Molecular detection of porcine parvovirus 1-associated reproductive failure in southern India.

This study used 56 aborted and stillborn fetuses from organized swine farms in Tamil Nadu and Kerala, southern states of India. All samples were screened by using a PCR assay that targets the NS1 gene for PPV. Furthermore, the PCR positive samples were subjected to amplification of the VP2 gene of PPV1 with designed primers and sequenced for further study. The PCR screening of 56 samples found that 14.3% (n = 8) were positive for PPV genome. According to VP2 gene-based PCR for PPV1, 897 bp specific amplicons were detected in all eight of the samples. Two of the eight positive samples (L17 and T5) were sequenced and annotated randomly. The BLAST analysis of contig sequence INDTNCHN-T5 revealed 100% sequence homology with Chinese PPV1genome, whereas sequence from INDTNCHN-L17 revealed 99.43% sequence homology with Spain, Chinese, and German. PPV1 sequences and both the sequences INDTNCHN-T5 and INDTNCHN-L17 were submitted to the GenBank under the accession numbers MW822566 and MW822567 respectively. A phylogenetic analysis of the sequences in this study revealed specific grouping along with PPV1 strains in cluster E. Amino acid analysis of both isolated sequences in addition to the reference sequence from PPV1 showed variations in position 215 (I to T) in both the isolates, variation at position 228 (Q to E) in T5 isolate and variations at position 59 (L to M) and 314 (K to E) in L17 isolate. This study represents the first report of PPV1 cluster E in Tamil Nadu, southern India.

Finite element method for estimation of applanation force and to study the influence of intraocular pressure of eye on tonometry.

PURPOSE: Discover the associations of force of applanation on the eye with the plunging depth of the cornea and quantify them. The results will be utilized as the feedback parameter in the new prototype development of eye care instruments as additional force may damage the internal structure of the eye or may result in erroneous output. METHOD: A finite element-based eye model is designed utilizing the actual dimensions of the human eye. A standardized tonometer is designed and the simulation is carried out at predetermined deformation of the cornea to find the force of applanation on the cornea during tonometry. Adding on, the influence of IOP during tonometry is analyzed for a range of plunging depths of the cornea. RESULTS: The graphical results inferred the linear relation between the force of applanation with the deformation of the cornea and the results are quantified. The resulting deformation and stress plot of FEM based simulation approach is analyzed and observations regarding deformations and stress are made. CONCLUSION: The human eye is successfully developed and also computed force on the cornea during tonometry is validated. The inference drawn from the deformation plot and stress plot is that the junction of cornea-sclera along with cornea-tonometer periphery undergo maximum deformation and experiences the highest stress compared to other areas of the eye while during tonometry.

Diabetic Hand Infections: Factors at Presentation Influencing Amputation and Number of Surgical Procedures.

Background Diabetic hand infections are associated with significant morbidity and disability. Amputations cause permanent disability, and multiple surgical procedures lead to morbidity. Diabetic foot infections have been well-studied but literature on hand infections is limited. We undertook a retrospective study of patients with diabetic hand infections operated at our center to study the factors at presentation with significant association with amputation and number of surgical procedures. Patients and Methods Demographic data of 51 patients was collected. The six parameters, namely, duration of diabetes, "onset of symptoms to presentation" interval, presence of comorbidities, HbA1c level, random blood sugar (RBS) levels at admission, and culture characteristics were selected for statistical analysis to find a relationship with the two outcome variables: number of procedures done and need for amputation. Results On bivariate analysis, Gram-negative infection was found to have a significant relationship with the need for multiple of procedures ( p = 0 . 014). The mean difference between the "onset of symptoms to presentation" interval between the amputation/non-amputation groups (2.9 days, p = 0 . 04) and the multiple procedures/non-multiple procedure groups (4.4 days, p = 0 . 02) was found to be statistically significant. Presence of comorbidities, long duration of diabetes, HbA1c, and RBS levels at admission did not show any statistically significant association with the two outcome variables studied. Conclusion In the present study, we found that infection with Gram-negative organisms is significantly related to the need for multiple surgical procedures. A delay in presentation can influence the risk of amputation as well as multiple procedures. Institution of early appropriate care is important to get a good outcome.

Minimally invasive substernal colonic transposition for corrosive strictures of the upper aerodigestive tract.

Corrosive upper aerodigestive tract strictures are conventionally treated by open surgery. Surgical advancements permit these strictures to be addressed with minimal invasion. Corrosive strictures treated minimally invasively over a 2-year period (2014-2015) were audited. Colonic mobilization and retrosternal tunneling were performed laparoscopically. The left colic vessel-based isoperistaltic colonic/ileocolonic segment was transposed substernally into the neck, aided by miniceliotomy. Proximal anastomosis was side-to-side esophagocolic in all patients except those who underwent pharyngolaryngectomy or partial laryngectomy, where pharyngocolic/pyriform fossa-ileal anastomosis was employed. Distal anastomoses were colo-jejunal and colocolic/ileocolic in all the patients. Enteral nutrition and ambulation were commenced on the first postoperative day. Oral nutrition was commenced following a normal contrast swallow on the seventh postoperative day. Patients were followed up on an outpatient basis. Ten adults, aged between 19 and 40 years, were treated for acid-induced strictures. Esophagus and stomach were multiply strictured in all patients. Additionally, duodenum was involved in two patients while pharynx and larynx were strictured in three patients. Two patients underwent pharyngolaryngectomy. One patient underwent partial laryngectomy. The average operative time was 240 minutes (range: 210-300 minutes). The mean blood loss was 150 mL (range: 100-200 mL). One patient (10%) had cervical anastomotic leak on the ninth postoperative day, which was resolved spontaneously. One patient (10%) had proximal anastomotic stricture, requiring dilatation thrice. One patient (10%) had the transient left recurrent laryngeal nerve paresis, which was resolved spontaneously. All the patients are on oral solid diet. The followup ranged from 5 months to 2 years. Minimal access substernal colonic transposition is feasible and efficacious in restoring alimentary continuity in corrosive strictures.

Complex dorsal dislocation of the distal interphalangeal joint: Perspectives on management.

Distal interphalangeal joint dislocations are only rarely complex and irreducible. We present a case and illustrate our approach to management of this problem. Open reduction is necessary, and preferred approach is volar. It is imperative to identify the injured soft tissue and repair them as is feasible.

Burden of death and disability due to adverse effects of medical treatment in India: An analysis using the global burden of disease 2019 study data.

Unsafe patient care can result in an adverse event that may lead to hospitalization, disability, or death. India has a vast and diverse population with varying degrees of access to tertiary healthcare. However, there is a lack of studies analyzing the burden of healthcare-related adverse events. We aimed to determine the burden of adverse effects of medical treatment (AEMT) in India from 2010 to 2019 using the global burden of disease (GBD) 2019 study database. Using the GBD data, we computed estimates for deaths and disability-adjusted life years (DALY) due to AEMT at the national level and stratified them based on age and gender. AEMT contributed to less than 0.01 % of death and DALY rates due to all causes in India. From 2010 to 2019, there was a decrease in the death rate from 2.34 (1.75-2.66) to 2.33 (1.73-2.86) per 100000 population. The number of deaths and DALYs was highest in the 50-74-year age group and in females. There has been a decrease in the death and DALY rates in India over the past decade. AEMT accounts for only a small percentage of deaths due to all causes; however, the potential underreporting and the impact of medical treatment-related adverse events on the public perception regarding healthcare services need to be studied.

A Systematic Review of the Economic Burden of Proton Therapy in Head and Neck Cancer.

BACKGROUND: Radiation therapy is used to treat head and neck cancer (HNC) patients. Proton beam therapy (PBT) is one of the newer treatment options. This systematic review will describe the cost and cost-effectiveness of PBT compared with other first-line treatment options based on available literature and provide a better understanding of its usage in HNC in the future. METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches were conducted in PUBMED, EMBASE and SCOPUS till February 2022. Original pharmacoeconomic articles written in English that considered PBT for HNC were included; the title, abstract and full text of the search items were screened. The included studies were critically appraised using the Drummond Checklist followed by data extraction. RESULTS: Eight of the ten included studies were of good quality; most were cost-effectiveness or cost comparison studies and used the Markov model and lifetime horizon. The dominant comparator was intensity-modulated radiotherapy. The willingness to pay threshold ranged from $30,828 to $150,000 per QALY. The incremental cost-effectiveness ratio (ICER) was between $4,436.1 and $695,000 per QALY. In HNC patients with human papillomavirus infection, the ICER was lower ($288,000/QALY) from the payer's perspective, but much higher ($390,000/QALY) from the societal perspective. CONCLUSION: Our systematic review showed that appropriate patient selection can make PBT cost-effective. HPV-associated tumors can be cost-effectively treated with PBT. From the payer's perspective, PBT is a cost-effective treatment option. In younger patients, PBT can result in lesser incidence of adverse effects, and hence, can reduce the subsequent need for long-term supportive care. Lower fractionation schedules can also make PBT a cost-effective treatment.

Association of vertical growth pattern with canine impactions in Dravidian subjects.

Canine impaction, ectopic canines, canine transposition, canine transmigration, and agenesis are all caused by disturbances during development and eruption of the teeth. The position of the canines is of utmost importance, and they should be carefully inspected as they follow the longest path during eruption in the oral cavity and their shape and position play a major role in occlusal guidance. The prevalence of canine impaction may also be connected to the pattern of facial growth. The objective of this study was to analyze the association of vertical growth pattern and canine impaction in Dravidian population. The dental records were consulted for information. The patient information was gathered from the outpatient data records of patients who were treated with fixed orthodontic treatment at the private dental setup. Patients with canine impactions were shortlisted. Malocclusion, growth pattern, and type of impaction were recorded. The data obtained were tabulated and analyzed using statistical software. Out of 1385 subjects, 35 patients had impacted canines. Among 35 patients with impacted canines, 23 (65.71%) have a vertical growth pattern, 6 (17.14%) have an average growth pattern, and 6 (17.14%) have a horizontal growth pattern. According to the findings of this investigation, there was no gender-related difference in canine impaction. The canine impaction prevalence in Dravidian subjects was found to be 2.53%. Most of them with impacted canines had a vertical growth pattern.

Awareness on the management strategy of stitch abscess among dental students.

Stitch abscesses are abscesses that develop following surgical procedures as a result of suture infections. Because of nonabsorbable sutures, the material reacts with connective tissue, generating adhesions around the stitch. The use of this type of material increases the risk of infection. The aim of this study was to establish awareness on the management strategy of suture stitch abscess among dental students. An online survey consisting of ten questions about suture stitch abscess along with sociodemographic factors was circulated among equal numbers of 2nd years, 3rd years, final years, and compulsory rotatory residential internship (CRRI). The data obtained from the questionnaire were transferred to Microsoft Excel and imported to SPSS software for statistical analysis. Interns are more aware about the complications and management strategy of suture stitch abscesses compared to others. Awareness on the management strategy of suture stitch abscess is important, and it helps to reduce the side effects to improve the outcomes. Educating the risk factors, signs and symptoms, and management strategy is the best way to help raise awareness.

Postburn Reconstruction of the Face and Neck.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the cardinal principles in the management of postburn deformities in the face and neck. 2. Understand reconstruction of specific subsites in the face and neck affected by burn contracture. 3. Acquire knowledge about the various techniques of burn reconstruction of the face and neck. 4. Grasp technical nuances and select appropriate surgical options for individual cases. SUMMARY: Postburn contractures in the face and neck region are multifactorial in origin and difficult to prevent in extensive burns. Facial burns lead to distortion of anatomical landmarks, causing aesthetic, functional, and psychological problems. Each subunit of the face is unique in structure; thus, the surgeon needs to adjust the timing of surgery and the technique according to region and the severity of contracture. Contracture of one unit, especially that of the neck and forehead, can exaggerate the contracture in neighboring subunits. The role of these extrinsic influences must be considered while sequencing surgical procedures. The burn surgeon must be adept in all reconstructive surgery techniques from skin grafting to tissue expanders to microsurgery to obtain the best outcomes. Surgery must be followed up with long-term physical therapy and psychological rehabilitation to help burn survivors with head and neck contractures to integrate back into society.

Chitosan-based scaffolds as drug delivery systems in bone tissue engineering.

The bone tissue engineering approach for treating large bone defects becomes necessary when the tissue damage surpasses the threshold of the inherent regenerative ability of the human body. A myriad of natural biodegradable polymers and scaffold fabrication techniques have emerged in the last decade. Chitosan (CS) is especially attractive as a bone scaffold material to support cell attachment and proliferation and mineralization of the bone matrix. The primary amino groups in CS are responsible for properties such as controlled drug release, mucoadhesion, in situ gelation, and transfection. CS-based smart drug delivery scaffolds that respond to environmental stimuli have been reported to have a localized sustained delivery of drugs in the large bone defect area. This review outlines the recent advances in the fabrication of CS-based scaffolds as a pharmaceutical carrier to deliver drugs such as antibiotics, growth factors, nucleic acids, and phenolic compounds for bone tissue regeneration.

Replantation surgery.

The current concepts of replantation surgery, a procedure that has been practiced for half a century, can be discussed in terms of patients' demands and expectations, present indications for the procedure, available evidence that influences decision making, and technical refinements practiced to produce better outcomes.

Port extériorisation appendectomy-our experience.

BACKGROUND: Laparoscopic appendectomy is conventionally performed using 3 ports, with division of appendicular base and artery using staples/endoloops/clips. Paucity of surgical laparoscope and laparoscopic disposables necessitated adoption of laparoscopic technique obviating the need for the above. We document our experience with the port exteriorisation appendectomy performed predominantly using two ports. METHODS: Between July 2008 and April 2009, 65 appendectomies were performed at a zonal hospital, of which 26 were performed using the contemplated technique. Technical challenges, conversions, operative time, complications, postoperative recovery, and cosmesis were analysed. RESULTS: Twenty-six patients (13 males and 13 females), with a mean age of 22.88 ± 11.94 years, underwent port exteriorisation appendectomy. The median operative time was 20 minutes. Two cases (7.7%) needed conversion to open appendectomy. Dense adhesions necessitated addition of a working instrument/port in two cases (7.7%). Postoperative pain was < 25 by verbal response score. Visceral component predominated on the operative day, which got confined to port sites subsequently. One patient (3.85%) developed surgical site infection. Friable, gangrenous, short fibrosed appendix on a fixed caecum and very thick abdominal wall were its limitations. Postoperative recovery and cosmesis were excellent. CONCLUSION: Port exteriorisation appendectomy proves simple, safe, economical, and efficacious, when conditions favour its performance. However, difficult appendices warrant conversion to three ports technique or to open procedure.

Molecular docking analysis of selected pyrimidine derivatives with human cyclin-dependent kinase 2.

A series of pyrimidine were synthesized, characterized and evaluated for their antioxidant properties using the human cyclin-dependent kinase-2 protein model. Data shows that the pyrimidine derivatives (compound ID 4G) with para fluoro groups substitution at phenyl ring attached to the 4th position (IC50: 98.5µg/ml), compound 4B bearing hydroxy group at para position of phenyl ring (IC50: 117.8 µg/ml) have significant antioxidant activity. Docking data infer that compounds 4c, 4a, 4h and 4b possess binding energy (-7.9, -7.7, -7.5 and -7.4 kcal.mol-1) with 1HCK (PDB ID) receptor.

A Meta-analysis of Oral Squamous Cell Carcinoma in Young Adults with a Comparison to the Older Group Patients (2014-2019).

BACKGROUND: The oral squamous cell carcinoma (OSCC) often affects elderly aged adults, who had long-term tobacco exposure. In the recent past decade, there is an increasing incidence of OSCC in younger individuals, who had less tobacco association. AIM: The aim of this study is to examine the risk factors and to assess and compare the clinicopathological features and prognosis of OSCC in young patients with the older group patients. MATERIALS AND METHODS: We included studies that addressed the OSCC involving young patients during the period between 2014 and 2019. Initially, we found 679 articles; after refined evaluation, 92 works had their titles matching to the present work. After extraction of case reports, reviews, and studies with un-matched objectives or inadequate data, we have chosen only 24 presentations matching to the abstract. The statistical analysis performed by Chi-square tests using SPSS 20.0 version for windows. RESULTS: Of the total OSCC, 10% of patients belonged to the younger age group, and 90% were the older aged group. Both the groups showed male gender predominance and tongue as the predominant site of involvement. The younger patients tend to have significantly reduced tobacco exposure. The highly reported tumors were advanced staged and moderately differentiated tumors in both groups. There was a statistically evident high recurrence reported in the younger group. The overall survival seems to be similar for both groups. CONCLUSION: The identification of the potential risk factors, along with unique molecular mechanisms, and biological behavior of the disease is mandatory to control the incidence of OSCC in young adults.