Prevalence of Pulmonary Hypertension in Chronic Kidney Disease.

Pulmonary hypertension is a common comorbidity in patients with chronic kidney disease and end-stage renal disease(CKD). The presence of pulmonary hypertension is associated with increased risk of hospitalization and mortality in patients with CKD. Review of literature showed that in one study, pulmonary hypertension was found in 40% of patients with end stage renal disease on chronic hemodialysis therapy via arteriovenous access. The presence of CKD was associated with 1.4-fold increased risk of having pulmonary hypertension after adjusting for other independent risk factors for CKD. Preventing pulmonary hypertension in this population is crucial because even kidney transplantation may not reverse the high mortality associated with established pulmonary hypertension. MATERIAL: Place of study- Rajendra Institute of Medical Sciences, Ranchi. Design of study- Observational and prospective single centered study. Duration of study-18 months. Sample size-100 CKD patients admitted to department of medicine, RIMS, Ranchi. Study population-100 CKD patients meeting our inclusion criteria, admitted in the department of medicine, Rajendra Institute of Medical Sciences, Ranchi, between 1st January 2020 and 30th June 2021. INCLUSION CRITERIA: Renal function was determined by estimated glomerular filtration rate. Only patients with stage 3 or worse CKD were included. EXCLUSION CRITERIA: 1. Those patients having stage 2 or less kidney disease were excluded. 2. Patients with congenital heart disease, chronic thromboembolic disease, acute myocardial infarction and previous lung disease or cardiac transplantation were excluded. Data was collected by oral questionnaire, relevant investigations and by doing 2D- ECHO and data was analyzed by using IBM SPSS Statistics software. OBSERVATION: Prevalence of pulmonary hypertension in the study group was 16%. Prevalence of pulmonary hypertension was more in stage 5 CKD patients (26.19%) and the difference in prevalence of pulmonary hypertension in different stages of CKD was statistically significant(p value-0.008). Prevalence of pulmonary hypertension was more in patients on hemodialysis (27.78%) compared to those not on hemodialysis (9.37%). Pulmonary hypertension was present in 13.85% males and 20% of females, there was no statistically significant difference (p value-.428). No significant difference was found in prevalence of pulmonary hypertension between diabetic and non- diabetic patients and hypertensive and normotensive patients. CONCLUSION: Prevalence of pulmonary hypertension was more in stage 5 CKD patients and patients on hemodialysis. There was positive correlation between high serum creatinine, high serum phosphorus, lower hemoglobin, lower serum calcium and pulmonary hypertension in CKD patients. There was no significant difference in prevalence of pulmonary hypertension in male and female patients.

"Enhanced recovery after surgery - ERAS in elective craniotomies-a non-randomized controlled trial".

BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at the early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups. METHODS: In this pragmatic non-randomized controlled trial (CTRI/2017/07/015451), consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Elements-of-care in the ERAS group were- Preoperative -family education, complex-carbohydrate drink, flupiritine; Intraoperative - scalp blocks, limited opioids, rigorous fluid and temperature regulation; Postoperative- flupiritine, early mobilization, removal of catheters, and initiation of feeds. Apart from these, all perioperative protocols and management strategies were similar between groups. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control, and hospital stay duration. The decision for discharge from ICU and hospital, data collection, and analysis was by independent assessors blind to the patient group. RESULTS: Seventy patients were enrolled. Baseline demographics - age, sex, tumor volume, and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 h after surgery, the cumulative insulin requirement, and the episodes of VAS scores > 4 in the first 48 h after surgery was significantly less in the ERAS group - 40.6% vs. 65.7%, 0.6 (±2.5) units vs. 3.6 (±8.1) units, and one vs. ten episodes (p = 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups. CONCLUSION: The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 h. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results. TRIAL REGISTRATION: Clinical Trial Registry of India ( CTRI/2018/04/013247 ), registered retrospectively on April 2018.

Linguistic and cultural validation of Ureteral Stent Symptom Questionnaire in Hindi.

INTRODUCTION: In the year 2003, Joshi et al. developed a validated outcome assessment tool to measure the ureteral stent-related symptoms. The original English language Ureteral Stent Symptom Questionnaire (USSQ) has been validated in various languages worldwide. Our objective was to develop the USSQ in Hindi, a commonlyused language in India, by validating it in patients undergoing ureteroscopic lithotripsy. MATERIALS AND METHODS: A final Hindi version of the USSQ was derived from the original English version to apply to the study population by translation, back translation, and face-to-face interviews. The Hindi and English versions were completed by 70 patients undergoing ureteroscopic lithotripsy with stent in situ, on postoperative days 7 and 8, and 4 weeks after stent removal. Similarly, discriminant validity was checked among 50 healthy individuals. A detailed statistical analysis was used to correlate results (Cronbach's α coefficient, Spearman's correlation, and Mann-Whitney U-test). RESULTS: A total of 70 patients were enrolled in the study and 61 completed the final assessment. The median age was 35 years (range: 18-60 years). The USSQ domain scores with the stent in situ were higher than poststent status. The test-retest reliability checked by Cronbach's α coefficient (>0.44) and Spearman's correlation coefficient (>0.44) were acceptable to good. We found high discriminant validity of the questionnaire between patients with stent and the healthy controls (P < 0.05). CONCLUSION: Our results demonstrate satisfactory validity for the Hindi version of the USSQ for the assessment of quality of life in patients with stent. This is ready for application in the clinical studies and the future stent-related research in Hindi language.

Evidence of Faradaic Reactions in Electrostatic Atomizers.

Any rational theory of electrostatic atomizers (EAs) would require a detailed understanding of the nature of the polarized layer near the electrode, since this is the source of the electric charge carried by the jets issued from the EAs. The polarized layer either is driven out as the electrically-driven Smoluchowski flow and/or entrained by the viscous shear imposed by the bulk flow. The standard Gouy-Chapman theory of polarized diffuse layers implies zero electric current passing across the layer, which is impossible to reconcile with the fact that there are leak currents in the EAs. Here, we show that the electric current through the EA is controlled by faradaic reactions at the electrodes. The experiments were conducted with stainless steel or brass pin-like cathodes and three different anode (the conical nozzle) materials, which were copper, stainless steel, and brass. The different electrode materials resulted in different spray, leakage, and total currents in all the cases. Accordingly, it is shown that the total electric current generated by EAs can be controlled by the cathode and anode materials, i.e., by faradaic reactions on them. This lays the foundation for a more detailed understanding and description of the operation of EAs.

Molecular characterization of Opisthorchis noverca (Digenea: Opisthorchiidae) based on nuclear ribosomal ITS2 and mitochondrial COI genes.

Opisthorchiasis is a public health problem in South-East Asian countries and Eastern Europe. The infection implicates mainly two species of Opisthorchis, namely O. viverrini and O. felineus, that occur mostly in fish-eating mammals and humans, although there are rare reports of human cases involving two other species, O. noverca and O. guayaquilensis. Opisthorchis noverca has been reported frequently in dogs and pigs from the Indian subcontinent, with rare reports from cattle and human subjects. With a view to supplementing morphology-based identification of this species, the present study aimed to provide molecular characterization of O. noverca, using rDNA internal transcribed spacer 2 (ITS2) and mitochondrial cytochrome oxidase I (mt COI) markers so as to determine its genetic correlation with other species of Opisthorchiidae, and also to generate a taxon-specific molecular marker based on the ITS2 region. The phylogenetic relationship between O. noverca and other species of the genus was determined using molecular sequence data. To strengthen the result, secondary structure sequence analyses of ITS2 with hemi-compensatory base changes (hCBCs), and amino acid sequence analyses, were also evaluated. Our results confirm that O. noverca is a distinct and valid species.

Low prevalence of latent autoimmune diabetes in adults in northern India.

AIM: To study the frequency of islet antibodies in a large cohort of clinic- and community-based patients with Type 2 diabetes in northern India. METHODS: We measured glutamic acid decarboxylase (GAD) antibodies in 618 adults with Type 2 diabetes (378 patients with diabetes attending a hospital clinic, 240 patients diagnosed in a community survey) and in 192 healthy subjects residing in north India. Islet antigen 2 (IA2) antibodies were also studied in a proportion of the patients with diabetes (n = 492) and in a control population (n = 191). GAD and IA2 antibodies were measured by immunoprecipitation of the respective (35) S-labelled recombinant antigen. RESULTS: We found that GAD antibodies were present in nine (1.5%) patients with diabetes (clinic population: 0.8%, community study: 2.5%), a prevalence similar to that among the subjects without diabetes (n = 2; 1%). IA2 antibodies were detected in seven patients with Type 2 diabetes (1.4%) and in two healthy control subjects (1.0%). The frequency of either GAD or IA2 antibodies was similar in people with and without diabetes (3.2 vs 2.1%). No subject was found to have both antibodies. Insulin requirement was higher among antibody-positive than among antibody-negative patients (GAD antibody: 33 vs 6.3%; P = 0.001; GAD or IA2 antibody: 23.1 vs 6.4%; P = 0.02); however, other clinical features were similar in the two groups. CONCLUSIONS: In the present north-Indian population with Type 2 diabetes, the overall prevalence of GAD antibodies and the prevalence of either GAD or IA2 antibodies were considerably lower than those reported in white European populations.

Superspreaders versus "cousin" non-superspreaders: disjoining pressure in gravitational film drainage.

Gravitational drainage of vertical films supported on a wire frame of two superspreaders SILWET L-77 and BREAK-THRU S 278 and their respective "cousin" non-superspreaders SILWET L-7607 and BREAK-THRU S 233 revealed drastic differences. The superspreader films showed complicated dynamic "turbulent"-like interferometric patterns in distinction from the ordered color bands of the "cousin" non-superspreaders, which resembled those of the ordinary surfactants. Nevertheless, the superspreader films stabilized themselves at the thickness about 35 nm and revealed an order of magnitude longer lifetime before bursting compared to that of the "cousin" non-superspreaders. Notably, the superspreaders revealed drastic differences from the non-superspreaders in aqueous solutions with no contact with any solid hydrophobic surface. The self-stabilization of the superspreader films is attributed to significant disjoining pressure probably related to long superspreader bilayers hanging from the free surfaces. The scaling law for the disjoining pressure was found as p(disj)(h) ~ h(-m) (with m ≈ 9-11) for the sufficiently concentrated superspreader solutions, and as p(disj)(h) ~ h(-s) (with s ≈ 6) for more dilute solutions (in both cases, concentrations were above the critical micelle concentration). The non-superspreaders do not possess any significant disjoining pressure even in the films with thicknesses in the 35-100 nm range. The results show that gravitational drainage of vertical films is a useful simple tool for measuring disjoining pressure.

Enhanced foamability of sodium dodecyl sulfate surfactant mixed with superspreader trisiloxane-(poly)ethoxylate.

Gravitational drainage from thin vertical surfactant solution films and gravitational drainage in a settler column are used to study the behavior of foams based on two-surfactant mixtures. Namely, solutions of the anionic sodium dodecyl sulfate (SDS) and nonionic superspreader SILWET L-77, and their mixtures at different mixing ratios, are studied. It is shown, for the first time, that solutions having a longer lifetime in the vertical film drainage process also possess a higher foamability. An additional and unexpected unique result is that when using a mixed surfactant system, the foamability can be much greater than the foamabilities of the individual components.

Endometriosis of conus medullaris: a case report.

Endometriosis involving the neural axis is extremely rare. A twenty-five-year-old woman presented with acute onset paraparesis with bladder involvement of five-day duration. We missed her history of cyclical back-ache related to menses at the emergency room. Magnetic resonance imaging (MRI) of spinal cord showed an intramedullary tumour with bleeding at conus-epiconus level. She was operated in the emergency department with laminectomy-durotomy and tumour decompression. Histopathology of the tumour was suggested endometriosis.

Entangling microwaves with light.

Quantum entanglement is a key resource in currently developed quantum technologies. Sharing this fragile property between superconducting microwave circuits and optical or atomic systems would enable new functionalities, but this has been hindered by an energy scale mismatch of >104 and the resulting mutually imposed loss and noise. In this work, we created and verified entanglement between microwave and optical fields in a millikelvin environment. Using an optically pulsed superconducting electro-optical device, we show entanglement between propagating microwave and optical fields in the continuous variable domain. This achievement not only paves the way for entanglement between superconducting circuits and telecom wavelength light, but also has wide-ranging implications for hybrid quantum networks in the context of modularization, scaling, sensing, and cross-platform verification.

Congenital paediatric atlantoaxial dislocation: clinico-radiological profile and surgical outcome.

INTRODUCTION: Congenital atlantoaxial dislocation (AAD) is the most common bony abnormality affecting the craniovertebral junction. The paediatric population has specific problems like preoperative diagnostic difficulties, precise neurological examination, radiological diagnosis, surgical problems including physical fitness to tolerate surgery (including problems of anaesthesia), technical difficulties in surgery and problems related to immobilization. MATERIAL AND METHODS: A total of 229 consecutive paediatric (≤18 years) patients of AAD visited our centre from the period of January 1997 to August 2011. Twenty-nine cases were excluded from the study as these cases were diagnosed as CVJ tuberculosis, 31 cases were excluded as they were traumatic and the remaining 169 cases were retrospectively analysed. These patients were operated by a single experienced surgeon (the senior author) at the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. The preoperative and the postoperative clinical evaluation of the patient was done by the Kumar and Kalra myelopathic scoring system. The score was recorded in the preoperative period, at the time of discharge, at 3 months follow-up and at 6 months follow-up. RESULTS: Ninety-four were males and 75 were females. The age range was 4 to 18 years with mean age 9.96±3.78 years. The follow-up ranged from 3 to 120 months with mean follow-up being 39.03±13.38 months. One hundred five cases were of fixed/irreducible AAD, and 64 were cases of mobile/reducible AAD. Majority of these cases presented with features of pyramidal tract involvement, and 108 cases had compromised pulmonary function test. One hundred thirty-seven cases had improved outcome, and 18 cases were in the same grade in the postoperative period with only 14 cases either deteriorated or died. CONCLUSIONS: Congenital paediatric AAD are a different subset of abnormalities and have a satisfactory outcome. Preoperative evaluation must also include identification of various syndromes associated with paediatric AAD and respiratory reserve. Cormack-Lehane grade can be helpful in selecting borderline cases for postoperative need of tracheostomy. Majority of the cases have a good outcome, and therefore, surgery should be offered even in severe grade.

Sociodemographic, clinical profile, and psychiatric morbidities among patients with attempted suicide in a tertiary care center: A study from Central India.

BACKGROUND: Suicide is a major public health concern and is considered one of the leading causes of death globally. Previous suicidal attempts can be considered as a predictor of underlying psychiatric illness. Identifying factors behind suicidal attempt can help mental health professionals for early diagnosis and treatment as well as designing effective suicide prevention strategies. AIM: The aim of the study is to assess sociodemographic, clinical characteristics, and prevalence of psychiatric morbidities among patients with attempted suicide. METHODS: A cross-sectional study was conducted in the emergency department of tertiary care hospital; patients of attempted suicide attending emergency from January 1, 2014, to January 1, 2020, constituted the sample for the study. Data were collected using semi-structured questionnaire which contained sociodemographic and clinical variables. All the subjects were administered mini-international neuropsychiatric interview (MINI), MINI Kid was applied for subjects <18 years, and MINI Plus was applied for subjects above 18 years. Patients were diagnosed according to the ICD-10 Classification of Mental and Behavioral Disorders for research. RESULTS: Suicide attempt was seen more commonly in males, and the most common age group is between 21 and 40 years residing in urban settings. The most common method was consumption of unknown substances (75.35%). Factors leading to suicide are multidimensional in nature. 30.4% of the patients had impulsive traits. 86.5% of people who attempted suicide had a history of psychiatric illness. Detailed assessment of patients for psychiatric illness and psychosocial factors is crucial for planning suicide prevention strategies and policymaking. CONCLUSIONS: Young population is at high risk for suicide. More than 80% of these have diagnosable psychiatric illness.

Glioblastoma with melanotic differentiation.

A 54-year-old male presented with the history of headache and vomiting. MRI of the head showed right posterior temporal mass which was surgically excised. Histopathological examination revealed features of glioblastoma with pigmented cells. The pigment was demonstrated to be melanin which was confirmed by special stains and immunohistochemistry. This is the first description of glioblastoma with melanotic differentiation reported in the literature. The relevant literature is briefly reviewed.

Functional Significance of Mirna-149 in Lung Cancer: Can it be Utilized as a Potential Biomarker or a Therapeutic Target?

Accumulating evidence has documented the significance of miR-149 as a promising tumor-suppressive non-coding RNA that play critical roles in regulating genes involved in cancer growth and metastasis. Notably, the ability of miR-149 to be utilized as a potential biomarker in the diagnosis/prognosis or a therapeutic target has also been explored using various cellular and preclinical models, as well as in clinical settings of lung cancer. While the applicability of miR-149 in assessing tumor progression has been suggested, its potential in predicting treatment outcomes is needed to be verified in diverse settings of lung cancer patients. The current review presents an overview of the functional significance of miR-149 with ongoing challenges in non-small cell lung cancer.

Activation of ATM/Chk1 by curcumin causes cell cycle arrest and apoptosis in human pancreatic cancer cells.

Curcumin has been shown to inhibit the growth of various types of cancer cells; however, at concentrations much above the clinically achievable levels in humans. The concentration of curcumin achieved in the plasma after oral administration in humans was estimated to be around 1.8 microM. Here, we report that treatment of BxPC-3 human pancreatic cancer cells with a low and single exposure of 2.5 microM curcumin for 24 h causes significant arrest of cells in the G2/M phase and induces significant apoptosis. Immunoblot studies revealed increased phosphorylation of H2A.X at Ser-139 and Chk1 at Ser-280 and a decrease in DNA polymerase-beta level in curcumin-treated cells. Phosphorylation of H2A.X and Chk1 proteins are an indicator of DNA damage whereas DNA polymerase-beta plays a role in the repair of DNA strand breaks. Normal immortalised human pancreatic ductal epithelial (HPDE-6) cells remained unaffected by curcumin treatment. In addition, we also observed a significant increase in the phosphorylation of Chk1 at Ser-345, Cdc25C at Ser-216 and a subtle increase in ATM phosphorylation at Ser-1981. Concomitant decrease in the expressions of cyclin B1 and Cdk1 were seen in curcumin-treated cells. Further, curcumin treatment caused significant cleavage of caspase-3 and PARP in BxPC-3 but not in HPDE-6 cells. Silencing ATM/Chk1 expression by transfecting BxPC-3 cells with ATM or Chk1-specific SiRNA blocked the phosphorylation of ATM, Chk1 and Cdc25C and protected the cells from curcumin-mediated G2/M arrest and apoptosis. This study reflects the critical role of ATM/Chk1 in curcumin-mediated G2/M cell cycle arrest and apoptosis in pancreatic cancer cells.

Two novel AIRE mutations in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) among Indians.

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare recessive disorder resulting from mutations in the autoimmune regulator (AIRE) gene. There is no information on AIRE mutations in Indians. In a cross-sectional study, nine patients (eight families), from four referral hospitals in India, were studied for AIRE mutations by direct sequencing. We screened for new mutations in 150 controls by allele-specific PCR. The patients had 1-7 known components of APECED. Three patients had unusual manifestations: presentation with type 1 diabetes; chronic sinusitis and otitis media; and facial dysmorphism. All patients carried homozygous, probably recessive, AIRE mutations. Two unrelated patients from a small in-bred community (Vanika Vaisya) in south India carried an unreported missense mutation, p.V80G, in the N-terminal caspase recruitment domain. Another unique mutation, p.C302X, resulting in a truncated protein with deletion of both zinc-finger domains, was detected in a patient from Gujarat. Neither mutation was detected in controls. Other mutations, previously described in Caucasians, were: 13 base pair deletion (p.C322fsX372) in 4 (38%), and Finn-major (p.R257X) and p.R139X (Sardinian) mutation in one subject each. In conclusion, in this first series of APECED in Indians, we detected AIRE mutations previously reported in Caucasians, as well as unique mutations. Of these, p.V80G is possibly an ancestral mutation in an in-bred community.

Priorities and preferences for school-based mental health services in India: a multi-stakeholder study with adolescents, parents, school staff, and mental health providers.

BACKGROUND: Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs. METHODS: We completed semi-structured interviews and focus group discussions with adolescents (n  =  191), parents (n  =  9), teachers (n  =  78), school counsellors (n  =  15), clinical psychologists/psychiatrists (n  =  7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers. RESULTS: All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents. CONCLUSION: SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.

Rapid Magnetic 3D Printing of Cellular Structures with MCF-7 Cell Inks.

A contactless label-free method using a diamagnetophoretic ink to rapidly print three-dimensional (3D) scaffold-free multicellular structures is described. The inks consist of MCF-7 cells that are suspended in a culture medium to which a paramagnetic salt, diethylenetriaminepentaacetic acid gadolinium (III) dihydrogen salt hydrate (Gd-DTPA), is added. When a magnetic field is applied, the host fluid containing the paramagnetic salt is attracted towards regions of high magnetic field gradient, displacing the ink towards regions with a low gradient. Using this method, 3D structures are printed on ultra-low attachment (ULA) surfaces. On a tissue culture treated (TCT) surface, a 3D printed spheroid coexists with a two-dimensional (2D) cell monolayer, where the composite is termed as a 2.5D structure. The 3D structures can be magnetically printed within 6 hours in a medium containing 25 mM Gd-DTPA. The influence of the paramagnetic salt on MCF-7 cell viability, cell morphology, and ability of cells to adhere to each other to stabilize the printed structures on both ULA and TCT surfaces is investigated. Gene expressions of hypoxia-inducible factor 1-alpha (HIF1α) and vascular endothelial growth factor (VEGF) allow comparison of the relative stresses for the printed 3D and 2.5D cell geometries with those for 3D spheroids formed without magnetic assistance. This magnetic printing method can be potentially scaled to a higher throughput to rapidly print cells into 3D heterogeneous cell structures with variable geometries with repeatable dimensions for applications such as tissue engineering and tumour formation for drug discovery.

Mandibular canal variant: a case report.

The mandibular canal transmits the inferior alveolar artery, vein and the inferior alveolar nerve. From an embryological perspective, there might be three inferior dental nerves innervating three groups of mandibular teeth. During rapid prenatal growth and remodeling in the ramus region there is spread of intramembranous ossification that eventually forms the mandibular canal. Occurrence of bifid/trifid mandibular canals in some patients is secondary to incomplete fusion of these three nerves. Various types of bifid mandibular canals have been classified according to anatomical location and configuration. This case report highlights an unusual variant of the mandibular canal.