An Insight into the Present Pandemic Scenario (COVID-19) with Respect to Maxfac Speciality.

The December 2019 pandemic killed about 2 million people and impacted countless more. SARS-CoV-2 causes COVID-19. The sickness causes dyspnea, high temperature, dry cough, loss of taste smell, etc., Due to the disease's fast spread, oral and maxillofacial surgical practices must be reconsidered. The World Health Organization, Association of Oral and Maxillofacial Surgeons of India, and other reputable bodies have released guidelines for safe and efficient COVID-19 therapy. This poll seeks surgeons' awareness of these worldwide and national bodies' guidance. A social media poll generated 173 replies, which were analyzed and interpreted. Many surgeons were aware of the recommendations and safety precautions, but others were unaware of the modifications in oral and maxillofacial surgery practice procedures.

A Modified Deep Learning Framework for Arrhythmia Disease Analysis in Medical Imaging Using Electrocardiogram Signal.

Arrhythmias are anomalies in the heartbeat rhythm that occur occasionally in people's lives. These arrhythmias can lead to potentially deadly consequences, putting your life in jeopardy. As a result, arrhythmia identification and classification are an important aspect of cardiac diagnostics. An electrocardiogram (ECG), a recording collecting the heart's pumping activity, is regarded the guideline for catching these abnormal episodes. Nevertheless, because the ECG contains so much data, extracting the crucial data from imagery evaluation becomes extremely difficult. As a result, it is vital to create an effective system for analyzing ECG's massive amount of data. The ECG image from ECG signal is processed by some image processing techniques. To optimize the identification and categorization process, this research presents a hybrid deep learning-based technique. This paper contributes in two ways. Automating noise reduction and extraction of features, 1D ECG data are first converted into 2D pictures. Then, based on experimental evidence, a hybrid model called CNNLSTM is presented, which combines CNN and LSTM models. We conducted a comprehensive research using the broadly used MIT_BIH arrhythmia dataset to assess the efficacy of the proposed CNN-LSTM technique. The results reveal that the proposed method has a 99.10 percent accuracy rate. Furthermore, the proposed model has an average sensitivity of 98.35 percent and a specificity of 98.38 percent. These outcomes are superior to those produced using other procedures, and they will significantly reduce the amount of involvement necessary by physicians.

Anesthetic management and outcomes of patients with Steven-Johnson Syndrome-A retrospective review study.

BACKGROUND AND AIMS: Steven-Johnson Syndrome (SJS) is a rare and severe form of erythema exudative multiforme. Multisystem involvement in SJS and the suspicion of precipitation of the disease with exposure to anesthetic drugs makes anesthesia a challenging task. The concerns during anesthesia are the mucosal lesions and special care that is required to prevent injury to the oropharynx and larynx during airway management and also the drugs used for anesthesia. In the literature, very few isolated case reports or case series are available. Here, we have analyzed the cases of SJS coming for ophthalmic anesthesia, taking into consideration factors like mode of presentation, precipitating factors, associated diseases, types of anesthesia, anesthetic modifications, and various drugs used during anesthesia. MATERIAL AND METHODS: The electronic medical records of 497 cases of SJS who required interventions like ophthalmic examination or surgery (either under local or general anesthesia) over a period of 18 months were analyzed retrospectively. The records were reviewed to obtain the concerned details like anesthesia-inducing agents, muscle relaxants, inhalational agents, and analgesics. The problems concerned with monitoring and intubation were also noted. The data were analyzed and presented as frequency and percentage. RESULTS: Patient age ranged between 9 months and 72 years. Many surgeries were conducted under general anesthesia (441) although a few required local (peribulbar block) anesthesia (56). The drugs administered for general anesthesia were sevoflurane, isoflurane, propofol, thiopentone, vecuronium, and atracurium and those administered for pain management were fentanyl, tramadol, butorphanol, and paracetamol. The patients who were sensitive to nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were not administered the same. None of the patients reacted adversely to the different drugs used for anesthesia. CONCLUSION: Identifying the precipitating factors, understanding the pathophysiology and its implications for anesthesia will help in successfully managing anesthesia in the rare cases of SJS.

FISH for EWSR1 in Ewing's sarcoma family of tumors: Experience from a tertiary care cancer center.

BACKGROUND: : Molecular confirmation of histologic diagnosis has become mandatory for the diagnosis of Ewing sarcoma family of tumors (ESFT). AIM: To validate the diagnosis made by morphology and immunohistochemistry (IHC) by fluorescence in-situ hybridization (FISH) for EWSR1 rearrangement on formalin fixed paraffin embedded (FFPE) tissues. Settings and design: A retrospective and prospective observational study. Material and methods: All patients who had FISH studies for EWSR1 rearrangement for small round cell tumors during 10 years period were included. Demographic, clinical and radiological details were obtained from medical records. Morphology was reviewed with IHC by CD99, FLI1 and others. FISH studies were performed using the break apart probe. Additional molecular studies and IHC were done to resolve the diagnosis in EWSR1 rearranged tumors. Final diagnosis was made by integrating clinical, morphology, IHC and molecular features. RESULTS: There were 81 patients (M: F 45:36, median age 21 years) with 32 skeletal and 49 extra skeletal tumors. CD 99 was positive in 94.52%. FISH for EWSR1 were positive in 59, negative in 13 and failed in 9. The final diagnosis was made as ESFT in 67, angiomatoid fibrous histiocytoma in 3, desmoplastic small round cell tumor in 3, myxoid chondrosarcoma in 2, unclassified in one, synovial sarcoma in 3, and one each of lymphoma and small cell neuroendocrine carcinoma. FISH was positive for ESFT in 89.83% of EWSR1 rearranged tumors. FISH validated the diagnosis made on IHC in 79.10%. FISH resolved the diagnosis in 1.49% CD99 negative tumors. CONCLUSION: FISH is a reliable ancillary technique for the diagnosis of ESFT on FFPE tissues.

Safety of tropicamide and phenylephrine in pupillary mydriasis for cataract surgery.

PURPOSE: A prospective study to evaluate the adverse cardiovascular effects of topical phenylephrine and tropicamide used for pupillary mydriasis before cataract surgery. METHODS: A total of 517 consecutive eyes in 517 patients subjected to routine 0.8% tropicamide and 5% phenylephrine eye drops before undergoing cataract surgery (phacoemulsification and manual small-incision surgery) under local or topical anesthesia in a medical college hospital were analyzed. RESULTS: No untoward cardiovascular effects were seen. The increase in blood pressure after 0.8% tropicamide and 5% phenylephrine eye drops was statistically significant, but it was not relevant as it was within clinically permissible limits. CONCLUSION: The combination of 0.8% tropicamide and 5% phenylephrine eye drops is a safe and effective option for pupillary mydriasis before cataract surgery.

Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar.

INTRODUCTION: A prospective randomized double-blind controlled trial was conducted to evaluate the latency and duration of pterygomandibular nerve block with a mixture of 1.8 ml 2% lignocaine with 1:80,000 epinephrine and 1 ml of 4 mg dexamethasone and its impact on postoperative sequelae after surgical extraction of impacted mandibular third molars. MATERIALS AND METHODS: This study was conducted in 40 subjects referred to the department of oral and maxillofacial surgery; they were divided into 20 subjects each in group A and B with the age range of 18-72 years planned for elective surgical removal of unilateral impacted mandibular third molar. Each patient was randomly selected to receive anesthesia using 1.8 ml 2% lignocaine with 1:80,000 epinephrine in group A or 2.8 ml twin mix (1.8 ml 2% lignocaine with 1:80,000 epinephrine + 1 ml 4 mg dexamethasone) in group B. After injection of the anesthetic solution, the time to anesthetic effect, duration of anesthesia from initial patient perception of the anesthetic effect to the time when the effect subsides, need to reanesthetize the surgical site were recorded, and 10-point visual analog scale (VAS) was used to subjectively assess the overall pain intensity while injecting the study drug, during surgery, and in the postoperative period. RESULTS: Mean VAS value for pain on local anesthetic injection was less in twin-mix group. The time of onset of the local anesthetic was significantly less for the study group T, 51.35 ± 7.15 s when compared with patients in study group C (P less than 0.0001). The duration of soft tissue anesthesia was longer for all the patients in the study group T. On comparative evaluation between study group C and study group T, patients in the control group had more severe swelling and reduction in mouth opening in the postoperative period. CONCLUSION: The addition of dexamethasone to lignocaine and its administration as an intraspace injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the postoperative period after surgical extraction of mandibular third molars.

Frequency and temperature dependent dielectric studies of propylene glycol-sulfolane binary mixtures in the microwave frequency region.

The dielectric permittivity of propylene glycol/sulfolane binary mixtures have been determined at various temperatures in the frequency range of 0.02 ˂ν/GHz˂ 20 using open-ended coaxial probe method. The permitivity spectra of propylene glycol/sulfolane mixtures with an asymmetric shape is observed. The experimental dielectric permittivity, relaxation time values are used to obtain remaining excessive parameters such as excess permittivity (εE), deviation in refractive index (ΔnD) excess inverse relaxation time (1/τ)ε, Kirkwood effective correlation factor (geff) and active thermodynamic parameters. Redlich-Kister polynomial equation is used to fit the excessive dielectric parameters. The molecular interaction between propylene glycol and sulfolane binary mixtures is interpreted in terms of short and long-range interactions among the dipoles. The experimental dipole moment values are compared with the theoretical dipole moment values from DFT/B3LYP, MP2 methods. Natural bond orbital (NBO) analysis is performed on the optimized geometrical structure of the above system to understand molecular interaction between the binary mixtures in terms of hydrogen bonding. The chemical stability of the system is studied from the HOMO-LUMO calculations. The energy of H- bond interaction between propylene glycol and sulfolane binary mixture is calculated from the single point energy calculations, and the results are correlated.

2,6-Diphenyl-3-(prop-2-en-1-yl)piperidin-4-one.

In the title compound, C20H21NO, the dihedral angle between the phenyl ring is 47.5 (1)° and the piperidine ring adopts a chair conformation. In the crystal, mol-ecules are linked by C-H⋯π inter-actions into dimers with the mol-ecules related by twofold symmetry.

Relaxation dynamics of l-alanine in water medium investigated by dielectric relaxation spectroscopy.

The complex dielectric permittivity of L-alanine in aqueous medium at different concentrations and different temperatures were measured in the microwave (0.02 < ν/GHz < 20) frequency region by using open-ended coaxial probe technique. From the reflection coefficient and impedance data, the real and imaginary part of the dielectric permittivity values is determined. It is observed that there is a decrease in the real part of the dielectric permittivity up to certain frequency and an increase in the imaginary part of the dielectric permittivity with increase in the molar concentration of L-alanine in water medium. Based on the experimental data the average relaxation time values are calculated and its behavior is analyzed in terms of bound water and free water molecules. The theoretical dipole moment of L-alanine is calculated at gaseous state as well as in aqueous medium by using PCM and IEFPCM model at HF, DFT/B3LYP and MP2 calculations using 6-311G* basis set. Analysis between experimentally determined parameters and computed dipole moments were discussed. The mean molecular polarizability is calculated from the Lippincott δ function potential model and compared with the Le Fèvre method of polarizability values.

Diagnostic Efficacy of Ultrasound-Guided Fine Needle Aspiration Combined with the Bethesda System of Reporting.

BACKGROUND: Image-guided fine needle aspiration cytology (FNAC) is emerging as an important diagnostic tool in the evaluation of thyroid swellings. AIM: This study aims to assess the efficacy of ultrasound (US)-guided FNAC combined with "The Bethesda system' of reporting as a primary screening test for all thyroid lesions. SETTINGS AND DESIGN: A prospective cohort study was made and all the US-guided FNACs done were followed up to find out the histopathological diagnoses wherever surgery was done. MATERIALS AND METHODS: In all, 1050 patients who underwent US-guided FNAC were studied during a period of 1 year. Age, sex, cytological features, and histological diagnoses were analyzed. Statistical analyses of all the findings were done to derive conclusions. RESULTS: Of the 1050 patients, only 10.5% underwent surgery. Higher than expected rate (as per the Bethesda system) of malignancy was noted with the so-called grey zone lesions. The test results revealed a high level of sensitivity, specificity, and diagnostic accuracy. CONCLUSION: The study showed that The Bethesda System of Reporting Thyroid Cytology provides effective communication between clinician and pathologists thereby enabling clear management strategies. We also concluded that US-guided FNACs offer better results compared with palpation-guided FNACs.

Comparison of efficacy of herbal disinfectants with chlorhexidine mouthwash on decontamination of toothbrushes: An experimental trial.

BACKGROUND: Toothbrushes in regular use can become heavily contaminated with microorganisms, which can cause infection or reinfection. There is a need for toothbrush disinfection methods, which are rapidly effective, cost-effective, nontoxic, and that can be easily implemented. AIM: To compare the efficacy of 3% neem, garlic of concentration 4.15 mg/mL and green tea of concentration 40 mg/mL with 0.2% chlorhexidine mouthwash as toothbrush disinfectants. MATERIALS AND METHODS: The study was a parallel in vitro comparative experimental trial conducted among 75 randomly selected boys aged between 18 years and 21 years. The subjects were divided into five groups, namely, Group I, Group II, Group III, Group IV, and Group V. They were provided with a new set of precoded toothbrushes and nonfluoridated tooth pastes. After 14 days of tooth brushing, the toothbrushes were immersed in antimicrobial solution for 12 h [Group I--distilled water (control), Group II--3% neem, Group III--garlic of concentration 4.15 mg/mL, Group IV--green tea of concentration 40 mg/mL, and Group V--0.2% chlorhexidine] and then subjected to microbial analysis to check the presence of Streptococcus mutans. The t-test and analysis of variance (ANOVA) were done using Statistical Package for the Social Sciences (SPSS) software version 16. RESULTS: All test solutions showed a statistically significant reduction of Streptococcus mutans count (P < 0.001). There was no statistical difference between the efficacies of neem, garlic, and green tea when compared with chlorhexidine mouthwash (P > 0.05). CONCLUSION: Neem, garlic, and green tea are equally efficacious as chlorhexidine and these herbal products can be used as potent alternatives to chlorhexidine as disinfectant for toothbrushes.

Prevalence of Anaemia and Its Associated Risk Factors Among Adolescent Girls of Central Kerala.

INTRODUCTION: Adolescent age group is the window of opportunity to correct nutritional status of children. If we intervene correctly during this period we can prevent future consequences of nutritional deficiencies. Very few studies have been conducted in kerala regarding adolescent anaemia. AIM: To estimate prevalence of anaemia and its associated factors among adolescent girls of central Kerala, India. MATERIALS AND METHODS: A cross-sectional study was conducted among 257 adolescent girls of ettumanoor panchayat, the field practice area of Government Medical College, Kottayam. A pre-designed and pre-tested proforma was used to obtain data regarding socio-demographic details and factors associated with anaemia. Relevant clinical examination of participants were done. Blood samples were analysed using an auto-analyser and stool examination for ova or cyst was done under microscopy. Diagnosis of anaemia was established when haemoglobin was less than 12gm/dl. Data analysis was done using SPSS 16.0. Association between Categorical variables were tested with Chi-square test and continuous variables independent t-test was used. Logistic regression was used to find out independent risk factors. The level of significance was fixed at p-value of < 0.05. RESULTS: The prevalence of anaemia was 21%. Risk factors associated with anaemia in the univariate analysis were presence of ova or cyst in stool (p = 0.003, OR = 2.94) and number of pads per day during menstruation (p = 0.004). Protective factors were hand washing after toileting (p = 0.021, OR = 0.311), hand washing before food intake (p = 0.026, OR = 0.5), foot wear usage (p = 0.022, OR = 0.25) and jaggery consumption (0.042). The factors which were significant in logistic regression were worm infestation, number of pads per day, washing hands before food intake and foot wear usage. CONCLUSION: Worm infestation and number of pads per day during menstruation were found to be risk factors for anaemia. Personal hygiene practices like hand washing and foot wear usage were found to be protective factors.

Descriptive study on selected risk factors and histopathology of breast carcinoma in a tertiary care centre in Kerala, India with special reference to women under 40 years old.

BACKGROUND: Breast cancer is the most common female cancer in Kerala, South India, with the incidence increasing in the past two decades, also in young women. However, there are limited data regarding the burden of disease, its epidemiology and histopathological characteristics in the state. MATERIALS AND METHODS: This desciptive study covered 303 breast cancers evaluated during the period of December 2011 to August 2013 in the Department of Pathology, Government Medical College, Kottayam.The patients were also interviewed regarding selected risk factors. RESULTS: The majority of the cases were 41-60 years of age with a mean at presentation of 53 years. Infiltrating ductal carcinoma was the most common subtype, followed by pure mucinous carcinoma and then lobular carcinoma. Of the cases, 6.6% were nullipara and 52.8% had fewer than or equal to 2 children. Median age at first child birth was 23 years (national value-19.8 years). A significant proportion (15%) had family history of breast cancer. Some 13.5%(41 cases) comprised the young breast cancer group (≤40years) with a mean age at first child birth in them was 27.4 years, 5 being nullipara and 6 having a positive family history. CONCLUSIONS: Breast cancer awareness, better availability of screening techniques and identification and targeting high risk groups all help to tackle the increasing load of breast carcinoma. A good proportion of cases comprised the young breast cancer group (under 40). Younger women should thus also be educated about breast carcinoma-risk factors, symptoms and diagnostic techniques to help in early detection and effective approach esto treatment.

Review of novel clinical applications of advanced, real-time, 3-dimensional echocardiography.

Advances in computer processing speed and memory along with the advent of the microbeam former that can sample an entire crystal of the ultrasound transducer made possible the performance of 3-dimensional echocardiography in real time (RT3DE). The miniaturization of a 3-dimensional transducer permitting its extension to transesophageal mode rapidly expanded its use in a variety of conditions. Recent development of user-friendly automated/semiautomated cropping and display software may make it rather simple, even for the novice to gather useful information from RT3DE. We discuss the background, technique, and cutting-edge research and novel clinical applications of advanced RT3DE, including left ventricular dyssynchrony assessment, 3-D speckle tracking, myocardial contrast echocardiography, complete 4-dimensional (4-D) shape and motion analysis of the left ventricle, 4-D volumetric analysis of the right ventricle, 3-D volume rendering of the mitral valve, and other percutaneous and surgical procedural applications.

A study of psoriasis and quality of life in a tertiary care teaching hospital of kottayam, kerala.

BACKGROUND: Psoriasis is a chronic skin disease which has an impact on health-related quality of life (QoL). The psoriasis disability index (PDI) is a simple 15-item questionnaire which is used to assess overall psoriasis disability. OBJECTIVES: (1) To assess the health-related QoL among patients with psoriasis, attending dermatology OPD of Medical College Hospital, Kottayam. (2) To find out the association of QoL with age and gender. MATERIALS AND METHODS: This was a descriptive case series study conducted in Dermatology OPD of Medical College Hospital, Kottayam, Kerala. Psoriasis patients attending the Dermatology OPD of Medical College Hospital for 2 months were assessed. RESULTS: Out of the total 32 patients, 56.2% were males, whose mean age was 45; 72% were married, 47% had education above plus two and were employed. Also, 34% had income above Rs. 3000 per month. Among the PDI subsets, daily activities were affected the most (90.6%), followed by work (84.4%), leisure activities (71.9%), problems with treatment (68.7%) and the least affected was personal relations (62.5%). Overall PDI score (median 14.5, interquartile range 4.5-22) showed that the QoL was affected in 75% of which 9.4% were mild (score < 9), 31.2% were moderate (score 10-18) and 34.4% were severe (score > 18). There was no association between the total PDI score and age or gender. CONCLUSION: QoL was affected in 75% of psoriasis patients. There was no association between QoL and age or gender.

Assessment of systolic and diastolic left ventricular and left atrial function using vector velocity imaging in Takotsubo cardiomyopathy.

Five adult patients with Takotsubo cardiomyopathy (TC) diagnosed by usual criteria were studied with velocity vector imaging (VVI) on admission and at follow-up, when their LV function had improved, as assessed by 2D TTE wall-motion score (WMS) index. Averaged peak segmental longitudinal strain (S) in systole, and velocity (V) and strain rate (SR) in both systole and diastole were measured from apical 4- (A4C) and 2-chamber views (A2C) in all patients. The data obtained by VVI were analyzed separately for involved and uninvolved segments, which were independently assessed by WMS. In the involved segments, systolic S, V, SR, and diastolic SR improved (P-value < 0.05) on follow-up. Diastolic V showed a trend toward improvement but did not reach statistical significance. In the uninvolved segments, none of the parameters improved significantly either during systole or diastole. In three of these five patients, left atrial (LA) walls were also studied by placing region of interest (ROI) points in the middle of each wall. Peak segmental LA systolic and diastolic V and SR as well as systolic S were obtained for both involved and uninvolved LA walls which were assessed independently using WMS similar to LV. In the involved LA walls, none of the atrial systolic and diastolic parameters changed significantly but all parameters with the exception of systolic V showed a tendency toward improvement during follow-up. Among the uninvolved LA walls, none changed significantly but atrial systolic SR and, diastolic V and SR tended to increase during follow-up. Our retrospective study using VVI demonstrates that TC patients also have LV systolic and diastolic longitudinal dysfunction, not just systolic radial dysfunction as assessed by traditional 2D TTE indices. Longitudinal LA dysfunction may also be present.

Effect of alcohol-induced septal ablation on left atrial volume and ejection fraction assessed by real time three-dimensional transthoracic echocardiography in patients with hypertrophic cardiomyopathy.

Alcohol-induced septal ablation (AISA) is an accepted treatment for hypertrophic cardiomyopathy (HCM) patients with left ventricular (LV) outflow obstruction who are unresponsive to medical therapy. As left atrial (LA) enlargement has been correlated with increased morbidity and mortality in HCM, we assessed LA volumes and ejection fraction (EF) prior to and after AISA using real time three-dimensional (3D) transthoracic echocardiography (TTE) in 12 patients (9 women; mean age 52 +/- 15 years; 11 Caucasian). All patients underwent successful AISA with no complications and their resting left ventricular outflow gradients decreased from 40.5 +/- 22.2 to 9.1 +/- 17.6 mmHg (P < 0.001) while their gradients with provocation decreased from 126.2 +/- 31.7 to 21.8 +/- 28.0 mmHg (P < 0.001). All patients showed improvements in their New York Heart Association (NYHA) functional class. Both the LA end-systolic (45.2 +/- 12.9 to 37.2 +/- 13.7 ml, P < 0.0001) and end-diastolic (79.6 +/- 18.9 to 77.1 +/- 18.6 ml, P = 0.001) volumes decreased after AISA. The LA EF increased from 43.1 +/- 9.0 to 52.5 +/- 8.8% (P = 0.001). The increase in LA EF correlated with the decrease in the resting left ventricular outflow gradient (R =-0.647, P = 0.03). In conclusion, 3D echocardiography can be utilized to follow LA function after AISA for HCM. AISA results in clinical improvement in patients with HCM and in improvement of LA EF that is correlated with the decrease in the left ventricular outflow gradient.

Amorphous calcific tumor of the mitral annulus echocardiographically mimicking a vegetation.

We describe echocardiographic findings in an elderly patient with histologically proven amorphous tumor involving the posterior mitral annulus, mimicking a vegetation.

Live/real time three-dimensional transthoracic echocardiographic description of chordoma metastatic to the heart.

We describe live/real time three-dimensional transthoracic echocardiographic features of a chordoma metastatic to the heart and correlate its appearance with the surgical pathology.