angiography (60 sides) were included in the anatomical and radiological study respectively. Superior aspect of the torus tubarius was taken as the reference point in cadaveric study and C1-C2 interspace was used as the reference point for the radiological study. The distance between the ICA to the landmarks such as fossa of Rosenmullaer, torus tubarius, medial and lateral pterygoid plates were recorded. The mean distance of ICA to the fossa of Rosenmuller was 8.5 ± 1.4 mm and 9.1 ± 1.1 mm in the cadaveric and radiological study respectively. The mean distance between ICA to torus tubarius was 19.8 ± 1.3 mm in cadaveric and 20.6 ± 1.0 mm in radiological study. The mean distance of ICA to medial and lateral pterygoid plates were 25.3 ± 1.4 mm and 18.2 ± 1.4 mm in the cadaveric study and 25.9 ± 1.2 mm and 18.8 ± 1.3 mm in the radiological study respectively. On correlating the measurements between cadaveric and radiological study, the p values were not statistically significant (p > 0.05). The closest landmark to the ICA was the fossa of Rosenmuller. ICA was located at the same sagittal plane as that of the lateral pterygoid plate. The nasopharynx is a complex anatomical region closely related to ICA. Inadvertent injury to ICA is one of the dreaded complications of nasopharyngeal surgery. Fossa of Rosenmuller is only few millimeters away from the ICA and must be treated very cautiously. During the endoscopic approach, the ICA is at the sagittal plane as of the lateral pterygoid plate. This must be kept in mind when advancing toward the ICA by keeping intact the lateral pterygoid plate when possible and one should stay in the plane of medial pterygoid plate as the ICA lies posterolateral to it. Cadaveric dissections supported by radiological data would definitely aid surgeons to successfully perform surgeries in nasopharynx.

Giant Facial Nerve Schwannoma with Extra-Temporal Involvement: A Series Of Two Cases.

Facial nerve schwannoma is a rare benign tumor of temporal bone arising from the schwann cells with incidence of 0.8%. They can arise from any segment of facial nerve with geniculate ganglion being the most common and labyrinthine segment the second commonest site. Intra-temporal location is common while only 9% of the cases have extra-temporal or parotid gland involvement. Bony remodeling or scalloping of the facial canal and the surrounding bone is the classic radiological feature of schwannoma. However schwannomas of temporal bone location can show bony erosions. The management option depends on site, extent, facial nerve function and hearing status. Surgery is reserved for large tumors with poor facial functions, hearing loss and giddiness. Giant facial nerve schwannoma with extra-temporal involvement is a rare entity with only handful number of cases reported in the literature. We present a series of two cases of giant facial nerve schwannoma with parotid gland involvement.

Anatomical and Surgical Study to Evaluate the Accuracy of "C-M-S" Technique in Facial Nerve Identification During Parotid Surgery.

Facial nerve identification is considered to be a crucial step in parotid surgery as inadvertent injury to the nerve will lead to facial paralysis. Multiple landmarks are described in literature to identify the facial nerve during parotid surgery but controversies remain as the consistency and accuracy of these landmarks vary. Numerous studies exist in literature but they fail to address a single landmark that is most reliable to identify the facial nerve during parotid surgery. The purpose of this study is to find reliable landmarks for identification of the main trunk of facial nerve during parotid surgery by evidence gathered by cadaveric dissection and intraoperative study during parotid surgery and develop a systematic approach to identify the facial nerve trunk. This prospective study included 41 cadavers (82 parotid regions) and 20 patients with parotid pathology who underwent parotidectomy. We evaluated the feasibility of our C-M-S technique to identify the main trunk of facial nerve in both anatomical and surgical study. The relationship of landmarks (tragal pointer, tympanomastoid suture, superior border of posterior belly of digastric muscle) to the facial nerve trunk was assessed and the shortest distance between them from the facial trunk was measured using a slide caliper. The measurements were compared between the anatomical and surgical study. The main trunk of facial nerve was successfully identified in all cases using C-M-S technique in both anatomical and surgical study. Distance of facial nerve trunk to tragal pointer was more in the cadaveric sample (13.04 ± 5.238 mm) compared to live patients (9.95 ± 3.967 mm) with statistically significant difference (p = 0.036). The mean distance of tympanomastoid suture and posterior belly of digastric muscle to the facial nerve trunk was similar in anatomical and surgical study with p value of 0.877 and 0.083 respectively. The tympanomastoid suture, posterior belly of digastric muscle and tragal pointer are the most useful landmarks for facial nerve identification during parotid surgery. In our study we found that the tympanomastoid suture line is the most consistent landmark present in all our cases and being closest to the facial nerve trunk in both anatomical and surgical study. Further we recommend using the "C-M-S technique" in order to locate the main trunk of the facial nerve.

Radiological and cadaveric study of anatomical safe zone for transoral base of tongue surgery.

The aim of this study is to identify a surgical safe zone in base of tongue surgery. Fifteen Fresh frozen cadavers (30 head and neck regions) were included in the anatomical study. Twenty-two CT-angiogram (CTA) scans of neck were included in the radiological study. Surgical safe zone for base of tongue surgery was studied in cadavers and correlated the same in CTA. Depth of the lingual artery (LA) from the tongue surface and distance of origin of lingual artery from tip of greater cornu of hyoid bone was significantly different when comparing anatomical to radiological study (p < 0.005). On protruded position of tongue, lingual artery appeared more close to the tongue surface and was never encountered posterior to foramen caecum. Preoperative CTA evaluation would over-estimate the depth of LA putting the lingual artery at risk during resection. A surgical safe zone exists posterior to foramen caecum and towards the midline.

High Confidence Identification of Cross-Linked Peptides by an Enrichment-Based Dual Cleavable Cross-Linking Technology and Data Analysis tool Cleave-XL.

Cleavable cross-linking technology requires further MS/MS of the cleavable fragments for unambiguous identification of cross-linked peptides. These spectra are sometimes very ambiguous due to the sensitivity and complex fragmentation pattern of the peptides with the cross-linked residues. We recently reported a dual cleavable cross-linking technology (DUCCT), which can enhance the confidence in the identification of cross-linked peptides. The heart of this strategy is a novel dual mass spectrometry cleavable cross linker that can be cleaved preferentially by two differential tandem mass spectrometry methods, collision induced dissociation and electron transfer dissociation (CID and ETD). Different signature ions from two different mass spectra for the same cross-linked peptide helped identify the cross-linked peptides with high confidence. In this study, we developed an enrichment-based photocleavable DUCCT (PC-DUCCT-biotin), where cross-linked products were enriched from biological samples using affinity purification, and subsequently, two sequential tandem (CID and ETD) mass spectrometry processes were utilized. Furthermore, we developed a prototype software called Cleave-XL to analyze cross-linked products generated by DUCCT. Photocleavable DUCCT was demonstrated in standard peptides and proteins. Efficiency of the software tools to search and compare CID and ETD data of photocleavable DUCCT biotin in standard peptides and proteins as well as regular DUCCT in protein complexes from immune cells were tested. The software is efficient in pinpointing cross-linked sites using CID and ETD cross-linking data. We believe this new DUCCT and associated software tool Cleave-XL will advance high confidence identification of protein cross-linking sites and automated identification of low-resolution protein structures.

Selective Neck Dissection Technique in the Treatment of Recurrent Pyriform Sinus Fistula.

The 3rd and 4th branchial arch fistulas are rare conditions which are due to embryological persistence or incomplete developmental anomalies. They have a typical course as described by the embryological development but the presentation of cases with true course as per embryology is rare. These patients usually present with repeated infections, inadequate surgical interventions and recurrences. We present two index cases of 3rd and 4th pyriform sinus fistulas with their varied anatomical course and clinical presentation who were treated by selective neck dissection technique.

Peripheral T Cell Lymphoma of Parotid Gland: A Diagnostic Challenge.

Peripheral T-cell lymphoma of salivary gland is a rare clinical entity most commonly involving the parotid gland and mimics a salivary gland carcinoma. It has an aggressive clinical course with poor prognosis. Majority of the cases are diagnosed after surgical excision whereas the principal treatment is non-surgical (chemotherapy). Core biopsy is an excellent method of identifying these indeterminate lesions pre-operatively which would avoid unnecessary surgical intervention. We present a case report with diagnostic challenge in identifying peripheral T cell lymphoma of salivary gland with the review of literature.

First report of detection and molecular characterization of porcine parvovirus in domestic and wild pigs in Kerala, India.

Porcine parvovirus (PPV) is a DNA virus of the genus Parvovirus of family Parvoviridae. It is the causative agent of many disease problems in pigs such as maternal reproductive failure, stillbirth, mummification, embryonic or fetal death, infertility, abortion and neonatal death. A study was conducted to assess the incidence of the virus in pigs in Kerala State in South India. A total of 38 samples were collected from domestic and wild pigs from different districts of the State. Polymerase chain reaction targeting a 265 bp fragment of the NS1 gene of the virus was carried out. Of the samples tested, 2 (5.26 %) were found to be positive for PPV virus genome, one of which was from a wild pig. One of the positive samples was sequenced and the nucleotide sequence obtained was compared with other sequences of PPV from India and abroad. The results revealed that the sequence had very close similarity to PPV sequences previously reported from India and to that of Chinese isolates. This is the first report of the existence of PPV in domestic and wild pigs in Kerala, India. The study highlights the need to test for the presence of PPV in addition to other infectious agents in diagnosis of cases of reproductive disorders in pigs.