eIF2A-knockout mice reveal decreased life span and metabolic syndrome.

Eukaryotic initiation factor 2A (eIF2A) is a 65 kDa protein that functions in minor initiation pathways, which affect the translation of only a subset of messenger ribonucleic acid (mRNAs), such as internal ribosome entry site (IRES)-containing mRNAs and/or mRNAs harboring upstream near cognate/non-AUG start codons. These non-canonical initiation events are important for regulation of protein synthesis during cellular development and/or the integrated stress response. Selective eIF2A knockdown in cellular systems significantly inhibits translation of such mRNAs, which rely on alternative initiation mechanisms for their translation. However, there exists a gap in our understanding of how eIF2A functions in mammalian systems in vivo (on the organismal level) and ex vivo (in cells). Here, using an eIF2A-knockout (KO) mouse model, we present evidence implicating eIF2A in the biology of aging, metabolic syndrome and central tolerance. We discovered that eIF2A-KO mice have reduced life span and that eIF2A plays an important role in maintenance of lipid homeostasis, the control of glucose tolerance, insulin resistance and also reduces the abundance of B lymphocytes and dendritic cells in the thymic medulla of mice. We also show the eIF2A KO affects male and female mice differently, suggesting that eIF2A may affect sex-specific pathways. Interestingly, our experiments involving pharmacological induction of endoplasmic reticulum (ER) stress with tunicamycin did not reveal any substantial difference between the response to ER stress in eIF2A-KO and wild-type mice. The identification of eIF2A function in the development of metabolic syndrome bears promise for the further identification of specific eIF2A targets responsible for these changes.

Obstetric and perinatal outcomes in pregnant women with COVID-19: an interim analysis.

The coronavirus disease (COVID-19) has affected the health-care system worldwide. The effect of COVID-19 on obstetric and perinatal outcomes is yet to be completely ascertained. A hospital-based prospective observational study was conducted at the Department of Obstetrics & Gynecology, AIIMS Rishikesh from July to December 2020. A total of 60 COVID-positive pregnant women were included. Obstetric and perinatal outcomes were compared with 60 COVID-negative pregnant women. A subgroup comparison was also performed between symptomatic and asymptomatic pregnant women with COVID-19. Majority of COVID-positive pregnant women were asymptomatic (81.7%). Eleven patients were symptomatic, out of which 9 (15%) had mild disease and only 2 (3.3%) had severe pneumonia. There was an increased likelihood of early pregnancy loss (5%), oligohydramnios (21.7%), preterm birth (31.7%), and cesarean section (53.3%). The occurrence of preterm birth was significantly higher in symptomatic women than asymptomatic women (p = .01). Oligohydramnios was significantly more frequent in COVID-positive than COVID-negative pregnant women (p = .048). Preterm birth and cesarean rate were slightly higher in COVID-positive group but the difference was not statistically significant. Other obstetric outcomes were comparable in both groups. The majority of women with COVID-19 infection in pregnancy remain asymptomatic or have mild symptoms. Still, it may lead to maternal death and poor fetal outcomes in form of early pregnancy loss, prematurity, oligohydramnios, intrapartum fetal distress, and increased cesarean rate. Therefore, COVID-19 preventive measures should be strictly implemented and followed.

Touch Imprint Cytology: Can It Serve as an Alternative to Frozen Section in Intraoperative Assessment of Cervical Metastasis in Oral Squamous Cell Carcinoma?

PURPOSE: The purpose was to assess the diagnostic accuracy of touch imprint cytology (TIC) compared with frozen section (FS) analysis as an intraoperative diagnostic tool to assess nodal metastasis in oral squamous cell carcinoma. MATERIALS AND METHODS: We intraoperatively assessed 38 patients undergoing neck dissection for oral squamous cell carcinoma, wherein a total of 248 nodes were sectioned and subjected to TIC and, subsequently, FS analysis and were finally submitted to the gold-standard histopathologic examination. The sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of TIC and FS analysis for the detection of metastasis in the cervical nodes were determined with the corresponding 95% confidence intervals. RESULTS: TIC had a sensitivity of 62.86%, specificity of 96.24%, PPV of 73.33%, NPV of 94.04%, and accuracy of 91.53% compared with histopathologic results. The sensitivity of FS analysis was 60%, specificity was 98.12%, PPV was 84%, NPV was 93.72%, and accuracy was 92.74% compared with histopathologic examination. These results of TIC were comparable to those of FS analysis. CONCLUSIONS: TIC is a straightforward, quick, and reliable technique. It has a definitive role in being used as an adjunct to FS analysis to increase intraoperative diagnostic accuracy. It can serve as a useful technique in centers that do not have FS availability.

Giant Cells, Giant Impact: A Case of Aggressive Central Giant Cell Granuloma in the Mandible.

Central giant cell granuloma (CGCG) is a bone lesion characterized by fibrous tissue containing areas of bleeding, giant cells with multiple nuclei, and trabeculae of woven bone. It is considered to be a local bone repair response, possibly triggered by inflammation, bleeding, or local injury. CGCG is more prevalent in females and can occur across a wide age range, typically diagnosed at a young age. Mandibular involvement is more common than maxillary involvement, with most lesions in the posterior region often extending into the ascending ramus. Management of aggressive CGCG can involve non-surgical (medical) and surgical treatment modalities. Surgical approaches vary from simple curettage to en bloc resection depending on various factors discussed in this case report.

Comparing the efficacy of adrenaline, clonidine, and dexmedetomidine in enhancing local anesthesia for impacted third molar extraction: a randomized controlled trial.

Background: In human dentition, the most commonly impacted teeth are the mandibular third molars (M3M). The removal or extraction of these teeth often causes anxiety in patients due to the perceived pain involved in the process. Therefore, pain must be effectively managed using anesthesia. The use of newer local anesthetic drugs can help minimize side effects and drug interactions. Traditionally, adrenaline is used as a vasoconstrictor along with lignocaine. When combined with lignocaine, the alpha agonists dexmedetomidine and clonidine can extend the duration of anesthesia, thereby reducing the need for additional pain-relieving medications. Methods: This study used a randomized, triple-blind, parallel-arm design. Sixty patients were screened, and 45 systemically healthy patients requiring unilateral surgical removal of impacted mandibular third molars with similar difficulty (moderate-to-difficult according to the Modified Pederson's Index) were included in the study. Patients were allocated into three groups as follows: Group A: 2% Lignocaine Hydrochloride with 1:100,000 Adrenaline, Group C: 2% Lignocaine Hydrochloride with 15 µg/mL Clonidine, and Group D: 2% Lignocaine Hydrochloride with 1 µg/mL Dexmedetomidine. The evaluated parameters were the time of onset of anesthesia, depth of anesthesia, hemodynamic parameters, and duration of postoperative analgesia. Results: Group D had a faster onset of action and prolonged duration of postoperative analgesia compared with Groups A and C. No statistically significant differences were observed between the three groups in terms of the depth of anesthesia and hemodynamic parameters. Conclusion: Group D exhibited a significantly more rapid onset of anesthesia than Groups A and C, and the postoperative analgesic effect in Group D was significantly prolonged (7.22 hours) compared with that in Groups A (4.54 hours) and C (2.1 hours). Patients receiving the Group D solution experienced an extended period of comfort without the need for analgesics for up to 7.22 hours post-procedure.

The Silent Spill: A Case Report on Navigating the Challenges of a Chyle Leak.

A chyle leak occurs due to a discontinuity in the thoracic duct. It is a very rare condition that occurs as a result of injuries or surgical procedures. Chyle is rich in antibodies. Its functions are to maintain the equilibrium of the human fluid system, draw in fatty acids, and maintain the natural immunity of humans. It is identified by the increased quantity of drains, which show a milky white color and clinically palpable supraclavicular collection. It is a condition that has to be managed as soon as possible as it leads to serious nutritional debridement, electrolyte imbalance, and complications such as chylothorax and chylomediastinum. It is managed by various surgical and conservative approaches, such as ligating the thoracic duct, using sclerosing agents, giving total parenteral nutrition, and restricting physical activities, as discussed in this article.

Sarcomatoid Squamous Cell Carcinoma in a 15-Year-Old Girl: A Report of a Rare Case.

Sarcomatoid is a rare variant of squamous cell carcinoma. We present here the case of a 15-year-old female patient; she presented with an extra-oral fungation on the right side of her face and restricted tongue movements, diagnosed as sarcomatoid squamous cell carcinoma of the tongue on incisional biopsy. A positron emission tomography scan was advised on the first visit to rule out distant metastasis. Due to the previous history of no improvement after medical oncology management and the extent of the lesion, which made the disease inoperable, the patient was planned for the best supportive care.

Rare Neck Venous Anatomy Anomalies - A Case Report.

Rationale: Knowledge of the venous systems of the neck is important in microvascular anastomosis as well as to avoid unintended bleeding during neck dissection. Patient Concerns: We present three rare variations of the jugular system of the neck which could have complicated neck dissection. Diagnosis: The first case is of a posterior tributary from an internal jugular vein (IJV). The second case is an IJV with increased diameter of 3 cm and the third case is an aneurysm of the external jugular vein. Treatment: Careful dissection was carried out to avoid complications and to preserve the vessels for microvascular anastomosis. Outcome: No complications were encountered intraoperatively and post-operatively. Take-away Lessons: Variations from normal anatomy should be dealt with caution to avoid complications and to perform surgery precisely and efficiently.

A Retrospective Study Comparing the Surgical Results of Platysma Myocutaneous Flap, Buccal Pad of Fat, and Nasolabial Flap for Reconstruction After Fibrotomy in Cases of Oral Submucous Fibrosis.

PURPOSE: To evaluate the effectiveness of nasolabial flap (NLF), a buccal pad of fat flap (BFP), and platysma myocutaneous flap (PMF) for reconstruction following fibrotomy for individuals with oral submucous fibrosis (OSMF). MATERIAL AND METHOD: A retrospective study was conducted among patients diagnosed with grade III and IV OSMF in the Department of Oral and Maxillofacial Surgery at Sharad Pawar Dental College between January 2016 and August 2018. The essential patient information was obtained from the Medical Record Department (MRD) at Acharya Vinoba Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences (DMIMS) Sawangi (Meghe) Wardha. The patients were categorized into three groups: the NLF, the BFP, and the PMF groups. Each group had 16 patients, and factors such as interincisal width, diminished burning sensation in the mouth, inter-commissure distance, and flap necrosis were compared pre- and post-operatively. Student's unpaired t-test and chi-square test were employed for statistical analysis. RESULT: Mean interincisal mouth-opening increased from pre-operative 4.79 to 41.42 mm post-operatively in the NLF group, BFP group from 6 to 39.42 mm and in the PMF group from 9.26 to 39.34 mm with p value=0.0001. NLF group showed complete and partial resolution of the burning sensation of the mouth at 93.75% and 6.25%, BFP at 62.25% and 32.75% while in PMF it was 68.5% and 31.25% respectively. One year postoperatively 3.28 mm increase in inter-commissure width was observed in the NLF group with a marginal increase in the PMF group and a negligible increase in the BFP group. 18.75% partial flap necrosis was seen in BFP, 18.75% in the PMF group, and 6.25% in the NFL group. CONCLUSION: All the flaps are efficacious in treating OSMF, however, NLF stands ahead with its higher reliability owing to its excellent blood supply.

To assess and compare the outcomes of the cutaneous neck dissection incision taken by colorado microdissection needle, surgical blade and cutting electrocautery in patients with oral squamous cell carcinoma: A prospective study.

Aim: To assess and compare the outcomes of the cutaneous neck dissection incisions taken by Colorado microdissection needle, surgical blade and cutting electrocautery in patients with oral squamous cell carcinoma. Materials and Methods: A prospective, randomized control, comparative study was carried out on 21 patients. These patients were divided into 3 groups containing 7 patients in each group. The intra operative and post operative outcomes were evaluated. Statistical analysis was done by using descriptive and inferential statistics using Chisquare test, Fisher's Exact Test, one way ANOVA and multiple comparison Tukey Test and software used in the analysis were SPSS 27.0 version and GraphPad Prism 7.0 version and P < 0.05 is considered as level of significance. Results: The time taken for placing cutaneous skin incision and blood loss was more in the surgical blade group as compared to the Colorado microdissection needle and electrocautery. Statistically no significant difference between the three group while comparing the cutaneous neck incision healing and post operative scar formation. Conclusion: This study proves the superiority of the Colorado microdissection needle in terms of time taken and blood loss with similar aesthetic outcome in terms of cutaneous wound healing and post operative scar formation when compared to surgical blade and cutting electrocautery.

Repository on maternal child health: health portal to improve access to information on maternal child health in India.

BACKGROUND: Quality and essential health information is considered one of the most cost-effective interventions to improve health for a developing country. Healthcare portals have revolutionalized access to health information and knowledge using the Internet and related technologies, but their usage is far from satisfactory in India. This article describes a health portal developed in India aimed at providing one-stop access to efficiently search, organize and share maternal child health information relevant from public health perspective in the country. METHODS: The portal 'Repository on Maternal Child Health' was developed using an open source content management system and standardized processes were followed for collection, selection, categorization and presentation of resource materials. Its usage is evaluated using key performance indicators obtained from Google Analytics, and quality assessed using a standardized checklist of knowledge management. The results are discussed in relation to improving quality and access to health information. RESULTS: The portal was launched in July 2010 and provides free access to full-text of 900 resource materials categorized under specific topics and themes. During the subsequent 18 months, 52,798 visits were registered from 174 countries across the world, and more than three-fourth visits were from India alone. Nearly 44,000 unique visitors visited the website and spent an average time of 4 minutes 26 seconds. The overall bounce rate was 27.6%. An increase in the number of unique visitors was found to be significantly associated with an increase in the average time on site (p-value 0.01), increase in the web traffic through search engines (p-value 0.00), and decrease in the bounce rate (p-value 0.03). There was a high degree of agreement between the two experts regarding quality assessment carried out under the three domains of knowledge access, knowledge creation and knowledge transfer (Kappa statistic 0.72). CONCLUSIONS: Efficient management of health information is imperative for informed decision making, and digital repositories have now-a-days become the preferred source of information management. The growing popularity of the portal indicates the potential of such initiatives in improving access to quality and essential health information in India. There is a need to develop similar mechanisms for other health domains and interlink them to facilitate access to a variety of health information from a single platform.

Polyostotic Fibrous Dysplasia: A Case Report of Rarity.

A skeletal condition known as fibrous dysplasia (FD) is characterized by the replacement of healthy bone with fibrous bone tissue. One bone (monostotic) or several bones could be involved (polyostotic). Any bone in the body might become affected by FD. The skull and face bones are the most typical locations. It is connected to a GNAS1 gene mutation (20q13.2). It begins during childhood and could continue far into adolescence and adulthood. In this case study, a 22-year-old woman was identified as having polyostotic FD based on her clinical, radiological, and histological characteristics.

Mandibular Ramus Fractures: A Case Series of Diversity in Rarity.

Mandibular ramus fracture is usually minimally displaced as it is surrounded by the medial pterygoid medially, masseter laterally, and the pterygomasseteric sling inferiorly. They are commonly caused either by road traffic accidents or interpersonal violence. Ramus fracture is usually seen in conjunction with other mandibular fractures and is seldom found alone. The ramus is located at the congregation of the dentate and the non-dentate parts of the mandible. Ramus fractures are generally managed by closed reduction when minimally displaced but this technique has its disadvantages like poor maintenance of oral hygiene and prolonged healing time. It can get fractured in various patterns. Owing to the presence of anatomical structures on either side of the ramus and the orientation of the fracture line, the treatment plan varies in each case to prevent paresthesia by preserving the inferior alveolar nerve. This article has demonstrated four distinct kinds of mandibular ramus fractures and their management with open reduction internal fixation (ORIF).

The Path of Birth is Not Always Normal: A Case Report of Cervicovaginal Agenesis.

Cervical agenesis is a rare congenital Mullerian anomaly. Its association with vaginal agenesis is further rare, reported in 39% of cases of cervical agenesis. The conventional treatment for this condition was hysterectomy. However, with evolving surgical skills and assisted reproductive techniques, conservative surgery could be considered as the first-line treatment in the current era. We report one such case of cervicovaginal agenesis in a 13-year-old adolescent girl managed successfully with cervicovaginoplasty. The patient was relieved of cyclical pain abdomen and resumed menstrual cycles postoperatively.

Do Blood-Borne Viruses Affect the Progression of Labor: A Hospital-Based Pilot Study.

Background Blood-borne viruses form the basis of enormous research on universal precautions. A paucity of research is noted regarding labor progression in seropositive women. Women testing positive for human immunodeficiency virus (HIV)/hepatitis B surface antigen (HBsAg)/hepatitis C virus (HCV) are often denied obstetric care and referred. Their need for safe delivery conditions propelled us to undertake this study to establish whether seropositive status affects labor progression or not. Methods Women in early labor (<4 cm cervical dilation) testing positive for HIV/HBV/HCV and delivering vaginally during the study period at All India Institute of Medical Sciences (AIIMS), Rishikesh, India, were included as Group A (n=36). The authors recruited an equal number of women with seronegative status with comparable age, parity, admission at or before 4 cm, body mass index (BMI) characteristics as Group B. They were compared in terms of effacement at 4 cm dilatation and time from 4 cm dilatation till delivery. Results The authors report a significant difference (p <0.05) between time to delivery between the two groups (2 hours vs. 2.43 hours in nulligravidas and multigravidas, respectively). Thirty-two (32) of 36 cases were already 70%-80% effaced at 4 cm dilation while only 25% of controls had similar findings. The present study suggests that seropositive women progress significantly faster in labor and need vigilant monitoring. We report such findings for the first time and aim to encourage similar research worldwide.