Diagnostic Utility of High-resolution Esophageal Manometry and Its Correlation with Symptoms.

BACKGROUND: Primary esophageal motility disorders present with a spectrum of symptoms where manometry plays an important role. We designed this study to evaluate the utility of esophageal manometry among various symptoms. MATERIALS AND METHODS: This is a single-center observational study conducted over 5 years in a tertiary referral center. A total of 564 patients who underwent high-resolution esophageal manometry (HREM) using a 16-channel water perfusion system were included in the study. Their clinical profile and manometric findings, as per the Chicago classification version 4.0, were recorded, and the diagnostic utility of HREM with respect to symptoms was studied. RESULTS: Motility disorders were identified in 48.8% of patients, the most common being Achalasia cardia (32.4%). Dysphagia (55.5%) was the most common indication of manometry, followed by gastroesophageal reflux disease (GERD) (34.9%), chest pain (6.2%), and symptoms such as belching, globus, and hiccoughs (3.4%). Among those who were re-classified from Chicago classification v3.0 to v4.0, 21.2% had a newer diagnosis. Among the patients with dysphagia, HREM revealed the highest yield of detecting an abnormal esophageal motility test (70.6%); meanwhile, this yield was much lower in those with GERD (21.8%), chest pain (22.8%), and other symptoms (15.7%). The most common finding among those with dysphagia was Achalasia cardia (55.9%), while the study was normal among those with GERD (78.1%), chest pain (77.1%), and other symptoms (84.2%). The sensitivity and specificity of dysphagia for major motility disorders were 65% and 91%, respectively, with a positive predictive value of 90. CONCLUSION: HREM has high accuracy and a good diagnostic yield among patients with dysphagia, with the most common finding being Achalasia cardia.

Résumé Contexte:Les troubles primaires de la motilité œsophagienne se manifestent par un spectre de symptômes dans lesquels la manométrie joue un rôle important. Nous conçu cette étude pour évaluer l'utilité de la manométrie œsophagienne parmi divers symptômesMatériels et méthodes:Il s'agit d'un centre unique étude observationnelle menée sur 5 ans dans un centre de référence tertiaire. Au total, 564 patients ayant subi une chirurgie œsophagienne à haute resolution la manométrie (HREM) utilisant un système de perfusion d'eau à 16 canaux ont été incluses dans l'étude. Leur profil clinique et leurs résultats manométriques, selon la classification de Chicago version 4.0, ont été enregistrés et l'utilité diagnostique du HREM en ce qui concerne les symptômes a été étudiéeRésultats:Des troubles de la motilité ont été identifiés chez 48,8 % des patients, la plus fréquente étant l'Achalasia cardia (32,4 %). La dysphagie (55,5 %) était la l'indication la plus courante de la manométrie, suivie du reflux gastro-œsophagien (RGO) (34,9 %), des douleurs thoraciques (6,2 %) et des symptômes tels que comme les éructations, les globus et le hoquet (3,4 %). Parmi ceux qui ont été reclassés de la classification de Chicago v3.0 à v4.0, 21,2 % avaient un diagnostic. Parmi les patients atteints de dysphagie, l'HREM a révélé le rendement le plus élevé de détection d'un test de motilité œsophagienne anormale (70,6 %); dans le même temps, ce rendement était beaucoup plus faible chez les personnes souffrant de RGO (21,8 %), de douleurs thoraciques (22,8 %) et d'autres symptômes (15,7 %). Le plus courant le résultat parmi les personnes souffrant de dysphagie était l'achalasie cardiaque (55,9 %), tandis que l'étude était normale chez les personnes souffrant de RGO (78,1 %), douleur thoracique (77,1 %) et autres symptômes (84,2 %). La sensibilité et la spécificité de la dysphagie pour les troubles majeurs de la motilité étaient de 65 % et 91 %, respectivement, avec une valeur prédictive positive de 90 %Conclusion:HREM présente une grande précision et un bon rendement diagnostique chez les patients atteints de dysphagie, la pathologie la plus fréquente étant l'achalasie cardiaque.

The influence of ghrelin agonist ipamorelin acetate on the hypothalamic-pituitary-testicular axis in a cichlid fish, Oreochromis mossambicus.

Ghrelin, a peptide found in the brain and gut, is predicted to play a significant role in the control of various physiological systems in fish. The objective of this study was to examine the impact of ipamorelin acetate (IPA), a ghrelin agonist, on the reproductive axis of the tilapia Oreochromis mossambicus. The administration of either 5 or 30 µg of IPA for 21 days led to a significant and dose-dependent rise in food intake concomitant with a significant increase in the numbers of primary spermatocytes, secondary spermatocytes, and early spermatids compared to the control group. There was a significant rise in the number of late spermatids, as well as the areas of the lobule and lumen, in fish treated with 30 µg of IPA, compared to the control group. Moreover, there was no significant difference in the percentage of gonadotropin-releasing hormone (GnRH)-immunoreactive fibres in the hypothalamus and anterior pituitary gland across different groups. However, a significant elevation in the expression of androgen receptor protein was observed in fish treated with 30 µg of IPA. Furthermore, the concentrations of luteinizing hormone (LH) and 11-ketotestosterone (11-KT) in the serum of fish treated with either 5 or 30 µg of IPA were significantly elevated in comparison to the control group. Collectively, these findings suggest that the administration of ghrelin enhances the development of germ cells during the meiosis-I phase and that this effect might be mediated via the stimulation of 11-KT and androgen receptors at the testicular level and LH at the pituitary level in the tilapia.

Organization of enkephalinergic neuronal system in the central nervous system of the gecko Hemidactylus frenatus.

Enkephalins are endogenous opioid pentapeptides that play a role in neurotransmission and pain modulation in vertebrates. However, the distribution pattern of enkephalinergic neurons in the brains of reptiles has been understudied. This study reports the organization of the methionine-enkephalin (M-ENK) and leucine-enkephalin (L-ENK) neuronal systems in the central nervous system of the gecko Hemidactylus frenatus using an immunofluorescence labeling method. Although M-ENK and L-ENK-immunoreactive (ir) fibers extended throughout the pallial and subpallial subdivisions, including the olfactory bulbs, M-ENK and L-ENK-ir cells were found only in the dorsal septal nucleus. Enkephalinergic perikarya and fibers were highly concentrated in the periventricular and lateral preoptic areas, as well as in the anterior and lateral subdivisions of the hypothalamus, while enkephalinergic innervation was observed in the hypothalamic periventricular nucleus, infundibular recess nucleus and median eminence. The dense accumulation of enkephalinergic content was noticed in the pars distalis of the hypophysis. In the thalamus, the nucleus rotundus and the dorsolateral, medial, and medial posterior thalamic nuclei contained M-ENK and L-ENK-ir fibers, whereas clusters of M-ENK and L-ENK-ir neurons were observed in the pretectum, mesencephalon, and rhombencephalon. The enkephalinergic fibers were also seen in the area X around the central canal, as well as the dorsal and ventral horns. The widespread distribution of enkephalin-containing neurons within the central nervous system implies that enkephalins regulate a variety of functions in the gecko, including sensory, behavioral, hypophysiotropic, and neuroendocrine functions.

The opioid peptide leucine enkephalin modulates hypothalamic-hypophysial axis in the cichlid fish Oreochromis mossambicus.

In vertebrates, opioid peptides are thought to be involved in the regulation of reproduction; however, the significance of enkephalins in testicular function remains unclear. We examined the influence of δ-opioid receptor agonist leucine enkephalin (L-ENK) on the hypophysial-testicular axis of the cichlid fish Oreochromis mossambicus. Treatment with a low dose of L-ENK (60 µg) caused a significant increase in the numbers of primary and secondary spermatocytes and early and late spermatids, concomitant with intense immunolabelling of testicular androgen receptors, but did not significantly alter serum luteinizing hormone (LH) and 11-ketotestosterone (11-KT) levels compared to those of controls. Nevertheless, treatment with a high dose of L-ENK (200 µg) caused a significant reduction in the numbers of secondary spermatocytes as well as late spermatids associated with marginal immunolabelling of androgen receptors and significantly lower concentrations of serum 11-KT and LH compared to controls. In addition, the serum cortisol level was not affected in low-dose L-ENK-treated fish, but its level was significantly increased in the high-dose L-ENK-treated group. Together, these findings indicate that a low dose of L-ENK stimulates the germ cells at the meiosis stage and promotes further stages of spermatogenesis, whereas a high concentration of L-ENK inhibits spermatogenesis at the advanced stages. This effect appears to be mediated through the suppression of testicular steroidogenesis and the reduction of LH release in the pituitary gland of tilapia. The findings also suggest that elevated L-ENK levels in teleosts may exert their inhibitory influence on the hypophysial-testicular axis via glucocorticoids.

The opioid peptide ß-endorphin interferes with the pituitary-testis axis in the Mozambique tilapia Oreochromis mossambicus.

Although the involvement of ß-endorphin (ß-ERP) in vertebrate reproduction has been suggested, its role in testicular activity is not clear in fish. We describe the influence of ß-ERP on spermatogenesis in a cichlid fish in the present paper. In comparison to the control group, the administration of ß-ERP (3 µg) caused a significant increase in the number of spermatogonia-A and spermatids. Following treatment with ß-ERP (6 µg), a significant increase in the number of spermatogonia-A was observed, whereas the numbers of all the other germ cells, excluding spermatogonia-B, significantly decreased in comparison to those in the control group. In addition, treatment of fish with 6 µg ß-ERP resulted in a significant reduction in the dimensions of the lumen and seminiferous lobules, the level of immunopositive androgen receptor (AR) expression in Sertoli cells, and the percentage of luteinizing hormone (LH) immunolabeled in the pituitary compared to those in the control group or the group treated with 3 µg ß-ERP. In contrast, the intensity of AR immunoreactivity and the percentage of LH immunolabeling were substantially increased in fish treated with 3 µg ß-ERP compared to those in the control group. These findings reveal for the first time that a low dose of ß-ERP stimulates the recruitment of spermatogonia as well as spermateleosis, whereas a high concentration affects the recruitment of germ cells prior to meiotic division in tilapia. These results suggest that ß-ERP exerts modulatory effects at the testicular and hypophysial levels through alterations in AR expression and LH secretory activity, respectively, in teleosts.

Serotonin-immunoreactivity in the brain of the cichlid fish Oreochromis mossambicus.

Serotonin (5-HT) is an evolutionarily conserved monoaminergic neurotransmitter found in the central nervous system and peripheral nervous system across invertebrates and vertebrates. Although the distribution of 5-HT-immunoreactive (5-HT-ir) neurons is investigated in various fish species, the organization of these neurons in cichlid fishes is poorly understood. These fish are known for their adaptability to diverse environments, food habits, and complex mating and breeding behaviors, including parental care. In this paper, we describe the organization of 5-HT-ir neurons in the brain of the cichlid fish Oreochromis mossambicus. Aggregations of 5-HT-ir neurons were spotted in the granule cell layer of the olfactory bulb and near the ventricular border in the preoptic area and magnocellular subdivisions of the nucleus preopticus. Although the presence of 5-HT-ir cells and fibers in the hypothalamic and thalamic regions, cerebellum, and raphe nuclei was comparable to that of other teleosts, the current study reveals the occurrence of 5-HT-ir cells and fibers for the first time in some areas, such as the nucleus posterior tuberis, nucleus oculomotorius, and nucleus paracommissuralis in the tilapia. While the presence of 5-HT-ir cells and fibers in gustatory centers suggests a role for serotonin in the processing of gustatory signals, distinctive pattern of 5-HT immunoreactivity was seen in the telencephalon, pretectal areas, mesencephalic, and rhombencephalic regions, suggesting a cichlid fish specific organization of the serotonergic system. In conclusion, the 5-HT system in the tilapia brain may serve several neuroendocrine and neuromodulatory roles, including regulation of reproduction and sensorimotor processes.

GABA-immunoreactive neurons in the Central Nervous System of the viviparous teleost Poecilia sphenops.

Gamma-aminobutyric acid (GABA) functions as the primary inhibitory neurotransmitter within the central nervous system (CNS) of vertebrates. In this study, we examined the distribution pattern of GABA-immunoreactive (GABA-ir) cells and fibres in the CNS of the viviparous teleost Poecilia sphenops using immunofluorescence method. GABA immunoreactivity was seen in the glomerular, mitral, and granular layers of the olfactory bulbs, as well as in most parts of the dorsal and ventral telencephalon. The preoptic area consisted of a small cluster of GABA-ir cells, whereas extensively labelled GABA-ir neurons were observed in the hypothalamic areas, including the paraventricular organ, tuberal hypothalamus, nucleus recessus lateralis, nucleus recessus posterioris, and inferior lobes. In the thalamus, GABA-positive neurons were only found in the ventral thalamic and central posterior thalamic nuclei, whereas the dorsal part of the nucleus pretectalis periventricularis consisted of a few GABA-ir cells. GABA-immunoreactivity was extensively seen in the alar and basal subdivisions of the midbrain, whereas in the rhombencephalon, GABA-ir cells and fibres were found in the cerebellum, motor nucleus of glossopharyngeal and vagal nerves, nucleus commissuralis of Cajal, and reticular formation. In the spinal cord, GABA-ir cells and fibres were observed in the dorsal horn, ventral horn, and around the central canal. Overall, the extensive distribution of GABA-ir cells and fibres throughout the CNS suggests several roles for GABA, including the neuroendocrine, viscerosensory, and somatosensory functions, for the first time in a viviparous teleost.

A Comparative Study of Intrathecal Fentanyl and Nalbuphine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anesthesia in Lower Limb Orthopedic Surgeries: A Prospective, Double-Blind, Randomized Controlled Study.

BACKGROUND: Spinal anaesthesia is the most commonly used technique for lower limb orthopaedic surgeries as it is economical and easy to administer. Opioids as adjuvants to local anaesthetics during spinal anaesthesia have played a vital role in reducing post-operative pain qualitatively and effectively. METHODS: This prospective randomised study was conducted on 100 patients divided into two groups scheduled for lower limb orthopaedic surgeries. Group bupivacaine fentanyl (BF) received 25 mcg of fentanyl with 15 mg of bupivacaine and Group bupivacaine nalbuphine (BN) received 1 mg of nalbuphine and 15 mg of 0.5% bupivacaine. The aim of the study was to compare the analgesic efficacy of intrathecal fentanyl and nalbuphine as an adjuvant to hyperbaric bupivacaine for spinal anaesthesia. Duration of effective analgesia, haemodynamic parameters, onset and duration of sensory and motor block, adverse effects, and visual analogue scale (VAS) score were assessed. RESULTS: Duration of effective analgesia was 388±24.88 minutes in the BN group and was higher (p-value <0.001) in comparison to the BF group, which was 304.70±15.76 minutes. CONCLUSION: Nalbuphine was more effective than fentanyl in providing post-operative analgesia when used as an adjuvant to hyperbaric bupivacaine.

The influence of the opioid pentapeptide methionine-enkephalin on seasonal and FSH-induced ovarian recrudescence in the gecko Hemidactylus frenatus.

Although methionine-enkephalin (M-ENK) is implicated in the regulation of reproductive functions in vertebrates, its function in reptiles is little understood. This study aims to elucidate the role of M-ENK on seasonal and follicle stimulating hormone (FSH)-induced ovarian recrudescence in the gecko Hemidactylus frenatus. In the first experiment, administration of 5 µg M-ENK did not affect germinal bed activity or follicular developmental stages I, II, and III (previtellogenic) and IV (vitellogenic), but there were no stage V (vitellogenic) follicles in the ovary. However, there was a significant decrease in the mean numbers of oogonia and primary oocytes in the germinal bed associated with the complete absence of stage IV and V follicles in 25 µg M-ENK-treated lizards in contrast to experimental controls. Furthermore, there was a significant decrease in gonadotropin-releasing hormone - immunoreactive (GnRH-ir) content in the median eminence (ME) and pars distalis (PD) of the pituitary gland and sparse labelling of hypothalamic GnRH-ir neurons in 25 µg M-ENK-treated lizards. In the second experiment, treatment with FSH during the regression phase of the ovarian cycle resulted in the appearance of stage IV and V follicles, in contrast to their absence in the initial controls and treatment controls. However, treatment with 25 µg M-ENK + FSH did not result in the appearance of these follicles, indicating the inhibitory effect of M-ENK on FSH-induced ovarian recrudescence. These findings suggest that M-ENK inhibits the germinal bed and vitellogenic follicular growth in a dose-dependent manner, possibly mediated through the suppression of GnRH release in the ME and PD. In addition, M-ENK may also act at the level of the ovary in the gecko.

The opioid peptide leucine-enkephalin disrupts seasonal and gonadotropin-induced ovarian recrudescence in the gecko Hemidactylus frenatus.

The enkephalins are known to regulate many physiological functions, including reproduction in vertebrates. However, the role of leucine-enkephalin (L-ENK) in the ovarian recrudescence activity of reptiles is not known. In the present study, we studied the influence of L-ENK on seasonal and FSH-induced ovarian recrudescence during the breeding and non-breeding phases of the cycle in the tropical and subtropical gecko Hemidactylus frenatus. In the first experiment, treatment with 5 and 25 µg L-ENK resulted in a dose-dependent inhibitory effect on the hypothalamic gonadotropin-releasing hormone (GnRH) neurons and ovary, as indicated by a significantly decreased percent area of GnRH-immunoreactive (GnRH-ir) fibres in the median eminence and pars distalis of the pituitary gland, concomitant with complete absence of stage V (late vitellogenic) follicles in the ovary compared to those of experimental controls. In the second experiment, administration of FSH to lizards in the regression phase stimulated the recruitment of stage IV and V (vitellogenic) follicles in contrast to their absence in initial controls or treatment controls. However, similar treatment of FSH in combination with 25 µg L-ENK did not result in the development of stage IV or V follicles. Together, these results suggest for the first time that treatment with 5 and 25 µg L-ENK exerts a dose-dependent inhibitory effect on the hypothalamic GnRH release into the median eminence and pituitary gland, leading to the blockade of ovarian recrudescence. These results also suggest a possible direct inhibitory effect of L-ENK at the level of the ovary in the gecko.

Efficacy of Intraperitoneal 0.2% Ropivacaine With Dexmedetomidine Versus 0.2% Ropivacaine With Ketamine in Laparoscopic Surgeries: A Randomized Controlled Trial.

BACKGROUND: Effective pain management modalities are the armamentarium for enhanced recovery in laparoscopic surgeries. Intraperitoneal instillation of local anaesthetics with adjuvants is advantageous in minimizing pain. So, we designed this study with the aim to compare the analgesic effectiveness of intraperitoneal ropivacaine with adjuvants like dexmedetomidine versus ketamine for postoperative analgesia. OBJECTIVE:  The objective of this study is to assess the total duration of analgesia and total rescue analgesic dose requirements in the first 24 hours postoperatively. MATERIALS AND METHODS: A total of 105 consenting patients for elective laparoscopic surgeries were enrolled and divided into three groups by computer-generated randomization as follows: Group 1: 30 ml of 0.2% ropivacaine with ketamine 0.5 mg/kg diluted to 1 ml; Group 2: 30 ml of 0.2% ropivacaine with dexmedetomidine 0.5 mcg/kg diluted to 1 ml; Group 3: 30 ml of 0.2% ropivacaine with 1 ml of normal saline. The postoperative visual analogue scale (VAS) score, total duration of analgesia, and total analgesic dose were calculated and compared among the three groups. RESULTS: The postoperative analgesic duration after intraperitoneal instillation of Group 2 was longer as compared to Group 1. The total analgesic requirement was lower in Group 2 as compared to Group 1, and the p-value was significant (p ≤ 0.001) for both parameters. Demographic parameters and VAS scores among the three groups were not statistically significant. CONCLUSION: We conclude that intraperitoneal instillation of local anaesthetics with adjuvants is effective for postoperative analgesia in laparoscopic surgeries, and ropivacaine 0.2% with dexmedetomidine 0.5 mcg/kg is more effective when compared to ropivacaine 0.2% with ketamine 0.5 mg/kg.

Organization of the galaninergic neuronal system in the brain of the gecko Hemidactylus frenatus.

Galanin (GAL) is a 29 amino acid peptide present in the central nervous system (CNS) as well as peripheral tissues in vertebrates. However, the brain distribution pattern of GAL is understudied in reptiles. The aim of this study was to determine the organization of galaninergic neuronal system in the brain of the gecko Hemidactylus frenatus, a tropical and sub-tropical lizard, using rabbit anti-galanin antibody. In the telencephalon, GAL-ir perikarya and fibres were found in the lateral septal nucleus, but only GAL-ir fibres were observed in the striatum, nucleus accumbens, anterior commissure, nucleus centralis amygdalae, dorsal and medial septal nuclei, nucleus of the diagonal band of Broca and in the optic chiasma. In the preoptic region, a cluster of GAL-ir cells and fibres was observed in the periventricular preoptic area and lateral preoptic area. GAL-ir perikarya and fibres were observed in hypothalamic areas such as the supraoptic nucleus, suprachiasmatic nucleus, paraventricular nucleus, periventricular nucleus of the hypothalamus, infundibular recess nucleus and in the median eminence, whereas GAL-ir fibres were present in the pars distalis of the pituitary gland. In the thalamus, GAL-ir fibres were observed in the dorsomedial, dorsolateral, and medial thalamic nuclei. GAL-ir fibres were also detected in mesencephalic areas such as the optic tectum, torus semicircularis, ventral tegmental area and substantia nigra, brain stem as well as the spinal cord. The organization of GAL-ir cells and fibres throughout the gecko brain suggests several neuroendocrine, neuromodulatory and behavioural functions for GAL in lizards. The study provides new insights into the evolutionarily conserved nature of GAL peptide in squamate reptiles and forms a valuable basis for future comparative studies.

An Analysis of Eosinophil- and Basophil-Based Indices in Patients with Glioblastoma and their Correlation with Survival.

BACKGROUND: Glioblastoma (GBM) is the most frequently diagnosed malignant brain tumor in adults. GBM is usually lethal within 24 months of diagnosis, despite aggressive multimodality treatment. Although it has been established that cancer-related inflammation is associated with worse outcomes, the role of eosinophils, basophils, atopy, and allergy in glioma biology is only gradually being delineated. In this study, we aimed to examine if eosinophil-based and basophil-based indices were altered in patients with GBM compared with healthy controls. We also aimed to study if there was any correlation between these indices and patient-related and tumor-related factors and survival. METHODS: This study was a retrospective analysis of prospectively maintained databases. Data pertaining to patient-related and tumor-related factors, hemograms, and survival data were obtained from the electronic medical records of selected patients. Correlations between eosinophil-based and basophil-based indices and these factors were studied, as was the association with overall survival. RESULTS: All the indices were altered in patients with GBM compared with normal healthy controls. The absolute eosinophil count was higher and the neutrophils/eosinophils ratio was lower in the better prognosis groups: those with better performance status; those without features of increased intracranial pressure or altered sensorium at presentation; those with ATRX-retained tumors that did not overexpress p53; and in the long-term survivors. The total lymphocyte count/basophils ratio and the absolute eosinophil count both independently predicted survival in a multivariate analysis. CONCLUSIONS: The absolute eosinophil count was consistently higher in the better prognosis groups and is likely to be incorporated into prognostic models for GBM.

Predictive Value of Modified Mallampati Test and Upper Lip Bite Test Concerning Cormack and Lehane's Laryngoscopy Grading in the Anticipation of Difficult Intubation: A Cross-Sectional Study at a Tertiary Care Hospital, Bhubaneswar, India.

Background and objective Many tests are at hand to predict difficult intubation preoperatively to prevent morbidity and mortality of unanticipated difficult intubation. The present study was conducted to evaluate and compare the efficacy of the modified Mallampati test (MMT) and upper lip bite test (ULBT) to foresee difficult intubation. Materials and methods After obtaining written informed consent, this prospective comparative observational study was conducted on 225 patients scheduled for elective surgery under general endotracheal anesthesia. Preoperative MMT and ULBT were performed. MMT Grade III, IV, and ULBT Grade IV were regarded as predictors of difficult intubation. The laryngoscopic view was graded as per Cormack and Lehane's laryngoscopic grading after induction of anesthesia by an experienced anesthesiologist ignorant of preoperative airway evaluation. Patients with Cormack and Lehane Class III and IV were regarded as difficult intubation. Sensitivity, specificity, and positive and negative predictive values of MMT and ULBT were computed. Agreement between two tests with the Cormack Lehane test was determined by the Kappa coefficient. Results In our research, the occurrence of difficult intubation was found to be 10.2% (23 cases of difficult intubation out of 225 patients). In our analysis, we found the sensitivity (95.5% vs. 95.4%), specificity (54.8% vs 50.0%), positive predictive value (91.6% vs 93.1%), and negative predictive value (39.1% vs 39.1%) were almost comparable between modified Mallampati test and upper lip bite test. Kappa coefficient for the upper lip bite test (0.492) was slightly higher as compared to modified Mallampati scoring (0.454), but both the values are highly statistically significant (p-value <0.001). Conclusion Both the upper lip bite test and modified Mallampati test are comparable with each other and since the upper lip bite test is easy to perform bedside test we recommend it to be used alone or in collaboration with other tests in assessing difficult airways.

Prevalence and Pattern of Mandibular Fractures: A Retrospective Study in India.

Objective: The main objective of this study is to analyze the prevalence of age, gender distribution, etiology, anatomic distribution, and treatment of mandibular fractures. Materials and Methods: This 2-year retrospective study was carried out in few multispeciality hospitals in India. The results were collected, and descriptive statistics were analyzed using SPSS. Results: Of 180 patients that were analyzed, males and the age group of 20-30 years had a higher prevalence of mandibular fractures with road traffic accidents being the most common etiological factor. Condyle was the most common site affected. Open treatment with rigid and nonrigid fixation was the commonly used method of treatment. Conclusion: Stratification of various epidemiological studies with data obtained over a large study period and sample size must be obtained to understand the plausible factors associated with mandibular fractures for appropriate diagnosis and management of mandibular fractures.

Organization of the Melanin concentrating hormone secreting neuronal system in the brain of the cichlid fish Oreochromis mossambicus.

Melanin concentrating hormone (MCH) is a highly conserved cyclic peptide present in vertebrates. In this study, we describe the organization of MCH-immunoreactive (MCH-ir) cells and fibres in different regions of the brain in the cichlid fish Oreochromis mossambicus. Only MCH-ir fibres were observed in dorsal and ventral subdivisions of the telencephalon, the preoptic area and magnocellular and parvocellular divisions of the nucleus preopticus, and in hypothalamic areas such as the suprachiasmatic nucleus and tuberal area. Distinctly labelled MCH-ir perikarya were observed in the paraventricular organ, lateral and medial subdivisions of the nucleus lateralis tuberis, nucleus recessus lateralis and in the nucleus posterior tuberis. The pituitary gland showed MCH-ir fibres in the proximal pars distalis, neurohypophyseal ramifications and in pars intermedia where the dark accumulations of MCH-ir content corresponded to enlarged axon terminals. In the diencephalon, MCH-ir fibres were also labelled in the pretectal area, thalamic nuclei and preglomerular complex. In the midbrain tegmentum, a cluster of MCH-ir neurons was detected in the dorsal tegmental nucleus, whereas MCH-ir fibres were distributed in the torus semicircularis and optic tectum. In the rhombencephalon, MCH-ir fibres were located in the nucleus lateralis valvulae, cerebellum and secondary gustatory nucleus. Overall, the widespread distribution of MCH-ir cells and fibres in the brain suggests diverse roles for MCH such as regulation of sensorimotor and neuroendocrine functions in the tilapia.

Chronic exposure to aquacultural stressors affects pituitary-testis axis in the Mozambique tilapia Oreochromis mossambicus.

Reproduction in fish is modulated by several factors that include environmental and endocrine components. The aim of this study was to elucidate the effect of aquacultural stressors along the pituitary-testis axis in a continuously breeding cichlid fish Oreochromis mossambicus. The fish (35.05 ± 2.20 g) were divided into three groups (n = 10 in each group, n = 5 in each replicate), namely initial controls (euthanized on the day of initiation of experiment), time-matched controls (kept undisturbed), and stressed fish, which were subjected to different kinds of randomized aquacultural stressors such as handling, chasing, frequent netting, and low water levels, daily for a period of 21 days. Although the gonadosomatic index and the mean numbers of spermatogonia-A and spermatogonia-B did not differ significantly among different experimental groups, significant decrease was observed in the mean numbers of primary spermatocytes, secondary spermatocytes, early spermatids, and late spermatids in fish exposed to stressors compared to those of initial controls and time-matched controls. While the diameter of the seminiferous lobule was significantly lower, the size of the lumen and the serum levels of cortisol were significantly increased in stressed fish compared with initial controls and time-matched controls. Furthermore, weak androgen receptor immunoreactivity was observed in the Sertoli cells of the testis in contrast to the strongly immunoreactive androgen receptors in initial controls and time-matched controls. Concomitant with this, there was a significant decrease in the percent area and the intensity of luteinizing hormone (LH) immunoreactive content in the proximal pars distalis (PPD) region of the pituitary gland in stressed fish compared with initial controls and time-matched controls. Overall, these results suggest that exposure to chronic aquacultural stressors causes suppression of LH synthesis in the pituitary gland concomitant with decreased androgen receptor expression and blockade of recruitment of germline cells at the meiosis stage. This inhibition appears to be mediated through the hypothalamic-pituitary-interrenal axis in the tilapia O. mossambicus.

Melanin-concentrating hormone interferes with the hypothalamic-pituitary-gonad axis in the Mozambique tilapia.

This study was conducted to elucidate the influence of melanin-concentrating hormone (MCH) along the reproductive-axis in the female tilapia Oreochromis mossambicus. Administration of MCH (4 µg / 0.1 ml saline) for 22 days resulted in significantly lower gonadosomatic index compared to controls. Significant reduction in the mean numbers of follicles at different stages of development such as previtellogenic (stages I-III), vitellogenic (stage IV) and preovulatory (stage V) follicles was observed in MCH-treated fish compared with controls. On the other hand, the rate of atresia was significantly higher in follicles at stages II, III and IV in MCH-treated fish. In addition, in the pituitary gland, sparsely labelled gonadotropin releasing hormone (GnRH)-immunoreactive fibres were observed in MCH-treated fish in contrast to their intense labelling in controls. The serum level of luteinizing hormone (LH) showed significant decrease, but the serum cortisol level rose significantly following MCH treatment compared to those of controls. Collectively, these results indicate for the first time, that MCH treatment blocks follicular development during the ovarian cycle, possibly through the suppression of GnRH-LH axis in fish. The results also indicate that MCH may activate the stress-axis pathway in fish.