Evaluation of the photocatalytic degradation mechanism of methylene blue using nascent and Ag+ ions-modified TiO2.

In photocatalytic removal of organic pollutants, adsorption and degradation are two important processes that take place. Various instrumental techniques and trapping experiments have been used to identify the reactive species and the mechanism of photodegradation. The present work focuses on investigating the mechanism of photo-induced degradation from the comparative characterization of fresh and used samples, isotherm models, competitive adsorption, and desorption studies of pure and Ag+-modified TiO2 NPs. The comparative characterizations of fresh and used NPs were carried out with FT-IR, EDX, and XRF analyses after methylene blue (MB) degradation. The Ag+ doped TiO2 used in this study was fabricated using simple impregnation technique. The prepared NPs were characterized using techniques including XPS, XRD, SEM/EDX, XRF, UV-DRS, and pH point-zero charge analyses (pHPZC). The Ag+-modified TiO2 NPs showed improved efficiency compared to pure TiO2 NPs using normal compact fluorescent light (CFL). The Langmuir and Freundlich isotherm models were applied to test the adsorption behavior on the surface photocatalysts. The investigational data finest fitted to the Langmuir isotherms model compared to Freundlich model, suggesting the homogeneous monolayer adsorption followed by degradations. The competitive removal of MB in the presence of a photo-generated electrons trapper (Cd2+) was enhanced almost 3-folds (115 mg/L) compared to the removal from a single MB solution (40 mg/L). The characterization of the used samples as well as adsorption in the dark and negligible desorption of used samples support the involvement of the proposed photo-induced degradation mechanism.

Unravelling the genetic basis of retinal dystrophies in Pakistani consanguineous families.

BACKGROUND: Retinitis Pigmentosa (RP) is a clinically and genetically progressive retinal dystrophy associated with severe visual impairments and sometimes blindness, the most common syndromic form of which is Usher syndrome (USH). This study aimed to further increase understanding of the spectrum of RP in the Khyber Pakhtunkhwa region of Pakistan. METHODOLOGY: Four consanguineous families of Pashtun ethnic group were investigated which were referred by the local collaborating ophthalmologists. In total 42 individuals in four families were recruited and investigated using whole exome and dideoxy sequencing. Among them, 20 were affected individuals including 6 in both family 1 and 2, 5 in family 3 and 3 in family 4. RESULT: Pathogenic gene variants were identified in all four families, including two in cone dystrophy and RP genes in the same family (PDE6C; c.480delG, p.Asn161ThrfsTer33 and TULP1; c.238 C > T, p.Gln80Ter) with double-homozygous individuals presenting with more severe disease. Other pathogenic variants were identified in MERTK (c.2194C > T, p.Arg732Ter), RHO (c.448G > A, p.Glu150Lys) associated with non-syndromic RP, and MYO7A (c.487G > A, p.Gly163Arg) associated with USH. In addition, the reported variants were of clinical significance as the PDE6C variant was detected novel, whereas TULP1, MERTK, and MYO7A variants were detected rare and first time found segregating with retinal dystrophies in Pakistani consanguineous families. CONCLUSIONS: This study increases knowledge of the genetic basis of retinal dystrophies in families from Pakistan providing information important for genetic testing and diagnostic provision particularly from the Khyber Pakhtunkhwa region.

Serum concentrations of secretory leukocyte protease inhibitor and IL6 can predict the onset of sepsis in pyometra bitches.

As onset of sepsis adversely affects the prognosis of canine pyometra, finding biomarkers that would distinguish sepsis status would be useful in the clinical management. Accordingly, we hypothesized that differential expression of endometrial transcripts and circulating concentration of certain inflammatory mediators would discriminate pyometra-led sepsis (P-sepsis+) from those of pyometra without sepsis (P-sepsis-). Bitches with pyometra (n = 52) were classified into P-sepsis+ (n = 28) and P-sepsis- (n = 24) based on vital clinical score and total leukocyte count. A group of non-pyometra bitches (n = 12) served as control. The relative fold changes in the transcripts of IL6, IL8, TNFα, IL10, PTGS2, mPGES1 and PGFS, SLPI, S100A8, S100A12 and eNOS were determined by quantitative polymerase chain reaction. Furthermore, the serum concentrations of IL6, IL8, IL10, SLPI and prostaglandin F2α metabolite (PGFM) were assayed by ELISA. The relative fold changes in S100A12 and SLPI and mean concentrations of IL6 and SLPI were significantly (p < .05) higher in P-sepsis+ than that of P-sepsis- group. Receiver operating characteristic analysis revealed that serum IL6 had a diagnostic sensitivity of 78.6% and a positive likelihood ratio (LR+) of 2.09, at a cut-off value of 15.7 pg/mL to diagnose P-sepsis+ cases. Similarly, serum SLPI had a sensitivity of 84.6% and an LR+ of 2.23, at a cut-off value of 2.0 pg/mL. It was concluded that SLPI and IL6 would serve as putative biomarkers for pyometra-led sepsis in bitches. Monitoring SLPI and IL6 would be a useful adjunct to the established haemato-biochemical parameters in customizing the treatment strategies and arriving at the decision for management of pyometra bitches with critical illness.

Secretory leucocyte protease inhibitor (SLPI) as an adjunct prognostic biomarker for canine pyometra.

Pyometra is a potentially life-threatening condition that affects intact female dogs in their middle to advance age. Timely diagnosis and appropriate treatment are critical for the survival of patients, especially when pyometra advances to sepsis. This study aimed to investigate the prognostic potential of certain haematology, serum biochemical and inflammatory biomarker, secretory leucocyte protease inhibitor (SLPI) for pyometra in bitches (n = 41). Blood samples were collected after clinical diagnosis of pyometra for haematology and serum biochemistry. Based on the prognosis following medical/surgical treatment, animals were retrospectively categorized into survivor (n = 29) and dead (n = 12). Endometrial tissue sections were obtained from the bitches undergoing ovariohysterectomy (n = 21). Serum concentration of SLPI was quantified using sandwich ELISA and its expression in the endometrium was investigated using RT-qPCR. A marked increase in the total leucocyte count (TLC), neutrophils, blood urea nitrogen (BUN) and serum creatinine was observed in the female dogs that did not survive. Significant elevation in the serum SLPI concentration (3.49 ± 0.44 vs. 2.38 ± 0.13 ng/mL) was observed in the bitches those died after the treatment, in comparison to those survived (p < .01). Additionally, there was a notable upregulation of SLPI in the endometrium in the bitches those died due to pyometra. Based on the ROC analysis results, it was observed that a cut-off concentration of 2.93 ng/mL for SLPI, 27.77 mg/dL for BUN and 16.3 × 103 /µL for TLC could effectively distinguish the prognosis of pyometra-affected dogs. From this study, it can be concluded that upregulation of SLPI in the endometrium and its elevated concentration in peripheral circulation along with TLC and BUN concentration could serve as valuable indicators for predicting the prognosis of pyometra in bitches.

Informed consent practices in oral and maxillofacial surgery setups - an audit report.

OBJECTIVE: To evaluate the existing practices of obtaining and documenting informed consent in cases of oral and maxillofacial surgery. METHODS: The cross-sectional study was conducted from April to June 2017 at the Oral and Maxillofacial Surgery departments of five teaching hospitals of Rawalpindi and Islamabad, Pakistan, and comprised patients who underwent surgery under general anaesthesia. Data was collected using questionnaire-based interviews a day after the surgery in each case regarding multiple aspects of the informed consent practices. Data was analysed using SPSS 21. RESULTS: Of the 100 patients, 58(58%) were males and 42(42%) were females, while 81(81%) were adults aged >18 years. In 42(42%) cases, the consent document was signed by the patient, and by a relative in 38(38%) cases. In the remaining 20(20%) cases, only verbal consent was taken. In 54(54%) cases nursing staff and in 46(46%) cases residents took the consent. Most patients were informed about nature of their disease 87(87%), proposed treatment 86(86%) and type of anaesthesia 100(100%). Fewer patients were informed about any alternative treatments 38(38%), and possible complications of the surgery 51(51%) or anaesthesia 26(26%). Overall, 44(44%) patients did not fully understand the written information, and 23(23%) said they were encouraged to ask questions. CONCLUSIONS: The quality of informed consent practices was found to be sub-optimal in oral and maxillofacial surgery setups.

Electrochemical corrosion and bacterial adhesion study of Two Osteosynthetic Maxillofacial Bone Plates.

OBJECTIVE: To evaluate the novel locally manufactured osteosynthetic titanium bone mini plates used for mandibular fracture fixation, and to compare it with an international brand to have an alternative to expensive plates. METHODS: The study was conducted at National University of Science and Technology from Jan 2013 to June 2013. Local and German brands of osteosynthetic titanium bone mini plates were studied electrochemically through Tafel extrapolation curves using Gamry® electrochemical framework in modified simulated body fluid prepared with pH 7.4 at 37OC. For bacterial adhesion, staphylococcus aureus bacterial culture of 50 l was used with an OD600 of 1.0 corresponding to approximately 1.79×109 cells ml-1. Data was analysed using SPSS 20.. RESULTS: Corrosion resistance behaviour of local and German plates was not significantly different (p>0.05), but in case of bacterial adhesion the local plates showed significantly low adhesion compared to the imported material (p<0.05). Overall, the biocompatible properties of local plates met international brand qualities. CONCLUSIONS: Electrochemical corrosion and bacterial adhesion of local osteosynthetic maxillofacial bone plates matched the quality of an international brand.

Backward Planning a Craniomaxillofacial Trauma Curriculum for the Surgical Workforce in Low-Resource Settings.

BACKGROUND: Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using competency-based curricula. We present a process for the development of a competency-based curriculum for low-resource settings in the context of craniomaxillofacial (CMF) trauma education. METHODS: CMF trauma surgeons representing 7 low-, middle-, and high-income countries conducted a standardized educational curriculum development program. Patient problems related to facial injuries were identified and ranked from highest to lowest morbidity. Higher morbidity problems were categorized into 4 modules with agreed upon competencies. Methods of delivery (lectures, case discussions, and practical exercises) were selected to optimize learning of each competency. RESULTS: A facial injuries educational curriculum (1.5 days event) was tailored to health professionals with diverse training backgrounds who care for CMF trauma patients in low-resource settings. A backward planned, competency-based curriculum was organized into four modules titled: acute (emergent), eye (periorbital injuries and sight preserving measures), mouth (dental injuries and fracture care), and soft tissue injury treatments. Four courses have been completed with pre- and post-course assessments completed. CONCLUSIONS: Surgeons and educators from a diverse geographic background found the backward planning curriculum development method effective in creating a competency-based facial injuries (trauma) course for health professionals in low-resource settings, where contextual aspects of shortages of surgical capacity, equipment, and emergency transportation must be considered.

Massive land system changes impact water quality of the Jhelum River in Kashmir Himalaya.

The pristine aquatic ecosystems in the Himalayas are facing an ever increasing threat from various anthropogenic pressures which necessitate better understanding of the spatial and temporal variability of pollutants, their sources, and possible remedies. This study demonstrates the multi-disciplinary approach utilizing the multivariate statistical techniques, data from remote sensing, lab, and field-based observations for assessing the impact of massive land system changes on water quality of the river Jhelum. Land system changes over a period of 38 years have been quantified using multi-spectral satellite data to delineate the extent of different anthropogenically driven land use types that are the main non-point sources of pollution. Fifteen water quality parameters, at 12 sampling sites distributed uniformly along the length of the Jhelum, have been assessed to identify the possible sources of pollution. Our analysis indicated that 18% of the forested area has degraded into sparse forest or scrublands from 1972 to 2010, and the areas under croplands have decreased by 24% as people shifted from irrigation-intensive agriculture to orchard farming while as settlements showed a 397% increase during the observation period. One-way ANOVA revealed that all the water quality parameters had significant spatio-temporal differences (p < 0.01). Cluster analysis (CA) helped us to classify all the sampling sites into three groups. Factor analysis revealed that 91.84% of the total variance was mainly explained by five factors. Drastic changes in water quality of the Jhelum since the past three decades are manifested by increases in nitrate-nitrogen, TDS, and electric conductivity. The especially high levels of nitrogen (858 ± 405 µgL(-1)) and phosphorus (273 ± 18 µgL(-1)) in the Jhelum could be attributed to the reckless application of fertilizers, pesticides, and unplanned urbanization in the area.

An emerging photocatalyst for wastewater remediation: a mini-review on CaCu3Ti4O12 photocatalysis.

Ceramics-based filter for water treatment is an ancient technology to procure potable water at the household level. The traditional clay pots (vessels or hollow cylindrical container) have been used since long in the developing countries. The ceramic material (CaCu3Ti4O12 or CCTO) is a hetero-junction of titanium oxide, a well-known UV-active photocatalyst, and visible light absorbing CuO materials. This hetero-junction is able to overcome the limitations such as high bandgap, poor stability, low efficiency, and high photo-generated charge (e-/h+) recombination rate, associated with the other commonly used metal oxide semiconductor photocatalysts. Moreover, the low-cost, viable and facile synthesis routes for CCTO triggered its potential applications in photoelectrochemical and photocatalytic processes. This review will elaborate on the available literature demonstrating the visible light activity of CCTO photocatalysts in water treatment technologies. Furthermore, the mechanism of photocatalysis and synthesis routes are presented in this work for broader impact of the CCTO potential applications. The extended porous character and excellent surface texture have made the ceramic materials as an ideal choice to combat the bacteria, pathogens and turbidity in aqueous medium at household level. Specifically, the controlled size and shape make the CaCu3Ti4O12 (CCTO) an excellent visible light-driven photocatalyst, involving highly reactive species such as •OH, •O2- anions, h+, and e-, for the removal of organic and inorganic pollutants from water.

Vitamin D Status and Mortality from SARS CoV-2: A Prospective Study of Unvaccinated Caucasian Adults.

COVID-19 and a low vitamin D state share common risk factors, which might explain why vitamin D deficiency has been linked with higher COVID-19 mortality. Moreover, measures of serum vitamin D may become lower during systemic inflammatory responses, further confounding the association via reverse causality. In this prospective study (recruited over 12 months), we examined whether the association between a low vitamin D state and in-hospital mortality due to SARS-CoV-2 pneumonia in unvaccinated subjects is explained by (i) the presence of shared risk factors (e.g., obesity, advanced age) or (ii) a reduction in serum 25(OH)D due to COVID-19 (i.e., reverse causality). In this cohort of 232 (mean age = 56 years) patients (all had SARS-CoV-2 diagnosed via PCR AND required supplemental oxygen therapy), we failed to find an association between serum vitamin D and levels of CRP, or other inflammatory markers. However, the hazard ratio for mortality for subjects over 70 years of age (13.2) and for subjects with a serum 25(OH)D level less than 30 nmol·L−1 (4.6) remained significantly elevated even after adjustment for gender, obesity and the presence of diabetes mellitus. Subjects <70 years and >70 years had significantly higher mortality with a serum 25(OH)D less than 30 nmol·L−1 (11.8% and 55%), than with a serum 25(OH)D greater than 30 nmol·L−1 (2.2% and 25%). Unvaccinated Caucasian adults with a low vitamin D state have higher mortality due to SARS CoV-2 pneumonia, which is not explained by confounders and is not closely linked with elevated serum CRP.

Heavy metal phytoremediation potential of the roadside forage Chloris barbata Sw. (swollen windmill grass) and the risk assessment of the forage-cattle-human food system.

This study presents the assessment of the risks incidental to the growth of the common tropical grass species Chloris barbata Sw. (swollen windmill grass) on road margins contaminated with Pb and Cd. Pot experiments were first carried out to quantify the Pb and Cd accumulation potential of the plant species in various plant parts as a function of the metal concentration in soil. C. barbata was found to be a hyperaccumulator for Cd (BCF>1, for aerial parts) and an excluder of Pb (BCF<1, for aerial parts). As the plant was found to accumulate Pb in its roots with TF<1, it can be considered a phytostabilizer of Pb. The mathematical relationship developed between soil concentrations of Pb and Cd and their corresponding concentrations in aerial parts were used in combination with the concentrations of these heavy metals reported in roadside soils to obtain estimates of their accumulation in the forage and consequently in the animal organs. Risk to the consumers of offal was estimated. It was found that the consumption of kidney meat was riskier than the consumption of liver meat. Furthermore, it was seen that despite the nearly two order less concentrations of Cd in roadside soils compared to Pb, it was posing a higher risk. For the median concentrations of Pb reported in roadside soils and cattle feeding exclusively on C. barbata growing on roadside soils, the HQ exceeded 1 for weekly consumption of kidney meat above 650 g. For median Cd concentrations, consumption of kidney meat above 230 g/week resulted in HQ>1. The scenario considered for risk assessment is significant for India, where stray grazing of cattle on road margins is common and offal offers a cheap source of animal protein for the economically poor.

Novel mutations in PDE6A and CDHR1 cause retinitis pigmentosa in Pakistani families.

AIM: To investigate the genetic basis of autosomal recessive retinitis pigmentosa (arRP) in two consanguineous/ endogamous Pakistani families. METHODS: Whole exome sequencing (WES) was performed on genomic DNA samples of patients with arRP to identify disease causing mutations. Sanger sequencing was performed to confirm familial segregation of identified mutations, and potential pathogenicity was determined by predictions of the mutations' functions. RESULTS: A novel homozygous frameshift mutation [NM_000440.2:c.1054delG, p. (Gln352Argfs*4); Chr5:g.149286886del (GRCh37)] in the PDE6A gene in an endogamous family and a novel homozygous splice site mutation [NM_033100.3:c.1168-1G>A, Chr10:g.85968484G>A (GRCh37)] in the CDHR1 gene in a consanguineous family were identified. The PDE6A variant p. (Gln352Argfs*4) was predicted to be deleterious or pathogenic, whilst the CDHR1 variant c.1168-1G>A was predicted to result in potential alteration of splicing. CONCLUSION: This study expands the spectrum of genetic variants for arRP in Pakistani families.

Clinical stage of oral cancer patients at the time of initial diagnosis.

BACKGROUND: Squamous cell carcinoma is the most common oral cancer. Early diagnosis ensures better prognosis. Late diagnosis is however common around the world and contributes to the high morbidity and mortality related to oral cancer. The objective of this study was to determine the clinical stage of oral cancer patients at the time of diagnosis. METHODS: This retrospective study was carried out on 334 oral cancer patients who presented to the outdoor departments of Armed Forces Institute of Dentistry, and Armed Forces Institute of Pathology, Rawalpindi from July 2008 to December 2009. The records that were reviewed included history and clinical examination findings. OPG and CT scans of the head and neck region, chest X-rays, abdominal ultrasounds and liver function tests. Size of the primary tumour, the size, number and laterality of the involved cervical lymph nodes and the presence/absence of distant metastases were documented and statistically analysed using SPSS-17. RESULTS: Out of the 334 patients, 203 (60.8%) were males and 131 (39.2%) females. The age range was from 21 to 88 years. Buccal mucosa was the most commonly involved site (32%). The primary tumour was 4 Cm or more in size, (T3/T4) 71.25% of the cases. Cervical lymph nodes were involved in 211 patients (63.2%) and distant metastases were present in 39 patients (11.7%). Overall, clinical stage IV was the most common (57.18%) followed by stage III (24.55%), stage II (13.77%) and stage I (4.49%). CONCLUSION: Oral cancers are diagnosed late (Stage III and IV) in Pakistan and need immediate public and professional attention.

Liability allocation in pollution involving multiple responsible parties.

World over, the instances where polluters are made to pay for the damages they have caused to the environment are on the rise. If more than one party is found responsible for pollution, our analyses of statutes of different countries, covering more than 57% of the world population and more than 45% of its land area, showed that liability is to be allocated among the involved parties on an equitable basis, often decided by the courts. Analyses of a number of court cases showed that the factors considered for allocation in such cases may be classified into two, technical and non-technical. It was also found that the legal liability of pollution was different from the technical liability in many cases due to the influence of non-technical factors that were very specific to the case. These non-technical factors often do not fall under the investigation purview of an environmental forensic expert who carries out technical investigations to find the responsible parties. Based on the analysis, it is suggested that the liability allocation be a two-stage process; the first stage being technical liability allocation done by the forensic expert and the second stage the final (legal) allocation by the court. It is also suggested that clear guidelines be prepared for technical liability allocation. There was also a felt need to quantify remediability to make the remediation liability allocation easier.

Demographic distribution of maxillofacial fractures in Ayub Teaching Hospital: 7-year review.

BACKGROUND: This retrospective study was carried out to determine the demographic distribution of Maxillofacial Fractures (MFF) in patients reported to Maxillofacial Surgical Unit, Ayub Teaching Hospital, Abbottabad from 2001 to 2007. METHODS: All the patients having a history of maxillofacial fractures were included according to age, gender distribution and risk factors. Isolated Nasal fractures, Naso-Orbito-Ethmiodal complex fractures and earthquake victims were excluded from this study. RESULTS: This study encompassed a total numbers of 952 patients. Males were 645 (67.8%) and females were 307 (32.2%) with male to female ratio 2.1:1. Most of the fractures occurred during third decade of life. The most common risk factor was Road Traffic Accident (RTA) n=70 (38.9%). Most of the fractures were occurred during the month of June, July and August. CONCLUSION: RTA is still the most common risk factor of maxillofacial fractures and is more common in male.

Update on the management of craniomaxillofacial trauma in low-resource settings.

PURPOSE OF REVIEW: Craniomaxillofacial (CMF) trauma is a common cause of global morbidity and mortality. Although in high resource settings the management of CMF trauma has improved substantially over the past several decades with internal rigid fixation technology; these advancements have remained economically unviable and have not yet reached low and middle-income countries (LMICs) en masse. The purpose of this review is to discuss the current management of CMF injuries in low-resource settings. RECENT FINDINGS: Trauma injuries remain a global epidemic with head and neck injuries among the most common. CMF trauma injuries largely occur in LMICs, with motor vehicle trauma being a common cause. Patients present in a delayed fashion which increases complications. Diagnostic methods are often limited to plain radiographs as computed tomography is not always available. In low-resource settings, CMF trauma continues to be treated primarily by closed reduction, maxillomandibular fixation, and transosseous wiring, yielding acceptable results through affordable methods. With the advent of less expensive plating systems, internal fixation with plates and screws are gradually finding their place in the management of facial trauma in low-resource settings. A shortage of CMF surgeons in LMICs is a recognized problem and is being addressed by targeted curricula. SUMMARY: CMF trauma is a major cause of morbidity and mortality globally that remains poorly addressed. Currently, conventional methods of treating CMF trauma in low-resource settings have evolved to meet resource constraints. The education of CMF surgeons remains a key leverage point in improving CMF trauma care globally.

Genomic Profiling for KRAS, NRAS, BRAF, Microsatellite Instability, and Mismatch Repair Deficiency Among Patients With Metastatic Colon Cancer.

PURPOSE: Genomic testing is recognized in national guidelines as essential to guide appropriate therapy selection in metastatic colorectal cancer. Previous studies report adherence to testing guidelines is suboptimal, but current testing rates have not been assessed. This study reports testing rates in metastatic colon cancer (mCC) for guideline-recommended biomarkers in a US-based population. MATERIALS AND METHODS: A retrospective review of data extracted from electronic medical records was performed to identify patients with pathologically confirmed mCC and describe patterns of guideline-aligned biomarker testing. Data were extracted from the electronic health records of 1,497 patients treated at 23 practices across the United States. Both community and academic centers were represented. RESULTS: A total of 1,497 patients with mCC diagnosed between January 1, 2013 and December 31, 2017 were identified. Guideline-aligned biomarker testing rates for RAS, BRAF, and microsatellite instability/mismatch repair deficiency over this study period were 41%, 43%, and 51%, respectively. Patients were more likely to have guideline-aligned testing for RAS and BRAF if they were treated at an academic center, were diagnosed with de novo metastatic disease, and were female. In addition, patients < 65 years of age were more likely to have guideline-aligned RAS testing. Of the 177 patients (12% of cohort) who received anti-epidermal growth factor receptor therapy, only 50 (28%) had complete guideline-aligned biomarker testing. CONCLUSION: Despite guideline recommendations and significant therapeutic implications, overall biomarker testing rates in mCC remain suboptimal. Adherence to guideline-recommended biomarker testing would potentially reduce exposure to expensive and ineffective therapies, resulting in improved patient outcomes.

Management of Obstructive Sleep Apnea Syndrome Associated with Severe Micrognathia.

Obstructive sleep apnea syndrome (OSAS), commonly associated with mandibular micrognathia, is a serious condition that can lead to various devastating cardiovascular and neurocognitive consequences. Patients of OSAS with micrognathia present with many functional and esthetic problems. Therefore, comprehensive management of these patients requires multiple surgeries and frequent follow-up. Several surgical and non-surgical treatment options have been proposed for the treatment of OSAS. Distraction osteogenesis (DO) in maxillofacial region, although a newer treatment modality, is being increasingly favoured by many surgeons because of its many advantages over other treatment methods. We present comprehensive management of a case of OSAS associated with post temporomandibular joint ankylosis severe micrognathia. Various surgical treatment methods including DO and conventional orthognathic surgical procedures were employed in management of this patient of obstructive sleep apnea. Both functional and esthetic complaints of the patient were addressed, and we achieved exceptional results at the end of treatment.

Neurobrucellosis Presenting as Acute Psychosis.

A 45-year-old female without any past or family history of psychiatric illness presented to the emergency department with complaints of abnormal behavior, irrelevant talking, restlessness, episodic crying, and decreased sleep of 2-day duration. On detailed interview, the attendants gave a history of an intermittent headache of 6-month duration and hearing impairment of 4-month duration. On investigation, her cerebrospinal fluid was reactive, and brucella titers were positive. She received appropriate treatment for 6 months and a short course of antipsychotics. Her symptoms settled, but she had persistent hearing loss. Psychosis as well as hearing loss is a very rare presentation of brucellosis. The case highlights the importance of considering neurobrucellosis as a differential diagnosis in patients with any unexplained neuropsychiatric symptoms such as acute psychosis or hearing loss.