Outcomes of therapeutic penetrating keratoplasty in Pythium insidiosum keratitis managed with a combination of antibiotics

Purpose: To describe the clinical outcomes of therapeutic penetrating keratoplasty (TPK) in patients with Pythium insidiosum keratitis following treatment with anti?pythium therapy (APT) consisting of linezolid and azithromycin. Methods: A retrospective review of medical records from May 2016 to December 2019 of patients with P. insidiosum keratitis was carried out. Patients who were treated with APT for a minimum of 2 weeks and then subsequently underwent TPK were included in the study. Data on demographic characteristics, clinical features, microbiology characteristics, and intraoperative details, postoperative outcomes were documented. Results: A total of 238 cases of Pythium keratitis were seen during the study period and 50 cases that satisfied the inclusion criteria were included. The median of the geometric mean of the infiltrate was 5.6 mm (IQR 4.0–7.2 mm). The patients received topical APT for a median of 35 days (IQR 25–56) prior to surgery. The most common indication of TPK was worsening keratitis (41/50, 82%). No recurrence of infection was observed. An anatomically stable globe was noted in 49/50 eyes (98%). The median graft survival rate was 2.4 months. A clear graft was present in 10 eyes (20%) with a final median visual acuity of 20/125 after a median follow?up period of 18.4 months (IQR 11–26 months). Graft size of less than 10 mm [OR: 5.824 (CI:1.292?41.6), P = 0.02] was found to be significantly associated with a clear graft. Conclusion: Performing TPK following the administration of APT has good anatomical outcomes. A smaller graft of <10 mm was associated with a higher chance of graft survival

Autologous serum eye drops in dry eye disease: Preferred practice pattern guidelines

Autologous serum eye drops provide lubrication and promote epithelial healing. They have been successfully used in the management of ocular surface disorders such as dry eye disease, persistent epithelial defects and neurotrophic keratopathy for many decades. A great deal of variation in the methods of preparation of autologous serum eye drops, the end concentration and the duration of use exists in published literature. In this review, simplified recommendations for preparation, transport, storage and use of autologous serum are described. Evidence for the use of this modality in aqueous deficient dry eye disease is summarized, along with expertise-based rationale.

Impact of crossplay between ocular aberrations and depth of focus in topo-guided laser-assisted in situ keratomileusis outcomes

Purpose: To develop a nomogram in cases with mismatch between subjective and Topolyzer cylinder, and based on the magnitude of the mismatch, customize a treatment plan to attain good visual outcomes post?laser?assisted in situ keratomileusis (LASIK) surgery. Methods: The patients were evaluated preoperatively using corneal tomography with Pentacam. Five optimal corneal topography scans were obtained from the Topolyzer Vario were used for planning the LASIK treatment. For the nomogram purpose, the patients were divided into three categories based on the difference between the subjective cylinder and Topolyzer (corneal) cylinder. The first group (group 1) consisted of eyes of patients, where the difference was less than or equal to 0.4 D. The second group (group 2) consisted of eyes, where the difference was more than 0.4 D and the subjective cylinder was lesser than the Topolyzer cylinder. The third group (group 3) included eyes where the difference was more than 0.4 D but the subjective cylinder was greater than the Topolyzer cylinder. LASIK was performed with the WaveLight FS 200 femtosecond laser and WaveLight EX500 excimer laser. Assessment of astigmatism correction for the three groups was done using Aplins vector analysis. For comparison of proportions, Chi?square test was used. A P value less than 0.05 was considered statistically significant. Results: The UDVA was statistically significantly different when compared between groups 1 and 2 (P = 0.02). However, the corrected distance visual acuity (CDVA) was similar among all the three groups (P = 0.1). Group 3 showed an increase of residual cylinder by ?0.25 D, which was significant at intermediate and near reading distances (P < 0.05). Group 3 showed significantly higher target?induced astigmatism (TIA) compared to groups 1 and 2 (P = 0.01). The mean surgically induced astigmatism (SIA) was the least in group 2, which was statistically significant (P < 0.01). Conclusion: The outcomes for distance vision using our nomogram postoperatively were excellent, but further refinement for improving the near vision outcomes is required

Prevalence of Oral Normal Variance in Healthy Elderly Patients: A Descriptive Study on Oral Pseudo-Lesions

Abstract Introduction The aging process in the elderly can change the condition of the oral cavity, regarding both clinical appearance and function. The oral mucosa becomes more susceptible to mechanical damage and irritant agents. Any changes in the oral mucosa, including normal variance, should be examined. This is especially true for the elderly, to improve oral health and prevent any abnormalities. Objective To describe the prevalence of oral normal variance in healthy elderly patients. Methods An observational descriptive study with a cross-sectional design with total sampling conducted from March to April 2020. Results Among the 117 elderly patients who participated in this study, 58 were described as healthy without any comorbidities. From those subjects, there were 117 cases of normal variance in the oral mucosa. The three most prevalent issues were fissured tongue (93.1%), coated tongue (58.62%), and crenated tongue (27.59%). Conclusion Fissured tongue is a normal variance of the oral mucosa that is commonly found in healthy elderly patients.

Acremonium keratitis: Risk factors, clinical characteristics, management, and outcome in 65 cases

Purpose: To study the risk factors, clinical presentation, management options, and outcomes in cases of culture?proven Acremonium keratitis. Methods: Medical and microbiology records of culture?proven Acremonium keratitis from Jan 2007 to Dec 2019 at a tertiary eye care center were reviewed. Details of clinical findings on each visit and operating notes were reviewed from the medical records. All cases were subjected to corneal scraping at the first visit for microbiological investigation consisting of direct smear examination and culture. Topical natamycin 5% was the mainstay of medical treatment. Surgical treatment was considered for nonresponding patients. Results: During the 13?year study period, 65 cases of culture?proven Acremonium keratitis were identified out of 1605 cases of fungal keratitis. Trauma was the most common predisposing factor in 32 cases (49.2%). The average area of the corneal stromal infiltrate was 24.8 mm2 at the initial presentation. Hypopyon at the time of presentation was evident in 28 (43.1%) cases. Staphylococcus spp. was the most common (n = 22, 33.8%) organism coexistent with Acremonium. Direct microscopy of corneal scraping was positive for fungal filaments in 57/65 (87.6%) cases. Medical management alone was given in 44 patients (67.6%). Age (>50 years) and treatment delay (>15 days) were found to be independent risk factors for the poor final visual outcome (VA <20/60). Conclusion: When treated early, Acremonium keratitis responds well to medical therapy with currently available topical antifungals. However, advanced and nonresponding cases require surgical intervention for resolution of the infection

Ectopic Pregnancy: A Single Tertiary Centre Experience

Background: EP is an unmitigated disaster of human reproduction, a major cause of reduced childbearing potential. EP can occur in Fallopian tubes, ovaries, cervix, abdominal cavity, cornua of uterus and c- section scar. But 95-98% of ectopic pregnancies are tubal. Aim: To study incidence, risk factors, clinical presentation immediate morbidity and mortality associated with ectopic pregnancy. Materials and methods: Patients diagnosed with ectopic pregnancy in reproductive age group (15-44 years) after clinical examination and investigations during one year period were included in the study. It was prospective study. Data was entered in MS excel spreadsheet and analyzed. Results: A total of 70 cases of ectopic pregnancy were included. Incidence of ectopic pregnancy in the present study was 7.6 per 1000 deliveries. Mean age was found to be 28 years and majority of them were multi gravida (93.3%) with low socioeconomic background (92.9%). Most common clinical presentation was a combination of amenorrhea (95.7%) and pain abdomen (100%). Bleeding per vagina was also seen in 28.6% of cases Past history of tubectomy was present in 24.3% of cases. Clinical signs such as abdominal tenderness, distension and guarding were noted in 75%, 88%, 75% of tubal rupture as compared to 25.7%, 12% and 25% of unruptured ectopic pregnancy. Cases of ruptured ectopic pregnancy presented with severe pallor (81.8%) and shock (100%). Urine pregnancy test was positive in all cases. Ultrasonography was an accurate tool for diagnosis and differentiated ruptured (74.3%) from unruptured (25.7%) ectopic pregnancies. Emergency laparotomy and salpingectomy (91.4%) on affected side was the treatment in majority of cases. Conclusion: Ectopic pregnancy is an important cause of maternal morbidity and mortality, high index of clinical suspicion, positive urine pregnancy test, ultrasonographic features point to early and accurate diagnosis of this entity. Treatment in time may save many lives and decrease associated morbidity.

Evidence of dengue virus in eviscerated specimens of panophthalmitis secondary to dengue fever: A possible cause-effect phenomenon

Purpose: To report a retrospective series of three cases of infectious panophthalmitis post?dengue fever with ex vivo confirmation of dengue virus ribonucleic acid (RNA) in the tissues of the eye. Methods: Four eyes of three patients, who were diagnosed with panophthalmitis following dengue fever and who underwent evisceration, were included. All demographic and clinical data were recorded. The eviscerated samples were subjected to direct microscopy, culture for bacteria, fungi, and parasites, and molecular virology (dengue virus [DENV] NS1?specific reverse transcription loop?mediated isothermal amplification (RT?LAMP) assay). Results: The time from the development of dengue fever to the occurrence of ocular symptoms was 4.33 ± 1.15 (median 5) days. DENV NS1 RNA, suggestive of the presence of the dengue virus, was confirmed in all evisceration specimens (uveal tissue, cornea). All the patients recovered completely from dengue fever and on follow?up had healthy eviscerated sockets. Conclusion: Demonstration of the DENV RNA in the eviscerated specimens of panophthalmitis following dengue fever implicates the DENV in the pathophysiology of the ocular infection.

Sensitivity and specificity of potassium hydroxide and calcofluor white stain to differentiate between fungal and Pythium filaments in corneal scrapings from patients of Pythium keratitis

Purpose: To assess the sensitivity of potassium hydroxide and calcofluor white (KOH+CFW) mount in the diagnosis of Pythium keratitis and concordance among microbiologists. Methods: Three microbiologists evaluated the microscopic images of KOH + CFW mounts of confirmed cases of Pythium and fungal keratitis seen between January 2019 and February 2021. The filaments were compared using specific differentiating features. The sensitivity and specificity of KOH + CFW in diagnosing Pythium infection were evaluated along with concordance among the microbiologists. Results: Sixty consecutive cases with confirmed growth of fungus or Pythium insidiosum (n = 29) were evaluated. The sensitivity of KOH + CFW in the correct identification of Pythium filaments ranged from 79.3% to 96.5% among three microbiologists. There was good interobserver (k = 0.76–0.90) and intraobserver (k = 0.70–0.97) agreements among three microbiologists. The differentiating findings (P < 0.0001) suggestive of Pythium filaments were the absence of septae in 23 (79.3%) and collapsed walls in 22 (75.9%) cases. Conclusion: KOH + CFW has good sensitivity and specificity in the diagnosis of Pythium keratitis with good interobserver and intraobserver concordance.

Biofilm formation and its effect on the management of culture-positive bacterial endophthalmitis

Purpose: To compare the clinicomicrobiological features and outcomes in patients with infectious endophthalmitis caused by biofilm?positive (BP) and biofilm?negative (BN) bacteria. Methods: This was a prospective, interventional, comparative, nonrandomized, consecutive case series. Culture?positive bacterial endophthalmitis cases from August 1, 2018 to July 31st 31, 2019 were included. All vitreous samples were tested for biofilm using crystal violet plate and XTT (2,3?bis?(2?methoxy?4?nitro?5?sulfophenyl)?2H?tetrazolium?5?carboxanilide) methods and classified as BN and BP. The antibiotic susceptibility of all organisms was determined. Anatomic and functional success was defined as intraocular pressure >5 mm Hg and final best?corrected vision ?20/400, respectively, at last visit. Results: There were 50 eyes in the BN group and 33 eyes in the BP group. BN group eyes required 2.86 ± 1.45 surgical interventions, and BP group eyes needed surgical 6.36 ± 2.89 interventions, P < 0.0001, 95% Confidence Interval, CI: 2–4. Median follow?up was 6 and 5 months, respectively (P = 0.33). Final logMAR vision was a median of 1.2 and 1.9 respectively; P = 0.0005, 95% C.I.: 0.4–1.7. Functional success was achieved in 44% and 21.2% (P = 0.03, 95% C.I.: 1.86%–40.08%) and anatomic success was achieved in 68% and 42.42%, respectively (P = 0.02, 95% C.I.: 3.85%–45.47%). The antimicrobial resistance patterns between the two groups were comparable. Conclusion: Endophthalmitis caused by the biofilm?forming bacteria needs a greater number of surgical interventions. The anatomic and functional outcomes are poorer than non?biofilm?forming bacterial endophthalmitis. The increased virulence and poorer outcomes can be hypothesized to be due to the physical barrier effect of the biofilm on the antibiotics

Clinical features and microbiology of post-cataract surgery endophthalmitis with and without intracameral moxifloxacin prophylaxis: Endophthalmitis prophylaxis study report 3

Purpose: This study aimed to analyze the clinical presentations, microbiology, and management outcomes of post–cataract surgery endophthalmitis, with and without intracameral moxifloxacin prophylaxis. Methods: This study was designed as a retrospective, consecutive, comparative case series. Records of consecutive cataract surgery from January 1, 2015, till June 30, 2020, were analyzed. The cases that developed endophthalmitis were analyzed. The endophthalmitis cases were divided by their prophylaxis treatment into two groups: with intracameral moxifloxacin (ICM) and without (N?ICM). Inclusion criteria were (1) age ? 18 years, (2) cataract surgery with intraocular lens implantation, (3) endophthalmitis within 6 weeks of cataract surgery, and (4) cataract surgery in the institute by any of the three methods—phacoemulsification, manual small incision cataract surgery, and extracapsular cataract extraction. Results: In the study period, 66,967 cataract surgeries were performed; 48.7% (n = 32,649) did not receive ICM. There was no difference between the N?ICM and ICM groups in the incidence of clinical (n = 21, 0.064% and n = 15, 0.043%; P = 0.23) and culture proven (n = 19, 0.033% and n = 11, 0.023%; P = 0.99) endophthalmitis, respectively. Greater number of patients in the N?ICM group had lid edema (76.2% vs. 40%; P = 0.03), corneal edema (71.4% vs. 33.3%; P = 0.03) and lower presenting vision with available correction (logMAR [logarithm of the minimum angle of resolution] 1.26 ± 1.2 vs. logMAR 0.54 ± 0.85; P = 0.02). The final best?corrected visual acuity following treatment was worse in the N?ICM group (logMAR 1.26 ± 1.2 vs. 0.54 ± 0.85; P = 0.02). Conclusion: Endophthalmitis after intracameral moxifloxacin may have relatively milder signs and symptoms and may respond better to treatment.

M2 Macrophage-Derived Concentrated Conditioned Media Significantly Improves Skin Wound Healing

BACKGROUND@#Macrophages, with many different phenotypes play a major role during wound healing process, secreting the cytokines crucial to angiogenesis, cell recruitment and ECM remodeling. Therefore, macrophage-derived cytokines may be attractive therapeutic resource for wound healing. @*METHODS@#To obtain a conditioned media (CM) from macrophages, human monocyte THP-1 cells were seeded on TCP or human fibroblast-derived matrix (hFDM) and they were differentiated into M1 or M2 phenotype using distinct protocols. A combination of different substrates and macrophage phenotypes produced M1- and M2-CM or M1-hFDM- and M2-hFDM-CM, respectively. Proteome microarray determines the cytokine contents in those CMs. CMs-treated human dermal fibroblast (hDFB) was analyzed using collagen synthesis and wound scratch assay. Concentrated form of the CM (CCM), obtained by high-speed centrifugation, was administered to a murine full-thickness wound model using alginate patch, where alginate patch was incubated in the M2-CCM overnight at 4 °C before transplantation. On 14 day post-treatment, examination was carried out through H&E and Herovici staining. Keratinocyte and M2 macrophages were also evaluated via immunofluorescence staining. @*RESULTS@#Cytokine analysis of CMs found CCL1, CCL5, and G-CSF, where CCL5 is more dominant. We found increased collagen synthesis and faster wound closure in hDFB treated with M2-CM. Full-thickness wounds treated by M2-hFDM-CCM containing alginate patch showed early wound closure, larger blood vessels, increased mature collagen deposition, enhanced keratinocyte maturation and more M2-macrophage population. @*CONCLUSION@#Our study demonstrated therapeutic potential of the CM derived from M2 macrophages, where the cytokines in the CM may have played an active role for enhanced wound healing.

Peripheral Blood Smear Morphology- A Red Flag in COVID-19

Covid-19 pandemic has affected the whole word medically, economically and emotionally. It is being considered as the biggest pandemic after the Spanish flu, with very high degree of morbidity and mortality in those with complications. The diagnostic and treatment criteria of this novel virus are being updated frequentlyas nothing much is known about it. This highlights the importance of hematology lab parametersin Coviddiagnosis and prediction of disease progression. Multiple studieson complete blood counts and it’s derived parametershave beenconductedin patients of Covid-19however limited literature is available whichdiscussesthe morphology of circulatingblood cellsin Covid-19 cases.This short communicationis presentedwith the purpose of highlighting theperipheral blood findings of 50 lab confirmed Covid-19 cases admitted atSuper SpecialtyPediatric Hospital and Post Graduate Teaching Hospital, NOIDA.Keywords: Covid-19; morbidity and mortality; SARS CoV2; real time RT-PCR.Short Communication

Study of socio-demographic factors in cases of pregnancy induced hypertension and its associated risk factors in a tertiary care hospital

Background: The aim of the study was to study the socio-demographic factors in cases of pregnancy induced hypertension and its associated risk factors in a tertiary care hospital.Methods: The present retrospective study was conducted in the obstetrics and gynecology department of Shrimati Heera Kunwar Baa Memorial Hospital, Jhalawar, Rajasthan from December 2018 to November 2019. A total of 80 cases of pregnant women with PIH were studied. The socio-demographic data like age, parity, gestational age of presentation, mode of delivery, maternal and perinatal complications were noted from the hospital records and studied.Results: The incidence of PIH was found to be 8.16% in pregnant women attending the SHKBM Hospital. Majority of the study subjects were rural dweller (70%). A higher incidence of PIH was found among illiterate women (51.25%). 53.75% cases were in the age group of 25-30 years and 25% were in the age group of 19-24 years. In the present study, incidence of PIH was found to be highest among primigravidas (67.50%) as compared to multigravidas (32.5%). Most cases were delivered by caesarean section (73.75%) and 26.25% were delivered vaginally. Out of 80 cases, 16.25% of cases were complicated by eclampsia, Severe PIH in 12.5%, abruptio placentae in 2.5% and HELLP Syndrome in 1.25% cases.Conclusions: PIH is a very common complication encountered in pregnancy associated with adverse maternal and fetal outcome. The risk is higher among young primigravidas and in rural population. Better health care facilities and awareness among the pregnant women will help in reducing the incidence of PIH and its associated complications.

Serum vitamin B12 associated with vitamin D/25(OH)D in women with recurrent aphthous stomatitis / Vitamina B12 sérica asociada con vitamina D / 25 (OH) D en mujeres con estomatitis aftosa recurrente

Vitamin B12 and Vitamin D deficiency may contribute to recurrent aphthous stomatitis (RAS). Current studies have showed vitamin B12 to be associated with vitamin D in women, however no study has assessed vitamin B12 associated with vitamin D/25(OH)D in women with RAS. Objective: To investigate the association between serum vitamin B12 and vitamin D/25(OH)D in women with RAS. Materials and Methods: Fourty one women with RAS who meet the inclusion criteria participated in this study. The inclusion criteria were women with RAS without other oral diseases. The exclusions criteria were those who have systemic diseases, taking medications or smoked. All subjects underwent venupuncture to draw blood to quantify serum vitamin B12 and vitamin D/25(OH)D. The characteristic of subjects, severity of RAS, serum Vitamin B12 and Vitamin D/25(OH)D were collected and presented descriptively. The correlation between vitamin B12 and Vitamin D/25(OH)D was analyzed using Pearson correlation test with 95% confidence interval. This study was approved by Medical and Health Ethics Committe, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia. Results: All RAS subjects have normal mean value of serum Vitamin B12 (453.97+154.44pg/ml) and have low mean value of serum vitamin D/25(OH)D (10.79 +3.29ng/ml) categorized as vitamin D deficiency. The Pearson correlation test showed that there was a significant positive correlation between mean serum Vitamin B12 and Vitamin D/25(OH)D (r= 0.313, p<0.05). Conclusion: There is correlation between vitamin B12 and Vitamin D, and a low level of Vitamin D may contribute in RAS in women.

Antecedentes: la deficiencia de vitamina B12 y vitamina D puede contribuir a la estomatitis aftosa recurrente (EAR). Los estudios actuales han demostrado que la vitamina B12 está asociada con la vitamina D en mujeres, sin embargo, ningún estudio ha evaluado la vitamina B12 asociada con la vitamina D/25 (OH) D en mujeres con EAR. Objetivo: investigar la asociación entre la vitamina B12 y la vitamina D / 25 (OH) D sérica en mujeres con RAS. Material y Métodos: Cuarenta y una mujeres con RAS que cumplen con los criterios de inclusión participaron en este estudio. Los criterios de inclusión fueron mujeres con RAS y sin otras enfermedades orales. Los criterios de exclusión fueron aquellos que tenían enfermedades sistémicas, tomaban medicamentos o fumaban. Todos los sujetos se sometieron a una venupuntura para extraer sangre para cuantificar la vitamina B12 y la vitamina D/25 (OH) D en suero. Las características de los sujetos, la severidad del EAR, la concentración de vitamina B12 y la vitamina D/25 (OH) D sérica fueron recolectadas y presentadas descriptivamente. La correlación entre la vitamina B12 y la vitamina D/25 (OH) D se analizó mediante la prueba de correlación de Pearson con un intervalo de confianza del 95%. Este estudio fue aprobado por el Comité de Ética Médica y de Salud, Facultad de Medicina, Universitas Gadjah Mada, Yogyakarta, Indonesia. Resultado: Todos los sujetos con EAR tienen un valor medio normal de vitamina B12 sérica (453,97pg/ml + 154,44pg/ml) y un valor medio bajo de vitamina D sérica/25 (OH) D (10,79 ng/ml + 3,29ng/ml) clasificado como deficiencia de vitamina D. La prueba de correlación de Pearson mostró que había una correlación positiva significativa entre la vitamina B12 media y la vitamina D/25 (OH) D en suero r=0.313, p<0.05). Conclusión: Existe una correlación entre la vitamina B12 y la vitamina D, y un bajo nivel de vitamina D puede contribuir al RAS en las mujeres.

Fibroadenoma: Common Neoplasm in an Uncommon Site.

Vulval fibroadenoma is an uncommon benign tumourthat has been suggested to originate from ectopic breasttissue or mammary like anogenital glands. We report acase of a 26 years old woman who presented with alarge, slow growing painless mass in vulvar region since2 months with a clinical diagnosis of sebaceous cyst/Inclusion epidermoid cyst. Excision was done and onhistopathological examination it was reported as ectopicbreast tissue with fibroadenoma and lactational change.

Study of ectopic pregnancy in a tertiary care centre

Background: Ectopic pregnancy is an obstetric emergency with high morbidity and mortality. Incidence of ectopic pregnancies has been increasing in last two to three decades with reduction in mortality. The presenting symptoms include irregular vaginal bleeding. The present study was undertaken to study the clinical features of ectopic pregnancies in a tertiary care hospital.Methods: The present study on ectopic pregnancies was carried out in department of obstetrics and gynaecology, jhalawar medical college, Jhalawar, Rajasthan, India from January 2019 to October 2019. All patients admitted with diagnosis of ectopic pregnancy, either ruptured or unruptured where included in the study.Results: Total 52 patient of ectopic pregnancy were studies. Majority (63.46%) of patients belong to the age group 21-30 years. Ectopic pregnancy was most commonly noted in nulliparous woman (44.23%) Majority of the case (31%) had no risk factors among remaining (34.61%), previous MTP (17%), (17-30%) previous ectopic (9%) and PID (15-38%) were identified risk factors. Ampulla (75%) was the most common site for ectopic pregnancy. 57% of the cases were on the right side. The common presenting complaints were pain in abdomen (81%) bleeding/ spotting per vaginal (42%). There was no mortality.Conclusions: Surgical treatment was done more often because of patients reporting late to the hospital screening of high-risk case, early diagnosis and early intervention reduce the morbidity and mortality in ectopic pregnancies.

Oral Candidiasis in Immunosuppressed Wistar Rats (Rattus norvegicus) Post Dexamethasone Injection at 7. 2 mg/kg and 16 mg/kg Doses / Candidíase oral em ratos Wistar imunossuprimidos (Rattus norvegicus) pós-injeção de dexametasona com doses de 7, 2 mg / kg e 16 mg / kg

Objective: Oral candidiasis is an infection that occurs in the oral cavity and is caused by candida species, often Candida albicans. This infection commonly occurs in a condition of immunosuppression caused by dexamethasone. Due to the side effects of antifungal therapy, developing a standardized immunosuppressed animal model to induce oral candidiasis for new therapies is required. The aim of this study is to observe oral candidiasis in immunosuppressed Wistar rats post dexamethasone injection at 7.2 mg/kg and 16 mg/kg doses. Material and Methods: Twenty-one Wistar rats were divided into three groups: control group, treatment group 1 (injected with dexamethasone at a concentration of 7.2 mg/kg), and treatment group 2 (at a concentration of 16 mg/kg) for five days. Immunosuppression status was observed by leukocyte count and all the subjects' palates were inoculated with C. albicans 0.1 ml of 15x108 UFC/ml 24 hours later. The subjects' tongues were observed and confirmed by laboratory examination on day 10. A statistical analysis was performed using one way ANOVA, Kruskal­Wallis, Tukey HSD, and Mann-Whitney U tests. Results: A significant clinical appearance of the subjects' tongues was observed only between C and T1 (p=0.023; p<0.05). Significant hyphal formation was observed between C and T1 (p= 0.037; p<0.05) and between C and T2 (p=0.007; p<0.05), and no significant difference was observed between T1 and T2. A significant increase in the colony count was also observed in similar results. Conclusion: Dexamethasone injection at doses of 7.2 mg/kg and 16 mg/kg is effective in triggering immunosuppression to induce oral candidiasis in immunosuppressed Wistar rats. (AU)

Candidíase oral é uma infecção que ocorre na cavidade oral e é causada por espécies de Candida, freqüentemente Candida albicans. Esta infecção geralmente ocorre em uma condição de imunossupressão causada por dexametasona. Devido aos efeitos colaterais de terapia antifúngica, o desenvolvimento de um padrão de modelo animal imunossuprimido para induzir candidíase oral para testar novas terapias se faz necessário. O objetivo deste estudo é observar candidíase oral em ratos Wistar imunossuprimidos pós-injeção de dexametasona utilizando doses de 7,2 mg /kg e 16 mg / kg. Material e métodos: Vinte e um ratos Wistar foram divididos em três grupos: grupo controle, tratamento grupo 1 (injetado com dexametasona na concentração de 7,2 mg / kg), e tratamento grupo 2 (concentração de 16 mg / kg) por cinco dias. A imunossupressão foi observada pela contagem de leucócitos e todos os palatos dos animais foram inoculados com C. albicans 0,1 ml de 15x108 UFC / ml após 24horas. As línguas dos animais foram observadas e confirmadas por exame laboratorial após 10 dias. A análise estatística foi realizada usando os testes de ANOVA um fator, kruskal ­ Wallis, Tukey HSD e de Mann-Whitney. Resultados: Significante diferença na aparência clínica da língua dos animais foi observada apenas entre C e T1 (p = 0,023; p <0,05). Significativa diferença na formação de hifas foi observada entre C e T1(p = 0,037; p <0,05) e entre C e T2 (p = 0,007; p <0,05), e nenhuma diferença significativa foi observada entre T1 e T2. Um aumento significativo na contagem de colônias foi também observado com resultados semelhantes. Conclusão: Injeção de dexametasona utilizando doses de 7,2 mg / kg e 16 mg / kg é eficaz no desencadeamento da imunossupressão para induzir candidíase oral em ratos Wistar imunossuprimidos. (AU)

Indications and foeto-maternal outcome of emergency cesarean sections in rural Mewar region

Background: In the 21st century caesarean section is the most common operation in modern obstetrics but its indications have been changed in elective and emergency cases. The aim of the present study was to find out the incidence, indication of caesarean, foeto-maternal outcome in patients who came in emergency from rural areas.Methods: This retrospective study was conducted at Pannadhai Mahila Hospital, R. N. T. Medical College, Udaipur from September 2017 to February 2018. All the women who were unbooked, belonged to rural Mewar region and underwent emergency caesarean section.Results: Total no. of deliveries conducted were 1560 in the emergency labour room out of which 462 were emergency caesarean sections. The mean age of the participants was 27 years. Foetal distress was the most common indication (17.75%) followed by prolonged labour/ failed induction 14.5%. Post-partum haemorrhage and adhesions were the commonly encountered complications.Conclusions: LSCS due to maternal and foetal indications is inevitable. Timely performed LSCS decreases the morbidity and mortality. The government of India has also taken initiative in making caesarean deliveries more acceptable, affordable to patients belonging to rural areas. The government is also enhancing primary and community health centers.

Oral Ulcer Healing after Treatment with Distilled Liquid Smoke of Coconut Shell on Diabetic Rats

Background: Distilled liquid smoke from coconut shell(Cocos nucifera L.) by pyrolysis process with final0 0temperature 400 C and then distilled in 120-150 C. Thecharacteristics of distilled liquid smoke are yellow3liquid, with acidity 2.39 and density 1.0643 g/cm . Themajor identified compounds arephenol (36.6%), 2-methoxyphenol (guaiacol) (25.2%), furfural (17.8%),2-methoxy-5-methylphenol (5.2%) and 4-ethyl-2-methoxyphenol (EMP) (3.5%) with 28 other minorconstituents by GCMS. Aim and Objectives: Distilledliquid smoke was examined to investigate its potentialtherapeutic to oral ulcer healing and diabetic conditionon the rat. Furthermore, the clinical oral ulcer healingwas evaluated based on ulcer size and diabetic wasevaluated based on Fasting Blood Glucose (FBG) andbody weight changes. Material and Methods: Diabeteswas induced by alloxan. Seventy-two hours afterinjection, the diabetic condition was confirmed withFBG of >200mg/dl, then the labial fornix anterior wasinjured to induce oral ulcer using round steel blade.Results: The clinical oral ulcer healing was improvedafter treatment with distillated liquid smoke comparedto benzydamine hydrochloride and aquadest sterile forthree days (p=0.005) and seven days (p=0.000).Treatment for seven days with distilled liquid smokeshowed significant improvement of the body masschanges compared to benzydamine hydrochloride(p=0.008) and aquadest sterile (p=0.002). There wasno improvement of FBG after treatment with distilledliquid smoke (p=0.152). Conclusion: Treatment withdistilled liquid smoke coconut shell can improved oralulcer healing and body weight changes, but not FBGchanges