Topsy turvy in the line of fire

In literature there are several schools of thoughts regarding the tooth present in line of fracture. Some supports the preservation to tooth and others in contrast against to the preservation of the tooth. A case of mandibular fracture with a tooth in the fracture line is presented in this paper. Removal of tooth done followed by reduction under G.A with 1 month postoperative follow-up. Different authors supporting different treatment plan for tooth in fracture line. It depends on case whether to remove the tooth or preserve. There are several pro and cons for both the treatment plan discussed in this paper.

Races and Biovar Characterization of Ralstonia solanacearum Causing Bacterial Wilt Disease of Potato

Ralstonia solanacearum, the causative agent of brown rot/bacterial wilt, is a major cause of severe potato illnesses in many impoverished nations located in tropical and subtropical regions of the world. When it occurs, the disease is to blame for significant losses to the potato industry. The illness has the potential to completely destroy a crop and stop using a piece of land for potato cultivation for a number of years. A survey was carried out to investigate the extent of Ralstonia solanacearum-caused bacterial wilt of potato crops in important potato-growing talukas in the Banaskantha district of Gujarat, India, including Deesa, Dantiwada, Palanpur, and Amirgadh. The frequency of bacterial wilt disease in potatoes is rather low in this region. Four talukas were utilised to identify ten isolates (RsSt1 to RsSt10) of R. solanacearum, which were then used to determine the biovar and race. Gram-negative rod-shaped cells were present in the isolates of R. solanacearum. On TZC agar medium, these isolates developed colonies that were creamy or dull white in colour with a hint of pink or red in the centre. The oxidation of disaccharides (sucrose, lactose, maltose) and sugar alcohols (manitol, sorbitol, and dulcitol) by R. solanacearum isolates was used to determine the biovar characteristics. This revealed that, of the ten isolates, eight were classified as bv2, and the two remaining isolates (RsSt5 and RsSt7) belonged to bv2T. The pathogenicity test conducted on tobacco, tomato, and brinjal allowed for the race identification of R. solanacearum isolates, which were classified as race 3 due to their limited host range and ability to exclusively elicit wilt symptoms in potatoes and tomatoes. As a result, Races 3 and bv2 and bv2T were represented among the R. solanacearum isolates that caused bacterial wilt of potatoes in the Banaskantha district.

Trends of humoral immune responses to heterologous antigenic exposure due to vaccination & omicron SARS-CoV-2 infection: Implications for boosting

Background & objectives: Vaccination and natural infection can both augment the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but how omicron infection has affected the vaccine-induced and hybrid immunity is not well studied in Indian population. The present study was aimed to assess the durability and change in responses of humoral immunity with age, prior natural infection, vaccine type and duration with a minimum gap of six months post-two doses with either ChAdOx1 nCov-19 or BBV152 prior- and post-emergence of the omicron variant. Methods: A total of 1300 participants were included in this observational study between November 2021 and May 2022. Participants had completed at least six months after vaccination (2 doses) with either ChAdOx1 nCoV-19 or an inactivated whole virus vaccine BBV152. They were grouped according to their age (? or ?60 yr) and prior exposure of SARS-CoV-2 infection. Five hundred and sixteen of these participants were followed up after emergence of the Omicron variant. The main outcome was durability and augmentation of the humoral immune response as determined by anti-receptor-binding domain (RBD) immunoglobulin G (IgG) concentrations, anti-nucleocapsid antibodies and anti-omicron RBD antibodies. Live virus neutralization assay was conducted for neutralizing antibodies against four variants – ancestral, delta and omicron and omicron sublineage BA.5. Results: Before the omicron surge, serum anti-RBD IgG antibodies were detected in 87 per cent participants after a median gap of eight months from the second vaccine dose, with a median titre of 114 [interquartile range (IQR) 32, 302] BAU/ml. The levels increased to 594 (252, 1230) BAU/ml post- omicron surge (P<0.001) with 97 per cent participants having detectable antibodies, although only 40 had symptomatic infection during the omicron surge irrespective of vaccine type and previous history of infection. Those with prior natural infection and vaccination had higher anti-RBD IgG titre at baseline, which increased further [352 (IQR 131, 869) to 816 (IQR 383, 2001) BAU/ml] (P<0.001). The antibody levels remained elevated after a mean time gap of 10 months, although there was a decline of 41 per cent. The geometric mean titre was 452.54, 172.80, 83.1 and 76.99 against the ancestral, delta, omicron and omicron BA.5 variants in the live virus neutralization assay. Interpretation & conclusions: Anti-RBD IgG antibodies were detected in 85 per cent of participants after a median gap of eight months following the second vaccine dose. Omicron infection probably resulted in a substantial proportion of asymptomatic infection in the first four months in our study population and boosted the vaccine-induced humoral immune response, which declined but still remained durable over 10 months

A Case Report of Mucormycosis in a Patient with a Recent History of COVID-19 Infection in India

Introduction: Mucormycosis is an angio-invasive fungal infection that increased significantly during the 2nd wave of the Covid-19 pandemic in India. The rise of cases was attributed to inflammatory changes, poor quality oxygen, immune suppression, and corticosteroid therapy. Case Presentation: This case study reports the history, treatment, and rehabilitation of a case of post-Covid-19 mucormycosis infection. The patient was admitted to the hospital following respiratory distress, at the beginning of the 2nd Covid-19 wave in India. Intravenous antibiotics, steroids, and moist O2 were administered, intensive support was provided and the patient was discharged after 13 days. Following extraction of 17, the patient reported signs of oro-antral communication which was managed by performing antral lavage and buccal advanced flap closure. Histopathological investigation of tissue salvaged during the procedure revealed the presence of fungal hyphae. Management and Prognosis: Following diagnosis, anti-fungal medication was prescribed, and a maxillectomy was performed to remove the affected tissue. On follow-up, the tissue healed with no further complications or symptoms, and rehabilitation was performed using an obturators and are movable complete denture. Histopathological investigations were carried out on the tissue salvaged during maxillectomy which confirmed Mucormycosis infection. Conclusion: The importance of histopathological investigation in the diagnosis of any infectious disease is enumerated in this paper

Report-based antibiotic sensitivity pattern of community-acquired urinary tract infection in rural Bengal

Background: Urinary tract infection (UTI), a common bacterial infection managed in general practice, is the second most common cause for antibiotic use in primary care setting. Antibiotic prescription is mostly empirical in UTI and it is imperative to choose one highly sensitive drug against the common pathogens. Aims and Objectives: In this study, it has been tried to find out the magnitude of community-acquired UTI in a rural population of West Bengal, its causative agents, and the sensitivity pattern of urinary isolates to reduce the development of antibiotic resistance. Materials and Methods: This is an observational, cross-sectional study over 1 year in a rural tertiary care hospital in West Bengal. Culture and sensitivity reports generated from diagnosed UTI patients from the different OPDs of the hospital were analyzed. Results: Out of 603 reports analyzed, culture-positive reports were 463. Escherichia coli was identified to be the most predominant (61.7%) followed by Staphylococcus aureus (17.3%). The sensitivity report of the empirically given antibiotics shows that among the oral antibiotics, nitrofurantoin was the most sensitive one (92%) followed by ciprofloxacin (83.1%) and ofloxacin (66%). Among the injectables, amikacin (84.5%) and ceftazidime (81.8%) were the antibiotics having the highest sensitivity. Conclusion: The sensitivity among the uropathogens to the commonly used antibiotics shows higher resistance rate toward norfloxacin, cephalexin, cotrimoxazole, ampicillin, amoxicillin, co-amoxiclav, and cefuroxime. Oral antibiotics such as nitrofurantoin and ciprofloxacin and parenteral antibiotic amikacin have found to be of higher sensitivity among all organisms identified clubbed together.

Reflective writing as a learning tool for Phase II MBBS students in India

Background: Reflection is essential in training physicians mainly because it helps them to participate in collaborative teams, respond in unique and compassionate manner to clinical cases and situations and behave professionally and with empathy. Aims and Objectives: The objective of this study was to observe the reflective writing ability of the Phase II MBBS students of the institute after a structured training and to obtain student feedback about the experience. Materials and Methods: This was a prospective, observational study conducted at the Department of Pharmacology, of a Medical college. A total of 102 students were included in an interactive lecture on reflection writing. Over 3 weeks they were shown three different videos (two of them doctor patient/family member interactions and one a teacher student interaction). The students were asked to reflect about what they saw in the videos. Their reflection was under three heads - “what happened, what was your reaction, and what can be done next.” Their reflection was analyzed using a scoring system (score 1 no refection to score 6 with in depth reflection) by a single observer. Their feedback was obtained using a 5-point Likert scale. Results: Average scores of the students in the three reflection exercises were 2.85 ± 0.78, 2.98 ± 0.84, and 3.36 ± 0.57, respectively, showing improvement in reflection skills. Feedback from the students showed that most liked the experience and recommended for their peers. Conclusions: We concluded that 2nd year MBBS students, when taught the structure of a reflective exercise may be able to reflect better on their day to day experiences.

Swyer syndrome presenting as dysgerminoma: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Complete gonadal dysgenesis with 46,XY karyotype is a clinical condition characterized by the absence of testicular tissue but typical Mullerian structures in a phenotypically female individual. The condition presents as primary amenorrhoea or delayed puberty. Eventually, malignant neoplasms may arise. We report a case of a 16-year-old patient with Swyer syndrome presenting with primary amenorrhoea and with previous diagnosis four years earlier of a malignant dysgerminoma in the right ovary.

A review of patent literature on the regulation of glucose metabolism by six phytocompounds in the management of diabetes mellitus and its complications / 中西医结合学报

Diabetes mellitus is a chronic disease, typified by hyperglycemia resulting from failures in complex multifactorial metabolic functions, that requires life-long medication. Prolonged uncontrolled hyperglycemia leads to micro- and macro-vascular complications. Although antidiabetic drugs are prescribed as the first-line treatment, many of them lose efficacy over time or have severe side effects. There is a lack of in-depth study on the patents filed concerning the use of natural compounds to manage diabetes. Thus, this patent analysis provides a comprehensive report on the antidiabetic therapeutic activity of 6 phytocompounds when taken alone or in combinations. Four patent databases were searched, and 17,649 patents filed between 2001 and 2021 were retrieved. Of these, 139 patents for antidiabetic therapeutic aids that included berberine, curcumin, gingerol, gymnemic acid, gymnemagenin and mangiferin were analyzed. The results showed that these compounds alone or in combinations, targeting acetyl-coenzyme A carboxylase 2, serine/threonine protein kinase, α-amylase, α-glucosidase, lipooxygenase, phosphorylase, peroxisome proliferator-activated receptor-γ (PPARγ), protein tyrosine phosphatase 1B, PPARγ co-activator-1α, phosphoinositide 3-kinase and protein phosphatase 1 regulatory subunit 3C, could regulate glucose metabolism which are validated by pharmacological rationale. Synergism, or combination therapy, including different phytocompounds and plant extracts, has been studied extensively and found effective, whereas the efficacy of commercial drugs in combination with phytocompounds has not been studied in detail. Curcumin, gymnemic acid and mangiferin were found to be effective against diabetes-related complications. Please cite this article as: DasNandy A, Virge R, Hegde HV, Chattopadhyay D. A review of patent literature on the regulation of glucose metabolism by six phytocompounds in the management of diabetes mellitus and its complications. J Integr Med. 2023; 21(3): 226-235.

Basal cell carcinoma-clinico-pathological study in Eastern India in correlation with different risk factors

Objectives: To study the histological variants and mimickers of basal cell carcinoma (BCC) alongwith different risk factors among a group of patients from eastern India. Methods: The specimen for the study was sent by the dermatology department for histopathology after skin biopsy. Results: Out of 42 patients, 15 patients studied were males and the rest of the cases were females. The male to female ratio was 0.55:1. Maximum (15 cases) cases were in the age group of 50–59 years. Apart from sunlight, chronic arsenic exposure is an important risk factor of BCC. Basal cell hyperplasia and squamous cell carcinoma are the histological differential diagnosis of nodular BCC and basosquamous BCC. Conclusion: BCC is a disease of the older age group and with female preponderance in our study. Nodular basal cell carcinoma was the most common histologic type of basal cell carcinoma. The face was the most common site for BCC followed by the scalp. UV radiations and Arsenic do play role in the pathogenesis of BCC. CD10 helps differentiate superficial BCC from basal cell hyperplasia.

Salivary microbial dysbiosis may predict lung adenocarcinoma: A pilot study

Background: Adenocarcinoma is a more common type of Non-small cell lung cancer (NSCLC). Lung cancer showed a statistically significant increment in the Kamrup Urban district of Assam, Tripura, Sikkim, and Manipur of India. The goal of our pilot study is to identify non-invasive microbial biomarkers to detect lung adenocarcinoma (LAC). Material and Methods: DNA extraction from saliva samples of five LAC patients and five healthy controls was performed by Qiagen DNeasy blood and tissue kit using Lysozyme (3mg/ml) treatment. 16S rRNA genes of distinct regions (V3-V4) were amplified from saliva DNA by PCR. Paired-end sequencing targeting the V3-V4 region of the 16S rRNA gene has been performed on the Illumina MiSeq platform. Raw sequences were analyzed using the QIIME(Quantitative Insights Into Microbial Ecology) software package. Results: Our preliminary results showed that Rothia mucilaginosa, Veillonella dispar, Prevotella melaninogenica, Prevotella pallens, Prevotella copri, Haemophilus parainfluenzae, Neisseria bacilliformis and Aggregatibacter segnis were significantly elevated in saliva of LAC which may serve as potential non-invasive biomarkers for LAC detection. Functional prediction analysis showed that bacterial genes involved in glycosyltransferase, peptidases, amino sugar, and nucleotide sugar metabolism, starch and sucrose metabolism were significantly enriched in LAC. Conclusion: These salivary bacteria may contribute to the development of LAC by increasing expression of glycosyltransferase and peptidases. However to understand their role in pathobiology, studies are required to perform in large cohort.

Statistical Validation of LENS: A Smartphone-based Empty Nest Syndrome Screening and Monitoring Biomarker Tool

Background: Empty Nest Syndrome (ENS) is a complex grief state, observed in the affected parents when their children leave home. Studies show ENS may progress to clinical-grade depression and anxiety if left uncared for. Methodology: In this double-blind case-control cross-sectional study, 80 subjects are recruited by a panel of psychologists and psychiatrists. Subjects are divided into two equal groups – case (with ENS symptoms) and control (without symptoms). Three instruments are applied – a) ENS interpretation by the psychologists based on the symptoms, b) Lyfas smartphone-based biomedical application to capture the cardiovascular optical biomarkers (COB) from the index finger non-invasively with the help of arterial photoplethysmography technique, and c) Hamilton’s depression scales (HAM-D), which psychiatrists have used to check the mental health of the subjects. The COB (e.g., SD1/SD2, LF/HF, HRVScore, and ENERGY) and a set of physical parameters (e.g., Body mass index or BMI, Heart rate or HR, Systolic blood pressure or SBP, Diastolic blood pressure or DBP, Glycosylated hemoglobin or HbA1c, Cholesterol, Triglyceride, Thyroid-stimulating hormone or TSH, Estradiol or E2, and Testosterone or TST) consist the independent variables, while ENS scores interpreted by the psychologists and HAM-D scores interpreted by the psychiatrists are the dependent variables. Spearman’s rank correlation and Bland Altman’s reliability tests are performed to mine the significant independent variables and reliability of Lyfas ENS (LENS) application. Results: The study observes that SD1/SD2, LF/HF, HRVScore, ENERGY, DBP, BMI, HR, HbA1c, TSH, and Estradiol have significant roles in ENS. Bland Altman's reliability measure shows that LENS (novel instrument under trial) has a high agreement of 92.85% and 93.86%, respectively with ENS scoring done by senior psychologists (champion instrument1) and HAM-D grading performed by psychiatrists (champion instrument2). Conclusions: LENS can be used as a clinical-graded pocket application for screening and monitoring ENS.

Chemical denaturants induced folding unfolding pathway of the recombinant zebrafish dihydrofolate reductase

Denaturation of proteins plays a crucial part in cellular activities. In this study, we have investigated the folding unfolding pathways of zebrafish dihydrofolate reductase (zDHFR) in presence of different chemical denaturants which were found to be an influential factor for the refolding yield by UV-visible spectrophotometric analysis. The activity change of zDHFR has been observed in presence of three different denaturants like Acetic Acid (AcOH), Sodium Dodecyl Sulphate (SDS), and Ethanol (C2H5OH). Spectrophotometric analysis reveals that protein unfolded completely at different concentrations and times by these denaturants. The spontaneous refolding experiments of chemically denatured zDHFR were also conducted to verify the spontaneous refolding yield. These investigations have helped us to decipher a picture about the denaturants contributing to achieving the refolding yield. We observed that acetic acid is a stronger denaturant among all, and the spontaneous refolding yields were higher from SDS denaturation. In the light of the above findings, higher spontaneous refolding yields were obtained from the low concentration of denaturants.

Verbal learning in schizophrenia in remission, first-degree relatives, and correlation to symptoms

Background: Cognitive impairments are fundamental in schizophrenia with verbal memory impairments commonly occurring not only in patients but also in unaffected genetically susceptible individuals. Deficits in verbal memory produce difficulty in problem-solving, emotional distress, and worsening of daily life skills resulting in a poor quality of life. Objectives: This study aims to evaluate the verbal memory in unaffected first-degree relatives of patients of schizophrenia in comparison to healthy controls as well as patients of schizophrenia in remission and to find correlation to symptom domains. Methods: It was a hospital-based, descriptive, cross-sectional case-control study. Three groups (n=40, each group) of patients, first-degree relatives, and controls were taken. Subjects were screened for mental retardation and remission was ascertained in the patient group by the Positive and Negative Syndrome Scale (PANSS). Rye’s Auditory Verbal Learning (RAVL) test was used to assess verbal leaning. Results: Verbal memory impairments were significant both in patients and unaffected first-degree relatives. Further, these impairments showed a strong correlation to negative symptoms. Conclusion: Significant (p<0.05) verbal learning impairments were noted in patients and first-degree relatives which showed a correlation to negative symptoms.

Imaging Insights into EHPVO Induced Portal Biliopathy and its Grading: Retrospective Study Over A Decade at A Tertiary Care Hospital

Background and Aim: There is limited data on imaging features of extra hepatic portal venous obstruction (EHPVO) induced portal biliopathy. We describe a decade long experience of imaging spectrum of EHPVO induced portal biliopathy using MR/CT in a referral centre for liver diseases. Methods: Retrospective data of patients with primary EHPVO on contrast magnetic resonance imaging MRI/ computed tomography (CT) (n=120) and portal biliopathy (PB) on subsequent magnetic resonance cholangiopancreatography (MRCP) (n=80/120) between June 2009 - 2019 was collected. Categorisation of portal biliopathy was as per the Sarin classification and the corresponding, relevant imaging parameters were studied and analysed. Results: Sarin Type 1 biliopathy was present in 16.3 %, Type 2 in 13.8%, Type 3a in 8.8% and Type 3b in 61.3%patients. The median total serum bilirubin was 1.6 (0.9-3.4) mg/dl with a mean CBD diameter of 6.7 ± 2.9 mm. Bilobar and unilobar IHBRD were observed in 87.5% and 6.3% patients respectively. The mean CBD angle was 138.9 ± 18.8º. CBD showed smooth wall contours (10%), extrinsic indentations (83.8%) and smooth strictures (6.3%). The median CBD stricture length was 26 mm (1.25- 45 mm). Pre-stenotic dilatation was observed in 66.3% with stricture length >16 mm (sensitivity 81.1 % specificity 78%) predisposing to it. Statistically significant associations were tabulated according to the classification of PB. Conclusion: This study provides the decade long experience of imaging findings in EHPVO induced portal biliopathy according to its classification and its clinical implications.

Evaluation of pedicled flaps for type IIIB open fractures of the tibia at a tertiary care center

Background@#Soft tissue coverage plays a vital role in replacing the vascularity of the underlying bone in Gustilo type IIIB fractures. The aim of this article was to evaluate the feasibility of local pedicled flaps in type IIIB fractures at a tertiary care center. @*Methods@#We included all cases of open Gustilo-Anderson type IIIB fractures of the tibia treated with local flap coverage from January 2017 to February 2019. We carried out a retrospective analysis to investigate the relationships of complications, hospital stay, and cost-effectiveness with the choice of flap, infective foci, site and size of the defect, and type of fixation. @*Results@#Out of 138 Gustilo type IIIB fractures analyzed in our study, 27 cases had complications, of which 19 (13.76%) involved flap necrosis, four (2.89%) were infections, three (2.17%) involved partial necrosis, and one (0.72%) was related to bone spur development. Flap complications showed a statistically significant association with the perforator flap category (propeller flaps in particular) (P=0.001). Flap necrosis showed a significant positive correlation with cases treated within 3 weeks after trauma (P=0.046). A significant positive correlation was also found between defect size and the duration of hospital stay (P=0.03). @*Conclusions@#Although local flaps are harvested from the same leg that underwent trauma, their success rate is at least as high as microvascular flaps as reported from other centers. Amidst the local flaps, complications were predominantly associated with perforator flaps.

Evaluation of pedicled flaps for type IIIB open fractures of the tibia at a tertiary care center

Background@#Soft tissue coverage plays a vital role in replacing the vascularity of the underlying bone in Gustilo type IIIB fractures. The aim of this article was to evaluate the feasibility of local pedicled flaps in type IIIB fractures at a tertiary care center. @*Methods@#We included all cases of open Gustilo-Anderson type IIIB fractures of the tibia treated with local flap coverage from January 2017 to February 2019. We carried out a retrospective analysis to investigate the relationships of complications, hospital stay, and cost-effectiveness with the choice of flap, infective foci, site and size of the defect, and type of fixation. @*Results@#Out of 138 Gustilo type IIIB fractures analyzed in our study, 27 cases had complications, of which 19 (13.76%) involved flap necrosis, four (2.89%) were infections, three (2.17%) involved partial necrosis, and one (0.72%) was related to bone spur development. Flap complications showed a statistically significant association with the perforator flap category (propeller flaps in particular) (P=0.001). Flap necrosis showed a significant positive correlation with cases treated within 3 weeks after trauma (P=0.046). A significant positive correlation was also found between defect size and the duration of hospital stay (P=0.03). @*Conclusions@#Although local flaps are harvested from the same leg that underwent trauma, their success rate is at least as high as microvascular flaps as reported from other centers. Amidst the local flaps, complications were predominantly associated with perforator flaps.

Outcome analysis of biplanar mandibular distraction in adults

Background@#Mandibular deficiency leading to facial asymmetry causes cosmetic deformity as well as psychological stigma for the patient. Correction of these mandibular asymmetries is a major challenge. The study investigates the efficacy of bidirectional mandible distraction for the treatment of mandibular deficiency. @*Methods@#This prospective study included six individuals aged between 17 and 24.4 years. Five patients had hemifacial microsomia and one had unilateral temporomandibular joint ankyloses. All patients underwent mandibular distraction osteogenesis. Postoperative skeletal changes in affected mandible, and changes in occlusal plane and oral commissure cant were evaluated using three-dimensional reconstruction. Patient satisfaction and understanding of the procedure were assessed through three questionnaires administered during pre-distraction, distraction and postdistraction phases. @*Results@#In pre-distraction phase, aesthetic appearance seemed to be the primary indication for surgery. In distraction phase, pain while chewing was the primary handicap. In post-distraction phase all patients were satisfied with the aesthetic outcome. The facial deformity was improved through mandibular distraction osteogenesis. On the affected side in all the patients, height and length of the mandible increased. Canting of the occlusal plane and oral commissure was corrected. @*Conclusion@#Bidirectional mandible distraction is an effective treatment for correction of mandible deformities in adult patients.

Frequency of anemia and micronutrient deficiency among children with cleft lip and palate: a single-center cross-sectional study from Uttarakhand, India

Background@#Children with cleft lip and/or palate can be undernourished due to feeding difficulties after birth. A vicious cycle ensues where malnutrition and low body weight precludes the child from having the corrective surgery, in the absence of which the child fails to gain weight. This study aimed to identify the proportion of malnutrition, including the deficiency of major micronutrients, namely iron, folate and vitamin B12, in children with cleft lip and/or palate and thus help in finding out what nutritional interventions can improve the scenario for these children. @*Methods@#All children less than 5 years with cleft lip and/or cleft palate attending our institute were included. On their first visit, following were recorded: demographic data, assessment of malnutrition, investigations: complete blood count and peripheral blood film examination; serum albumin, ferritin, iron, folate, and vitamin B12 levels. @*Results@#Eighty-one children with cleft lip and/or palate were included. Mean age was 25.37± 21.49 months (range, 3–60 months). In 53% of children suffered from moderate to severe wasting, according to World Health Organization (WHO) classification. Iron deficiency state was found in 91.6% of children. In 35.80% of children had vitamin B12 deficiency and 23.45% had folate deficiency. No correlation was found between iron deficiency and the type of deformity. @*Conclusion@#Iron deficiency state is almost universally present in children with cleft lip and palate. Thus, iron and folic acid supplementation should be given at first contact to improve iron reserve and hematological parameters for optimum and safe surgery.

A novel modification of Bardach’s two-flap palatoplasty for the repair of a difficult cleft palate

Bardach described a closure of the cleft utilizing the arch of the palate, which provides the length needed for closure and is most effective only in narrow clefts. Herein, we describe a case where we utilized Bardach’s two-flap technique with a vital and easy modification, done to allow closure of a wide cleft palate and to prevent oronasal fistula formation at the junction of the hard and soft palate, which are otherwise difficult to manage with conventional flaps. The closed palate showed healthy healing, palatal lengthening, and no oronasal regurgitation. We advise using this modification to achieve the goals of palatal repair in difficult cases where tension-free closure would otherwise be achieved with more complex flap surgical techniques, such as free microvascular tissue transfer.

Inheritance pattern of okra enation leaf curl disease among cultivated species and its relationship with biochemical parameters

Okra production in eastern India at present is severely threatened by whitefly-mediated okra enation leaf curl disease(OELCuD). Identification of resistant genotype and understanding the genetic control and biochemical relationship of OELCuD resistanceare prerequisite for developing an effective breeding strategy. This study was conducted employing six populations (P1, P2, F1, F2, BC1 andBC2) of two selected (resistant 9 susceptible (R9S)) crosses. Associationship between severity of OELCuD and biochemical parametersof parents and hybrids at preflowering and flowering stages was studied. Segregation pattern of the genotypes in F2 generation showingOELCuD reaction of two crosses suggested that two duplicate recessive genes was operative for resistance to OELCuD. Generation meananalysis revealed involvement of both additive and nonadditive effects in the inheritance of disease resistance. Hence, postponement ofselection in later generations or intermating among the selected segregates followed by one or two generations of selfing to break theundesirable linkage and allow the accumulation of favourable alleles could be suggested for the development of stable resistant genotypeagainst this disease. Higher peroxidase activity and total phenol content in leaf emerged as reliable biochemical markers for early selectionof genotype resistant to OELCuD.