Spectrum of fetal limb anomalies.

PURPOSE: Antenatal detection of limb anomalies is not uncommon, and pregnancies are usually terminated in view of the expected physical handicap. The aim of this retrospective observational study is to delineate the spectrum of fetal limb anomalies and provide evidence in support of complete postnatal evaluation in establishing recurrence risk. METHODS: We present 54 cases of limb malformations detected antenatally and discuss the spectrum of abnormalities, the utility of fetal autopsy, and genetic testing to establish recurrence risk in subsequent pregnancies. RESULTS: 16/54 cases were isolated radial ray anomalies. There were five cases of amniotic band syndrome, five limb body wall complex cases, three VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) associations, one case of sirenomelia, two cases of limb pelvis hypoplasia, and one case of OEIS (Omphalocele Exstrophy Imperforate anus and spinal defects). Four fetuses with non-isolated radial ray anomaly had trisomy 18. One case with bilateral radial ray defect had a mutation in the FANC-E gene confirming fanconi anemia. Twelve cases were unclassified. CONCLUSION: Autopsy is the most important investigation in fetuses with limb anomalies. We suggest chromosomal microarray (CMA) as a first-tier test after autopsy. However, in cases of bilaterally symmetrical limb anomalies, in case of previous similarly affected child, or history of consanguinity, whole exome sequencing (WES) can be offered as the primary investigation, followed by CMA if WES is normal.

A myriad of posterior fossa cysts: A single center experience.

Antenatal posterior fossa cystic lesions are intimidating due to overlapping imaging features of benign and severe malformations. Sonographic assessment of the posterior fossa with good resolution median sagittal and axial views, either primary or secondarily reconstructed, plays the lead role in antenatal evaluation, further enhanced when sequential assessments are added. We present 10 cases of fetal posterior fossa cystic lesions diagnosed in the first and second trimesters that were sequentially analyzed and followed up till delivery or termination. The ultrasound imaging appearance, evolution, and morphometry have been presented in this article.

Revisiting absent nasal bone in the second trimester.

PURPOSE: To evaluate the outcomes of fetuses diagnosed with absent nasal bone in the second trimester. METHODS: This prospective, observational study included all fetuses who were diagnosed at or referred to our fetal medicine center with an absent nasal bone from 16 weeks onwards from November 2017 to December 2019. Amniocentesis for fetal karyotype and microarray was offered to all women. Women who opted not to undergo invasive testing were also followed up and neonatal outcome noted. RESULTS: 26 fetuses were eligible for inclusion in the study. 8 (30.8%) out of these were diagnosed with aneuploidy: 7 with trisomy 21 and one with trisomy 18. All fetuses with aneuploidy had additional ultrasound abnormality and/or high risk on biochemical screening. CONCLUSIONS: Isolated absent nasal bone in the second trimester with prior low risk on combined screening performed by certified sonographers is unlikely to be associated with Down syndrome.

A missing kidney and a hidden congenital diaphragmatic hernia.

Congenital intrathoracic kidney (ITK) is a rare condition, which is usually discovered incidentally in asymptomatic children who do not need any intervention. However, it may be associated with congenital diaphragmatic hernia (CDH), in which case it requires urgent surgical intervention. We present a case of prenatally diagnosed ITK associated with a left CDH that was operated on day 5 of life. The neonate is currently well at 15 months of age.

Comparative epidemiology and pathophysiology of patent and latent babesiosis caused by Babesia bigemina in buffaloes and cattle from different agroclimatic zones of Punjab State, India.

To conduct comparative epidemiology of parasitologically positive (patent) and polymerase chain reaction positive (latent) cases of bovine babesiosis in Bet Region (low-lying areas adjoining Sutlej, Beas, Ravi, and Ghaggar rivers of Punjab) of diverse agroclimatic zones of Punjab state in relation to haematobiochemical parameters as patho-physiological markers, blood samples from 783 dairy animals (487 buffaloes and 296 cattle) were analysed parasitologically by Giemsa-stained blood smears (GSBS) and by molecular-based polymerase chain reaction (PCR) targeting SpeI-AvaI restriction fragment of Babesia bigemina. We ruled out the endemicity of the disease with 2.17% patent and 3.96% latent cases of B. bigemina with significantly higher prevalence (P < 0.01) in cattle than buffaloes. The spatial distribution for a guideline to local veterinary practitioners and policy-makers indicated highest number of patent and latent cases in western zone and undulating plain zone, respectively. District wise highest prevalence of patent as well as latent infection observed in SBS Nagar of undulating plain zone showed substantial agreement (Kappa value: 0.70) between the two techniques. Haematology revealed marked microcytic hyperchromic anaemia in patent animals of group I (GSBS positive; n = 17) and latent animals of group II (PCR positive; n = 14) as compared to disease-free controls (group III; n = 10). Blood urea nitrogen (BUN), creatinine and gamma-glutamyltransferase (GGT) levels were significantly increased (P < 0.05) in group I in comparison to group II and group III indicated comparative pathogenic effect of babesiosis in patent cases. Though patent cases showed higher pathogenicity of babesiosis, diagnosis of latent infection is significant as it may act as source of infection for spread to other highly prone bovines.

Promising Roles of Alternative Medicine and Plant-Based Nanotechnology as Remedies for Urinary Tract Infections.

Urinary tract infections (UTIs) are considered to be the most common infections worldwide, having an incidence rate of 40-60% in women. Moreover, the prevalence of this disorder in adult women is 30 times more than in men. UTIs are usually found in many hospitals and clinical practice; as disorders, they are complicated and uncomplicated; in uncomplicated cases, there is no structural or functional abnormality in the urogenital tract. However, obstruction, retention of urine flow and use of catheters increase the complexity. There are several bacteria (e.g., E. coli, Klebsiella pneumoniae, Proteus vulgaris, etc.) successfully residing in the tract. The diagnosis must not only be accurate but rapid, so early detection is an important step in the control of UTIs caused by uropathogens. The treatment of UTIs includes appropriate antimicrobial therapy to control the infection and kill the causal microbes inside the body. A long-time usage of antibiotics has resulted in multidrug resistance causing an impediment in treatment. Thus, alternative, combinatorial medication approaches have given some hope. Available treatments considered Homeopathic, Ayurvedic, Unani, and other herbal-based drugs. There are new upcoming roles of nanoparticles in combating UTIs which needs further validation. The role of medicinal plant-based nanotechnology approaches has shown promising results. Therefore, there must be active research in phyto-based therapies of UTIs, such as Ayurvedic Biology.

Improved efficacy of doxycycline in liposomes against Plasmodium falciparum in culture and Plasmodium berghei infection in mice.

The rate at which Plasmodium falciparum is developing resistance to clinically used antimalarial drugs is alarming. Therefore, there is a compelling need to develop an efficient drug delivery system to improve the efficacy of existing antimalarial agents and circumvent drug resistance. Here, we report the antibacterial drug doxycycline (DOXY) in liposomal formulations exhibits enhanced antiplasmodial activity against blood stage forms of P. falciparum (3D7) in culture and established Plasmodium berghei NK-65 infection in murine model. Parasite killing on blood stage forms in culture was determined by a radiolabeled [3H] hypoxanthine incorporation assay and infected erythrocytes stained with Giemsa were counted using microscopy in vivo. The 50% inhibitory concentration (IC50) of DOXY-stearylamine liposome (IC50 0.36 µM) and DOXY-SPC:Chol-liposome (IC50 0.85 µM) exhibited marked growth inhibition of parasites compared with free DOXY (IC50 14 µM), with minimal toxicity to normal erythrocytes. Administration of polyethylene glycol distearoyl phosphatidylethanolamine-methoxy-polyethylene glycol2000 (DSPE-mPEG-2000) coated liposomes loaded with DOXY at 2.5 mg/kg per day resulted in efficacious killing of blood parasites with improved survival in mice relative to the free drug in both chloroquine sensitive and resistant strains of P. berghei infection. This is the first report to demonstrate that DOXY in liposomal system has immense chemotherapeutic potential against plasmodial infections at lower dosages.

Resource use efficiency of broiler production in tunnel-ventilated environmental control vis-à-vis open-sided conventional shed during summer.

Present study was conducted to assess the resource use efficiency of broilers production, in tunnel-ventilated environment control (ECBH) and open-sided conventional (OSCBH) house under different stocking densities. Different treatments comprised of T 0 (birds with floor space, 1.0/ft2/bird in open-sided conventional broiler house (OSCBH) as control, while different treatments in tunnel-ventilated environment control broiler house (ECBH) were T 1, T 2, T 3, T 4 and T 5 with floor space of 1.0, 0.9, 0.8, 0.7and 0.6 ft2 per bird, respectively. The results of shed microclimate indicated that shed temperature and temperature humidity index (THI) at 12:00 and 15:00 IST and maximum and minimum temperature in OSCBH were significantly (p ≤ 0.05) higher than ECBH. Litter moisture and pH did not differ significantly and were within permissible limits in both OSCBH and ECBH. Final body weight, body weight gain, feed intake were significantly higher and FCR, PER and EER were significantly better in ECBH than OSCBH (T 0) even at 10% increase in stocking density (T 2). Margin of receipt in T 2 in ECBH from sale of live bird/unit area and kilogram live weight per unit area was maximum which was Rs. 5.08/- and 3.56/- higher than T 0 for OSCBH.

Traumatic Herniation of the Buccal Fat Pad Into the Oral Cavity of a 3.5-Year-Old Boy: A Case Report.

The buccal fat pad represents a specialized type of tissue that is distinct from subcutaneous fat. Its primary function is to serve as a cushioning tissue and as a sucking pad. In this case report, we present an interesting lesion and its management, wherein a tiny traumatic perforation of the buccal mucosa caused a large portion of the buccal fat pad to extrude into the oral cavity.

Impact of gestational age on nuchal fold thickness in the second trimester.

OBJECTIVES: The purpose of this study was to establish gestational age (GA)-specific nomograms for nuchal fold thickness between 16 and 24 weeks. METHODS: This retrospective cross sectional study included 32,207 women who underwent a second-trimester anomaly scan at the Fetal Care Center of National University Hospital from January 2005 to April 2011. Nomograms were plotted for nuchal fold thickness at each gestation to study its variation with GA. RESULTS: Nuchal fold thickness increased with GA in a linear manner from 3.13 ± 0.68 mm (mean ± SD) at 16 weeks to 5.08 ± 0.76 mm at 24 weeks. The 95th percentile measurement at 24 weeks remained less than 6 mm. CONCLUSIONS: A threshold of 6 mm appears to be appropriate for the diagnosis of a thick nuchal fold even for gestations between 20 and 24 weeks.

Diagnosis of sirenomelia in the first trimester.

Sirenomelia or "mermaid syndrome" is a rare congenital abnormality with an incidence of 1 in 60,000. We report a case diagnosed in the first trimester using two-dimensional, three-dimensional, and color Doppler ultrasound. With increasing emphasis on early diagnosis of fetal abnormalities, this case highlights the importance of looking for anomalies in the first trimester itself. In fact, the diagnosis of sirenomelia should be easier in the first trimester as severe oligohydramnios in later gestation hampers vision.

Alternative approach to management of early loss of second primary molar: a clinical case report.

Preservation of space after premature loss of the second primary molar is essential to prevent mesial drifting of the permanent first molar. Various modifications of distal shoe space maintainers, which have been documented, are all nonfunctional in nature. This paper describes an innovative design of a functional distal shoe space maintainer that is intended to overcome the disadvantages of conventional non-functional space maintainers and that does not hamper the periodontal status of the abutment tooth.

Clinical and microbiological evaluation of the carious dentin before and after application of Papacarie gel.

OBJECTIVE: To evaluate clinically and microbiologically the efficacy of Papacarie in the removal of carious dentin in both permanent and primary teeth. STUDY DESIGN: Thirty permanent and primary molars with dentinal carious lesions were excavated and subjected to clinical and microbiological assessment before and after application of Papacarie. The gel was further tested for in vitro antimicrobial efficacy against standard cariogenic micro-organisms using agar diffusion assay. RESULTS: Papacarie was able to differentiate between infected and affected dentin clinically along with high patient comfort during caries excavation. The mean time taken for caries removal and restoration was observed to be 4.17 +/- 0.40 min. and 8.57 +/- 0.45 min. for permanent teeth and 4.21 +/- 0.36 min. and 9.24 +/- 0.58 min. for primary teeth. There was a significant reduction in the total viable colony forming units from the dentin samples before and after application of Papacarie. It was also observed that Papacarie had no inhibitory effect on standard cariogenic microorganisms in the agar diffusion assay. CONCLUSIONS: Papacarie is an effective caries removal method clinically in both permanent and primary teeth. The number of viable microorganisms after complete caries excavation using Papacarie still appears to be high and this bacterial count should be tackled by a suitable restorative material with potent antimicrobial activity.

Knowledge, Attitude, and Practices of Pregnant Women Towards COVID-19: An On-site Cross-sectional Survey.

OBJECTIVE: To assess the knowledge, attitude, and practices (KAP) of pregnant women towards coronavirus disease 2019 (COVID-19). METHODS: This on-site cross-sectional survey was conducted in the antenatal and fetal medicine clinics in a tertiary care hospital in North India. Pregnant women attending the maternal-fetal unit filled out a 31-item questionnaire assessing their KAP towards COVID-19. Correlation between KAP was assessed by using Spearman's rank correlation. RESULTS: Some 302 questionnaires were analyzed: more than 90% of women had correct general knowledge of COVID, but only 12.3% scored 50% or more for pregnancy-related knowledge. Some 67% of women reported more than usual anxiety, and 7.7% reported severe anxiety levels. General knowledge improved with age, education, and occupation but pregnancy-related knowledge and anxiety score were unaffected by these variables. CONCLUSIONS: Pregnant women's knowledge of COVID-19 infection, in general, is excellent and they have the correct attitude towards preventive strategies. However, knowledge and attitude towards its effect on pregnancy are limited.

Status of Dental Caries and Its Association with Oral Hygiene Practices among School-going Children of Rural and Urban Areas in Kamrup District of Assam.

Aim and objective: The study aimed to assess and compare the prevalence of dental caries with its association with oral hygiene practices among 13-14 years old schoolchildren in urban and rural areas in Kamrup Metropolitan (M) District, Assam. Materials and methods: A total of 1,501 schoolchildren in the age group of 13-14 years were included in the study and dental caries was recorded from decayed missing filled teeth (DMFT)/deft index as described by World Health Organization (WHO) (1997). The children were asked to fill in the basic information in the proforma by themselves. The statistical tests used in this study were unpaired t-test, Chi-square test, and one-way ANOVA test to compare the DMFT among the different age groups, gender, and location. Results: A statistically significant difference was found in the prevalence of the decayed (D) component between the 14 years old (33.9%) and the 13 years old (28.5%) age groups and a highly statistical difference was found between the male (27.9%) and the female (35.7%) population. However, the prevalence of decayed components for the rural (30.1%) and the urban (33.1%) population was not statistically significant. Conclusion: The overall prevalence of dental caries among schoolchildren of Kamrup (Metropolitan) District was 33.6%. Clinical Significance: Dental caries is a major public dental health problem; hence, an active and effective preventive program for dental care is needed for the child population in the area. How to cite this article: Doley S, Srivastava M, Piplani A, et al. Status of Dental Caries and Its Association with Oral Hygiene Practices among School-going Children of Rural and Urban Areas in Kamrup District of Assam. Int J Clin Pediatr Dent 2022;15(2):182-186.

Clinical outcomes in higher-order multiples reduced to dichorionic diamniotic (DCDA) twins compared with primary twins and singletons: A prospective observational study.

OBJECTIVE: To compare outcomes in higher-order multiple pregnancies reduced to dichorionic diamniotic (DCDA) twins with primary DCDA twins and singleton pregnancies. METHODS: This prospective observational study included all higher-order multiple pregnancies that underwent ultrasound-guided transabdominal fetal reduction at 11-13 weeks of gestation from January 2018 to June 2020. Outcomes were compared with 100 primary DCDA twins and 1078 singletons. RESULTS: Sixty-four higher-order multiples underwent reduction at mean gestational age of 11.46 weeks. Of the reduced pregnancies, 3.12% resulted in miscarriage before 24 weeks compared with 2% (2/100) of primary twins and 0.74% of singletons (P = 0.09). The mean gestational age at delivery was 33.48 weeks for reduced twins, 34.52 weeks for primary twins (P = 0.10) and 38.14 weeks for singletons (P < 0.001). Compared with primary twins, the adjusted odds of preterm delivery before 34 weeks and before 36 weeks for reduced twins were 0.56 (95% confidence interval [CI] 0.48-3.54, P = 0.62) and 0.84 (95% CI 0.78-8.85, P = 0.08), respectively. There was no significant difference in rates of pre-eclampsia, Cesarean delivery, birth weight below the 10th and 3rd centiles, and perinatal mortality among primary and reduced twins. All risks were significantly lower in singleton pregnancies. CONCLUSION: Reduced twins have similar obstetric and perinatal outcomes as primary twins, but adverse outcomes are significantly higher in both groups when compared with singleton pregnancies.

Synthetic Approach to Potential Anticancer Benzimidazole Derivatives: A Review.

Cancer is one of the deadliest diseases in many developed and developing countries. Continuous efforts are required for designing better therapeutic agents for the treatment of cancer with more efficacy, selectivity, and less toxicity. The fused heterocyclic ring system has been identified by several researchers as a privileged structure that can be used as the basis for drug discovery in medicinal chemistry. The hetero-aromatic bicyclic ring system acts as a pharmacophore in a wide range of drugs with therapeutic potential. According to studies in the literature, various substituted benzimidazoles have distinct pharmacological profiles with multi-targeting ability, making them an important anchor for the production of novel therapeutic agents against complex cancers, including breast cancer, skin cancer, and blood cancer. In this article, we have discussed various synthetic methods for the synthesis of anti-cancer benzimidazoles and their derivatives in different solvent conditions, substrates, and various catalysts, mainly those which are eco-friendly and economical. We also focused on various derivatives those are under clinical trials containing benzimidazole moiety.