The Effectiveness of High-Fidelity Simulation on Clinical Competence Among Nursing Students.

Introduction: Clinical competence is a pre-requisite for every student nurse to showcase their proficiency in providing quality nursing care. Effective clinical experience during the study period plays a pivotal role in developing clinical competence among nursing students. Hence, the purpose of the study was to find the effectiveness of high fidelity simulation (HFS) on clinical competence among nursing students. Objectives: The objectives of the study were to determine the impact of HFS on level of clinical competence among nursing students, to find the association between selected demographic characteristics of nursing students with their level of clinical competence and also, to find the association between academic performances of nursing students with their level of competence. Method: The current study employed a quasi-experimental study design. Sixty-five nursing students from second year Bachelor of Science in Nursing (BSN) program were selected using consecutive sampling technique. The data was collected using demographic data form, objective structured clinical examination (OSCE) grade performa, and academic score sheet. SPSS version 24 was used to analyze data. Results: The study revealed a significant impact of HFS on clinical competence of nursing students. Majority (52.3%) of the nursing students obtained high level clinical competence following the HFS. The findings showed a significant association between gender and medium of instruction with the level of clinical competence of nursing students. Further, there was a significant correlation between academic performance and level of clinical competence of the nursing students. Conclusion: HFS served as a useful pedagogical approach in fulfilling the clinical learning outcomes. It further facilitated readiness of nursing students in second year BSN in terms of developing competence and confidence for clinical placement at the hospital for the third year of their study. However, further research is required to determine if HFS can be used in developing clinical reasoning skills in nursing students.

Antibacterial and Immunomodulatory Properties of Stem Cells from Human Exfoliated Deciduous Teeth: An In Vitro Study.

Stem cells from human exfoliated deciduous teeth (SHED) provide an important autologous source for stem cell-based regenerative therapies with their easy acquisition and multipotency. However, the understanding of their antibacterial and immunomodulatory properties is limited. This in vitro research aims to determine whether SHED inhibits the growth of Streptococcus mutans (S. mutans) and Enterococcus faecalis (E. faecalis), as well as whether or not it has immunomodulatory effects by measuring interleukins (ILs)-2 and -6 levels. SHEDs were derived from the pulp of deciduous teeth that had undergone up to two-thirds of their roots' resorption. Isolated SHEDs were characterized on their morphological features, viability, assessment of surface markers, and in vitro induction into osteocytes and adipocytes. SHED was tested for its antibacterial efficacy against S. mutans and E. faecalis using a colony-forming units (CFU) assay. Lastly, we checked the cytokine levels by enzyme-linked immune sorbent assay (ELISA) for assessing the immunomodulatory properties of SHED. The results showed that the established SHED had fibroblastic morphology with higher viability. The ability to differentiate into osteocytes and adipocytes, as well as the expression of stem cell-specific markers, demonstrated their potential and flexibility under in vitro settings. SHED demonstrated antibacterial characteristics by significantly (p < 0.05) lowering S. mutans CFU, whereas E. faecalis CFU was either unaffected by or just slightly affected by the cells. SHED also helped keep inflammatory indicators, including IL-2 and IL-6, at stable levels when compared to the control. The results indicate that SHED may aid in preventing or reducing an infection due to its antibacterial activity and may provide immunomodulatory activities by controlling the production of cytokines. How to cite this article: Tyagi A, Shetty J, Shetty S, et al. Antibacterial and Immunomodulatory Properties of Stem Cells from Human Exfoliated Deciduous Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-3):S240-S246.

Understanding Long-Term Outcomes of Public Health Strategy in Palliative Care at Micro Level: Impact of Home-Based Palliative Care Services under Local Self-Government Institutions in Kerala, India.

Objectives: Palliative care units under Local Self-Government Institutions (LSGIs) are increasing in number in the state of Kerala, India, since the announcement of the Pain and Palliative Care Policy, 2008. Whether these units are functioning with a view to materialise the long-term objectives, following the guidelines stipulated by the Government of Kerala and serve the neediest patients with quality care are a matter of debate. Hence, a microlevel study of the palliative care unit is attempted. The aims of the study were to understand the extent to which the structure and nature of functioning of the Pain and Palliative Care Unit under LSGI comply with guidelines set by the Pain and Palliative Care Policy of the Government of Kerala and to check whether the palliative care services are reaching the needy and, if so, are they provided to patients in good quality. Materials and Methods: The award winning Pain and Palliative Care Unit attached to LSGI is selected for analysis and a hybrid research design is followed. Data are collected from 25 patients and their caregivers selected randomly. Mean score of satisfaction level on the basis of Quality care questionnaire -Palliative care is used. Results: Sample unit complies with the revised guidelines of 2015, Pain and Palliative Care Policy. It serves the neediest patients and the quality of care is satisfactory. Conclusion: The study reaffirms the strength of the public health model in palliative care which can provide quality care to the neediest patients.

Sagacious Perceptive on Marburg Virus Foregrounding the Recent Findings: A Critical Review.

Infectious diseases are defined as a group of diseases caused by any infecting microorganism which are highly potent to severely affect human life. The end can vary from critical infection to mortality. Most infectious diseases are reported with a rapid rate of transmission. Marburg virus disease is a kind of infectious viral disease usually manifested as hemorrhagic fever. The latest reported case of Marburg virus disease confirmed by WHO was on 6th August 2021 in the south-western province of Guinea. Marburg virus disease exhibit similar manifestations to that of infection with the Ebola virus. Though not widely spread to emerge as a pandemic, Marburg virus disease remains a serious threat to human life. This review emphasizes the novel current facts determined through various studies related to Marburg virus infection. From these promising theories, the review tries to put forward the importance of various study conclusions, which are likely to have a major impact on the health sector in the near future.

Consumption of fruits, vegetables and salt in the context of control of type 2 diabetes and hypertension in Kerala, India.

BACKGROUND: Proper diet is necessary to control hypertension and diabetes. This paper describes the combined fruit and vegetable, and salt intake of adults (>=18 years) who were detected to have hypertension or diabetes. METHODS: We analysed the data from a state-wide survey of 12012 adults using the World Health Organization STEPs for NCD risk factor surveillance. We evaluated the recommended intake of fruit and vegetable (>=5 servings/day) and salt (<5 gm/day) across participants divided into four strata, and the probabilities were also estimated using the fitted multiple binary logistic regression models. RESULTS: Overall, 13.9% (95%CI: 12.2%-15.9%) and 29.4% (95%CI: 28%-30.8%) of participants consumed the recommended level of fruit and vegetable, and salt, respectively. Adjusted odds ratios were not significantly different across the four strata based on the status of treatment and control of diabetes or hypertension. The likelihood of following the recommended fruit and vegetable intake was highest for 50-69-year-old females with above high school education, obese, under treatment for diabetes or hypertension, and had normal values of FBS and BP (0.28). The likelihood for recommended salt intake was highest for 50-69-year-old males with above high school education and had normal BMI, under treatment for diabetes or hypertension, and had normal values of FBS and BP (0.69). CONCLUSION: The status of diabetes or hypertension did not show considerable influence in the fruit, vegetable, and salt intake of adults in general. A detailed exploration of the accessibility and acceptability of such recommended intakes in the Kerala context is warranted.

Tissue-engineered Maxillofacial Skeletal Defect Reconstruction by 3D Printed Beta-tricalcium phosphate Scaffold Tethered with Growth Factors and Fibrin Glue Implanted Autologous Bone Marrow-Derived Mesenchymal Stem Cells.

The study aimed to investigate whether a 3D printed beta-tricalcium phosphate (ß-TCP) scaffold tethered with growth factors and fibrin glue implanted autologous bone marrow-derived mesenchymal stem cells would provide a 3D platform for bone regeneration resulting in new bone formation with plasticity. Twenty 3D printed ß-TCP scaffolds, ten scaffolds engrained with osteogenic mesenchymal stem cells with fibrin glue (group A), and ten scaffolds used as a control group with ß-TCP scaffold and fibrin glue inoculation only (group B) were included in the study. Cell infiltration, migration, and proliferation of human osteogenic stem cells on the scaffolds were executed under both static and dynamic culture conditions. Each scaffold was examined post culture after repeated changes in the nutrient medium at 2, 4 or 8 weeks and assessed for opacity and formation of any bone-like tissues macroscopic, radiographic, and microscopic evaluation. Significant changes in all the prerequisite parameters compiled with an evaluated difference of significance showing maxillofacial skeletal repair via tissue engineering by ß-TCP scaffold and MSCs remains will be the most promising alternative to autologous bone grafts and numerous modalities involving a variety of stem cells, growth factors from platelet-rich fibrin.

Validated HPLC Method for Quantification of a Novel Trk Inhibitor, Larotrectinib in Mice Plasma: Application to a Pharmacokinetic Study.

Larotrectinib, is an orally active novel small molecule approved for the treatment of solid tumors in pediatrics and adult patients. It acts by inhibiting tropomyosin receptor kinase. In this paper, we report the development and validation of a high-performance liquid chromatography (HPLC) method for the quantitation of larotrectinib in mice plasma as per the FDA regulatory guideline. Plasma samples processing was accomplished through simple protein precipitation using acetonitrile enriched with internal standard (IS, enasidenib). The chromatographic analysis was performed using a gradient mobile phase comprising 10 mM ammonium acetate and acetonitrile at a flow-rate of 0.8 mL/min on an X-Terra Phenyl column. The UV detection wave length was set at λmax 262 nm. Larotrectinib and the IS eluted at 3.85 and 6.60 min, respectively with a total run time of 8.0 min. The calibration curve was linear over a concentration range of 0.20-5.00 µg/mL (r2=≥0.992). The intra- and inter-day precision and accuracy results were within the acceptable limits. Results of stability studies indicated that larotrectinib was stable on bench-top, in auto-sampler, up to three freeze/thaw cycles and long-term storage at -80°C. The validated HPLC method was successfully applied to a pharmacokinetic study in mice.

Vibrational Spectroscopy: A Valuable Screening and Diagnostic Tool for Obstetric Disorders?

Preeclampsia (PE) is a common obstetric disorder typically affecting 2-8% of all pregnancies and can lead to several adverse obstetric outcomes for both mother and fetus with the greatest burden of severe outcomes in low middle-income countries (LMICs), therefore, screening for PE is vital. Globally, screening is based on maternal characteristics and medical history which are nonspecific for the disorder. In 2004, the World Health Organization acknowledged that no clinically useful test was able to predict the onset of PE, which prompted a universal search for alternative means of screening. Over the past decade or so, emphasis has been placed on the use of maternal characteristics in conjunction with biomarkers of disease combined into predictive algorithms, however these are yet to transition into the clinic and are cost prohibitive in LMICs. As a result, the screening paradigm for PE remains unchanged. It is evident that novel approaches are needed. Vibrational spectroscopy, specifically Raman spectroscopy and Fourier-transform infrared spectroscopy (FTIR), could provide better alternatives suited for implementation in low resource settings as no specialized reagents are required for conventional approaches and there is a drive to portable platforms usable in both urban and rual community settings. These techniques are based on light scattering and absorption, respectively, allowing detailed molecular analysis of samples to produce a unique molecular fingerprint of diseased states. The specificity of vibrational spectroscopy might well make it suited for application in other obstetric disorders such as gestational diabetes mellitus and obstetric cholestasis. In this review, we summarize current approaches sought as alternatives to current screening methodologies and introduce how vibrational spectroscopy could offer superior screening and diagnostic paradigms in obstetric care. Additionally, we propose a real benefit of such tools in LMICs where limited resources battle the higher prevalence of obstetric disorders.

Macrophage Plasticity in Reproduction and Environmental Influences on Their Function.

Macrophages are key components of the innate immune system and exhibit extensive plasticity and heterogeneity. They play a significant role in the non-pregnant cycling uterus and throughout gestation they contribute to various processes underpinning reproductive success including implantation, placentation and parturition. Macrophages are also present in breast milk and impart immunomodulatory benefits to the infant. For a healthy pregnancy, the maternal immune system must adapt to prevent fetal rejection and support development of the semi-allogenic fetus without compromising host defense. These functions are dependent on macrophage polarization which is governed by the local tissue microenvironmental milieu. Disruption of this microenvironment, possibly by environmental factors of infectious and non-infectious origin, can affect macrophage phenotype and function and is linked to adverse obstetric outcomes, e.g. spontaneous miscarriage and preterm birth. Determining environmental influences on cellular and molecular mechanisms that control macrophage polarization at the maternal-fetal interface and the role of this in pregnancy complications could support approaches to alleviating adverse pregnancy outcomes.

Prevalence of risk factors of non-communicable diseases in Kerala, India: results of a cross-sectional study.

OBJECTIVE: To estimate the prevalence of non-communicable disease (NCD) risk factors in Kerala. DESIGN: A community-based, cross-sectional survey. PARTICIPANTS: In 2016-2017 a multistage, cluster sample of 12 012 (aged 18-69 years) participants from all 14 districts of Kerala were studied. MAIN OUTCOME MEASURES: NCD risk factors as stipulated in the WHO's approach to NCD risk factors surveillance were studied. Parameters that were studied included physical activity score, anthropometry, blood pressure (BP), and fasting blood glucose (FBG) and morning urine sample to estimate dietary intake of salt. RESULTS: The mean age was 42.5 years (SD=14.8). Abdominal obesity was higher in women (72.6%; 95% CI 70.7 to 74.5) compared with men (39.1%; 95% CI 36.6 to 41.7), and also higher among urban (67.4%; 95% CI 65.0 to 69.7) compared with rural (58.6%; 95% CI 56.6 to 60.5) residents. Current use of tobacco and alcohol in men was 20.3% (95% CI 18.6 to 22.1) and 28.9% (95% CI 26.5 to 31.4), respectively. The estimated daily salt intake was 6.7 g/day. The overall prevalence of raised BP was 30.4% (95% CI 29.1 to 31.7) and raised FBG was 19.2% (95% CI 18.1 to 20.3). Raised BP was higher in men (34.6%; 95% CI 32.6 to 36.7) compared with women (28%; 95% CI 26.4 to 29.4), but was not different between urban (33.1%; 95% CI 31.3 to 34.9) and rural (29.8%; 95% CI 28.3 to 31.3) residents. Only 12.4% of individuals with hypertension and 15.3% of individuals with diabetes were found to have these conditions under control. Only 13.8% of urban and 18.4% of rural residents did not have any of the seven NCD risk factors studied. CONCLUSION: Majority of the participants had more than one NCD risk factor. There was no rural-urban difference in terms of raised BP or raised FBG prevalence in Kerala. The higher rates of NCD risk factors and lower rates of hypertension and diabetes control call for concerted primary and secondary prevention strategies to address the future burden of NCDs.

Diagnosis and treatment of herpes simplex 1 virus infection in pregnancy.

A nulliparous woman presented at 21 weeks' gestation with a 72-h history of a rash on her left arm. Initially isolated to the forearm, it had quickly spread, becoming multiple itchy fluid-filled blisters. Blood tests showed mild neutrophilia and raised CRP. Skin swabs demonstrated the presence of herpes simplex virus type 1 (HSV1) DNA. There was no history of previous HSV1 exposure. There is scant literature on uncomplicated cutaneous HSV1 since the majority is oral/genital. The incidence of transmission varies and is dependent on site of infection and immunological status. Type-specific serological testing is recommended to identify a primary first episode infection due to the 30-60% vertical transmission rate. Infection is associated with morbidity and mortality for both mother and fetus including maternal encephalitis, acute retinal necrosis, pneumonia and hepatitis. Neonatal disease can be congenital (cutaneous lesions, microcephaly, hydranencephaly, intracranial calcifications, chorioretinitis, microphthalmia and optic nerve atrophy) or acquired (skin, eyes and mouth disease or central nervous system disease or disseminated disease). Prophylactic aciclovir reduces the number of women with active genital lesions at the time of delivery. If primary infection occurs outside of the first trimester and active genital lesions are present, then vaginal delivery should be avoided. If infection has occurred in the first trimester, vaginal birth can be attempted even in the presence of active lesions. There is no available guidance on prophylactic treatment of non-genital HSV1 in pregnancy.

Multi-Parameter Approach for Evaluation of Genomic Instability in the Polycystic Ovary Syndrome.

BACKGROUND: The polycystic ovary syndrome (PCOS), characterized by hyperandrogenism and chronic anovulation, is a common endocrine disorder in women. PCOS, which is associated with polycystic ovaries, hirsutism, obesity and insulin resistance, is a leading cause of female infertility. In this condition there is an imbalance in female sex hormones. All the sequelae symptoms of PCOS gradually lead to cancer in the course of time. It is heterogeneous disorder of unknown etiology so it is essential to find the exact cause. MATERIALS AND METHODS: In this study both invasive and non-invasive techniques were employed to establish the etiology. Diagnosis was based on Rotterdam criteria (hyperandrogenism, ovulatory dysfunction, PCOM) and multiparameters using buccal samples and dermatoglypic analysis and cytogenetic study for 10 cases and four age and sex matched controls. RESULTS: In clinical analysis we have observed the mean value of total testosterone level was 23.6nmol/L, total hirsutism score was from 12-24, facial acne was found in in 70% patients with 7-12 subcapsular follicular cysts, each measuring 2-8 mm in diameter. In dermatoglypic analysis we observed increases in mean value (45.9°) of ATD angle when compared with control group and also found increased frequency (38%) of Ulnar loops on both fingers (UU), (18%) whorls on the right finger and Ulnar loop on left finger (WU) and (16%) arches on right and left fingers (AA) were observed in PCOS patients when compared with control subjects. Features which could be applied as markers for PCOS patients are the presence of Ulnar loops in middle and little fingers of right and left hand. The buccal micronucleus cytome assay in exfoliated buccal cells, we found decrease in frequency of micronuclei and significant increases in frequency of karyolysed nuclei in polycystic ovarian syndrome patients. Chromosome aberration analysis revealed a significant increase in frequency of chromosome aberrations (CAs) in PCOS patients when compared with controls. CONCLUSIONS: From this present work it can be concluded that non-invasive technique like dermatoglypics analysis and buccal micronucleus cytome assays with exfoliated buccal cell can also be effective biomarkers for PCOS, along with increased CAs in lymphocytes as a sign of genetic instability. There is a hypothesis that micronuclei and chromosomal aberrations could have a predictive value for cancer. From this present work it can be concluded to some extent that non-invasive technique like dermatoglypics and buccal cell analysis can also be effective for diagnosis.

The effect of yoga in stress reduction for dental students performing their first periodontal surgery: A randomized controlled study.

CONTEXT: The dental students experience a lot of stress, which increase when they perform their first surgical procedure. Yoga as an anxiolytic tool in anxiety reduction has been practiced over centuries in India. AIM: To assess the efficacy of yoga in reducing the state trait anxiety of dental students before their first periodontal surgery performance. SETTINGS AND DESIGN: A randomized controlled study using a two-way split plot design (pre-post-test) was conducted in the department of periodontics, Pacific Dental College, Udaipur, India. MATERIALS AND METHODS: One hundred clinical dental students who were ready to perform their first periodontal surgery were selected. Students were randomly assigned to two groups and were given a 60-min session on stress reduction. Group A, yogic intervention group, were instructed to do yoga and their performances were monitored for a period of one week and Group B, control group, were given a lecture on stress reduction without any yoga instructions. The investigator who was unaware of the groups had taken the state trait anxiety score of the students three times a) before assigning them to each group, b) prior to the surgical procedure and c) immediately after the performance of surgery. STATISTICAL ANALYSIS USED: Analyses of variance (ANOVA) by SPSS V.16. RESULTS: The statistical results showed a significant reduction in the VAS and state trait anxiety of Group A compared to Group B (ANOVA; P<0.001). CONCLUSIONS: This study concludes that Yogic breathing has a significant effect on the reduction of state trait anxiety level of dental students.

Simple bone cyst of mandible mimicking periapical cyst.

Simple bone cysts (SBC) are pseudocysts occurring less commonly in the maxillofacial region. The uncertain and unclear etiopathogenesis led to numerous synonyms to refer this particular cyst. These cysts are devoid of an epithelial lining and are usually empty or contain blood or straw-colored fluid. In jaws initially it mimics a periapical cyst and later can lead to cortical bone expansion warranting for radical approach, which is seldom required. SBC is predominantly diagnosed in first two decades of life. Here we report a case of solitary bone cyst mimicking a periapical cyst of a mandibular molar in a 37-year-old patient.

Keratocystic odontogenic tumor with impacted maxillary third molar involving the right maxillary antrum: an unusual case report.

The odontogenic keratocyst (OKC), first described by Phillipsen in 1956, has metamorphosized as a keratocystic odontogenic tumor (KCOT) as reported in WHO classification of head and neck tumors in 2005. KCOT is a benign intraosseous neoplasm of the jaw and its occurrence in maxilla is unusual and its appearance in maxillary antrum along with maxillary impacted third molar is very uncommon. This article reports a case of KCOT associated with impacted maxillary third molar in right maxillary antrum and describes its rare site of occurrence.

Use of temporalis fascia as an interpositional arthroplasty in temporomandibular joint ankylosis: analysis of 8 cases.

PURPOSE: Different interpositional materials have been used to prevent recurrence after gap arthroplasty in temporomandibular joint ankylosis. In this study, the versatility of the temporalis fascia as an interpositional arthroplasty was evaluated. MATERIALS AND METHODS: Eight cases of unilateral temporomandibular joint ankylosis were evaluated, with a follow-up of 11 months to 6 years. RESULTS: Patients had a preoperative maximal interincisal opening of 1 to 9 mm (mean, 2.75 mm). During the last follow-up observation after surgery, patients had a maximum interincisal opening of 32 to 40 mm (mean, 36.5 mm). Deviation to the affected side was observed in all cases. Paresthesia or anesthesia of the temporal branch of facial nerve was absent in all cases. Periodic panoramic radiographs showed that the intra-articular space was well maintained because of interposed tissue, without signs of relapse. There were no signs of reankylosis in any patient. CONCLUSION: The findings of this study show that the temporalis fascia is a good alternative for interpositional arthroplasty.

Periodontal and gingival parameters in young adults with acute myeloid leukaemia in Kerala, South India.

PURPOSE: Patients presenting with leukaemic blast crisis with acute myeloid leukaemia (AML) may have gingival enlargements that interfere with oral hygiene. Few large cohort studies of gingival lesions have been carried out on AML patients. The aim of the present study was to assess gingival and periodontal pathology at the time of presentation, prior to chemotherapy, in a cohort of adult patients presenting at a cancer hospital in Kerala, a region located in southern India. MATERIALS AND METHODS: A total of 73 young adult patients (mean age 20.6 ± 2.3) who were diagnosed with AML were examined. These patients did not suffer from any other systemic disorder. The oral hygiene status, gingival overgrowth (GO) and periodontal status were assessed using traditional clinical indices. RESULTS: Around three-quarters of the patients had either fair or poor oral hygiene. A statistically significant association between dental plaque levels and both GO and periodontal index (P < 0.001) was observed. CONCLUSIONS: Poor oral hygiene is a risk factor for leukaemic GO and for destructive periodontal disease. Both conditions add to the microbial burden these patients are exposed to. In patients showing high levels of oral hygiene, the GO tends to be mild and does not seem to be problematic, especially with respect to mechanical tooth cleaning.

Factors associated with underweight and stunting among children in rural Terai of eastern Nepal.

Malnutrition continues to affect a large proportion of children in the developing world. The authors undertook this study to identify biologic, socioeconomic, and health care factors associated with underweight and stunting in young children in an the eastern Tarai (plains) district of Nepal. Data were collected via questionnaires from mothers of 443 children aged 6 to 36 months in Sunsari district. Multistage cluster sampling was used to select villages and children. Anthropometric measurements were made on both children and their mothers. Logistic regression was used to measure the independent (adjusted) effect of risk and protective factors on the odds of underweight or stunting. More than half (53.3%) of the children were found to be underweight (<2 standard deviations weight for age below reference median) and more than one third (36.6%) had stunting (<2 standard deviations height for age below reference median). Low maternal body mass index, child's age, higher birth order, and lower standard of living score were strong predictors of underweight, whereas mother's education >5 years and participation in vitamin A and nutritional programs were protective. Infant age, low maternal body mass index, and low standard of living score were significant risk factors for stunting, whereas mother's education >5 years was strongly protective. These results suggest that underweight and stunting are the result of a nexus of biological, socioeconomic, and health care factors.

Single layer closure of palatal fistula using anteriorly based dorsal tongue flap.

Palatal fistulas are the common complications seen after cleft palate repair. Small fistula may be asymptomatic, the large ones produce various symptoms including regurgitation of fluids into nasal cavity and interference with normal speech. Although small fistulas can be successfully treated with local flaps such as palatal or buccal mucosal flaps, large fistulas pose difficulty. Because of rich blood supply, tongue is a suitable and convenient source of large flap. The anterior based dorsal tongue flap is a safe and effective method for closure of relatively large recurrent palatal fistula with out any functional impairment of donor site. This article describes one such case treated by single layer closure using anteriorly based tongue flap with excellent outcome.

Renal metastasis from primary hepatocellular carcinoma. A case report and review of the literature.

Secondary malignant tumors of the kidney are uncommon. These secondary tumors are usually the result of hematogenous spread from solid or hematologic malignancies. These tumors are almost always discovered at autopsy, with only 40 cases diagnosed prior to death reported in the literature. Primary tumors of the lung, breast and gastrointestinal tract are the most common sources of renal metastases. The occurrence of a renal secondary from a primary hepatocellular carcinoma is the subject of this presentation. To the best of our knowledge, such an occurrence has not been reported previously.