Artificial intelligence in clinical medicine: catalyzing a sustainable global healthcare paradigm.

As the demand for quality healthcare increases, healthcare systems worldwide are grappling with time constraints and excessive workloads, which can compromise the quality of patient care. Artificial intelligence (AI) has emerged as a powerful tool in clinical medicine, revolutionizing various aspects of patient care and medical research. The integration of AI in clinical medicine has not only improved diagnostic accuracy and treatment outcomes, but also contributed to more efficient healthcare delivery, reduced costs, and facilitated better patient experiences. This review article provides an extensive overview of AI applications in history taking, clinical examination, imaging, therapeutics, prognosis and research. Furthermore, it highlights the critical role AI has played in transforming healthcare in developing nations.

A Case of Disseminated Melioidosis With Cerebritis.

Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative, facultative intracellular bacterium. Because melioidosis can mimic many diseases, it requires more advanced laboratory facilities with the necessary expertise and can become an underdiagnosed yet serious infection with high mortality and morbidity. Our patient is a middle-aged male with new-onset uncontrolled type 2 diabetes mellitus who presented with high-grade fever, productive cough and altered mental status. CT thorax showed diffuse middle and lower zone consolidation while MRI brain noted meningitis with cerebritis. Blood culture grew Burkholderia pseudomallei. The patient was started on meropenem for melioidosis, however, no adequate improvement was seen. In view of this inadequate response, parenteral cotrimoxazole was added. Significant improvement was noted and cotrimoxazole was continued for six months.

Aspirin vs Clopidogrel: Antiplatelet Agent of Choice for Those With Recent Bleeding or at Risk for Gastrointestinal Bleed.

Antiplatelet agents are used worldwide mainly for primary and secondary prevention of cardiovascular events on a long-term basis for mortality benefit. Gastrointestinal bleeding is a well-known adverse effect. Various factors are to be considered while choosing antiplatelet agents to prevent the risk of bleed and rebleed incidents. These range from deciding on the agent, timing of therapy, underlying indications, coadministration of proton pump inhibitor, etc. At the same time, one must weigh the risks of cardiovascular events secondary to the stoppage of antiplatelet therapy. With this review, we have tried to guide the clinician on decision-making regarding the care of patients on management of acute upper and lower gastrointestinal bleeding, stoppage, restarting of agents, and measures to prevent a recurrence. We have focused on aspirin and clopidogrel as they are among the most widely used antiplatelet agents.

Hemophagocytic lymphohistiocytosis: A scourge for the physician and bane to the bone marrow.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by hyperinflammation. It can occur due to primary genetic defect or secondary to other etiology such as infection and rheumatological conditions. Clinical features include fever, cytopenia, organomegaly and several laboratory abnormalities. It can be a life-threatening condition secondary to worsening cytopenia and multiorgan dysfunction. Aims and Objectives: To study the clinical profile of HLH in a tertiary care hospital in Southern India. Materials and Methods: Our study has reviewed nine cases of HLH among adult patients presented over 5 years (2017-2022). Results: The majority of our cases were secondary to infection and had a hospital stay over two weeks and with a good response to steroid and immunomodulators. Conclusion: We would like to stress upon the importance of awareness of such a condition so that there can be early suspicion and workup including bone marrow examination, enabling early initiating of specific therapy for this fatal condition.

Résumé Contexte: L'hémophagocytose lymphohistiocytaire (HLH) est une affection caractérisée par une hyperinflammation. Elle peut survenir en raison d'un défaut génétique primaire ou être secondaire à d'autres étiologies telles que l'infection et les affections rhumatologiques. Les caractéristiques cliniques comprennent de la fièvre, une cytopenie, une organomégalie et plusieurs anomalies de laboratoire. Il s'agit d'une affection potentiellement mortelle en raison de l'aggravation de la cytopenie et du dysfonctionnement multi-organes. Objectifs: Étudier le profil clinique de l'HLH dans un hôpital de soins tertiaires du sud de l'Inde. Matériel et méthodes: Notre étude a examiné neuf cas d'HLH chez des patients adultes sur une période de 5 ans (2017-2022). Résultats: La majorité de nos cas étaient secondaires à une infection et ont nécessité une hospitalisation de plus de deux semaines, avec une bonne réponse aux stéroïdes et aux immunomodulateurs. Conclusion: Nous tenons à souligner l'importance de la sensibilisation à cette affection afin qu'il puisse y avoir une suspicion précoce et des examens approfondis, y compris une ponction de moelle osseuse, permettant ainsi de démarrer rapidement une thérapie spécifique pour cette affection mortelle. Mots-clés: Score H, hémophagocytose lymphohistiocytaire, immunosuppression, hémophagocytose lymphohistiocytaire secondaire.

Liver: Function and dysfunction in COVID-19.

Context: COVID-19 is known to cause extrapulmonary manifestations, including gastrointestinal and abnormal liver functions. Multiple mechanisms have been proposed to explain the pathobiology of liver damage: ACE2 receptor cholangiocytes mediated systemic inflammation, cytokine storm, hyperinflammation, and hypoxic changes. This was a cross-sectional study done in Department of General Medicine,JJM Medical College Davangere between July and September 2020 of patients falling under Category B and Category C. Materials and Methods: The aim is to describe the clinical characteristics in patients of COVID-19 and investigate the gender difference with particular regard to liver impairment.Confirmation of COVID-19 positivity was based on RT-PCR for SARS-CoV-2 RNA. Laboratory investigations and clinical data was analyzed using SPSS Statistics 27. Results: The final study population consisted of 116 patients. On performing the Mann Whitney U test, adjusted P values reveal a significant difference in ALT (P = 0.0348), total bilirubin (P = 0.0012) and direct bilirubin (P = 0.0024). The degree of hypoalbuminemia in males was significantly higher than in females (P = 0.0075). Other biochemical parameters, however, did not show significant difference amongst patients based on gender. Acute kidney injury was the most prevalent condition, present in 67.2% of the patients. Other co-morbidities were diabetes mellites, chronic liver disease, hypertension, hepatitis B and C, and hypothyroidism. Conclusion: Ultrasonography of the abdomen is an essential investigation for all patients testing positive for COVID-19. Pre-existing disease may aggravate the viral hepatic injury, thereby worsening the clinical outcome. The profiles of liver toxicity of the drugs used in the treatment of COVID-19 also warrant watchful monitoring of liver function.

Hiccups and hyponatremia: Unusual co-presentation in COVID-19.

Coronavirus disease (COVID-19) is the newly discovered infectious disease, affecting millions worldwide. Majority of the patients present with mild respiratory syndrome. Some neurological symptoms are reported like anosmia & dysgeusia. We are presenting a case with hiccups as an unusual symptom. An elderly male patient presented to Bapuji teaching hospital attached to JJM medical college, Davangere on 24th July 2020 with intractable hiccups in the last 5 days. There were no other symptoms. Patient's saturation was initially 98% at room air which then dropped to 90%. Based on clinical knowhow, SARS-Cov-2 RNA qualitative RT-PCR test was sent, and the results came positive. Patient improved symptomatically in 2 days and was kept in ward for observation for a total of 7 days. This extremely rare case report brings to light new atypical symptom of COVID-19 are being presented every other day, which shows how the importance being aware of the same.

Prognosis of COVID-19: Red Cell Distribution Width, Platelet Distribution Width, and C-Reactive Protein.

Introduction Cytokine storm is central in the pathobiology of Coronavirus disease 2019 (COVID-19). The pro-inflammatory state and hypoxia disrupt erythropoiesis leading to alterations in red cell distribution width (RDW) and hematocrit. Platelet production increases alongside its destruction, inviting newly formed immature platelets into the circulation. Thus, the platelet distribution width (PDW) and mean platelet volume (MPV) are also affected. The study's objective is to analyze these indices and C-reactive protein (CRP) to elucidate prognostic insights in COVID-19 patients at the time of admission. Methodology This study was a retrospective cross-sectional study conducted at Chigateri General Hospital, attached to JJM Medical College, Davangere, over two months, July and August of 2020. Patients falling under categories B and C according to the interim guidelines issued by the Ministry of Health and Family Welfare, Government of India were enrolled in this study. Patients requiring mechanical ventilation and those with a prior diagnosis of malignancy were excepted from the study. Results The study population comprised a total of hundred patients. Seventy-five patients survived the disease and were discharged; twenty-five patients succumbed to the viral illness. The mean age of survivors (43.0 +/- 13.6 years) was significantly lesser than that of non-survivors (59.1 +/- 11.5 years) (p <0.001). RDW was significantly different among survivors (p=0.002); PDW and CRP were lower among the deceased (p=0.05 and p=0.10, respectively). Cut off values for RDW as 15%, CRP as 67 mg/l, and PDW as 17% were significantly associated with mortality. Hematocrit and MPV were not significantly associated with mortality. RDW has a sensitivity of 92% and a negative predictive value of 95% in predicting mortality. Discussion RDW showed a significant association with increased mortality. Impaired cell-mediated immunity at the onset of infection is responsible for rapid progression to moderate or even severe COVID disease. Since the investigations in our study were ordered at the time of admission, it may lead us to believe that higher RDW is associated with a better patient outcome. Lower C-reactive protein levels are associated with higher mortality. CRP is a non-specific marker for inflammation. Raised CRP is customarily an indicator of acute inflammation. Notwithstanding, the raised CRP may be an indicator of baseline immune response in early COVID infection. High PDW shows a significant association with increased mortality. The pathobiology of change in platelet indices in COVID-19 patients is presumably multifactorial: infection of the bone marrow; autoimmune platelet destruction; platelet sequestration.  Conclusion Red cell distribution width, platelet distribution width, and C-reactive protein are useful early predictive markers of mortality in COVID-19. Although serial investigations would provide a better picture, these indices at admission can gauge the clinical outcome early in the disease. As there is still a lot to be understood about the natural history of COVID-19, our study aims to propose relatively inexpensive indices of mortality that can aid efficient management.

Insulin, Insulin Everywhere: A Rare Case Report of Rabson-Mendenhall Syndrome.

Rabson-Mendenhall syndrome (RMS) is a rare autosomal recessive disorder characterized by severe insulin resistance, a condition in which the body's tissues and organs do not respond appropriately to the hormone insulin. Insulin resistance impairs blood sugar regulation and ultimately leads to diabetes mellitus. A 19-year-old male presented with joint pain, blurring of vision, and generalized weakness. Investigations revealed hyperglycemia (random blood sugar (RBS) > 625 mg/dL, glycosylated hemoglobin (HbA1c) 18%), as well as sugars, protein, and ketone bodies in urine routine examination. An ultrasound of the abdomen was normal. Cardiac status was normal. Based on the clinical features, particularly the head to toe examination, skin changes, and the onset of type 2 diabetes mellitus, RMS syndrome was considered. The joint pain was alleviated with intravenous tramadol. Actrapid®, a fast-acting insulin, was given to control sugar levels, along with metformin. Vitamin B12 and pregabalin were also supplemented. A dermatological cream containing ammonium chloride, calcium lactate, glycerin, potassium chloride, sodium dihydrogen phosphate, and urea was given for skincare. It is an extremely rare disease with a frequency of fewer than one million people worldwide. Most patients survive only up to 15 years of age, although some can live into their third decade of life. Hepatic gluconeogenesis and fatty acid oxidation are affected, leading to ketoacidosis. The progression is much faster in RMS. In RMS, the genetic defect affects the insulin receptor (INSR) gene transcription with non-sense mutations and causes splicing defects. This results in premature chain termination and eventually to lower amounts of the insulin receptor messenger ribonucleic acid (mRNA). Ultimately, the number and density of insulin receptors in the plasma membrane are smaller, making the cells resistant to insulin. Herein, we report the case of a 19-year-old patient with RMS who was treated in our hospital, leading to a successful improvement in symptoms and discharge of the patient.

Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19.

Background and objective Neutrophils are primarily responsible for activating the immune system, and systemic inflammation destroys CD4+ T lymphocytes and increases suppressor CD8+ T lymphocytes, thereby leading to an increased neutrophil-to-lymphocyte ratio (NLR). An increase in the apoptosis of lymphocytes leads to lymphopenia and elevated thrombopoietin (THPO) promotes megakaryocyte production. The reflections of these inflammatory changes can be vital in gauging the progression of the disease. This study aimed at examining the prognostic value of normal and derived neutrophil-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte, and mean platelet volume (MPV)-to-platelet count ratios in patients with coronavirus disease 2019 (COVID-19). Methodology This was a retrospective cross-sectional study conducted in the wards of Chigateri General Hospital, Davangere for a period of two months. Complete blood count was ordered for all patients at the time of admission along with confirmation of the disease by reverse transcription-polymerase chain reaction (RT-PCR). Results The final study population consisted of 100 patients. The mean age of patients who survived (43 years) was significantly lower than the mean age of non-survivors (59.1 years), with a p-value of <0.001. NLR was raised in 60% of the population and was significantly higher in patients who survived the disease, with a p-value of 0.004. The platelet-to-lymphocyte ratio (PLR) also followed a similar trend with a p-value of 0.017. Even though the lymphocyte-to-monocyte ratio (LMR) also mimicked the trend, the statistical association was not significant (p-value: 0.09). The derived NLR and MPV-to-platelets ratios were not found to be significantly associated with mortality in this study. Discussion Younger patients had better clinical outcomes in our study population compared to the geriatric age group. A significant correlation between LMR and mortality was observed when a cut-off of 2.5 was considered as a differentiating benchmark. Conflicting trends were observed in NLR and PLR in our study; however, LMR was in accordance with most other studies. The phase that a patient is in with regard to the natural history of the disease also influences the blood cell ratios. Nonetheless, all three ratios can be used as crucial screening and prognostic tools as they are readily available with the help of a complete hemogram. This is an investigation modality that is widely accessible even in remote areas and resource-limited settings. Conclusion These hematological ratios can facilitate in categorizing the disease severity and progression in patients, thereby enabling us to make appropriate and informed clinical decisions. Since the second wave of the novel coronavirus is on the verge of arrival, it is imperative to channel resources for the patients early in their disease course to ultimately prevent complications and reduce mortality.

Dengue Fever: Prognostic Insights From a Complete Blood Count.

Introduction Dengue fever is endemic in more than 100 countries. Early indicators of prognosis are vital to reduce the fatality rate associated with dengue fever. The objective of this study is to investigate the value of a complete blood count (CBC) in determining the prognosis of dengue fever. Methodology This was a retrospective study of all patients admitted to Chigateri General and Bapuji hospitals, Davangere over two months. Fifty-six patients were included in the study. Medical records were accessed to obtain data on the clinical profile and laboratory investigations. Results Thrombocytopenia was the most common hematological feature, in 50 cases (~90%), followed by leukopenia in 43 cases (~76%). The duration of hospital stay ranged from two to seven days. Interestingly, the percentage of lymphocytes in the differential leukocyte count at the time of admission showed a significant negative correlation with the duration of hospital stay (p=0.028). Also, three distinct trends were observed in the sequence of recovery of platelets and white blood cells (WBCs). Discussion A repertoire of prognostic indicators have been described to predict the course and outcome of dengue fever: liver enzymes, interleukins 4 and 10, tumor necrosis factor α (TNFα), some proteases, soluble adhesion molecules, the surface area of atypical lymphocytes, high fluorescent lymphocyte counts, immature granulocytes and immature platelet factor (IPF). However, these markers are not routinely employed due to financial constraints and lack of infrastructure. The percentage of lymphocytes in the differential leukocyte count performed at the time of admission predicted the length of hospital stay. The higher the percentage of lymphocytes, the faster the recovery from dengue and shorter the duration of stay in the hospital. This is particularly important in remote areas with limited laboratory facilities. High-risk patients can be referred to a higher centre before they develop complications of the disease. Conclusion The complete blood count can function as an early indicator of prognosis in dengue fever even in areas where sophisticated biomedical infrastructure is lacking. The lymphocyte percentage on admission could significantly predict the length of hospital stay.

Allopurinol: Sorrow to the marrow.

Allopurinol is a xanthine oxidase inhibitor used in management of chronic gout. It acts by reducing the amount of uric acid by inhibiting purine metabolism. A middle-aged hypertensive female who was on allopurinol for 7 months presented with generalized weakness and exertional dyspnea. Investigations revealed pancytopenia: normocytic normochromic anemia (Hb-3.2g/dL, TLC-3400/mm3) and severe thrombocytopenia (Platelets-1000/mm3) with mild hepatosplenomegaly and grade 2 medico renal disease with normal cardiac status. Nutritional, hemolytic and infective causes were ruled out. She was transfused with fresh whole blood, platelets, administered empirical antibiotics and started on steroids. Initially, she responded to treatment but later developed an episode of convulsions with anuria and succumbed to leukopenic sepsis secondary to hypo/aplastic anemia probably due to allopurinol. Allopurinol is used extensively in the management of chronic gout and is well tolerated due to its safety profile. But we here report a case of allopurinol induced aplastic anemia leading to the demise of a patient. Allopurinol though safe needs careful monitoring.

Study on the Relation between Colorectal Cancer and Gall Bladder Disease.

INTRODUCTION: Colorectal cancer is cancer of the large intestine, the lower part of digestive system which includes the sigmoid colon and rectum. AIM: To study the relation of incidence of colorectal cancer with previous gall bladder disease or post-cholecystectomy status, a relation between gall bladder disease and smoking in particular and the most common region of colon involved in colorectal cancer in gall bladder disease and non-gall bladder disease patients. MATERIALS AND METHODS: A total of 256 patients with symptoms of rectal bleeding, change in bowel habit, unexplained tiredness, weight loss, pelvic pain, jaundice and abdominal distension were screened by using colonoscopy among whom 30 patients were diagnosed with colorectal cancer. Detailed history was taken with the help of a modified questionnaire and the patients were assessed, examined and the list of investigations such as faecal occult blood test, ultrasound of abdomen and pelvis, colonoscopy, sigmoidoscopy, barium enema, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) of the abdomen and pelvis, tumour markers like Carcinoembryonic Antigen (CEA) and biopsy were collected. Patient pool was categorized into Gall Bladder Disease (GBD) and Non Gall Bladder Disease (NGBD). Proportions test and Fisher's-Exact test were used to calculate the p-values. RESULTS: Ten patients had previous gall bladder disease (33%) which was significant with a p-value of 0.016 by proportions test. Two patients underwent cholecystectomy, two patients underwent Endoscopic Retrograde Cholangio Pancreatography (ERCP) and the remaining six patients did not take any treatment for their gall bladder disease. Five patients with previous gall bladder disease were found to be smokers with a p-value of 0.091. The average age was 47.2 years in males and 42.2 years in females. Males constituted 66.6% (20 males) of the diseased population whereas, females constituted 33.4% (10 females). Rectal bleeding and altered bowel habits were the commonest symptoms. Confirmation of the disease was proven using CT abdomen and biopsy. Right sided colorectal cancer was common in GBD patients. Left sided colon cancer was common in NGBD patients. CONCLUSION: This study established a statistically significant risk of colorectal cancer following cholelithiasis though no risk was apparent following cholecystectomy.

An In-vitro Comparative Stereomicroscopic Analysis and Evaluation of Marginal Accuracy in Porcelain Fused to Metal Copings Fabricated in Two Different Finish Lines Using Variant Die Materials.

INTRODUCTION: Limited published information is available about the influence of preparatory designs and die materials on marginal accuracy of porcelain fused to metal copings using recently developed die materials. AIM: To detect the influence of margin geometries and dimensional accuracy of contemporary die materials on vertical marginal gaps in Porcelain fused to metal coping using a Stereomicroscope (three dimensional analysis). MATERIALS AND METHOD: Two chrome cobalt alloy models of mandibular first molars prepared to have shoulder and deep chamfer finish lines were CAD-CAM milled. Elastomeric impressions of these models were made in a custom tray, poured in Type IV Gypsum(n=10) and Resin modified Gypsum(n=10) and also packed with Epoxy resin (n=10) as a die material to form a total of 60 samples, 30 in each group (shoulder and deep chamfer). Wax patterns were fabricated, invested and castings in ceramic alloy were obtained in traditional manner. These copings were later analyzed on CAD/CAM models using stereomicroscope. RESULTS: Both the designs did not exhibit significant difference (p<0.05). Whereas, the three die materials exhibited significant difference (p<0.05) by Two way ANOVA test and Tukey's multiple Post Hoc test. Results from this study showed that vertical marginal gaps for copings fabricated on resin modified gypsum as a die material were within the clinically acceptable range. CONCLUSION: Margin geometries both shoulder and deep chamfer have equal influence on vertical marginal gaps in metal ceramic restorations. Copings fabricated on Epoxy resin dies exhibited highest value of vertical marginal discrepancy, where as least value was determined for copings constructed on dies fabricated from resin modified gypsum.

Factors Contributing Towards Poor Asthma Control in Patients on Regular Medication.

INTRODUCTION: In-spite of the availability of effective medications, it is observed that patients with bronchial asthma on treatment are poorly controlled. An objective evaluation of asthma control especially with respect to inflammation and the factors contributing towards poor control is crucial in obtaining relief of symptoms. AIM: 1) To measure the asthma control using modified Mini Asthma Quality Of Life Questionnaire (MAQOL) and sputum eosinophil count; 2) To identify the role of factors viz. age, duration of asthma, severity, compliance, technique of inhalation and knowledge of asthma action plan on asthma control. MATERIALS AND METHODS: Total 50 asthmatic patients on regular medication were included in the study after obtaining written informed consent. The asthma-control was evaluated based on history, clinical symptoms, need for short-acting bronchodilators, FEVs1 and sputum eosinophil count with the help of modified MAQOL. A global score of <80% was considered as poor control. The proportion of patients under each factor, in poorly-controlled group (PC) was compared with the well-controlled group (WC). The results were analysed using descriptive statistics and unpaired student's t-test. RESULTS: Of the total, 33 (66%) patients were in PC category with a mean global asthma score of 58.46 ± 2.881 vs 85.2 ± 1.19 in the WC group (34%) (p<0.05). The mean age in PC was 41.41 ± 2.413 vs 29.00 ± 2.157(p<0.05) in the WC. The mean duration of asthma was 16.76 ± 2.761 in PC vs 7.882 ± 2.065 years in WC (p<0.05). The severity score was 7.265 ± 0.4434 in PC vs 6.706 ± 0.64 in WC. Eight patients in PC and six in WC were unaware of the treatment plan. One in PC group and three in WC were unaware of technique of inhalation. One in PC group and three in WC were non-compliant. Mean sputum eosinophil count was 7.441 ± 1.081 in PC vs 5.176 ± 1.201 in WC. CONCLUSION: MAQOL is useful in evaluating asthma-control. Sputum eosinophil count correlates with asthma-control. Duration of asthma, age and severity contributed significantly to the poor control of asthma. There is a need for an objective monitoring in asthma and the treatment strategies need to be modified accordingly.

A Study of Prescription Pattern of Neutraceuticals, Knowledge of the Patients and Cost in a Tertiary Care Hospital.

INTRODUCTION: Neutraceuticals are increasingly becoming a part of diet in a health-conscious society. People have changed their outlook towards neutraceuticals because of varying lifestyle diseases and they see the need to improve their physical and mental health. AIM: To study the prescription pattern by doctors, knowledge of patients, cost for patients and patient satisfaction regarding neutraceuticals. MATERIALS AND METHODS: Total of 120 patients were included in the study after obtaining written informed consent. The patients were interviewed and the prescriptions and bills were scrutinized. The data was gathered based on a structured pretested questionnaire comprising of socio-demographic variables, their knowledge of neutraceuticals and history of regular usage, reason for their use, total cost for a month on neutraceuticals alone. The data was analysed using tests of proportions and percentages. RESULTS: Vitamins were prescribed maximum in Internal Medicine (51%), Orthopaedics (43%) and Surgery (37%). Minerals were prescribed maximum in Obstetrics and Gynaecology (30%). 66% of the patients were aware about neutraceuticals. The awareness was maximum in medicine department (70%) and least in surgery department (63.3%). The study showed that the average amount that the patients spent was Rs 357.45 per month on neutraceuticals alone, maximum was Rs 557 in orthopaedics and minimum was Rs 219 in medicine respectively. A 61.6% of the patients expressed their satisfaction after taking the neutraceuticals. However, 12.45% of the patients were dissatisfied even after taking the neutraceuticals. CONCLUSION: Neutraceuticals are being increasingly perceived as beneficial to health and are being continuously used in the treatment of various diseases. Therefore, it is imperative that a doctor educates the public and creates an awareness of the required amount of neutraceuticals that can be safely used. The future of neutraceuticals is bright and can transform healthcare in a developing country like India which utilizes a large number of natural compounds.

Forensic odontology: A prosthodontic view.

The most common role of the forensic dentist is the identification of deceased individuals. Dental identifications have always played a key role in natural and manmade disaster situations, and in particular, the mass casualties normally associated with aviation disasters. Because of the lack of a comprehensive fingerprint database, dental identification continues to be crucial in the world. An all-acrylic resin appliance such as a full denture or an all-acrylic partial denture (or orthodontic appliance), prior to delivery, could be inscribed with the patient's full name on a substrate (paper, metal) and sealed inconspicuously into the surface of a denture by various processes. It has been noted by several authors that in many cases of air disaster where the limbs are completely burnt off, some denture materials survive, especially the posterior part of acrylic dentures and metal-based dentures. Thus, marked dental prostheses (full and partial dentures, mouthguards and removal orthodontic appliances) would lead to rapid identification in the event of accidents and disaster.

Local and systemic effects of unpolymerised monomers.

Methyl methacrylate (MMA), a widely used monomer in dentistry and medicine has been reported to cause abnormalities or lesions in several organs. Experimental and clinical studies have documented that monomers may cause a wide range of adverse health effects such as irritation to skin, eyes, and mucous membranes, allergic dermatitis, stomatitis, asthma, neuropathy, disturbances of the central nervous system, liver toxicity, and fertility disturbances.